Item C14BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 9/17/14 Division: Social Services
Bulk Item: Yes X No Department: Social Services
Staff Contact Person: Sheryl Graham (305)292-4511
AGENDA ITEM WORDING: Request approval of Amendment #001 to the Alzheimer's Disease
Initiative Program (ADI) Contract #KZ 1497 between the Alliance for Aging, Inc. (AAA) and Monroe
County Board of County Commissioners (Monroe County Social Services/In Home Services) for the
contract period of 7/11'14 to 6/30/15.
ITEM BACKGROUND: Amendment 4001 to the Alzheimer's Disease Initiative Program (ADI)
contract KZ1497 will de -obligate funds in the amount of $26,661.00 thereby reducing the total contract
amount from $83,407.00 to $56,746.00
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted by the BOCC on 7/16/14 for the
Alzheimer's Disease Initiative (ADI) Contract # KZ 1497, between the Alliance for Aging, Inc. (AAA)
and Monroe County Board of County Commissioners (Social Services/In Home Services) for the
contract period of 7/ 1 / 14 to 6/30/15.
CONTRACT/AGREEMENT CHANGES: Amendment #001 decreases the total grant contract by
$26,661.00 from the original allocation of $83,407.00 to $56,746.00 and will also amend the maximum
number of units from 3,471 to 2,361 due to the Alliance for Aging's clerical error when drafting the
original contract.
STAFF RECOMMENDATIONS: Approval
TOTAL AMOUNT: S56,746.00
TOTAL COST: $5,674.60 (CASH) BUDGETED: Yes _ No _
COST TO COUNTY: S5,674.60 (CASH) SOURCE OF FUNDS: Grant funds plus match dollars
REVENUE PRODUCING: Yes X No _
(Source of revenue — client co -payments)",.,
APPROVED BY: County Atty.
DOCUMENTATION: Included X
AMOUNT PER: MONTH: $400 YEAR: $4.800
[ .
O /Purchasing
Not Required
Risk Management
To Follow
DISPOSITION: AGENDA ITEM #
Revised 8'06
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Contract with: Alliance For Aging, Inc.
CONTRACT SUMMARY
Contract: KZ 1497
Effective Date: 09/17/2014
Expiration Date: 06/30/2015
Contract Purpose/Description: To Request approval of Amendment 9001 of the Alzheimer's Disease
Initiative Program (ADI) Contract #KZ 1497 between the Alliance for Aging, Inc. (AAA) and Monroe
County Board of County Commissioners (Monroe County Social Services/In Home Services) for the
contract period of 7/1/14 to 6/30/15.
Contract Manager: Sheryl Graham (305) Social Services/Stop I
292-4511
(Name (Ext.) (Department/Stop #)
For BOCC meeting on 9/17/14 Agenda Deadline: 9/2/14
CONTRACT COSTS
Total Dollar Value of Contract: approx. $56,746.00
Budgeted: Yes No
Grant: $56,746.00
County Match: $5,674.60 (CASH)
Additional Match:
Total Match $5,674.60 (CASH)
Estimated Ongoing Costs: $
(Not included in dollar value above)
Account Codes:
/yr
For:
Current Year Portion: $_
125-6153614
ADDITIONAL COSTS
salaries, etc
CONTRACT REVIEW
Changes
Date Out
Division Director/
Date In
Needed
Yes No�
evieer
v
;
Risk Management
Yes T
O.M.B./Purchasing
,1I
Yes No
u. 1 ;C
County Attorney
�:
Yes Nod
Comments:
OMB Form Revised 2/27/01 MCP #2
Amendment 001 CONTRACT NUMBER KZ-1497 r, Page 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred
to as the "Alliance", and "Monroe County Board of Commissioners, Social Services/In-Home
Services." amends contract KZ-1497.
The purpose of this amendment is to correct amount of contract by $26,661.00 in Home
Respite services. Allocation of funds as indicated in Section II below. This amendment
changes total contract funding from $83,407 to $56,746.
Section 11, Contract Amount, is hereby amended to read:
Services to be Provided
Service
Maximum
Maximum Dollars
Unit Rate
Units of
Service
IN -HOME RESPITE
$24.03
2,361
$56,746.00
TOTAL FUNDS AND UNITS IN THIS CONTRACT: $56,746.00
2. This amendment shall begin on the date it has been signed by both parties.
All provisions in the contract and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform to this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the contract are hereby amended to conform with this amendment.
This amendment is hereby made a part of the contract.
IN WITNESS WHEREOF, the parties hereto have caused this 1-page amendment to be
executed by their undersigned officials as duly authorized.
SIGNED BY:
NAME:
TITLE:
DATE:
"Monroe County Board of
Commissioners, Social Services/In-
Home Services."
SIGNED BY:
Sylvia Murphy NAME:
Mayor
For Fiscal Year 2014/2015.
TITLE:
DATE:
ALLIANCE FOR AGING, INC.
President/CEO
CONTRACT KZ- 1497 Page 1
ALZHEIMERS' DISEASE INITIATIVE CONTRACT
2014-2015 Fiscal Year b ,
TEIIS AGREEMENT is entered into between the Alliance for Akin;;, Inc., hereinafter referred
to as the "Alliance" and "Monroe County Board of Commissioners, Social Servicesiln-
Home SerNices.", hereinatter referred to as the" provider, and collectively referred to as the "parties,
WHEREAS, the Alliance has been designated as the area agency on aging, for Planning and Service area
t l encompassing Miami -Dade and Monroe Counties: and
WHEREAS, the Florida Department of Elder Affairs (the "Department") has entered into a Contract with
the Alliance to administer the Alzheimer 's disease Initiative Program in Miatni-Dade and Nlonroe
Counties; and
.Now THEREFORE, in consideration of the services to be performed and payments to be made,
together with the mutual covenants and conditions set forth in this Contract, the Parties ataree as follows:
1.
2.
3.
4.0
4.1
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.
Incorporation of Documents within the Contract
The contract will incorporate attachments, pmposal(s), state plan(s), grant agreements, relevant
Department of Elder Affairs handbooks, manuals or desk books, 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.
Term of Contract
Effective Date:
This contract shall begin on July 1, 2014 or on the date the contract has been signed by both
parties, whichever is later.
Delivery of services shall end at midnight, local time in Nliami, FL on June 30, 2015. The
Alliance will not reimburse the provider for services provided after this date. However, the
parties recognize that they will need to perform continued activities relating to reporting,
invoicing and payment in July of?Ol5 to facilitate payment for services rendered by the provider
under this contract through and including the contract expiration date of July 15. 2015.
Contract Amount
The Alliance agrees to pay for contracted services accordim-Y to the terns and conditions of this
contract in an amount not to exceed 83,407 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
elii,ible for payment under this contract.
Obligation to Pay
Mlle Alli�lnce`s pertOrm ince Mild obliation to pay under this contract is continr,erit
upon'in �ulnual appropriation w rile Le',islature to tilt Dcpar1111ent'111d fimdiII,,
CCC1`=Cd 1)y the .U!"IIIce ;bider its c:O!It raCt CCitil the Dtr'lrtnmetIt,
4.2 Source of Funds
CONTRACT KZ- 1497 Page 2
The costs Of services paid under any other contract or From any other source are not
eligible for reimbursement under this contract. The funds awarded to the prodder
pursuant to this contract are in the state grants and aids a �_to ztpions M'd consists
1 t '� 1 1,' p'«
of the followinga:
Program Title
Near
Funding Source
I CSFA#
Fund
Amounts
ADI
j 2014-
General Revenue, Tobacco
583,407
2015
Settlement Trust Funds
TOTAL FUNDS CONTAINED IN THIS CONTRACTr:
S83,407
5. Renewals
The contract may be renewed on a yearly basis for no more than four 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.
6. Compliance with Federal Law
6.1 If this contract contains federal funds the following shall apply:
6.1.1 The Provider 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 Provider 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 Provider shall report any violations of the above to
the Alliance.
6.1.3 The Provider, or agent acting for the Provider, may not use any federal funds received in
connection with this contract to influence legislation or appropriations pending before the
Congress or any state le,-,islature. If this contract contains federal funding in excess of
S 100,000.00, the Provider must, prior to contract execution, complete the Certification Regarding
Lobbying form, ATTACHMENT IL All disclosure forms as required by the Certification
Regarding Lobbying forth 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 Provider shall comply with Executive Order
1 1246. Equal Employment Opportunity. as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor re<uulation 41 CFR 60 and 45 CFR 92, if applicable.
6.1.5 If this contract contains federal funds and provides set -%ices to children up to age 18, the Provider
,hall comply with the Pro -Children Act of 1094 (20 U.S.C. 6081 ).
6.1.6 l :ontract �v,v(ird tG!th all 11110LIM eyI)CC"Cd to Cc1Ua1 or txCCCd 52�.Of)O,i)O and CCI"Ci1111 )!her
,�onti',Ict 1\\;Irds tkill not PC 111adc" to 1).3rtic°s 11"Ied on the -olcrTlnlcnt-it"ide Excluded Panics L1st
Svstclll. in [ICcordaticc v. Ith the (AI13 >uidchncs .It 2 CFR 1 SO that implement Fxccutl�e ()rders
I
CONTRACT KZ- 1497 Page 3
125 1) and 12689, "DeballIient and Suspension... The F.xCIUded PartieS List System contains the
lianles of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineli�aible under statutory or re�aulator_V authority other than Executive Order 125-41). 1
Provider shall comply with these provisions before doing business or cnterin(� into subcontracts
receitiing federal funds pursuant to this contract. The Pro%idcr shall complete and sizzn
ATTACHMENT N' prior to the execution of this contract.
6.2 The Provider shall not employ all unauthorized alien. The Alliance will consider the employment
of unauthorized aliens a violation of the Inuni<zration and Nationality Act (8 G.S.C. 1324a) and
the Immigration Reform and Control Act of 1986 (8 U.S.C. 1 101). Such violation will be cause
for unilateral cancellation of this contract by the Alliance.
6.3 If the Provider is a non-profit provider and is subject to Internal Revenue Service (IRS) tax
exempt organization reporting requirements (tiling 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 Provider must notify the Alliance in writing within
thirty (30) days of receiving the IRS notice of revocation.
6•4 The Provider shall comply with Title 2 CFR Part 275 regarding Trafficking in Persons.
Unless exempt under 2 CFR Part 170.110(b), the Provider shall comply with the reporting
requirements of the Transparency Act as expressed in 2 CFR 170.
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 Provider shall comply with requirements of s. 2S7.05S, F.S. as amended.
7.2.1 The Provider 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 in accordance with s. 215971, F.S. (1)
and (2).
7.2.2 The Provider 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 Provider shall 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 Provider shall allow public access to all documents, papers, letters, or other public records as
defined in subsection 1 19A 1 1(12). F.S., made or received by the Provider in conjunction with this
contract except for those records which are made confidential or exempt by law. The Provider's refusal
to comply with this provision tivill constitute an inunediate breach of contract for which the Alliance
may unilaterally terminate the contract.
1.3 If clients are to be transported under this contract, the Provider shall comply with the provisions of
Chapter -127, F.S.. and Rule 41-2. F..V C.
7.3 1-lie pro%ider nuly not SUbcontract 1 ith any irrdiyiduals or entities on the discriminatory %cndor list
l`ccause they Islay not transact buisIltess Itith "illy pLINIC cntlty. ill a CordallCe it"Ith the pro%isiolls itt s.
CONTRACT KZ- 1497 Page 4
7.5 The Provider shall comply %cith the pro%isIons of s. 11.002, F.S., and s. 216.347, F.S., «hicli prohibit
the expenditure of contract funds for the purpose of lobo% In,-, the legislature, judicial branch or a state
agcncv.
7.6 In accordance tivith S. IS7.135 F.S., any Contractor on the Scrutinized Companies with Acti%ities 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 or agreement
with the Department for goods or services of SI million or more. Pursuant to s. 2S7.135 F.S., the
Department may terminate this Contract and any contract or a(-Treement incorporating this Contract by
reference 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 any contract or
agreement incorporating this Contract contains S I million or more, the Contractor shall complete and
sign ATTACHMENT H, Certification Regarding Scrutinized Companies Lists, prior to the execution of
this Contract.
8. Background Screening
The Provider 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, will 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 apply to employees,
subcontractors, consultants, direct service providers and volunteers. Consequently, any commitment
for employment, purchase of services, or volunteer program participation will be contingent upon the
passing of a Level II background check. The background screening will include employment history
checks as provided in s. 435.03(1), F.S., and both local and national criminal record checks coordinated
through law enforcement agencies.
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
8.2 facilities and volunteers.
Background Screening Affidavit of Compliance - To demonstrate compliance with section 6 of this
Master Contract, the Contractor shall submit ATTACHMENT G, Background Screening Affidavit of
Compliance annually, by January f 5th.
8.3 Further information concerning the procedures for background screening is found at
littp:/,"elderaffairs.state.fl.us/doea,�backuroundscreemng.php.
9. Grievance and Complaint Procedures
9.1 Grievance Procedure
The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guideline
for Recipient Grievance Procedures, Appendix D. Department of Elder Affairs Programs and Services
Handbook, to address complaints regarding the termination, suspension or reduction of services, as
required for receipt of funds.
9.2 Complaint Procedures:
The Contractor shall develop and implement complaint procedures and ensure that Subcontractors
dccciop and implement :omplaint procedures to process and resole client dissatisfaction with
<er.iccs. Complaint procedures shall address the quality and timeliness of services. provider and
t ircct ser%ice worker coiiiplaints. or inv other ad%ice related to complaints other than termination.
;aspcnsion or reduction in ser%tccs that require the gric%<ince process as described in :Appendix D.
4
CONTRACT KZ- t • Y
Department of Elder Affairs Pro<urams and Seri ices Handbook. The complaint procedures shall
_ include tiotiticatloll to III clients of the complaint procedure and include tracking the slate. nature of
the colhhplaint and the determination of' the complaint.
10, audits Inspections, Investigations, Public Records and Retention
10.1 The provider shall establish and maintain books, records, and documents (including electronic storage
media) in accordance with generally accepted accounting procedures and practices that sufficiently
and properly reflect all revenues and expenditures of funds provided by the Alliance under this
contract. Provider aurees to maintain records, including paid invoices, payroll registers, travel
vouchers, copy logs, postage logs, time sheets, etc., as supporting documentation for service cost
reports and for administrative expenses itemized for reimbursement. This documentation will be
made available upon request for monitoring and auditing purposes. Whenever appropriate, financial
information should be related to performance and unit cost data.
10.2 The Provider 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 Alliance.
10.3 Upon demand, at no additional cost to the Alliance, the Provider shall facilitate the duplication and
transfer of any records or documents during the required retention period in Paragraph 10.2.
10.4 The Provider shall assure that the records described in Paragraph 10 will be subject at all reasonable
times to inspection, review, copying, or audit by federal, state, or other personnel duly authorized by
the Alliance.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Alliance,
the Department and federal auditors, pursuant to 45 CFR 92.36(1)(10), will be allowed full access to
and the right to examine any of the Provider's contracts and related records and documents pertinent
to this specific contract, regardless of the form in which kept.
10.6 The Provider shall provide a financial and compliance audit to the Alliance as specified in this
contract and in ATTACHTNIENT III and ensure that all related third -party transactions are disclosed
to the auditor.
10.7 The Provider shall comply and cooperate immediately with any inspections, reviews, investigations,
or audits deemed necessary by the office of the Inspector General pursuant to s. 20.055, F.S.
10.8 The Provider shall maintain and file with the Alliance such progress, fiscal and inventory and other
reports as the Alliance may require within the period of this contract.
10.9 The Provider shall submit management. program, and client identifiable data, as specified by the
Department of Elder Affairs and / or the Alliance. The provider must record and submit program
specific data in accordance with the Department's Client Information Registration and Tracking
Svstem (CIRTS) Polley Guidelines.
10.10 If. under an,,, contract or agreement incorporating this Contract by reference, the Contractor is
pro%idin scr%ices and is actin�_, on behalf of the Department of Elder Affairs or the Alliance for
A,_=ing. Inc. as provided under section 1 19.01 1(2), Florida Statutes, the Contractor, subject to the
m ters of section 2S7.t)�s( I )(c), Florida Statutes. and any other applicable legal and equitable
remedies. shall:
m Keep and 111a1:htain public records that ordinarilti,'Ind ncccssaril% be required by the puhiic
,11 ency ill order to pertOrm the sei-Nices,
91
CONTRACT KZ- 1497 Page 6
b) Provide the public with access to public records on the same terms and conditions that the
Department of Elder Affairs or the alliance for Aging. Inc. %kould provide the records and at a cost
that does not exceed the cost provided in C lwpter 119, Florida Statutes, or as other<G ise prof ided b
law.
c) Ensure that public records that are exempt or confidential and exempt From public records
disclosure requirements are not disclosed except as authorized by law.
d) Meet all requirements for retaining public records and transfer, at no cost, to the Department of
Elder .Affairs or the Alliance for Acing. Inc. all public records in possession of the Contractor upon
termination or expiration of any contract or aureement incorporating this Contract by reference and
destroy any duplicate public records that are exempt or confidential and exempt from public records
disclosure requirements. All records stored electronically must be provided to the Department of
10.11 Elder Affairs or the Alliance for A-ing, Inc, in a format that is compatible with the information
technology systems of the Department.
The Alliance for Aging, Inc, may unilaterally cancel this Master Contract, and any contract or
agreement incorporating this Contract by reference, notwithstanding any other provisions of this
Contract, for refusal by the Contractor to comply with Section 8 of this Contract by not allowing
public access to all documents, papers, letters, or other material made or received by the Contractor in
conjunction with the contract or agreement incorporating this Contract by reference, unless the
records are exempt from Section 24(a) of Article I of the State Constitution and Section 119.07(1),
Florida Statutes.
if. Nondiscrimination -Civil Rillhts Compliance
11.1 The Provider 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 ague,
race, religion, color, disability, national origin, marital status or sex in compliance with state and federal
law and regulations. The Provider further assures that all Providers, 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 because of age, race, religion, color,
disability, national origin, marital status or sex.
11.2 During the term of this contract, the Provider shall complete and retain on file a timely, complete and
accurate Civil Rights Compliance Checklist (ATTACHIbIENT B).
11.3 The Provider 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.
11.1 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 Provider, its successors, transferees, and
assignees for the period during which such assistance is provided. The Provider 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, re�aulations. - idelines, and standards. In
the event of failure to comply, the Provider understands that the Alliance may, at its discretion, seek a
court order requiring compliance with the terms of this assurance or seek other appropriate judicial or
,idministratite relief: includin{_= but not limited to, termination of and denial of further assistance.
12. Provision of Services
1-Ile Provider shall provide services in the :manner described in in .k,TT.AciimFNT 1 of this iurccmcnt
�Ulki in the Bernice Prot"ider.Applicition (SP.\). In the ccent of a con tiict lic't%%een the Ser%ice Prodder
\ppi1c,alotl'111d this contract, t11c oiltraCt iattL?ua,-,e pret'afis.
I
CONTRACT KZ- 1497 Page 7
13. Monitoring be the Alliance for A(ing
The alliance w ill perform administrative and programmatic monitoring of the provider to ensure
contractual Compliance, fiscal accountability, programmatic perfornance, and compliance with
applicable state and federal laws and regulations.
13.1 The provider N< ill supply progress reports, including, data reporting requirements as specified by the
Alliance or the Department to be used for monitonrig progress or performance of the contractual
services as specified in this contract. Following the nouns set down by the Department, the Alliance
will track performance on a monthly basis, through desk reviews of available fiscal, CIRTS, and
research production reports and any other system or process designated by the Alliance. Examples of
review criteria are surplus,deficit, independent audits, internal controls, reimbursement requests,
subcontract monitoring,!, tar,_,eting, proi7ram eligibility, outcome treasures, service provision to clients
designated as "high risk" by the Department of Children & Families, Adult Protective Services
program, data integrity, co -payments, client satisfaction, correspondence, and client file reviews.
13.2 The provider shall permit persons duly authorized by the Department or the Alliance to inspect and
copy any records, papers, documents, facilities, goods and services of the provider which are relevant to
this contract, and to interview any clients, employees, and subcontractor employees of the provider to
be assure the Alliance of the satisfactory performance of the terms and conditions of this contract.
Following such review, the Alliance will deliver to the provider a written report of its findings and
request for development, by the provider, of a corrective action plan (CAP) where appropriate. The
Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as
determined by the Contract Manager.
13.3 Extraordinary Reporting
The provider shall notify the contract manager for the Alliance immediately, but no later than within 48
hours, from the provider's awareness or discovery of conditions that may materially affect the
provider's ability to perform, such as problems, delays, or adverse conditions which may impair the
provider's ability to meet the objectives of this contract or that may affect the health, safety or well-
being of clients. The notice shall include a brief summary of the problem(s), a statement of the action
taken or contemplated, time frames for implementation, and any assistance needed to resolve the
situation.
Examples of reportable conditions may include:
• proposed client terminations
■ provider financial concerns/difficulties
■ non-payment or untimely payment reported by vendors
• service documentation problems
■ agreement non-compliance
• service quality problems and consumer complaint trends
• IIIPAA violations
• Potential fraud allegations or accusations of malfeasance by board members.
Cmplovees, volunteers, or other associates
1 he Aill'Ince s11a11 Im esrlgate allegations rcgarding falsittcation of client Infortnatton, service records,
»�Ivment requests, and otl cr related information. Substantiated allegations ;hall be reported to the
DCpartlllcnt s Contract I11tll1aLIer and to law entorcemc llt as Ippropriatc.
CONTRACT.• •.•-
[n the ekcnt that a situation results in the cessation ofservIces by a subcontract, the provider retains the
responsi1 1 ty for performance of all services covered by this contract and must ensure that clients
i continue recciving services %tiitl�out internaption, e. �T. exercising their emergency procurement
procedures, temporary assumption of the direct provision of services, etc.
14. Coordinated Monitoring Nrith Other agencies
[f the Provider receives funding from one or more of the State of Florida other human service
agencies, in addition to the Department of Elder Affairs, 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 desiiznated agency's lead administrative coordinator, the Provider shall comply and
cooperate with all monitors, inspectors, andlor investigators.
15. Indemnification
The provider shall indemnify, defend, and hold harmless the Department and the Alliance and their
officers, agents, and employees from any claim, loss, damage, cost, charge, or expense whatever
nature or character arising out of any acts, actions, neglect or omission, action in bad faith, or violation
of federal or state law by the provider, its agents, employees, or subcontractors during the performance
of this contract, whether direct or indirect, and whether to any person or property. It is understood and
agreed that the provider is not required to indemnity the Alliance for claims arising out of the sole
negligence of the Alliance.
The provider's obligation to indemnify, defend, and pay for the defense or, at the Department's and /
or the Alliance's option, to participate and associate with the Department and / or the Alliance in the
defense and trial of any claim and any related settlement negotiations, shall be triggered by the
Department's and ,/ or Alliance's notice of claim for indemnification to the provider. The provider's
inability to evaluate liability or its evaluation of liability shall not excuse the provider's duty to defend
and indemnify the Department and or the Alliance, upon notice by the Department and / or the
Alliance. Notice shall be given by registered or certified mail, return receipt requested. Only an
adjudication or judgment after the highest appeal is exhausted specifically finding the Alliance solely
negligent shall excuse performance of this provision by the provider. The provider shall pay all costs
and fees related to this obligation and its enforcement by the Department and / or the Alliance. The
Alliance's failure to notify the provider of a claim shall not release the provider of the above duty to
defend and indemnify.
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 Alliance and state agencies or subdivisions defined in s. 768.28(2),
F.S.
16. Insurance and Bonding
16.1 The provider must carry adequate liability insurance and worker's compensation insurance coverage, on
a comprehensive basis, and must hold such liability and worker's compensation insurances at all times
during the effective period of this contract and any renewal(s) or extension(s) of this contract. The
:alliance shall be included as an additional insured on the provider's liability insurance policy, or
policies and a copy of the Certificate of Insurance shall be provided annually or Nshen any
chances —occur. The provider accepts tull responsibility for identifying and detennining the o,pe(s)
,111d extent of liability insurance necessary to provide reasonable financial protections fOr the provider
a1ild the cllcllts to be screed under this contract. L, poml execution of this contract, the provider shall
h rnish the Ailialnce %bitten verification supporting both the determllination alnd CyI tense of such
insuraCce ct?sera=_'c . 1 he limits of cot"cm,-Teunder each pollc� tlitiint mted b% the pro%Icier do not limit
8
CONTRACT KZ- 1497 Page 9
the provider's liability tend obligations under this contract. I'lic provider shall ensure that the Alliance
has the most current Gcritteii verification of insurance covcrage throughout the term of this contract.
tThe Department and the Alliance resertie the right to require additional insurance where appropriate.
16.2 Throegtiout the term of this contract, the provider must maintain an insurance bond from a responsible
corrimerciai insuxaltce company coveriutu all officers, directors. employees and agents ofthe provider,
authorized to handle funds received or disbursed under this contract, in an amount commensurate with
the funds handled, the degree of risk as determined by the insurance company and consistent with good
business practices.
16.3 If the provider is a state a<uency or subdivision as defined by section 768.28, F.S., the provider shall
furnish, upon request, written verification of liability protection in accordance with section 768?8, F.S.
Nothing herein shall be construed to extend any party's liability beyond that provided in section 768 28,
F.S. (See also Indemnification clause.)
17. Confidentiality of Information
The Provider 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 Portabilitv and Accountability .,et
Where applicable, the Provider 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 Provider shall notify the Alliance immediately, but no later than forty-eight (48) hours from, the
Provider's awareness or discovery of conditions that may materially affect the Provider 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 Provider 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 Provider and its employees.
20. Bankruptcy Notification
During the term of this contract, the Provider shall immediately notify the Alliance if the Provider, its
assi�,2nees, subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after
notification, the Provider must also provide the following information to the Alliance: (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.(-,r., Northern District of Florida, Tallahassee Division); and, (4) the name,
address. and telephone number of the bankruptcy attorney.
21. Sponsorship and Publicity
21.1 Any nongovernmental organization which sponsors a program financed partially by state funds or
binds obtained from a state agency shall, in publicizing. advertising. or describing the sponsorship of
the program, state: "Sponsored by. the State of Florida. Department of Eider Affairs and Alliance for
\ging Inc." If the sponsorship reference is in written material. the '~words "State of Florida,
Department of Flder _Affairs and the :alliance for ALung_ _,hail appear in ti,e same size letters or t_,pe
;la the Manic o rile ortuanlLatloll (rcf.: _,ection 2>�.��. F. SA I I shall 12.ClUde, !)Lit IS not httitted to.
:'il .` Corre_,pondenCc: or othcr \t-ritlni,. publication oI" oroadcast Chat rcters to _,Lich proLmilll.
9
CONTRACT KZ- 1497 Page 10
21.2 The provider shall not use the words "State of Florida, Department of Elder Affairs"and,or -The
tr,..._.
Alliance for .aging, Inc." to indicate sponsorship of a prog ram otheiAvise tLnanCed unless specific
1 authorization has been obtained by the Alliance prior to use.
22. Assi(nmetits
22.1 The provider shall not assitzn its ri<uhts and responsibilities under this contract without the prior
written approval of the Alliance. All contracts or agreements incorporating this Contract by
reference shall remain binding upon the successors in interest of either the Contractor or the
Alliance for Aging, Inc.
22.2 No approval by the Alliance of any assignment or subcontract shall be deemed in any event or in
any manner to provide for the incurrence of any obligation of the Alliance in addition to the dollar
amount agreed upon in this contract.
22.3 The State of Florida is at all times entitled to assign or transfer, in whole or part, its rights, duties,
or obligations under any contract or agreement to another governmental agency in the State of
Florida, upon giving prior written notice to the Contractor. In the event the State of Florida
approves transfer of the Contractor's obligations, the Contractor remains responsible for all work
performed and all expenses incurred in connection with the contract or agreement.
23. Subcontracts:
23.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to
this contract, whether actually furnished by the Contractor or its subcontractors. Any subcontracts
shall be evidenced by a written agreement subject to all applicable terms and conditions of this
contract. Alliance approval of the service application presented by the provider shall constitute
Alliance approval of the provider's proposed subcontracts if the subcontracts follow the service and
funding information identified in the provider's service application. All other subcontracts
proposed to be funded under this contract must be approved in advance by the alliance. The
provider agrees that the alliance shall not be liable to any subcontractor in any way or for any
reason. The provider, at its expense, will indemnify and defend the Alliance against any
subcontractor claims.
23.2 The provider shall promptly pay any subcontractors. Failure to pay subcontractors pursuant to any
subcontract or as required by law may result in enforcement action under this contract.
23.3 The provider maintains responsibility for the monitoring and performance of all subcontracts in
accordance with all applicable federal and state laws.
23.4 The Contractor shall have a procurement policy that assures maximum free and open competition.
Such procurement policy must conform, as applicable, with Federal and State contracting and
procurement regulations, as set forth in Title 45 Code of Federal Regulations (CFR) part 74 - Sub -
Part C, Ch.287.057 Florida Statutes (F.S.), U.S. Office of Management and Budget (OMB)
Circular 110, Florida Department of ;Management Services (DMS) Rule 60A-1, Florida
Administrati%e Code, and with the Department of Flder Affairs Program and Services Handbook
1012,
23.5 The Contractor shall submit annually to the Alliance service cost reports, which reflect actual costs
of providing each service by program. This report provides information for planning and
netaotiatint! unit rates.
24. Independent CapacitN, of Provider
24.1 flee provider will !�e Actin- in its independent capacity 'Ind not ",s an e!:Ipiovee, a,aent or
;eprescutat1%C of "he :Alliance or the Department. He provider shall not be deenied or construed to be
3n empiovec. i,!cnt or !-cpresentativ e of [lie Alliance or the Department for tinv purpose a hatsoevcr.
I'
CONTRACT ,.
Nothim* contained in this contract is intended to, or shall be construed in any manner, as creating, or
establishing, the relationship of emplo%cr'employce between the parties.
24.2 The proOder shall be responsible for completely supervising and directing the work under this
contract whether performed by the provider or by any subcontractor that it may utilize. The provider
shall be responsible for all subcontractors who perform %work under this contract. The provider agrees
that it is as fully responsible for the acts and omissions of its subcontractors and of persons employed
by them as it is for the acts and omissions of its own employees.
24.3 It is further understood that the Alliance does not control the employment practices of the provider
and shall not be liable for any wage and hour, employment discrimination, or other labor and
employment claims against the provider or its subcontractors. All deductions for social security,
withholding taxes, income taxes, contributions to unemployment compensation funds and all
necessary insurance for the provider shall be the sole responsibility of the provider.
25. Pavment
25.1 Payments shall be made to the Provider as services are rendered and invoiced by the Provider. The
Alliance's Contract Manager will have final approval of the invoice for payment, and will approve the
invoice for payment only if the Provider 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 Alliance's finance section for budgetary approval and processing.
25.2 Payment Documentation Required
The provider shall maintain documentation to support payment requests which shall be available
to the Comptroller, the Department, or the Alliance upon request. Invoices must be submitted in
sufficient detail for a proper pre audit and post audit thereof. The provider shall comply with all
state and federal laws governing payments to be made under this contract including, but not
limited to the following: (a) paragraph (16) (b) of section 216.1 S 1, F. S., regarding advances; (b)
Rule 691-40.103 F.A.C. pertaining to Restriction of Expenditures from state funds; and (c) the
Contract Payment Requirements sub -section of section C of the Reference Guide for State
Expenditures from the Department of Financial Services
lijt nL, www.dbf.state.fl.us_aadir.'reference <guide.).
The provider shall maintain detailed documentation to support each item on the itemized invoice
or payment request for cost reimbursed expenses, including paid subcontractor invoices, and will
be produced upon request by the Alliance. The provider shall only request reimbursement for
allowable expenses as defined in the laws and guiding circulars cited in this agreement, in the
Reference Guide for State Expenditures, and any other laws or regulations, as applicable, and that
administrative expenses do not exceed amounts budgeted in the provider's approved service
application.
The Contractor will certify that detailed documentation is available to support each item on the
itemized invoice or payment request for cost reimbursed expenses, fixed rate or deliverables
contracts or agreements incorporating this Contract by reference. including paid Subcontractor
invoices, and will be produced upon request by the Department. The Contractor will further
certify that reimbursement requests are only for allowable expenses as defined in the laws and
_�uidin<u circulars cited in Sections 6 and . of this Contract. in the Reference Guide for State
Expenditures. and any other laws or regulations, as applicable, and that administrative expenses
do not exceed amounts budgeted in the Contractors approved area plan as developed in
�iccordance with artd pursuant to section 06{a) of the Older Americans .act of ? 905> as amended.
25.3 Limit on Funding Obligations
t he :yiliance "or Al-in�a. Inc. lcknowlcdg=es its obli�Tauon to pay the C��rnractor tier the perfornlzznce
11
CONTRACT KZ- 1497 Page /
of the Contractor's duties and responsibilities set turth in any contract or agreement incorporating
this Contract b% reference.
The Alliance shall not be liable to the provider for costs incurred or performance rendered unless
such costs and performances are strictly in accordance with the terms ofthis contract, including, but
not limited to terms �-,o%erninta the pro%ider's promised performance ar,d unit rates and. or
reimbursement capitations specified.
The Alliance shall not be liable to the provider for any expenditures which are not allowable costs
as defined by applicable federal or state law, or which expenditures have not been made in
accordance with the fiscal guidelines and requirements outlined by the Department,
The Alliance shall not be liable to the provider for expenditures made in violation of regulations,
the Older Americans Act, Department rules, Florida Statutes, or this contract.
26. Return of Funds
The Contractor shall return to the Alliance any overpayments due to unearned funds or funds
disallowed and any interest attributable to such funds pursuant to the terms and conditions of any
contract or agreement incorporating this Contract by reference that were disbursed to the
Contractor by the Alliance. 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 Alliance. In the event that the Alliance first discovers an overpayment
has been made, the Contract Manager will notify the Contractor in writing of such findings. Should
repayment not be made forthwith, the Contractor shall be charged at the lawful rate of interest on
the outstanding balance pursuant to s. 55.03, F.S., after Alliance's notification or Contractor
discovery.
27. Data Intel4rity and Safe:uardin2 Information,
{ The provider shall ensure an appropriate level of data security for the information the provider is
collecting or using in the performance of this contract. An appropriate level of security includes
approving and tracking all provider employees that request system or information access and
ensuring that user access has been removed from all terminated employees. The provider, 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
computer systems. The security over the back-up data is to be as stringent as the protection
required of the primary systems. The provider shall insure all subcontractors maintain written
procedures for computer system backup and recovery. The provider shall, prior to execution of
this agreement, complete the Data Integrity Certification form, ATTACHMENT IV.
28. Computer Use and Social Media Policy
The Department of Elder Affairs 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 Department's computer resource systems
must comply with the Department`s policy regarding social media. Social :Media includes, but is
not limited to blogs, podcasts, discussion thrums, Wikis, RSS feeds. video sharim-,. social networks
like MvSpaee. Facebook and Twitter. as well as content sharing networks such as tlickr and
YouFube (This policy is a%ailable on the Department's NFebsite at:
http:';eIderaffairs.state.fl.ust`(loea,tinancia1.phpj.
19. Conflict of Interest
l he Pro. idcr shall rsiablish ,,11egu1rds to f_)rohibit en,plovices. hoard rrenlbers. ::nd
'Uhcontr:lciors Iroill ll"ing their posYtlo115 for a tuurpose that constitutes or presents the appearance
12
CONTRACT KZ- 1497 Page 13
of' personal or car<zanizational conflict of interest or personal No employee, officer or a,zent of
the Provider or subcontractor shalt 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 Invoked.
Such a conflict %tiould arise when: (a) the employee, officer or agent; (b) any member of his her
immediate lainily: (c) his or her partner, or: (d) an organization which employs, or is about to
employ, any of the above, has a tinancial or other interest in the firm selected for award. The
Provider or 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 Provider's board members and manatyement must disclose to the Alliance 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 in incumbent, within thirty (30) calendar days of the commencement of
this contract. The Provider's employees and subcontractors must make the salve disclosures
described above to the Provider's board of directors. Compliance with this provision will be
monitored.
30. Public Entitv Crime
Pursuant to s. 287.133, F.S., 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 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.
The provider represents and warrants that the provider, its officers, directors, senior management,
partners, employees or agents have not been convicted of any public entity crimes within the last 36
months. If the provider or any of its officers or directors is convicted of a public entity crime during
the period of this agreement, the provider shall notify the Alliance immediately. Non-compliance
with this statute shall constitute a breach of this agreement. The provider must ensure that it does
not enter into with any subcontractor on the convicted vendors list or otherwise prohibited from
contracting for state funds pursuant to section 2S7.133, F.S.
31. Purchasing
Procurement of Products or Materials with Recycled Content.
Reusable materials and products shall be used where economically technically
feasible.
32. Patents, Copyri-_hts 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 Provider shall refer the discovery. invention or
material to the Alliance to be referred to the Department of State. Any and all patent rights or
copyriuhts accruing under this contract are hereby reserved to the State of Florida in accordance
1%ith Chapter 2.S6, F.S.
33. Emer<;encv Preparedness and Continuity of Operations
33.1 lie Provider shall. ,Cithin thirty ( 3O) calendar days of the execution of tliis contract, submit to the
Contract ~lava)=er %erltlCat?on of an einergency preparedness plan. In the C%clit of an e?ilcr�'ene�'.
13
CONTRACT KZ- 1497 Page 14
the Provider shalt notify the Alliance of emergency proyi;ions.
33.2 In the event a situation results in a cessation of ser<ices by a subcontractor, the Provider shall
retain responsibility for performance under this contract and must follow procedures to ensure
continuity of operations without intemlption.
33.3 In preparation for the threat of an emergency event as defined in the State of Florida
Comprehensive Emergency Management Plan, the Department may exercise authority o%er an
area agency or service provider agency to implement preparedness activities to improve the safety
of the elderly in the threatened area and to secure area agency and service provider facilities to
minimize the potential impact of the event. These actions will be within the existing roles and
responsibilities of the area agency and provider.
33.4 In the event the President of the United States or Governor of the State of Florida declares a
disaster or state of emergency, the Department may exercise authority over an area agency or
service provider agency to implement emergency relief measures and/or activities.
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CONTRACT KZ- 1497 Page 15
34. Equipment
I - - (a) an article of nollcxpendablc� tangible personal property having a useful
'4� I Equipment means - 1 -
life of Inore 111,111 one %c'Ir and MI aC(jUISItI0n COSt which equals or exceeds the lesser of the
capitalization level established by the organization for the financial statement purposes, or
S 5,000
) _00 [for federal funds], or (b), tionexpenclable, tangible personal property of a non-
consumable nature with an acquisition cost of S1.000.00 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. %% Ith
a value or cost of S250.00 or more [for state funds].
34' Contractors and Subcontractors who are Institutions of Hi,_,her Education, Hospitals, and
Other Non-Protit Organizations shall have written property inarim-yernent standards in compliance
with 2 CFR Part 21-5 Administrative Requirements (formerly 0%1B Circular A-1 10) 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
tile and shall be provided to the Alliance 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.
34.3 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 govenu-nent;
(5) Acquisition date (or date received, if the equipment was furnished by the federal government)
and
cost:
(6) Information frorn 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 awardinL, a,_,ency for its
share.
1 -,4.4 Equipment purchased with federal funds %�Ith an acquisition cost over S5,000.()() and
equipment purchased with state Rinds %cith an acquisition cost over S1.000.00 that is specifically
identified III the area pi'm 'ij1j_)r0% cd by the Department Is 0,11-t of the cost of Carn III,-, out the
'IC11%ities �111d function-, of 1111C _111111 and I 1t1c (,mncrs1iip) %%ill test M the
,U bll Cc t to t I I c cold it 101 IS of _' C FR Part 21 � Ad I I I I I I I st ra I I% e RC<JU I FC I I I t211t-S ( former Iv (.)1113 Circular
15
CONTRACT KZ- 1497 Page 16
A -I i0). Subpart C, paragraph 3.1. 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 ativ contract or agreement incorporating this
Contract by reference, or identified in the sub-atzreements :with Subcontractors (not included in a
cost methodologv), is subject to the conditions of section 273. F. S. and 60A-I.0017, F. A. C. or
Title 45 CFR Part 74,
35.5 The Contractor shall not dispose of any equipment or materials provided by the Alliance, or
purchased with funds provided through any contract or agreement incorporating this Contract
without First obtaining the approval of the 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, and percentage of state or federal participation, acquisition date and
condition of the property. The request should also indicate the Contractors proposed disposition
(i.e., transfer or donation to another agency that administers federal programs, offer the items for
sale, destroy the items, etc.).
35.6 The 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).
35. 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 Provider 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.
36. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager,
who shall reduce the decision to writing and serve a copy on the Provider.
37. Financial Consequences of Non -Performance
If the Provider fails to meet the minimum level of service or performance identified in this
agreement, or that is customary for the industry, then the Alliance must 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, andlor cancellation of contract and reacquiring services from an
alternate source,
37.1 The Provider will not be charged with financial consequences. when a failure to perform arises out
Of causes that were the responsibility of the Alliance.
38. No Waiver of Sovereign Immunity
Xothinu contained in this aureement is intended to sere as a waiver of sovereit-yn immunity by aiiv
entity to which so% ereign immunity may be applicable.
in
CONTRACT KZ- 1497 Page 17
39. Venue
If any dispute arises out of this contract. the `tientte of such legal recourse will be ylianii-Dade
County, Florida.
39. 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 Alliance or the Provider unless expressly
contained herein or by a written amendment to this contract signed by both Parties.
40. 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.
41. 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.
42. Condition Precedent to Contract: appropriations
The Parties agree that the Alliance's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Legislature to the Department and a corresponding
allocation under contract from the Department to the Alliance.
43. Addition/Deletion
The Parties agree that the Alliance reserves the right to add or to delete any of the services required
under this contract when deemed to be in the State of Florida's best interest and reduced to a
written amendment signed by both Parties. The Parties shall negotiate compensation for any
additional services added.
44. Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract will
not constitute or be deemed a waiver of the Alliance's right thereafter to enforce those rights, nor
will any single or partial exercise of any such right preclude any other or further exercise thereof or
the exercise of any other right.
45. Compliance
The Provider 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 Provider to abide by these laws shall be deemed an event of default of the Provider, and
subject the contract to immediate, unilateral cancellation of the contract at the discretion of the
Alliance,
46. Final Invoice
I'he Provider shall submit the final invoice for payment to the Alliance as specified in Paragraphs
�. . �.4.1 and 1.4,2 {bate for final request for payment) of:1TT:1CHJlEVT [. If the Provider f�iils
tO submit tinai request fur pavt,?ent by the deadline. then al1 rights to pacn,ent may be turfeited and
the Alh1 incc nnay aot honor requests submitted after the aforesaid time period. .lnv p,tvTllent
due under ti-le ternis of this c:OMI"Ict 111av he v% itl1hcld ut,til ail reports due fr0111 the Provider and
17
CORTRACT ♦ f Page
necessary adjustments thereto have been approved by the Alliance.
4'. Rene(otiations 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 chanties in
the rate of payment when these have been established through the appropriations process
and subsequently identified in the Alliance's operating budget.
48. Termination
48.1 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 L.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 Provider responsible for administration of the contract.
48.2 In the event funds for payment pursuant to this contract become unavailable, the Alliance may
terminate this contract upon no less than twenty-four (24) hours' notice in writing to the Provider.
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 Provider responsible for administration of the contract. The Alliance will be the final
authority as to the availability and adequacy of funds. In the event of termination of this contract,
the Provider will be compensated for any work satisfactorily completed prior to the date of
termination.
48.3 This contract may be terminated for cause upon no less than twenty four (24) hours' notice in
writing to the Provider. 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 Alliance's or the Provider's
rights to remedies at law or in equity.
48.4 Failure to have performed any contractual obligations with the Alliance in a manner satisfactory to
the Alliance will be a sufficient cause for termination. To be terminated as a Provider under this
provision, the Provider must have (1) previously failed to satisfactorily perform in a contract with
the Alliance, been notified by the Alliance of the unsatisfactory performance, placed by the
Alliance under a corrective action plan and failed to correct the unsatisfactory performance to the
satisfaction of the Alliance as outlined in the corrective action plan; or (2) had a contract
terminated by the Alliance for cause.
48.5 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 Alliance's right to remedies at law or to damages of tevaal
or equitable nature.
48.6 Suspension of %Vork:
If the Department of Elder Affairs detennines in its sole discretion suspend any or all activities
Il;der this Contract and any Contract or agreement incorporating this Contract by reference. at anv
t 2ne, %k i1cli In the hest interests oI the State to do so, the Alliance will suspend the contractor s
;cork As the Department provides the :A1liance With %lritten notice outlining the particulars of
'!lil?c nsion, tl1cSC reaiolls a;ll be :olnIminic.acd to the contractor by the :Alliance. f=Xanlples of
tile= rcasoil for su;pensior, incudc. but arc not limited to, bud2etary co=lstraints, declaration of
RM
CONTRACT KZ- 1497 Page 19
cn"ez-21ericy. or ether such circumstances. After receiving a suspension notice. the Contractor shall
comply %vith the notice and shall not accept any purchase orders. Within ninety days, or any
longer period agreed to by the Contractor, the Alliance shall either ( l ) issue a notice authorizinU
resumption of work. at %% hich time activity shall resume, or (2) terminate the Contract or purchase
order. Suspension of %york shall not entitle the Contractor to any additional compensation.
49. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the
provider.
50 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 Unijbrrrn Electronic Transaction Act, s. 668.50, Fla. Stat. All electronic records must
be fully auditable; are subject to Florida's Public Records Latin, ch. 119, Fla. Stat.; must
comply with section 28, Data Integrity and Sa%guardinrg Inrfonrncrtiorn; 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.
50.1 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.
50.2 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.
51
Special Provisions
The Contractor agrees to the following provisions:
51.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Contractor or any Subcontractors
and referred to a governmental or investigatory agency must be sent to the Alliance. If the
Contractor has reason to believe that the allegations will be referred to the State Attorney, a
law enforcement a<zencv. the United States Attornev's office, or other governmental
agency, the Contractor shall notify the contract manaoer. A copy of all documents, reports.
notes or other written material concerning the investigation. %whether in the possession of
the Contractor or Subcontractors. must he sent to the Alliance's contract manager with a
sumr11ary of the in%estivation and allcgations.
5 1 .2 111lrrIteer'S:
we
CONTRACT KZ- 1497 Page 20
The Contractor shall ensure the use of trained volunteers in providing direct services
delivered to older individuals and indi%'iduals %� Ith disabilities needing such services. It
possible, the Contractor shall work in coordination with organizations that have experience
in providin�� training, placement, and stipends for %otunteers or participants (such as
onaanizations carrving out federal service programs administered by the Corporation for
National and Community Service), in community service settintas,
5 1. 3 Enforcement:
51.3.1 In accordance with Section 430,04, F.S., the Alliance may, without taking any
intermediate measures available to it against the Contractor, rescind the Contractors
designation as an area agency on aging, if the Alliance finds that:
51.3.2 An intentional or negligent act of the Contractor has materially affected the health,
welfare, or safety of clients served pursuant to any contract or agreement incorporating this
Contract by reference, or substantially and negatively affected the operation of services
covered under any contract or agreement;
51.3.3 The Contractor lacks financial stability sufficient to meet contractual obligations or
that contractual funds have been misappropriated;
51.3.4 The Contractor has committed multiple or repeated violations of legal and
regulatory standards, regardless of whether such laws or regulations are enforced by the
Alliance, or the Contractor has committed or repeated violations of Alliance standards;
51.3.5 The Contractor has failed to continue the provision or expansion of services after
the declaration of a state of emergency; and/or
51.3.6 The Contractor has failed to adhere to the terms of any contract or agreement
incorporating this Contract by reference.
51.3.7 In the alternative, the Alliance may, at its sole discretion, in accordance with
section 430.04, F.S., take immediate measures against the Contractor, including: corrective
action, unannounced special monitoring, temporary assumption of the operation of one or
more contractual services, placement of the Contractor on probationary status, imposing a
moratorium on Contractor action, imposing financial penalties for nonperformance, or
other administrative action pursuant to Chapter 120, F.S.
51.3.8 In making any determination under this provision the Alliance may rely upon the
findings of another state or federal agency, or other regulatory body. Anv claims for
damages for breach of any contract or agreement incorporating this Contract by reference
are exempt from administrative proceedings and shall be brought before the appropriate
entity in the venue of Miami -Dade Count%
CONTRACT KZ- 1497 Page 21
i1. Official Pavee and Representatives (Names, Addresses, and 'Celephone `umbers):
The name, address, and telephone number of the representative for the Alliance for this contract
altt.t B. Rothman, JD, LL. 1L
Presiclent tend CEO
760 NW 107`' Ave, Suite 214
Miami, Florida 33172
(305) 670-6500, Ext. 224
The name, address, and telephone number of the representative of the provider responsible for
administration of the program under this contract is:
The Contractor name, as shown on page I of this
MONROE COUNTY BOCCiSOCIAL SERVICES'IN HOME
a.
contract, and mailing address of the official payee to
SERVICES
whom the payment shall be made is:
500 WHITEHEAD STREET -CLERKS OFFICE
KEY WEST, FLORIDA 33040
KIM WILKES WEAN -COMPLIANCE MANAGER
The name of the contact person and street address
1 100 SIMONTON STREET, SUITE 190
b.
where financial and administrative records are
KEY WEST, FLORIDA 33040
maintained is:
The name, address, and telephone number of the
SHERYL GRAHAM -SR DIRECTOR
C.
representative of the Contractor responsible for
1 100 SIMONTON STREET, SUITE 2-257
administration of the program under this contract is:
KEYW WEST, FLORIDA 33040
I
The section and location within the AAA where
Associate Vice President Finance
d.
Requests for Payment and Receipt and Expenditure
760 NW 107th Avenue, Suite214
forms are to be mailed is:
I
Miami, Florida 33172-3155
i I
�
Contract Manager
The name, address, and telephone number of the
Alliance for Aging, Inc.
e
760 NW 107th Avenue, Suite 214
Contract Manager for the AAA or this contract is:
Miami, Florida 33 172-3 155
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.
In the event different representatives are designated by either party after execution of this contract, notice
ot, the name and address of the nel% representati%e will be rendered in whiting to the other party and ;aid
notitication attached to on<Linals of this contract.
21
_,`I, All Terms and Conditions Included
Fhls contract and its Attaclunents, I throw -di X, A, B, C, D, E, and any exhibits referenced in said
attachments, touether vi Ith any documents incorporated by reference, contain all the teens 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 67 page contract, to be executed by their
undersigned officials as duly authorized.
Contractor Monroe County Board of
Commissioners,
SIGNED BY:
NAME: ROMAN GASTESI
ALLIANCE FOR AGING, INC.
SIGNED BY:
NAME: MAX B. ROTHMAN, JD, LL.M.
TITLE: COUNTY ADMINISTRATOR TITLE: PRESIDENT AND CEO
DATE: j DATE:
Name: --
Sylvia Murphy
Title: Mayor
Date- Atk-61b ?
W
CONTRACT i
INDEX TO ATTACHMENTS
Attachment 1
SERVICE PROVISIONS ALZHEIMER'S DISEASE INITIATIVE PROGRAM
Attachment II
CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND AGREEMENTS
Attachment III
FINANCIAL AND COMPLIANCE AUDIT
Attachment IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,
GRANTS, LOANS AND COOPERATIVE AGREEMENTS
Attachment V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
Attachment VI
ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII
CONTRACT REPORT SCHEDULE
Attachment VIII
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Attachment IX
REQUEST FOR PAYMENT FORM
Attachment X
RECEIPT AND EXPENDITURE REPORT
Attachment A
DOEA HANDBOOK
Attachment B
CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C
DOEA COMPUTER USE POLICY
Attachment D
BACKGORUND SCREENING AFFIDAVIT OF COMPLIANCE
Attachment E
E-VERIFY
Attachment F
BUSINESS ASSOCIATE AGREEMENT
Attachment G
AGING AND DISABILITY RESOURCE CENTER (ADRC) — OUTSOURCED FUNCTIONS
Attachment H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
23
CONTRACT 1497 Page 24
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. STATEMENT OF PURPOSE
The Alzheimer's disease Initiative (ADI) Program is focused on caring for persons IS + with memory
disorders.
II. SERVICES TO BE PROVIDED
A. Services:
1. The provider's service provider application for state fiscal year 2014 and any revisions
thereto approved by the Alliance and located in the contract manager's file, are
incorporated by reference in this contract between the Alliance and the provider, and
prescribe the services to be rendered by the provider.
2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue
funded program, including ADI, who are also enrolled in a Medicaid eapitated long-
term care health plan or program.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the provider's
service provider application for state fiscal year 2014 and the 2013 Department of Elder
- Affairs Home and Community Based Services Handbook. In the event the 2013 handbook
is revised, such revision will automatically be incorporated into the contract and the provider
will be given a copy of the revisions.
III. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed rate reimbursement for approved
services. The provider must cnsure fixed rates include only those costs that are in accordance
with all applicable state and federal statutes and re rulations and are based on audited
historical costs in instances where an independent audit is required. All requests for payment
and expenditure reports submitted to support requests for payment shall be on DOER forms
I06Z and 105Z. Duplication or replication of both forms via data processing equipment is
permissible, provided all data elements are in the same format as included on departmental
fonns.
B. Invoices must be submitted no later than 90 days after the end of the month on which the
expense was incurred, except that invoices can not be submitted after close out report date
(usually July I5th.) Invoices submitted late will not pay. Exceptions to this rule are at the
discretion of the Alliance, on a case by ease basis; such exceptions must be requested prior to
the expiration of the invoicing deadline. In making a determination of the exception the
Alliance vFill consider whether the disruption to the billing cycle %Gas bevond the control of
the provider. the frequency %� ith %%hick Such exceptions are requested by the provider. and
t hctlier the Alliancc can request reiinbursenicnt at a late date from )()FA.
24
CONTRACT KZ- 1497 Page 25
C. I -Fie provider shall maintain documentation to support payment requests which shall be
available to the Comptroller, the Department of Elder Affairs, or the .Alliance upon request.
D. The provider shall maintain documentation to support payment requests which shall be
available to the Alliance, the Department of Elder Affairs or the Comptroller upon request.
E. The provider may request a monthly advance for service costs for each of the first two
months of the contract period, based on anticipated cash needs. Detailed documentation
justifying, cash needs for advances must be submitted with the signed contract, approved by
the Alliance, and maintained in the contract manager's tile. All payment requests for the
third throu<-,h the twelfth months shall be based on the submission of monthly actual
expenditure reports beginning with the first month of the contract. The schedule for
submission of advance requests is ATTACHMENT I1 to this contract. Reconciliation and
recouping of advances made under this contract are to be completed by March and April. All
advance payments are subject to the availability of funds.
F. advance funds may be temporarily invested by the provider in an insured interest bearing
account. All interest earned on contract fund advances must be returned to the Alliance
within thirty (30) days of the end of the first quarter of the contract period.
G. The Alliance shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rate(s) stated below:
Service
Maximum
Maximum
Service to be Provided
Unit Rate
Units of
Dollars
Service
In Home Respite
524.03
3,471
583,407
H. 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 provider and any adjustments thereto, including any
disallowance not resolved.
IV. SPECIAL PROVISIONS
k. State LaFvs and Regulations:
The provider aLrees to comply with applicable parts of Rule 5SD-1, Florida Administrative
Code promulgated for administration of Sections 430.5'01 through 430.304, Florida Statutes,
.Ind the Department of Elder .AffI.irs Client Home and Community Based Services
1 Iandbook dated O? 201 1.
13. Assessment and Prioritization for Service Delisery for tie« Consumers:
25
CONTRACT•• •-
The follo�k ing are the criteria to prioritize new consumers for service delivery. It is not the
intent of the Department of Eider Affairs to remove existing clients from any progralxi in
Order to serve new clients beimz assessed and prioritized for service deliVerx.
1. Priority Criteria for Service Delivery:
a= individuals in nursing homes under Medicaid who could be transferred to the
collltntinity;
b. individuals in nursing homes whose Medicare coverage is exhausted and may be
diverted to the community,
c. individuals in nursing homes which are closing and can be discharged to the
colnlnunity; or
d. An individual whose mental or physical health condition has deteriorated to the
degree self care is not possible, there is no capable caregiver and institutional
placement will occur within 72 hours.
2. Priority Criteria for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means of
service delivery. Functional impairment shall be determined through the department's consumer
assessment form administered to each applicant. The most frail individuals not prioritized in groups
one, two or three above, regardless of referral source, will receive services to the extent funding is
available.
C. Co -payment Collections:
i 1. The provider will establish annual co -payment goals. The Alliance also has the option
to withhold a portion of the provider's Request for Payment if goals are not met
according to the Department of Elder Affairs' co -payment guidelines.
2. Co -payments include only the amounts assessed consumers or the amounts consumers
opt to contribute in lieu of an assessed co -payment. The contribution must be equal to
or greater than the assessed co -payment.
D. Evaluation, Statistics and Reports
The provider agrees to respond to requests for evaluation information and statistical data
concerning its consumers based on information requirements of the Memory Disorder Clinics and
Brain Bank. The provider will ensure Nlodel Day Care Centers supported by this contract
develop innovative therapies and interventions which can be shared with other Alzheimer's
disease Initiative health and social services personnel via training. Model Day Care Centers
supported by this contract must report to the provider all training activities provided to health care
and social service personnel and caregivers, as well as serve as a natural laboratory for service
related applied research by ,Memory Disorder Clinics. An annual Model Day Care Center
Training Report. ATTaCHtiIENT IV. is due by Jul',' 5, 241 5.
F. Collaboration with Metnory Disorder Clinics:
26
CONTRACT 1497 Page
�tc�?x?ry Disorder Clinics are required to provide io Ir hours ofin-service training to all respite and model day care
centers in their designated service ice areas. he pro,, ider a`arecs to collaborate %t ith Memory Disorder Clinics to assist <<?
this effort.
F. Service Cost Reports:
The provider will submit annual service cost reports which reflect actual costs of providing each service by program.
This report provides information for plarming and negotiating unit rates.
G. Reporting:
The provider need to provide the Alliance with an expenditure plan by July 15 or two weeks after contract has been
signed, a monthly update due on the 21 of each following month.
The expenditure plan and updates must follow the format provided by the Alliance.
M
CONTRACT KZ- 1497 Page 2?
VIA'ACHNIEN'I' II
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersiuried 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 S10-,000.00 and not more than S100,000.00 for each such failure.
Signature
t /zs
ate
ROl✓IAN GASTESI-COUNTY ADMINISTRATOR KZ1497
Name of Authorized Individual Application or Agreement Number
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
;dame and Address of Organization
iN_W y Form 1
Rz:%I-«t \k,%
M
CONTRACT&- MM
ATTACHMENT Ili
FINANCIAL AND COMPLIANCE AUDIT
'he administration of resources awarded by the Department of Elder Affairs or the Alliance for Aging. Itic. to the provider
may be subject to audits and, or monitoring by the Department of Elder Affairs or the Alliance for Aging, [tic., 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 S500,000 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
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
ONIB Circular A- 133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part 1, 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 S500,000 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 S500,000 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 or,.zanization'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 ti:e Department of Elder affairs or the :Alliance for Auin�_,. Inc. shall be fully discloses} in the audit
report ,s ith reterence to the Department of Elder :Affairs or the :Alliance for .Aging. Inc. a,,reement imol%cd. If not othenvise
d ,closed is required by Section .3100)(2) of ()%IB Circular A-133. Lis revised, the schedule ot, eypendinires of Federal
�l,t ir1> shall idei2tli�' etpc:nditures by a<_=reemcni number for each igreeinent tikith the Depiirtment of 1;dcr :Affairs or the
29
CONTRACT KZ- 1497 Page 30
Alliance for ALing Inc. in effect during the audit period. Financial reporting packages required under this part mint be aubtrntted «ith n
the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's tiseat %ear end.
'�kwr II: STATE FUNDED
'l his part is applicable ifthe provider is a nonstate entity as defined by Section 2159'(2}- Florida Statutes
In the went that the provider expends a total amount of state tinancial assistance equal to or in excess of S500.(tt)0 in any fiscal %,ear A
such provider (for fiscal vears 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 _' 15.97, Florida Statutes: applicable rules of the Department of Financial Services: an
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 throu<uh 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 S500,000 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 S500,000 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
` is met for each applicable agreement. All questioned costs and liabilities due to the Department of Elder Affairs or the Alliance for
_-ging, 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 69I-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 0.%IB Circular A-133, as revised, and required by PART I of this
agreement shall be submitted, when required by Section .320 (d), 01ti1B 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: Fiscal Manager
760 NAV 107" Avenue, Suite 214
;Miami, FL 33172-3155
1-11e Federal Audit Cicarirn_='.souse dc-,lunated in OMB Circular A-I3 j, as revised (the number of copies required by Sections
_ 20 (d)( 1 ) and (_'). O%113 C rcular _1-133, as revised. ,hould be ;L1ht111ttCd to the Federal Audit Clearimuhou5c), at the
CAlo;v,address:
30
• aCT KZ- 1497 • . 31,
Federal Audit Clearinghouse
Bureau of the Census
1201 East IOIh Street
Jeffersonville, IN 47132
Other Federal agencies and pass -through entities in accordance with Sections .330 (e) and (r). OMB Circular A-133. its
revised.
Pursuant to Sections .320(t). 0y113 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: Fiscal Manager
760 NW 1071" 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 directly to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Manager
760 NW 107t' 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
- I I I West Nladison 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 sir
Gears 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 akailable to the
:Alliance for Agin<u. Inc. , or its designee. CFO, or Auditor General upon request for a period of six %cars from the date the
audit report is issued, unless extended in writing by the Alliance for A<ging. Inc.,
31
�El
ATTACHMENT III
EXHIBIT
1. STATE RESOURCES ANVARDEDTO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE
CSFA#
A.NIOUNT
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLONVING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
I — T -T 1 PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
ALSTATEAWARD
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
ADI General
556,746
Revenue/Tobacco
Setlement Trust Funds
TOTAL AWARD I S56,746
32
CONTRACT KZ- 1497 Page 33
ATTACHMENT III
EXHIBIT 2
PART 1: AUDIT RELATIONSHIP DETFRMINA lON
Pro% iders �G ho recei,, e state or federal resources may or may not be subject to the audit requirement; of OMB Circular A-13 3, as rc\ Ised
and or Section -115.9', Fla. Stat. Prodders ,sho are detennined to be recipients or subrecipients of federal a.tiards and. or state tinanci.11
assistance may be subject to the audit requirement, if the audit threshold requirements set forth in Part I and or Part II of Exhibit 1 are
met. Providers who ha%e 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 Miether the audit requirements are met, providers who hale been determined to be
recipients or subrecipients of Federal alvards and or state financial assistance, must comply with applicable programmatic and fiscal
compliance requirements.
In accordance with Sec. 210 of ONIB Circular A-133 and or Rule 691-5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to 0%113 Circular A-133 and or Section 215.97, F.S.
Y 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 1IUST 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-1 10 — Administrative Requirements)
ONIB 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 FINANCLAL :kssisTANCE. Pro%lders %ho receive state financial assistance and w0ho are determined to be a
recipient subrecipient, must comply with the tolkming fiscal laws, rules and regulations:
Section _' 15.`}7. Fla. Star.
t hapter i,91-5. Fla. Admin, Code
Nt,ite Projects Compliance Supplement
17e(erence i,utde for State Ixpenditures
()tier fiscal requirc:inents Net forth ill pro<<ram iaa"s, rubes atld ret'ulatlons
33
'P,I a
-� tct- �3 I(-,
34
CONTRACT KZ- 1497
y l_ AC I [M ENT IV
CERTIFICATION REGARDING DATA I\TEGRaN, COMPLIANCE
FOR AGREE MEN-rs, GRAWS, LOANS .LSD
COOPER:ITIN'E AGREEMENTS
The undersigned, an authorized representative of the contractor named in the contract or agreement to which this form is in
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 eacli
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 -contractors) 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 ONIB
Circulars A-102 and 2 CFR Part 215 (formerly OMB Circular A-1 10).
Name and .-\d�,dres- ofC
C.-
Signature
ROMAN G AS I FSI
Lame of authorized Signer
1100 SIM
—COUNTY ADMItiISTRATOR Z_G `f
Title Date
35
Y
CONTRACT KZ- 1497 Page 36
VI'T,kCII�NIENT �-
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LONVER 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.
Signature Date
ROMAN GASTESI-COUNTY ADMINISTRATOR MONROE COUNTY BO C
f
Title Agency/Organization
(Certification signature should be same as Contract signature.) "
Instructions for Certification 1 jJ
L 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 exchtded from participation in this transaction, in addition to other remedies available to the
federal !oyern111ent. the department may pursue available remedies, including suspension. and or debarment.
the contractor may rein upon a certification of a prospective participant in a lkmer tier covered transaction that it is
;ot debaixed. suspended, inchuible. or Wluntarily excluded from the co%crcd transaction, unless it knows that the
certification is erroneous.
tztti�aa `�,;,c
991
CONTRACT KZ- 1 497 Page 37
ATTACHMENT VI
kSSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, includin<, time for revie%� ing
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, includim, sus_gestions for
reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM 1U 1HE MHCE OF MANAGLME\l ADD BUDGEt
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.
I. 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.
Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) 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 illerit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
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. 1681-1683. and 1685-1686). which prohibits discrimination on the basis
of sex; (e) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis
of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 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) 523 and 527 of the
Public health Service Act of 1912 (42 U.S.C. 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 (j) the requirements of any other nondiscrimination statute(s) %chich 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 propertv
acquired for project purposes regardless of Federal participation in purchases.
will c��n�plc. ,is applicable. kith the provisions Of the Hatch :act (5 U.S.C. 1501-15t)8 <ind 324- 328), Much limit the political
tcti� ittes of cmpio%ecs �v hose principal employ nient activities are tiundcd in A hole or in part with Federal funds.
37
CONTRACT KZ- 1497 Page 33
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 3-6a to'_'6a-7), the Copeland Act (40 US.C.
276c and I S U.S.C. 8-4) and the Contract \� ork Flours and ``aCet� Standards Act (40 U.S.C. 333 ). re Jardin, labor
standards for tederally assisted construction suba<greeinents.
Will comply, if applicable, with flood insurance purchase requirements of Section 10-1(a) of the Flood Disaster Protection Act of 19) 3
(P.L. 93 _'341 which requires recipients in a special flood hazard area to participate in the prouram and to purchase flood insurance if
the total cost of insurable construction and acquisition is S 1 0,000.0o or more.
11, Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of em iromnental
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. 1451 et seq.): (0 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. 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. 470), 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. 2131 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. 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
COUNTY ADMINISTRATOR
ROMAN GASTESI
APPLICANT ORGANIZATION DATE SUBMIED
Monroe County Board of Commissioners. (p Z5 �LlfJ
E
ATTACHK8ENTVU
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
Report Bas-q�
Number
1 July Advance ~ .................
2 August Advance*
3 July Expenditure Report ... 1/12Advance ReCOOCiU3d0n ........'
4 August Expenditure Report ... 1/12Advance Reconciliation ......
5 September Expenditure Report ... 1/12Advance Reconciliation
0 October Expenditure Report ... 1/12Advance Reconciliation
.
7 November Expenditure Report ... 1/12Advance Reconciliation
8 December Expenditure Report ... 1/12Advance ReCOOoi|i8d0O
S January Expenditure Report /... 1/12Advance Reconciliation ....
10 February Expenditure Report ... 1/12Advance ReoonCiU8hOO ....
11 March Expenditure Report ...... 1/12Advance Reconciliation ....
12 April Expenditure Report ... 1/12Advance F(gCOnCi|i8d0n ..........
13 May Expenditure Report ... 1/12Advance R8SOnCUiaUOn ........'
14 June Expenditure Report ... /12Advance Reconciliation ..........
16 Final Expenditure and Closeout Report ....................... '.'.—
Ju|y 1
July 1
AuguSt10
SeDbeDlber1O
C}CtOb8[10
November 1O
08o8mbBF1O
January1O
February 1O
Muroh1O
Apri|1O
MQy1O
June1O
July 10
July 20
Legend:° Advance based On projectedcash need.
Note # : Report #1for Advance Basis Contracts cannot b8submitted hrthe Alliance prior hzJuly 1oruntil the
contract with the Alliance has been executed. Actual submission ofthe vouchers tOthe Department
OfElder Affairs isdependent Unthe accuracy 0fthe expenditure report.
39
CONTRACT KZ- 1497 Page 40
•i •'11 ilk, TeJJJA.i.
Model Day Care Center Name:
Printed Name of Person
Completing Report
Signature of Person
Completing Report
ATTACHMENT Vlll
Date Executed
The purpose of each model day care program must be to provide service delivery to persons suffering from
Alzheimer's disease or a related memory disorder and training for health care and social service personnel in the
care of persons having Alzheimer's disease or related memory disorders. This report documents the required
training for the State Fiscal Year July 1 st through June 30th.
Actual Training Event(s)
Number
Health Care
Professiona
Is Trained
Number
Social
Services
Personnel
Trained
Total
People
Trained
Training Title:
Date:
Training Summa
w
CONTRACT
.• aC 1497 Page a..
1T'r:1CIIIIEVT I
REQUEST FOR PAYMENT
LOCAL SERVICE PROGRAM
RECiP..E?4T."LAMEACCRES3.PI40NEiand FEi24
TYdECFPayMENTREQUEST
'h15PequestPeriod
P SA s
Report 9
Regular
Cw'dct e
Contract Period
Advance
C ERTiFiC,ATICN I hereby certify to this best of my knowledge that this request rs complete and correct and conforms with the terms and the purposes of" above contract.
Prepared try: Cate. °pproved by: Cate.
PART A: BUDGET SUMMARY
LCP
TOTAL
t. Approved Corrtract Amount
50.00
S0.00
2- Previous Funds Received for Contract Period
S0.00
S0.00
3. Contract Balance (line t minus line 2)
$0 00
30.00
A. Previous Funds Requested and Not Received for Contract Period
$0.00
S0 00
5- Contract Balance (line 3 minus line 6)
$0.00
5000
PART 8: CGNTRACT FUNDS REQUEST
t. Anncrpated Cash Needs 0 st - 2nd month. Attach Jus56cahon)
S0.00
S0.00
2. Net Expercitures For Month
$0 00
$0 00
,0CEA Form 105L Part 8, line 8)
3- TOTAL
$0.00
50.00
PART C NET FUNDS REQUESTED
3000
t. less Advance Applied
SO 00
2. Contract Funds are Hereby Requested
"0 00
S^v 0C
.cart B. Ure 3 minus Part C. L,ne 1)
'_ct of SKr ces 1 J:^es i Rates prwiCed - wee attacned report.
41
CONTRACT KZ- 1497 Page 42
ATT_A[l_0����X
RECEIPT AND EXPENDITURE REPORT
LOCAL SERVICE PROGRAM
PROVDER NAME ADDRESS, PHONE and FE:D::
Pcgrarr, FL.-Cirg So,.rce
�THiS REPORT PERIOD.
From To
!ADVANCE
':CONTRACT PER�CD
REGULAR
iCERTIFICATiON I cert;fy to the best ofmy knowledge and belief t1hat the report is complete and correct and all outlays
I herein are �or purposes set forth in
the contract,
1P,epared by Date
Apprcved 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
PART B , EXPENDITURES (From Approved Budget)
I Approved
2. Expenditures
3. Expenditures
4. Percent of
Budoet
For This Report
Year to Date
Approved Budget
PART C OTHER REVENUEAND EXPENDITURES
Interest
Earned or OR Adiarce S
42
CONTRACT KZ- 1497 Page 43
ATTACHMEN-r.k
Department of Elder Affairs Programs & Services Handbook,
Available at the Alliance for Aging Internet site under, -Downloads".
43
CONTRACT KZ- 1497
9�
A'F'FACIIIlIEN-r 13
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name -ii Q>:�
County at�
AAA/Contractor
Address I I Z) C) I Cf c'
Completed By lqm
City, State, Zip Code I (" We S-t li:�f C)'-� c::,
Date
Telephone
PART I.
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: T-;Ie_
FICA(VA, t<,e- Mctsaae- aixroke S I a-P-0- c5n.6"mcil AAAA wit -pi one, Wzho-r-5
st4j -'C I -k 11 -r-c-
\Art XAltr ki q,-4 O-LO- C-:
i Ij
9 Pr)PI H AMN nF ARFA SFRVFD. Source of data: 2C10 LI-S Ce-r-tku-c-
Total
red%Whk
'
% Black
11/6 Hispanic
% Other
% Female
3 -
CTAPP ('I 1PPf=r\1T1 V PINAPI (,)vpn Pffi-rtix/p riqt,--
Total
RTZ-2.
#
% White iro
I % Black 3 0
1 % Hispanic I
% Other
%-Female
% Disabled
CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date:
Total
116
k
7
%-White
% Black
% Hispanic
% Other
e=;m-a I e
%
d
%
5
ADVISORY OR GOVERNING BOARD. IF APPLICABLE.
Total
1 0 t3
0
C)
# 5-
% White
1
% Black
1
% Hispanic
1
% Other
I I
/. Female
% Disabled
I
I
PAK I
111. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. NA YES
6 NO
Is an Assurance of Compliance on file with DOEA? If NA or NO, explain. i7 71 Z
7. Compare the staff composition to the population. Is staff representative of the NA YES
population? If NA or NO, explain. NO
8. Compare the client composition to the population.
pulation. Are race and sex characteristics ',A YES
epresentative of the Popuiation? If NA or NO, explain. %0
44
CONTRACT KZ- 1497 Page 45
9. Are eligibility requirements for services applied to clients and applicants without regard to
race, color. rational origin, sex, age, religion or disability? If NA or NO, explain.
NA YES
NO
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
11. For in -patient services, are room assignments made without regard to race, color, national origin or disability? If NA or
NO, explain.
'ES NO
moo❑
12. Is the program/facility accessible to non-English speaking clients? If NA or NO, explain.
13. Are employees, applicants and participants informed of their protection against discrimination?
If yes, ,/
how? Verbal Writtenij 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,
15. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? If NA or
NO, explain.
YES :40
C
45
CONTRACT KZ- 1497 Page 46
PART Ill, THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES
18 Has o self -evaluation been conducted to identify any barriers toserving disabled individuals, and to make any
necessary modifications? If NO. explain.
17. Is there and established grievance procedure that incorporates due process in the resolution of
complaints? If NO, explain.
YES NO
[� n
v= `�
18. Has a person been designated to coordinate Section 504 compliance activities? IfNO, explain.
YES NO
�� [�
�� ��
_
19. Do recruitment and notification materials advise upp|ioanha, employees and participants of
nondiscrimination onthe basis ofdisability? |fNO, explain.
\
--^ �|m<
20. Are auxiliary aids available to assure accessibility of services to hearing and sight impaired
individuals? If NO, explain.
YES NO
" [�
+" ^�
PART FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50.000 OR
|V. MORE.
21 Do you have a written affirmative action YES NO
plan? |fNO, explain.
46
CONTRACT KZ- 1497 Pad=
USE ONLY
r-�eviewed By
Program
*Notice of Corrective Action Sent -
Off ice
Response
Date
Telephone_,,,�
Due
Response
On -Site Desk Review
Received
47
��
i
CONTRACT KZ- 1497 Page 49
.kTTACH'NIENT I3
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
Describe the ;geographic service area such as a district, county, city or other locality. If the program fLicilit"
serves a specific target population such as adolescents, describe the target population. Also, define the type of
service provided.
?. Enter the percent of the population served by race and sex. The population served includes persons in the
'eographical 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.)
3. Enter the total number of lull -time staff and their percent by race, sex and disability. Include the effective date of
your sutnrnary.
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.
5. 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 DOER 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'?
8. 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 orium,
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
�0.3 (b ).
For in -patient sen-ices. residents must be assluned to rooms, %%ards. etc.. %%ithout regard to race, color, national
oriLIin or disability. Also. residents ;rust not be asked whether thev are to share accommodations with
ersons oa dif`terent race. color. national origin, or disab f ility. 45 CFR
I -lie program tac iiity ,,nd all sen ices must be accessible to participants and Iipplicants, including those persons wlto
nw%, not speak Fngllsh. In geot mph(c areas �chere a sltuniticaIlt populatlotl of 11011-Fn-11S11 ;pe�tklM_l people 11ye,
49
CONTRACT49•.•'
pro, -,rain aCCc Sibllity may tnClude the employment of bilingual staff. In other areas, it Is sufficient to ha%c a policy
or plan for service, such as a current list of names and telephone nuIllbers of bilingual indll IdUalS %6110 will assist 1II
the provision of services, 45 CFR S0.3 (a).
13. Prouramm
s:'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 I- HS.
The inforiation 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 tiled. 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 prograrn 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).
_0. Programs; facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with
impaired sensory. manual or speaking skills inhere 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
u ed to provide equally effccti�c cr, iccs. {45 CFR 54.5� {d}.
1. Prourmis taciiitic'.s %4 ',1, 50 or more enlployc°es and in federal contracts must del"clop. iinplcincait Ind
iilaintaln a %%ritteI1 aitiImati%e action coniph,,ince program in ticcordancc %Pith hxcclitiye ()rdcr 1 1'46. 41 I'R 60
'Ind Title VI oldie Citiil Rl'-dits Act of 1004. is anlendcd.
Im
•. KZ- 1497 PagME
VFF. k C I I 1 I E NT C
Department's Computer Use Policy and its Social Media Policy
Available at the Alliance for Aging Internet site under, "Downloads".
a
CONTRACT KZ- 1497
ZEM
..t,viI ..I,i
AFFAIRS
TATE OF FLORIDA
ATTACHMENT D
AUTHORITY: This form Is required annually of all employers to comply with tho attestatlon
requirements set forth in section 435.05(3), Florida Statutes.
The term employer" means any p.nrson or _ntirr ri�quired oy iaw t,7 cnrluct background screenirg,
nciudin, but rnot limited to, Area Apencies on Aging, 4ging Rescurce C�:n-ers, KRing and Cisabihty
Rr_sowce Centers, Lead .fir?_+ncies, Long -Term Cara Ombudsman Prr-,ram, ,ervina keaitn Insurance Needs
cf Elders Prr7prarn, �r>rvice Provr ers, D_vervcn Providers, and ar,,y other person or entity which nfires
*n pE CYy rtS or hos vok,4nh:,r, , in yrrviri, whp rraCOt tnL oi-+n,t,nn of .) provider- `NYC §4
4111 n2,-4,40114(12, Fia -7!,It
r A I,wtt trrwe providee is ",i in "wars of FAt- a( :)Her wnr), ji,ir:ivrit to a pre,�,r:em to provide
rrvir,r5 to they alde ely, ha, direct, runtae_t va,h a cl ant nraviding ,ervl< es .0 they Ow -It
and has ,access to the cliaat"s living area, funds, personal property, or ptr oral ident,rieation information
as defined in s. 817 St-S. rht ,errn ncl� das coordinators, man.3gers, arsd w �erviscrs of rc si{ienti3l
facilities: and valuntc ers_" 4 430.0402(t}lbl, Fla. Stat
ATTESTATION -
As the duly authorized representatNe of
Em pic yer Aiame
forarari
t creel Address Lire' `'tale OP CoIJ2
I. do hereby affirm under penalty of perjury
nma r1f!te�rese=�rrcr.ve
chat the jbuye iaoled employer is in rorn:)aa+lee .with the provisior*s of Chapter 4-15 ana Section
410.11 02, Florida Statutes, re.gardin.gI?vaf 2 background screening.
S hnarure rst RF--prpsentative,
SrAFE OF FLORIDA. COUNTY OF
natp
�-.v^,rr) t) I,rr if'irmetlp and ,-b crinPd hefore rre to s _-- 11,iy of -- --- :0__ , by
o me or uroduced
;Narnc of Reprrs( rntathvej ,d)v i, pcf5,urially known
i ; proot of ideot,fic ition.
WN
CONTRACT KZ- 1497
9�
A'Fr.kcII'NIEN"F E
Verification of Employment Status Certification
As a condition of contracting with the Alliance for Aging, Inc.,
P'r3 le QD 0 Cf— hereby referred to as contractor, certifies the
use of the U.S. Departmeit of Homeland Security's E-v-erify 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.
Signature --etmq� G-42s-1 Date
(Same as contract signature)
.�
Title
Ka+3e-oa— � oL�v Poc—c,
Company Name I
53
CONTRACT KZ- 1497 Page 54
ATTACHMENT F
Alliance for Aging, Inc.
Business Associate Agreement
This Business Associate leement is da ed by the Alliance for Aging, Inc ("Covered Entity") and
fog -. (-Business Associate"), a not -for -profit 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
54
CONTRACT KZ- 1497 -
age 5E
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.
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.
55
CONTRACT • Page •
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
under 42 U.S.C. section 17932(h)(2).
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
oreach: and
o
CONTRACT KZ- 1• • . • -
(b) All information required for the Notice to the Secretary of NHS 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
(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 Knovviedge Elements Associated with
Contracts):
M
CONTRACT / ♦ ♦ i
(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,
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 §164.502(j)(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 1 to this Agreement. Future Notices and/or
modifications to the NPP shall be posted on Covered Entity's website at
,.v,rvw.aIhanceforaging.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.
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
0
CONTRACT KZ• 1497 Page 59
would not be permissible under the Privacy Rule if done by Covered Entity.
&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
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.
CONTRACT KZ- 1497 Page 60
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).
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: N omroe_ HUCC....
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.
TO 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
CONTRACT KZ- 1497
NMM
have been required kzifthat succession had not taken place. This assumption
bythe successor ofthe Business Associate's obligations shall bebywritten
agreement satisfactory to Covered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement ofthe
parties relating to the subject matter of this agreement and supersedes all other
oral orwritten agreements orpolicies relating thereto, except that this agreement
does not limit the amendment ofthis agreement inaccordance with section 10O
of this agreement.
Covered Entity:
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By: .
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CONTRACT KZ- 14Q7 Page 62
'kU7/k[H.NyEN3G
Alliance for Aging, I
Aging and [)is8bi|hv R8S0U[Ce Center/Elder H8lDliOe
AGING AND DISABILITY RESOURCE CENTER (ADRC)-OUTSOURCE8FUNCTIONS
i Ifapplicable, the provider agrees hothe following:
A. Perform ADRC outsourced functions in accordance with the Alliance's policies and procedures.
i Policies and Procedures for DutsouroedFunction-Screening
ii Policies and Procedures for OutsourcedFunction-Triage
Po|iciesandProcedunsmfnrAdivahonhnmVVoiUiat-C|ientServioea
iv. Policies and Procedures for Termination from Waitlist- Client Services
B. Maintain wait lists in C/RTS in accordance with UUEArequiraments.
C. Report number of client contacts to the Aging and Disability Resource Center.
D. Adhere to prioritization policy as set forth by ODEAon o monthly basis. Reference DOEA Notice
of Instruction: Assessed Priority Consumer List#:062906-1 -I-OVCS as applicable.
E. Ensure the agency's Disaster Plan reflects AORC Dutoouroad Funndona, annually oras 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 oana ommioea beyond the provider's scope ofservices 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)ismaintained when services funded bythe department are not
available. Contracted providers of registered services for A|zheimer'y Disease Initiative (AD|) and Older
American's Act (OAA) maintain waiting lists in the CIRTS database for registered services when funding is not
RegioteredServio*sfon,henbove|istedprognamsuneashd|owe:Adu|tDayCane(ADC).Adu|tDeyHee|thCere
(AOHC). Chore(CH0). Eacort(ESC). Home Delivered k4eo|a(HOKJ). Home Health Aide (HHA). Homemaker
(H[NK), Model Day Care (K3DC), Personal Care (PECA). Facility -Based Respite (RESF). In -Home Respite
CONTRACT KZ- 1497 Page 63
Alliance for Aging. Inc.
Aging and Disability Resource Center/Eider He|p|ine
/ \ Policy and Procedure for
~' Outaourcedfunction-Soreoning
Creation Date: March 5, 2008
Revision Date: KJay2012
Objective: To ensure that a comprehensive list of clients in need of services is maintained in C|RTS by
appropriate funding source and that the ADRC is thereby able to effectively gauge the level of elder
service need inMiami-Dade and Monroe Counties.
Policy: To obtain necessary information from clients in order to assist in determining level of need and
eligibility for OOEAfundad services
Procedure:
1 . ADRC Contracted Providers will collect information from callers and conduct a 701A assessment.
/Ukannodvey. J a 701B 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, theAORC Contracted Provider will
make a determination as to the services that the caller is in need of receiving .
3. The AORC 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 He|p|ine utilizing the AURC Referral Form
and/or toanAOF{CContracted Provider that provides the needed service.
5. The caller will be provided with general information regarding the ADRC as well as the ADRC Elder
Ho|p|inecontact number.
6. The caller will be informed of the services and funding sources that they are being placed on the wait
list for inC|RTS.
7. AORC Contracted Provider will create m client record in QRTS (if thaana 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].
G, If the AORC 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
CONTRACT KZ- 1497 Page84
funding sources. [|f there is an existing client record in C|RTS, the client record in C|RTS will be
updated with appropriate information].
9ADRC 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,
64
CONTRACT KZ- 1497 Page 65
Alliance for Aging, Inc.
dm�
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 vviil apply targeting criteria, as appropriate, to prioritized clients to ensure
activations meet programmatic requirements.
Alliance for Aging, Inc.
65
CONTRACT KZ- 1497 Page 66
Aging and Disability Resource Center/Eider 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 DOER 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.
ME
CONTRACT,• ag .
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 DOER Notice of Instruction: Assessed Priority Consumer List#:062906-1-1-OVCS as
applicable.
M
CONTRACT KZ- f Page• 1
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, e-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.
ROOM • a a •
.k"TT.ICIINIEVT II
CERTIFICA TIGV REGARDING SCRL TIN IZED COMPANIES LISTS
The undersigned, an authorized representative of the Contractor named in the contract or agreemem to
which this form is an attachment, hereby certifies that:
{ I ) The Contractor understands that pursuant to s. ZS7.135 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 S 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.
N yl
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Signature = RornR1s GA�STESS 1 Dat
(Same as contract signature)
Title
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Company Name
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