07/19/2017 AgreementKEVIN MADO& CPA
MONROE COUN'T'Y CLERK OF THE CIRCUIT COURT & COMPTROLLER
DATE: August 8, 2017
TO: Sheryl Graliam, Director
Social Services
ATTN: Lourdes Francis, Administrator
FROM: Pamela G. Hanc ck, . .
SUBJECT: July 19th BOCC Meeting
Enclosed are the following documents:
C13 Amendment #002 of Alzheimer's Disease Initiative Program (ADI) Contract
KZ -1697 between the Alliance for Aging, Inc., and Monroe County Board of County
Commissioners/Monroe County Social Services/In Home Services for the contract year 2016-
2017 (ending June 30, 2017) in order to increase the total grant funding by $7,050.00 from
$164,647.80 to $171,697.80. These additional funds are non - recurring. Enclosed are three fully
executed duplicate originals for your handling.
C14 Alzheimer's Disease Initiative Program (ADI) Contract KZ -1797 between the
Alliance for Aging, Inc., and Monroe County Board of County Commissioners/Monroe
County Social Services In -Home Services for the contract year 2017 -2018 (07/01/2017-
06/30/2018) in the amount of $164,647.80. Enclosed are three fully executed duplicate originals
for your handling.
C19 Board granted approval and authorized execution of a Federally Funded
Weatherization Assistance Program (WAP) Subgrant Agreement # 17WX- OG- 11 -54 -01 -039
between the State of Florida, Department of Economic Opportunity (DEO) and County of
Monroe, Monroe County Board of County Commissioners (Monroe County Social Services)
for the period of 04/01/2017 through 03/31/2018 in the amount of $125,572.00. Enclosed are
five duplicate originals, executed on behalf of Monroe County, for your handling. Please be sure
to return two fully executed duplicate originals to my office once signed by the state.
Should you have any questions, please feel free to contact me at ext. 3130. Thank you.
cc: County Attorney w/o document
Finance
File
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ALZHEIMER'S DISEASE INITIATIVE CONTRACT ONGINAL
2017 -2018 Fiscal Year
THIS CONTRACT is entered into between the Alliance for Aging Inc., hereinafter referred to as the "Alliance" and
"Monroe County Board of County Commissioners, Social Services /In -Home Services. "„ hereinafter referred to as the
"provider," and collectively referred to as the "parties."
Attachments 1, 11, 111, IV, V, VI, VII, VIII, IX, X, A, B, C, E, F, G, and H are incorporated herein and made a part of
this Contract.
WHEREAS, the Alliance has been designated as the Area Agency on Aging for Planning and Service Area 11
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 fund Alzheimer Initiative Providers in Miami -Dade and Monroe 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 agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in
this contract including all attachments and exhibits, which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(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.
Incorporation of Reference Memoranda:
In accordance with Chapter 287 F.S., amended, and Department of Financial Services' Chief Financial
Officer
Memoranda, the following memoranda are hereby incorporated by reference:
(1) CFO Memo No. 02: Release date, October 3, 2012;
(2) CFO Memo No. 06: Release date, June 27, 2012;
(3) CFO Memo No. 01: Release date, July 26, 2012; and
(4) CFO Memo No. 04: Release date, June 30, 2006
3. Term of Contract
Effective Date:
This contract shall begin on July 1, 2017 or on the date the contract has been signed by both parties,
whichever is later.
Delivery of services shall end at 11:59 PM, local time in Miami, FL on June 30, 2018. 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 2017 to
facilitate payment for services rendered by the provider under this contract.
4.0 Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions of this contract in
an amount not to exceed $164,647.80 funds for 27 clients, or the rate schedule, subject to the availability of
funds. Any costs or services paid for under any other contract or from any other source are not eligible for
payment under this contract.
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4.1 Obligation to Pay
The Alliance's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature to the Department and funding received by the Alliance under its contract
with the Department.
4.2 Source of Funds
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 provider pursuant to this contract are in the
state grants and aids appropriations and consists of the following:
Program Title
Year
Funding Source
CSFA#
Fund Amounts
Alzheimer Disease
Initiative
2017-
2018
General Revenue
65004
$164,647.80
TOTAL FUNDS CONTAINED IN THIS CONTRACT:
$164,647.80
5. Renewals
The contract may be renewed on a yearly basis for no more than two additional years. Such
renewals shall be contingent upon satisfactory performance evaluations as determined by the
Alliance and the availability of funds. Any renewal of a contract shall be subject to mutual
agreement, confirmed in writing, and subject to the same terms and conditions set forth in the initial
contract, with the exception of establishing unit rates which is described further in this section. The
renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply.
Requests to renegotiate the original contractual established rates are provided for in the Alliance's
approved Reimbursement Rate Review Policy, which is incorporated by reference.
The parties shall re- evaluate the contract's reimbursement rates on an annual basis pursuant to DOEA's
Notice of Policy Clarification: Service Cost Reports Notice #092815- 1- PC -SCBS dated September 28`
2015 and the approved Alliance's Reimbursement Rate Review Policy.
In the event that contracts cannot be executed prior to the July 1" start date, the Alliance may, at its
discretion, extend this Agreement upon written notice for up to 120 days to ensure continuity of service.
Services provided under this extension will be paid for out of the succeeding agreement amount
6. Compliance with State Law
6.1 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.
6.2 The Provider shall comply with requirements of s. 287.058, F.S. as amended.
6.2.1 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. 215.971, F.S. (1) and (2).
6.2.2 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.
6.2.3 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.
6.2.4 The Provider shall allow public access to all documents, papers, letters, or other public records as defined in
subsection 119.011(12), F.S., made or received by the Provider in conjunction with this contract except for
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those records which are made confidential or exempt by law. The Provider's refusal to comply with this
provision will constitute an immediate breach of contract for which the Alliance may unilaterally terminate
the contract.
6.3 If clients are to be transported under this contract, the Provider shall comply with the provisions of Chapter
427, F.S., and Rule 41 -2, F. A. C.
6.4 The provider may not subcontract with any individuals or entities on the discriminatory vendor list because
they may not transact business with any public entity, in accordance with the provisions of s. 287.134, F.S.
6.5 The Provider shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
In accordance with s. 287.135 F.S., any Provider on the Scrutinized Companies with Activities in Sudan List
6.6 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 $1 million or more. Pursuant to s. 287.135 F.S., the Department may terminate this
Contract and any contract or agreement incorporating this Contract by reference if the Provider is found to
have submitted a false certification of its status on the Lists or has been placed on the Lists. Further, the
Provider 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 $1 million or
more, the Provider shall complete and sign ATTACHMENT H, Certification Regarding Scrutinized
Companies Lists, prior to the execution of this Contract.
7. Background ScreeninE
The Provider shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met
regarding background screening for all persons who meet the definition of a direct service provider and who
are not exempt from the Department's level 2 background screening pursuant to s. 430.0402(2) -(3), F.S. The
Provider must also comply with any applicable rules promulgated by the Department and the Agency for
Health Care Administration regarding implementation of s. 430.0402 and Chapter 435, F.S.
7.1 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 and has access to the client's living areas or to the client's funds or personal
property. This term includes coordinators, managers, and supervisors of residential facilities and volunteers.
7.2 Background Screening Affidavit of Compliance - To demonstrate compliance with section 7 of this
Contract, the Provider shall submit ATTACHMENT G, Background Screening Affidavit of Compliance
annually, by January 15th.
7.3 Further information concerning the procedures for background screening is found at
http• / /elderaffairs. state. fl. us /doea/backgroundscreenin„ >.php .
8. Grievance and Complaint Procedures
8.1 Grievance Procedure
The Provider shall comply with and ensure sub - provider 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
8.2 for receipt of funds.
Complaint Procedures:
The Provider shall develop and implement complaint procedures and ensure that sub - providers develop and
implement complaint procedures to process and resolve client dissatisfaction with services. Complaint
procedures shall address the quality and timeliness of services, provider and direct service worker
complaints, or any other advice related to complaints other than termination, suspension or reduction in
services that require the grievance process as described in Appendix D, Department of Elder Affairs
Programs and Services Handbook. The complaint procedures shall include notification to all clients of the
complaint procedure and include tracking the date, nature of the complaint and the determination of the
complaint on a complaint log.
9. Public Records and Retention:
9.1 The Provider, subject to the terms of section 287.058(1)(c), Florida Statutes, and any other applicable legal
and equitable remedies, shall:
a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency
in order to perform the services.
b) Provide the public with access to public records on the same terms and conditions that the
Department would provide the records and at a cost that does not exceed the cost provided in Chapter
119, Florida Statutes, or as otherwise provided by 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 Alliance and the
Department of Elder Affairs all public records in possession of the Provider upon termination or expiration
this contract 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 in a
format that is compatible with the information technology systems of the Department.
10. Audits, Inspections, Investizations:
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 agrees 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 11.2.
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 and
the Department, 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 ATTACHMENT 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
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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 System (CIRTS) Policy
Guidelines.
10.10 The Alliance for Aging, Inc. may unilaterally cancel this Contract, and any contract or agreement
incorporating this Contract by reference, notwithstanding any other provisions of this Contract, for refusal
by the Provider to comply with Section 9 of this Contract by not allowing public access to all documents,
papers, letters, or other material made or received by the Provider 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(l), Florida Statutes.
11. Nondiscrimination -Civil Rights 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 age, 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, sub - providers, sub - grantees, 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 (ATTACHMENT 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.
11.4 These assurances are a condition of continued receipt of or benefit from 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 sub - providers, vendors, or others with whom it arranges to
provide services or benefits to participants or employees in connection with any of its programs and
activities are not discriminating against those participants or employees in violation of the above statutes,
regulations, guidelines, and standards. In the event of failure to comply, the 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 administrative relief, including but not limited to, termination of and denial
of further assistance.
12. Provision of Services
The Provider shall provide services in the manner described in in ATTACHMENT I of this agreement and
in the Service Provider Application (SPA). In the event of a conflict between the Service Provider
Application and this contract, the contract language prevail
13. Monitoring by the Alliance for Aging
The Alliance will perform administrative, fiscal, and programmatic monitoring of the provider to ensure
contractual compliance, fiscal accountability, programmatic performance, and compliance with applicable
state and federal laws and regulations.
13.1 The provider will supply progress reports, including data reporting requirements as specified by the Alliance
or the Department to be used for monitoring progress or performance of the contractual services as specified
in this contract. Following the norms set down by the Department, the Alliance will track performance on a
monthly basis. In addition to monthly tracking, annual monitoring will include desk reviews and on -sight
visits to review requested fiscal documents, CIRTS, and research production reports and any other system or
process designated by the Alliance. Examples of review criteria are surplus /deficit, independent audits,
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internal controls, reimbursement requests, subcontract monitoring, targeting, program eligibility, outcome
measures, 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. (see ATTACHMENT I, Section 2.9.2)
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 sub - provider 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 provide the provider a written report of its findings. The Provider hereby agrees to correct
all deficiencies identified in a timely manner as determined by the Contract Manager.
14. Coordinated Monitoring with Other Agencies
If the Provider receives funding from one or more other State of Florida 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 designated agency's lead
administrative coordinator, the Provider shall comply and cooperate with all monitors, inspectors, and /or
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 sub - providers 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 indemnify 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 16 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 provide continuous 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 when any changes — occur. The provider
accepts full responsibility for identifying and determining the type(s) and extent of liability insurance
necessary to provide reasonable financial protections for the provider and the clients to be served under this
contract. Upon execution of this contract, the provider shall furnish the Alliance written verification
supporting both the determination and existence of such insurance coverage. The limits of coverage under
each policy maintained by the provider do not limit the provider's liability and obligations under this
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contract. The provider shall ensure that the Alliance has the most current written verification of insurance
coverage throughout the term of this contract. Such coverage may be provided by a self - insurance program
established and operating under the laws of the State of Florida. The Department and the Alliance reserve the
right to require additional insurance where appropriate.
16.2 Throughout the term of this contract, the provider must maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the provider,
authorized to handle funds received or disbursed under this 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 agency 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 768.28, 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 Portability and Accountability Act
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 Contractor shall notify the Alliance immediately but no later than forty -eight (48) hours from the
Contractor's awareness or discovery of conditions that may materially affect the Contractor or
Subcontractor's ability to perform the services required to be performed under this contract. Such notice
shall be made orally to the Contract Manager (by telephone) with an email to immediately follow.
19.2 The 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
assignees, sub - providers 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.g.,
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 wholly or partially by state funds or
funds 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 Elder Affairs and Alliance for Aging
Inc." If the sponsorship reference is in written material, the words "State of Florida, Department of Elder
Affairs and the Alliance for Aging" shall appear in the same size letters or type as the name of the
organization (ref.: section 286.25, F. S.). This shall include, but is not limited to, any correspondence or
other writing, publication or broadcast that refers to such program.
21.2 The provider shall not use the words "State of Florida, Department of Elder Affairs" and/or "The Alliance
for Aging, Inc." to indicate sponsorship of a program otherwise financed unless specific authorization has
been obtained by the Alliance prior to use.
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22. Assignments
22.1 The provider shall not assign its rights 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 Provider 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 Provider. In the event the State of Florida approves transfer of the
Provider's obligations, the Provider remains responsible for all work performed and all expenses incurred in
connection with the contract or agreement.
23. Subcontracts:
23.1 The Provider is responsible for all work performed and for all commodities produced pursuant to this
contract, whether actually furnished by the Provider or its sub - providers. 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 sub -
provider in any way or for any reason. The provider, at its expense, will indemnify and defend the Alliance
against any sub - provider claims.
23.2 The provider shall promptly pay any sub - providers. Failure to pay sub - providers pursuant to any subcontract
or as required by law may result in enforcement action under this contract.
23.3 The provider shall monitor, at least once per year, each of its Subcontractors, Sub - recipients, Vendors,
and/or Consultants paid from funds provided under this contract. The provider shall perform fiscal,
administrative, and programmatic monitoring to ensure contractual compliance, fiscal accountability,
programmatic performance and compliance with applicable state and federal laws and regulations. The
provider shall monitor to ensure that time schedules are met, the budget and scope of work are accomplished
within the specified time periods, and other performance goals sated in this contract are achieved.
23.4 The Provider 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 Administrative Code, and with the Department of Elder
Affairs Program and Services Handbook 2012.
23.5 The provider shall dedicate the staff necessary to meet the obligations of this contract and ensure that
subcontractors dedicate adequate staff, accordingly.
23.6 The provider shall ensure that staff responsible for performing any duties or functions within this contract
have the qualifications as specified in the DOEA Programs and Services Handbook
24. Service Cost Reports and Unit Cost Methodology Reports:
The Provider shall submit Service Cost Reports to the Alliance annually, but no later than ninety
(90) calendar days after the contract year ends. The Service Cost Reports shall reflect actual costs
of providing each service by program for the preceding contract year. If the Provider desires to
renegotiate its reimbursement rates, the Provider shall make a request in writing to the Alliance in
accordance with the Alliance's approved Reimbursement Rate Review Policy, which is
incorporated by reference.
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25. Funding Obligations:
25.1 The Alliance for Aging, Inc. acknowledges its obligation to pay the Provider for the performance of the
Provider's duties and responsibilities set forth in any contract or agreement incorporating this Contract by
reference.
25.2 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 of this contract, including but not limited to terms
governing the provider's promised performance and unit rates and/or reimbursement capitations specified.
25.3 The Alliance shall not be liable to the provider for any expenditure which are not allowable costs as defined
by applicable federal or state law, or which expenditures have not been made in accordance with the terms of
this contract or fiscal or programmatic guidelines and requirements outlined by the current Department of
Elder Affairs Programs and Services Handbook.
25.4 The Alliance shall not be liable to the provider for expenditures made in violation of regulations
promulgated under the Older Americans Act, Department rules, Florida Statutes, or this contract.
26. Independent Capacity of Provider
26.1 The provider will be acting in its independent capacity and not as an employee, agent or representative of the
Alliance or the Department. The provider shall not be deemed or construed to be an employee, agent or
representative of the Alliance or the Department for any purpose whatsoever. Nothing contained in this
contract is intended to, or shall be construed in any manner, as creating or establishing the relationship of
employer /employee between the parties.
26.2 The provider shall be responsible for completely supervising and directing the work under this contract
whether performed by the provider or by any sub - provider that it may utilize. The provider shall be
responsible for all sub - providers who perform work under this contract. The provider agrees that it is as fully
responsible for the acts and omissions of its sub - providers and of persons employed by them as it is for the
acts and omissions of its own employees.
26.3 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 sub - providers. 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.
27. Payment
27.1 Payments shall be made to the Provider as services are rendered and invoiced by the Provider. The Alliance
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 fiscal department
for budgetary approval and processing per ATTACHMENT VIII.
27.2 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 216.181, 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
( http: / /www.dbf.state.fl.us /aadir /reference izuide / ).
The provider shall maintain detailed documentation to support each item on the itemized invoice or payment
request for cost reimbursed expenses, including paid sub - provider invoices, and will be produced upon request
0
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 Provider 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 Sub - provider invoices, and will be produced upon
request by the Alliance or the Department. The Provider will further certify that reimbursement requests are
only for allowable expenses as defined in the laws and guiding circulars cited in 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 Provider's approved budget as developed in accordance with and
pursuant to section 306(a) of the Older Americans Act of 1965, as amended.
27.3 The Provider and Sub - providers shall provide units of deliverables, including reports, findings, and drafts as
specified in this contract to be received and accepted by the Contract Manager prior to payment.
28. Return of Funds
The Provider 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 Provider by the Alliance. In the event that
the Provider or its independent auditor discovers that an overpayment has been made, the Provider 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 Provider in writing of such
findings. Should repayment not be made forthwith, the Provider 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 Provider discovery.
29. Data Integrity and Safeguarding 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 sub - providers 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.
30. 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 forums, Wikis,
RSS feeds, video sharing, social networks like Myspace, Facebook and Twitter, as well as content sharing
networks such as Flickr and YouTUbe (This policy is available on the Department's website at:
http: / /elderaffairs.state.fl.us /doea /fnancial.php ).
31. Conflict of Interest
The Provider shall establish safeguards to prohibit employees, board members, management and sub - providers
from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest or personal gain. No employee, officer or agent of the Provider or sub - provider shall
participate in selection, or in the award of an agreement supported by state or federal funds if a conflict of
interest, real or apparent, would be involved. Such a conflict would arise when: (a) the employee, officer or
agent; (b) any member of his /her immediate family; (c) his or her partner, or; (d) an organization which
employs, or is about to employ, any of the above, has a financial or other interest in the firm selected for award.
10
The Provider or sub - provider's officers, employees or agents will neither solicit nor accept gratuities, favors or
anything of monetary value from providers, potential providers, or parties to subcontracts. The Provider's
board members and management 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 an incumbent, within thirty (30) calendar days of
the commencement of this contract. The Provider's employees and sub - providers must make the same
disclosures described above to the Provider's board of directors. Compliance with this provision will be
monitored.
32. Public Entity 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 provider, supplier, sub - provider,
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 an agreement with any sub -
provider on the convicted vendors list or otherwise prohibited from contracting for state funds pursuant to
section 287.133, F.S.
33. Purchasing
Procurement of Products or Materials with Recycled Content:
Reusable materials and products shall be used where economically technically feasible.
34. Patents, Copyrights, Royalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed
produced or for which ownership was purchased in the course of or as a result of work or services performed
under this contract, the 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 copyrights accruing under this contract are hereby
reserved to the State of Florida in accordance with Chapter 286, F.S.
35. Emergency Preparedness and Continuity of Operations
35.1 The Provider shall, within thirty (30) calendar days of the execution of this contract, submit to the Contract
Manager verification of an emergency preparedness plan. In the event of an emergency, the Provider shall
notify the Alliance of emergency provisions.
35.2 In the event a situation results in a cessation of services by a sub - provider, the Provider shall retain
responsibility for performance under this contract and must follow procedures to ensure continuity of
operations without interruption.
35.3 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 over 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.
35.4 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.
Y < v, i ,� t_ _ .
36. Equipment
36.1 Use of Contract Funds to Purchase Equipment
No funds under this contract will be used by the Provider to purchase equipment.
36.2 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life of more than
one year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by the
organization for the financial statement purposes, or $5,000.00 [for federal funds], or (b); nonexpendable,
tangible personal property of a non - consumable nature with an acquisition cost of $1,000.00 or more per unit,
and expected useful life of at least one year; and hardback bound books not circulated to students or the general
public, with a value or cost of $250.00 or more [for state funds].
37. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
littp://www.iiivflorida.coiii/apps/vbs/adoc/F7740 OOO.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of any contract or
agreement terms or conditions the contract shall take precedence over the PUR 1000 Form. However, if the
conflicting terms or conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the
terms or conditions contained in the PUR 1000 Form shall take precedence.
38. 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.
39. 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.
40. Corrective Action Plan
a) Provider shall ensure 100% of the deliverables identified in ATTACHMENT], Section II —MANNER
OF SERVICE PROVISION are performed pursuant to contract requirements.
b) If at any time the Provider is notified by the Alliance Contract Manager that it has failed to correctly,
completely, or adequately perform contract deliverables, the Contractor will have 15 days to submit a
Corrective Action Plan (`CAP ") to the Alliance Contract Manager that addresses the deficiencies and
states how the deficiencies will be remedied within a time period approved by the DOEA Contract
Manager. The Alliance shall assess a Financial Consequence for Non - Compliance on the Provider for
each deficiency identified in the CAP which is not corrected pursuant to the CAP. The Alliance will
also assess a Financial Consequence for failure to timely submit a CAP.
c) In the event Provider fails to correct an identified deficiency within the approved time period specified
in the CAP, the Alliance shall deduct, from the payment for the invoice of the following month, 1% of
the monthly value of the monthly invoiced funds in the contract for each day the deficiency is not
corrected. The Alliance shall also deduct, from the payment for the invoice of the following month,
1% of the monthly value of the invoiced funds in the contract for each day the Provider fails to timely
submit a CAP.
d) If Provider fails to timely submit a CAP, the Alliance shall deduct 1% of the monthly value of the
invoiced funds in the contract for each day the CAP is overdue, beginning the I V day after
notification by the Alliance Contract Manager of the deficiency. The deduction will be made from the
payment for the invoice of the following month.
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41. 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, and /or cancellation of contract
and reacquiring services from an alternate source.
The Alliance will withhold or reduce payment if the Provider fails to perform the deliverables to the
satisfaction of the Contract according to the requirements referenced in ATTACHMENT I, Section I and
Section II of this contract. The following financial consequences will be imposed if the deliverables stated do
not meet in part or in whole the performance criteria as outlined in ATTACHMENT I, Section II of this
contract.
1. Delivery of services to eligible clients as referenced in ATTACHMENT I, Section I, 1.3 Section II, 2.1
of this contract — Failure to ensure adherence to established assessment and prioritization criteria as
evidenced in CIRTS reports will result in a reduction of payment equal to the percentage of new clients
served who did not meet the criteria, compared to the total number of clients served.
2. Services and units of services as referenced in ATTACHMENT I, Section II, 2.2 of this contract —
Failure to ensure the provision of services in accordance with the current DOEA Programs and Services
Handbook, and ATTACHMENTS VII, and submission of required documentation will result in a 2%
reduction of payment per business day any identified deficiency is not cured or satisfactorily addressed.
3. Performance Specifications as referenced in ATTACHMENT I, Section II, 2.6 of this contract — Failure
to perform the performance specifications and oversight of CCE Program operations will result in a 2%
reduction of payment per business day any identified deficiency in duties is not cured or satisfactorily
addressed in accordance with ATTACHMENT I, Section II, 3.6.3
4. Exceptions may be granted solely, in writing, by the DOEA contract manager.
41.1 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.
41.2 No Waiver of Sovereien Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to
which sovereign immunity may be applicable.
43. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Miami -Dade County, Florida.
44. 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.
45. 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.
46. 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
13
effect.
47. 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.
48. 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.
49. 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.
50. 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.
51. Final Invoice
The Provider shall submit the final invoice for payment to the Alliance as specified in Paragraphs 3.4, 3.4.1 and
3.4.2 (date for final request for payment) of ATTACHMENT I. If the Provider fails to submit final request
for payment by the deadline, then all rights to payment may be forfeited and the Alliance may not honor any
requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be
withheld until all reports due from the Provider and necessary adjustments thereto have been approved by the
Alliance.
52. 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.
53. Suspension of Work:
The Alliance may in its sole discretion suspend any or all activities under this contract when in the Department
of Elder Affairs and the Alliance determination that it is in the best interests of State to do so. The Alliance
shall provide the Provider written notice outlining the particulars of suspension. Examples of the reason for
suspension include, but are not limited to, budgetary constraints, declaration of emergency, or other such
circumstances. After receiving a suspension notice, the Provider shall comply with the notice and shall not
accept any purchase orders. Within ninety days, or any longer period agreed to by the Provider, the Alliance
shall either (1) issue a notice authorizing resumption of work, at which time activity shall resume, or (2)
terminate the Contract or purchase order. Suspension of work shall not entitle the Provider to any additional
compensation.
54. Termination
54.1 This contract may be terminated by either party without cause upon no less than thirty (30) calendar days'
notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall be
delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or by
hand delivery to the Contract Manager or the representative of the Provider responsible for administration of
the contract. The Provider shall not furnish any product after it receives the notice of termination, except as
necessary to complete the continued portion of the contract, if any. The Provider shall not be entitled to recover
14
Z 17
any cancellation charges or lost profits.
54.2 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.
54.3 Termination for Cause:
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.
54.4 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.
54.5 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 a legal or equitable nature.
55. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the provider.
56. Electronic Records and Signature
The Alliance authorizes, but does not require, the Provider to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this Contract. A provider that
creates and retains electronic records and uses electronic signatures to conduct transactions shall comply with
the requirements contained in the Uniform Electronic Transaction Act, s. 668.50, Fla. Stat. All electronic
records must be fully auditable; are subject to Florida's Public Records Law, Ch. 119, and Fla. Stat.; must
comply with Section 29, Data Integrity and Safeguarding Information; must maintain all confidentiality, as
applicable; and must be retained and maintained by the Provider to the same extent as non - electronic records
are retained and maintained as required by this Contract.
56.1 The Alliance's authorization pursuant to this section does not authorize electronic transactions between the
Provider and the Alliance. The Provider is authorized to conduct electronic transactions with the Alliance
only upon further written consent by the Alliance.
56.2 Upon request by the Alliance, the Provider shall provide the Alliance or DOEA with non - electronic (paper)
copies of records. Non- electronic (paper) copies provided to the Alliance 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.
57. Special Provisions
The Provider agrees to the following provisions:
57.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Provider or any sub - providers and referred to a
governmental or investigatory agency must be sent to the Alliance. If the Provider has reason to believe that
15
the allegations will be referred to the State Attorney, a law enforcement agency, the United States Attorney's
office, or other governmental agency, the Provider shall notify the contract manager. A copy of all
documents, reports, notes or other written material concerning the investigation, whether in the possession of
the Provider or Sub - providers, must be sent to the Alliance's contract manager with a summary of the
investigation and allegations.
57.2 Volunteers:
The Provider shall ensure the use of trained volunteers in providing direct services delivered to older
Individuals and individuals with disabilities needing such services. If possible, the Provider shall work in
coordination with organizations that have experience in providing training, placement, and stipends for
volunteers or participants (such as organizations carrying out federal service programs administered by the
Corporation for National and Community Service), in community service settings.
57.3 Enforcement:
57.3.1 In accordance with Section 430.04, F.S., the Alliance may, without taking any intermediate measures
available to it against the Provider, rescind the Provider's contract, if the Alliance finds that:
• An intentional or negligent act of the Provider 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;
• The Provider lacks financial stability sufficient to meet contractual obligations or that contractual
funds have been misappropriated;
• The Provider 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 Provider has
committed or repeated violations of Department standards;
• The Provider has failed to continue the provision or expansion of services after the declaration of a
state of emergency; and/or
• The Provider has failed to adhere to the terms of this contract.
• The provider_ consistently misses performance measure targets, or does not demonstrate to the
satisfaction of the Alliance that a program budget surplus /deficit problem is being addressed in order
to avoid closing out the contract year with a budget variance of more than two percent.
57.3.2 In making any determination under this provision the Alliance may rely upon the findings of another state or
federal agency, or other regulatory body. Any 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 County.
57.3.3 In the alternative, the Alliance may, at its sole discretion, in accordance with section 430.04, F.S., take
immediate measures against the Provider, including: corrective action, unannounced special monitoring,
temporary assumption of the operation of one or more contractual services, placement of the Provider on
probationary status, imposing a moratorium on Provider action, imposing financial penalties for
nonperformance, or other administrative action pursuant to Chapter 120, F.S.
57.4 Use of Service Dollars:
The Provider will optimize the use of contract funds by serving the maximum possible number of individuals
LL
with appropriate care plans with the services allowed by this contract. The Provider will spend all funds
provided by this contract to provide such services.
57.5 Surplus /Deficit Report:
The Provider will submit a consolidated surplus /deficit report by program in a format provided by the Alliance
to the Alliance's Contract Manager with the monthly request for payments according to the calendar on
ATTACHMENT VIII.
57.6 Surplus Recapture.
In accordance with its surplus /deficit management policies, in order to maximize available funding and
minimize the time that potential clients must wait for services, the Alliance in its sole discretion can reduce
funding awards if the Provider is not spending according to monthly plans and is projected to incur a surplus at
the end of the year.
58. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
The name, address, and telephone number of the representative for the Alliance for this contract is:
Max B. Rothman, JD, LL.M. President and 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:
In the event different representatives are designated by either party after execution of this contract, notice of the name
and address of the new representative will be rendered in writing to the other party and said notification attached to
originals of this contract.
17
The Provider name, as shown on page 1 of this
Monroe County Board of County Commissioners, Social
a.
-contract, and mailing address of the official payee
Services /In -Home Services
to whom the payment shal I be made is:
1100 Simonton Street, 2 -257
Key West, FL 33040
The name of the contact person and street address
Sheryl Graham, Senior Director
b.
where financial and administrative records are
Monroe County Board of County Commissioners, Social
maintained is:
Services /In -Home Services
1100 Simonton Street, 2 -257
Key West, FL 33040
The name, address, and telephone number of the
Sheryl Graham, Senior Director
C.
representative of the Provider responsible for
Monroe County Board of County Commissioners, Social
administration of the program under this contract
Services /In -Home services
is:
1100 Simonton Street, 2 -257
Key West, FL 33040
The section and location within the AAA where
Vice President for Finance
d•
Requests for Payment and Receipt and
760 NW 107th Avenue, Suite214
Expenditure forms are to be mailed is:
Miami, Florida 33172 -3155
Contract Monitor
e
The name, address, and telephone number of the
Alliance for Aging, Inc.
Contract Manager for the AAA for this contract is:
760 NW 107th Avenue, Suite 214
Miami, Florida 33172 -3155
In the event different representatives are designated by either party after execution of this contract, notice of the name
and address of the new representative will be rendered in writing to the other party and said notification attached to
originals of this contract.
17
59. All Terms and Conditions Included
This contract and its Attachments, I through X, A, B, C, E, F, G, and H and any exhibits referenced in said
attachments, together with any documents incorporated by reference, contain all the terms and conditions
agreed upon by the Parties. There are no provisions, terms, conditions, or obligations other than those
contained herein, and this contract shall supersede all previous communications, representations or agreements,
either written or verbal between the Parties.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this 66 page contract, to be executed by their undersigned
officials as duly authorized.
Monroe County Board of County
Provider : Commissioners, Social Services /In - Home
Services ALLIANCE FOR AGING, INC.
SIGNED BY: SIGNED BY:
NAME: NAME: MAX B. ROTHMAN, JD, LL.M.
TITLE: a C� �$ p� TITLE: PRESIDENT AND CEO
DATE: DATE: I`1
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TITLE: MAYOR
DATE: 11, ?'D ' ?
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18
-o tract But -bc. J
INDEX TO ATTACHMENTS
Attachment I
SERVICE PROVISIONS COMMUNITY CARE FOR THE ELDERLY
Attachment 11
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
BUDGET SUMMARY
Attarhmpnt Vill
INVnirF RFPCIRT -qrHFDLILF
Attachment IX REQUEST FOR PAYMENT FORM
Attachment X RECEIPT AND EXPENDITURE REPORT
Attachment A DOEA HANDBOOK
Attachment B CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C REFERRAL PROTOCOL AGING AND DISABILITY RESOURCE CENTER (ADRC) —
OUTSOURCED FUNCTIONS
Attachment E BUSINESS ASSOCIATE AGREEMENT
Attachment F VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
Attachment G BACKGROUND SCREENING AFFADAVIT OF COMPLIANCE
Attachment H CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
C ;-7
ATTACHMENT
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION L SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Alzheimer's Disease (AD)
Alzheimer's Disease Initiative (ADI)
Activities of Daily Living (ADL)
Assessed Priority Consumer List (APCL)
Adult Protective Services (APS)
Client Information and Registration Tracking System (CIRTS)
Community Care for Disabled Adults (CCDA)
Department of Elder Affairs — (DOEA) or Department
Department of Elder Affairs Program and Services Handbook (DOEA HANDBOOK)
Home Care For Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IADL)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the Department
of Children and Families Services Community Care for Disabled Adults (CCDA) or Home Care for
Disabled Adults (HCDA) services to the Department's community -based services.
Area Plan: A plan developed by the Alliance outlining a comprehensive and coordinated service delivery
system in the respective planning and service area, in accordance with the Section 306 of the Older
Americans Act (42 U.S.C. 3026) and Department instructions. The Area Plan includes performance
measures and unit rates per service offered per county.
Area Plan Update: A revision to the Area Plan wherein the Alliance enters ADI specific data into the
CIRTS. An update may also include other revisions to the Area Plan as instructed by the Department.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability
to remain independent and in the least restrictive living arrangement. DOEA Form 701 B is used by case
managers to conduct the functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1) and (2),
F.S., to provide diagnostic and referral services, conduct basic and service- related multidisciplinary
research, and develop training materials and educational opportunities for lay and professional caregivers
of individuals with AD.
Model Day Care: A program of therapeutic, social and health activities specific to clients with memory
disorders. Services and activities include, but are not limited to, active and quiet games, reminiscence,
validation therapy, pet therapy, water therapy and other failure free activities appropriate to the client's
level of functioning. Model day care centers will also provide training for health care and social service
personnel in the care of persons having AD or related memory disorders.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
The primary purpose of the ADI program is to provide a continuum of services addressing the special
needs of individuals with AD, their families and caregivers.
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Alzheimer's Disease Initiative Mission Statement
The ADI program ensures that persons afflicted with AD and other forms of dementia are given essential
1.2.2 services to help them age in place in an elder - friendly environment with security, dignity, and purpose.
The program also provides support to family members and caregivers of persons afflicted with AD.
1.2.3 Authority
The relevant authority governing ADI program are:
(1) Rule 5813-1, Florida Administrative Code
(2) Sections 430.501 through 430.504, F.S.
1.2.4 Scope of Service and Eligible Individual
The services to be provided are those described in the provider's service provider application and as
described in this contract and the current DOEA Programs and Services Handbook.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The ADI Program addresses the special needs of individuals with AD and their caregivers.
1.3.2 Individual Eligibility
Those individuals eligible to receive services under this contract must meet the following conditions:
(1) Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be suspected of having
AD or a related disorder; and
(2) Not be enrolled in a Medicaid capitated long -term care program.
1.3.2.1 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk
of placement in an institution.
SECTION II. MANNER OF SERVICE PROVISION
2.0 Conditions
All services under this contract will be provided in a manner consistent with the conditions set forth in the
current Florida Department of Elder Affairs Programs and Services Handbook.
Client access to services, assessment and eligibility determination must conform to the protocols listed in
ATTACHMENT C.
2.1 Service Tasks
To achieve the goals of the ADI program, the Provider shall perform or ensure the performance of its Sub -
Providers, the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients;
2.1.1 Client Eligibility Determination
The Provider shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based on meeting the requirements described in this ATTACHMENT I, Section 1.3.
2.1.2 Assessment and Prioritization of Service Delivery for New Clients
The Provider shall ensure the following criteria are used to prioritize new clients for service delivery. It is
not the intent of the Department to remove existing clients from any services in order to serve new clients
being assessed and prioritized for service delivery.
Priority Criteria for Service Delivery
(1) Individuals in nursing homes under Medicaid who could be transferred to the community;
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(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the
community;
(3) Individuals in nursing homes that are closing and can be discharged to the community;
(4) Individuals 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;
and
(5) For the purpose of transitioning individuals receiving CCDA and HCDA services through the
Department of Children and Families' Adult Services to community -based services provided
through DOEA when services are not currently available, area agency on aging staff and lead
agency case managers will ensure that "Aging Out" individuals are prioritized for services only
after APS High Risk and Imminent Risk individuals.
2.1.2.1 Priority Criteria for Service Delivery for Other Assessed Individuals
The assessment and provision of services should always consider the most cost effective means of service
delivery. Functional impairment will be determined through the Department's functional assessment form
administered to each applicant. The most frail individuals not prioritized as described in this attachment,
Paragraph 2.1.2.1 will receive services to the extent funding is available.
2.1.3 Delivery of Services to Eligible Clients:
The Provider shall ensure the provision of a continuum of services addressing the diverse needs of
individuals with AD and their caregivers. The Provider shall ensure services are performed in accordance
with the current Department of Elder Affairs Programs and Services Handbook. Services categories include:
(1) Caregiver Training/Support;
(2) Case Aide;
(3) Case Management;
(4) Counseling (Gerontological);
(5) Counseling (Mental Health /Screening);
(6) Education /Training;
(7) Intake;
(8) Model Day Care;
(9) Respite (Facility- Based);
(10) Respite (In- Home); and
(11) Specialized Medical Equipment, Services, and Supplies.
Caregivers benefit from receiving training, respite and related support services to assist them in caring for the
ADI client.
2.1.3.1 Memory Disorder Clinics
MDCs are required to provide four (4) hours of in- service training to all respite, in- facility respite and model
day care centers in their designated service areas. In- service training topics may include physiological,
behavioral and emotional aspects of AD and related diseases as well as caregiver techniques, coping strategies
and information regarding Silver Alert. The Provider shall collaborate with MDCs to assist in this effort and in
the effort to carry out Silver Alert protocol activities. The Provider shall respond to requests for evaluation
information and statistical data concerning its consumers, based on information requirements of the MDCs and
Brain Bank.
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2.1.3.2 Model Day Care Programs
The Provider will ensure Model Day Care Centers supported by this contract develop innovative therapies and
interventions which can be shared with other ADI 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 performed by MDCs. The Provider shall submit an annual Model Day Care Center
Training Report, to the Department by July 16, 2017, if applicable.
2.2 SERVICE TIMES AND LOCATION
2.2.1 Service Times
The Provider shall ensure the provision of the services listed in this contract is available at times appropriate
to meet client service needs at a minimum, during normal business hours. Normal business hours are defined
as Monday through Friday, 8:OOam to 5:OOpm.
2.3 Service Units
Services will be reported in units as described in the DOEA Handbook.
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2.4 REPORTS
2.4.1 The Provider shall submit Service Cost Reports to the Alliance annually, but no later than ninety
(90) calendar days after the contract year ends. The Service Cost Reports shall reflect actual costs
of providing each service by program for the preceding contract year. If the Provider desires to
renegotiate its reimbursement rates, the Provider shall make a request in writing to the Alliance in
accordance with the Alliance's approved Reimbursement Rate Review Policy, which is
incorporated by reference.
2.4.2 Client Information and Registration Tracking System (CIRTS) Reports
The Provider shall ensure timely input of ADI specific data into CIRTS. To ensure CIRTS data accuracy,
the Provider shall adhere to the Alliance's CIRTS Data Integrity Policy and use CIRTS - generated reports
which include the following: .
• Client Reports;
• Monitoring Reports;
• Service Reports;
• Miscellaneous Reports;
• Fiscal Reports; and
• Outcome Measures Reports.
2.4.3 The provider shall provide the Alliance with an expenditure plan by July 15 or two weeks after this contract
has been signed; a monthly update is due on the 15th" day of each following month. The expenditure plan
and updates must follow the format provided by the Alliance.
2.4.4 The provider shall respond to surplus /deficit inquiries and will provide ad -hoc reports as requested by the
Alliance.
2.4.5 The provider shall submit Program Highlights referencing specific events that occurred in SFY /FFY 2016-
2017 by September 15, 2017. The provider shall provide a new success story, quote, testimonial, or human -
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical
terms. For all agencies or organizations that are referenced in the highlight, the provider shall provide a
brief description of their mission or role. The active tense shall be consistently used in the highlight
narrative, in order to identify the specific individual or entity that performed the activity described in the
highlight. The provider shall review and edit Program Highlights for clarity, readability, relevance,
specificity, human interest, and grammar, prior to submitting them to the Alliance.
2.5 ELECTRONIC RECORDS AND DOCUMENTATION
The provider will ensure the collection and maintenance of client and service information on a monthly basis
from the Client Information and Registration Tracking System (CIRTS). Maintenance includes valid exports
and backups of all data and systems according to Alliance and Department standards.
2.5.1 Timely Data Entry
The provider must enter all required ADI data per the Department's CIRTS Policy Guidelines for consumers
and services in the CIRTS database. The data must be entered into CIRTS before the provider submits its
request for payment and expenditure reports to the Alliance as per ATTACHMENT VIII.
2.5.2 Data Accuracy
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The provider will run monthly CIRTS reports and verify client and service data in CIRTS is accurate. This
report must be submitted to the Alliance with the monthly request for payment and expenditure report and
must be reviewed by the Alliance before the provider's request for payment and expenditure reports can be
approved by the Alliance.
2.5.3 Failure to Maintain CIRTS Database
Failure to ensure the collection and maintenance of the CIRTS data may result in the Alliance enacting the
"Enforcement" clause of this agreement in ATTACHMENT I, Section 2.7, including delaying or
withholding payment until the problem is corrected.
2.5.4 Computer System Backup and Recovery
Each provider, among other requirements, must anticipate and prepare for the loss of information processing
capabilities. The routine backing up of data and software is required to recover from losses or outages of the
computer system. Data and software essential to the continued operation of provider functions must be
backed up. The security controls over the backup resources shall be as stringent as the protection required
of the primary resources. It is recommended that a copy of the backed up data be stored in a secure, offsite
location. The provider shall maintain written policies and procedures for computer backup and recovery.
These policies and procedures shall be made available to the Alliance upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1) The Provider shall timely submit to the Alliance all reports described in ATTACHMENT I,
SECTION 2.4: REPORTS;
(2) The Provider shall timely submit to the Alliance all information described in ATTACHMENT I,
SECTION 2.5: ELECTRONIC RECORDS AND DOCUMENTATION;
(3) The Provider shall ensure services in this contract are in accordance with the current DOEA Programs
and Services Handbook.
(4) Establish procedures for handling complaints concerning adverse actions such as termination,
suspension, or reduction in services, as per Section of of the Contract.
(5) Conduct client satisfaction surveys to evaluate and improve service delivery.
(6) Monitor and evaluate subcontractors and vendors for programmatic and fiscal compliance.
2.6.2 The performance of the Provider in providing the services described in this contract shall be measured by the
current strategies for the following criteria:
(1) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(2) Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
(3) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(4) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(5) Percent of family and family- assisted caregivers who self -report they are likely to provide care;
(6) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor);
The Provider's performance will be documented in the Alliance's annual monitoring report.
2.7 Compliance and Enforcement
2.7.1 The provider shall comply with all the terms and conditions set -forth in this contract, the CCE RFP pursuant
to which this contract was awarded, the Service Provider Application and the most recent edition of the
Department of Elder Affairs Programs and Services Handbook. The provider is also responsible to respond to
any fiscal or programmatic monitoring items /issues within the timeframe stipulated by the Alliance.
Monitoring Items /Issues may include Corrective Actions, Reportable Conditions or Quality Improvement
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Recommendations provided by the Alliance. The provider is also responsible to provide timely response to
any inquiry related to program expenditures including, but not limited to, addressing program surplus or
deficit and corresponding program spend -out plan.
Failure to meet any of the contractual requirements or compliance items mentioned above will result in the
imposition of sanctions and/ or other enforcement actions by the Alliance as stipulated in Section 41.
2.8 PROVIDER'S FINANCIAL OBLIGATIONS
2.8.1
2.8.1 Cost Sharing and Co- payments
The provider in conjunction with the Alliance shall establish an annual co- payment goal (amount to be
collected from clients). Using the method prescribed in the current Department of Elder Affairs Program and
Services Handbook, the provider shall project the annual co- payments to be collected from each active client
in all income ranges prior to the start of each fiscal year. The provider is required to meet at least 90 percent
of the goal. Co- payments collected in the CCE program can be used as part of the local match.
The Alliance For Aging Inc. will hold back 5% of the provider's contract amount. The amount held back
shall be released to the provider after 50% of the adjusted annual goal is collected, but no later than February
15th of the fiscal year. Hold back amounts not earned by providers as of February 15th will be reallocated to
other providers meeting or exceeding 50% of their annual goal, except when no provider agency is meeting
or exceeding its annual goal, or when an agency that is meeting or exceeding such goal affirms that it lacks
the capacity to receive additional funds.
2.9 ALLIANCE FOR AGING RESPONSIBILITIES
2.9.1 Program Guidance and Technical Assistance
The Alliance will provide to the Provider guidance and technical assistance as needed to ensure the
successful fulfillment of the contract by the Provider.
2.9.2 Contract Monitoring
The Alliance will review and evaluate the performance of the Provider under the terms of this contract.
Monitoring shall be conducted annually through direct contact with the Provider through telephone, in
writing, or an onsite visit. The Alliance's determination of acceptable performance shall be conclusive. The
Provider agrees to cooperate with the Alliance in monitoring the progress of completion of the service tasks
and deliverables. The Alliance may use, but is not limited to, one or more of the following methods for
monitoring:
(1) Desk reviews and analytical reviews;(2) Scheduled, unscheduled and follow -up on -site visits;
(3) Client visits;
(4) Review of independent auditor's reports;
(5) Review of third -party documents and/or evaluation;
(6) Review of progress reports;
(7) Review of customer satisfaction surveys;
(8) Agreed -upon procedures review by an external auditor or consultant;
(9) Limited -scope reviews; and
(10) Other procedures as deemed necessary.
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SECTION III. METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs, as well as
fixed rate and cost reimbursement for services. Payment may be authorized for all allowable expenditures to complete
the tasks identified in the deliverables, in accordance with all applicable state and federal statutes and regulations, and
are based on audited historical costs in instances where an independent audit is required. All Provider requests for
payment and expenditure reports submitted to support requests for payment shall be on Department forms 106Z and
105Z, included as ATTACHMENTS IX, and X. Duplication or replication of both forms via data processing
equipment is permissible, provided all data elements are in the same format as included on department forms.
3.1.1 Provider invoices shall be submitted in accordance with ATTACHMENT VIII, except that invoices cannot be
submitted beyond the date for final invoicing, as stated in this contract. Invoices submitted late will not be honored.
Exceptions to this rule are at the discretion of the Alliance, on a case by case basis; such exceptions must be requested
prior to the expiration of the invoicing deadline. In making a determination of the exception the Alliance will consider
whether the disruption to the billing cycle was beyond the control of the provider, the frequency with which such
exceptions are requested by the provider, and whether the Alliance can request reimbursement at a late date from
DOEA. Exceptions for invoicing late after the closeout date will not be made.
3.2 Advance Payments
Non - profit providers 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 file. All payment
requests for the third through 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 VIII to this contract. Reconciliation and recouping of advances made under this contract are to be
completed by October. All advance payments are subject to the availability of funds.
3.3 Advance funds may be temporarily invested by the provider in an FDIC 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.
3.4 Final Request for Payment:
3.4.1 The provider must submit the final request for payment to the Alliance no later than July 15, 2018; if the provider fails
to do so, all right to payment is forfeited, and the Alliance will not honor any requests submitted after the aforesaid
time period.
3.4.2 If the contract is terminated prior to the contract end date of June 30, 2018, then the provider must submit the final
request for payment to the Alliance no more than 45 days after the contract is terminated, but no later than July 15,
2018. If the provider fails to do so, all right to payment is forfeited, and the Alliance will not honor any requests
submitted after the aforesaid time period.
3.5 Documentation for Payment
The Provider will maintain documentation to support payment requests that shall be available to the Alliance or
authorized individuals, such as the Department of Financial Services, upon request.
3.5.1 The Provider must require subcontractors to enter all required data per the Department's CIRTS Policy Guidelines for
clients and services in the CIRTS database. The data must be entered into the CIRTS before the sub - providers submit
their request for payment and expenditure reports to the Provider. The Provider shall establish time frames to assure
compliance with due dates for the requests for payment and expenditure reports to the Alliance.
3.5.2 The Provider must require subcontractors to run monthly CIRTS reports and verify client and service data in the CIRTS
is accurate. This report must be submitted to the Provider with the monthly request for payment and expenditure report
and must be reviewed by the Provider before the subcontractors' request for payment and expenditure reports can be
approved by the Provider.
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3.6 Remedies for Nonconforming Services
The Provider shall ensure that all goods and/or services provided under this contract are delivered timely, completely
and commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible
program participants.
3.6.1 If the Provider fails to meet the prescribed quality standards for services, such services will not be reimbursed under
this contract. In addition, any nonconforming goods (including home delivered meals) and/or services not meeting
such standards will not be reimbursed under this contract. The Provider's signature on the request for payment form
certifies maintenance of supporting documentation and acknowledgement that the Provider shall solely bear the costs
associated with preparing or providing nonconforming goods and/or services. The Alliance requires immediate notice
of any significant and/or systemic infractions that compromise the quality, security or continuity of services to clients.
3.6.2 Financial Consequences of Surplus
Provider shall ensure the provision of services to the projected number of clients in accordance with Alliance's
forecasts and within the contract amount. The Provider shall ensure expenditure of 100% of the contract amount
budgeted for services to clients at the unit rates established in this contract. In the event the Provider has a surplus of
1% or more at the end of the contract term, the Alliance will reallocate 1 % of the budget for the next year contract term
to other lead agencies found to be serving clients to the fullest extent of their allocated budgets.
3.6.3 The Alliance reserves the right to adjust the total award as well as the contracted unit rate to reflect provider costs and
utilization rates based on active clients enrolled in the program.
The Alliance may withhold payment under the terms of this contract, pending the receipt and approval by the Alliance
3.6.4 of complete and accurate financial and programmatic reports due from the provider and any adjustments thereto,
including any disallowance not resolved.
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ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress,
an officer or employee of congress, an employee of a member of congress, or an officer or employee of the state
legislator, in connection with the awarding of any federal grant, the making of any federal loan, the entering into of
any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of
congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to
Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all sub -
awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative
agreements) and that all sub - providers shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Signature Date
S Ins I G-rd_k nr\
Name of Auth rized Individual
7, 1 9'i
Application or Agreement Number
6M I su dc'-1
Name and Address of Or nization
t O U S iM ON +bt s 6Y'"
5th.�z ice- S
5ui�e_ a. a5_7
Kcy we S+ , F L -
DOEA Form 103
(Revised Nov 2002)
Im
FINANCIAL AND COMPLIANCE AUDIT
ATTACHMENT III
The administration of resources awarded by the Alliance for Aging, Inc. to the provider may be subject to audits and /or
monitoring by the Alliance or the Florida Department of Elder Affairs, 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 Elder Affairs and Alliance 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 Alliance or the Department of Elder Affairs. In the event
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 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 $750,000 or more in federal awards during its fiscal year, the provider must have
a single or program - specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised.
EXHIBIT 1 to this agreement indicates federal resources awarded through the Department of Elder Affairs and the
Alliance 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 Alliance or the Department of Elder Affairs.
The determination of amounts of federal awards expended should be in accordance with the guidelines established by
OMB Circular A -133, as revised. An audit of the provider conducted by the Auditor General in accordance with the
provisions of OMB Circular A -133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the requirements
relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
If the provider expends less than $750,000 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
$750,000 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of
OMB Circular A -133, as revised, the cost of the audit must be paid from non - federal resources (i.e., the cost of such
audit must be paid from provider resources obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Alliance for Aging. Inc. shall be based on the agreement's
requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall
disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and
liabilities due to the Alliance for Aging, Inc. shall be fully disclosed in the audit report with reference to the Alliance for
Aging, Inc. agreement involved. If not otherwise disclosed as required by Section 310(b) (2) of OMB Circular A -133,
as revised, the schedule of expenditures of federal awards shall identify expenditures by agreement number for each
agreement with the Alliance for Aging, Inc. in effect during the audit period. Financial reporting packages required
under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end
of the provider's fiscal year end.
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PART II: STATE FUNDED
This part is applicable if the provider is a non -state entity as defined by Section 215.97(2), Florida Statutes.
In the event that the provider expends a total amount of state financial assistance equal to or in excess of $750,000 in
any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a
State single or project - specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable
rules of the Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit
and for - profit organizations), Rules of the Auditor General. EXHIBIT 1 to this agreement indicates state financial
assistance awarded through 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 Alliance for Aging, Inc., other state agencies, and other non -state entities. State financial
assistance does not include federal direct or pass- through awards and resources received by a non -state entity for federal
program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph l; 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 $750,000 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 $750,000 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 non -state 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 Alliance for Aging, Inc. shall be based on the agreement's
requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or
not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the
Alliance for Aging, Inc. shall be fully disclosed in the audit report with reference to the Alliance for Aging, Inc.
agreement involved. If not otherwise disclosed as required by Rule 691- 5.003, Fla. Admin. Code, the schedule of
expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the
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 Alliance and the Department of Elder Affairs retain all right and obligation to monitor
and oversee the performance of this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A -133, as revised, by or
on behalf of the provider directly to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107` Ave. Suite 214
Miami, FL. 33172 -3155
31
The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of copies required by
Sections .320 (d) (1) and (2), OMB Circular A -133, as revised, should be submitted to the Federal Audit
Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10 Street
Jeffersonville, IN 47132
Other federal agencies and pass- through entities in accordance with Sections .320 (e) and (f), OMB Circular A -133, as
revised.
Pursuant to Sections .320(f), OMB Circular A -133, as revised, the provider shall submit a copy of the reporting package
described in Section .320(c), OMB Circular A -133, as revised, and any management letter issued by the auditor, to the
Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107` Ave. Suite 214
Miami, FL. 33172 -31550
Additionally, copies of financial reporting packages required by Part 11 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 Monitor
760 NW 107` Ave. Suite 214
Miami, FL. 33172 -3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399 -1450
Any reports, management letter, or other information required to be submitted to the Alliance for Aging, Inc. 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 Alliance for Aging, Inc. for audits done in accordance
with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit
organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to the
provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of
six years from the date the audit report is issued, and shall allow the Alliance for Aging, Inc. or its designee, the CFO or
Auditor General Access to such records upon request. The provider shall ensure that audit working papers are made
available to the Alliance for Aging, Inc., or its designee, the Department or its designee, CFO, or Auditor General upon
request for a period of six years from the date the audit report is issued, unless extended in writing by the Alliance for
Aging, Inc.
32
ATTACHMENT III
EXHIBIT —1
i. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
AGREEMENT CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA I AMOUNT
I TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST
OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM T ITLE I FUNDING SOURCE I CFDA I AMOUNT
TOTAL STATE AWARD I $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec. 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Revenue
65004
$164,647.80
TOTAL AWARD
$164,647.80
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
State Financial Assistance
Section 215.97 F.S.
Chapter 691 -5 Fla. Administrative Code
33
ATTACHMENT III
EXHIBIT -2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular
A -133, as revised, and/or Section 215.97, Fla. Stat. Providers who are determined to be recipients or sub - recipients of
federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold
requirements set forth in Part I and/or Part II of Exhibit 1 is met. Providers who have been determined to be vendors are
not subject to the audit requirements of OMB Circular A -133, as revised, and/or Section 215.97, Fla. Stat. Regardless
of whether the audit requirements are met, providers who have been determined to be recipients or sub - recipients of
federal awards and/or state financial assistance must comply with applicable programmatic and fiscal compliance
requirements.
In accordance with Sec. 210 of OMB Circular A -133 and /or Rule 691 - 5.006, FAC, provider has been determined to be:
_ Vendor or exempt entity and not subject to OMB Circular A -133 and /or Section 215.97, F.S.
2L_ Recipient/sub- recipient subject to OMB Circular A -133 and /or Section 215.97, F.S.
Exempt organization not subject to 2 CFR Part §200 and /or Section 215.97, F.S. For Federal awards, for - profit
organizations are exempt; for state financial assistance projects, public universities, community colleges,
district school boards, branches of state (Florida) government, and charter schools are exempt. Exempt
organizations must comply with all compliance requirements set forth within the contract or award document.
NOTE: If a provider is determined to be a recipient /sub - recipient 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 sub - recipient must comply
with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB
Circular A -87)*
OMB Circular A -102 — Administrative Requirements
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON - PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A -122 — Cost
Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -1 10 — 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
34
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)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the
OMB Circular A -133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be
a recipient /sub- recipient must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
THE REST OF THIS PAGE WAS LEFT BLANK INTENTIONALLY
35
r .. .
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS,
LOANS AND COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the Provider named in the contract or agreement to which this form is
an attachment, hereby certifies that:
(1) The Provider and any sub - providers of services under this contract have financial management systems capable of
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of
each grant- funded project or program in accordance with the prescribed reporting requirements; (2) the source and
application of funds for all agreement supported activities; and (3) the comparison of outlays with budgeted
amounts for each award. The inability to process information in accordance with these requirements could result in
a return of grant funds that have not been accounted for properly.
(2) Management Information Systems used by the Provider, sub - provider(s), or any outside entity on which the
Provider 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, provider(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 Provider (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 Provider 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 Provider and any sub- provider(s) of services under this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from
data integrity compliance issues.
The Provider shall require that the language of this certification be included in all sub - agreements, sub - grants, and other
agreements and that all sub - providers shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
OMB Circulars A -102 and 2 CFR Part 215 (formerly OMB Circular A -110).
Monroe County Board of County Commissioners, Social Services /In -Home Services
Gato Building, Board of County Commissioners
1100 Simonton Street, Suite 2 -257
Key WestTl) 33040
Lla
Signature Date
Aaxa. Qou6 v A&w % siydlte-�
Title
Name of Authorized 'Signer
36 � 1 / /L6/1-'
al t
(Revised June 2008)
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective provider certifies, by signing this certification, neither it nor its principals is 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 provider is unable to certify to any of the statements in this certification, such
prospective articipant shall attach an explanation to this certification.
Signature Date
Date
�"
Monroe County Board of County Commissioners
f W%L M Q( Social Service.In -Home Services
T itle j 0 Agency /Organization
(C i Ication s' to ould be sam Contract signature.)
✓'
2 G / 7 Instructions for Certification
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
"person," "primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set
out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5- 180.1020, as supplemented
by 2 CFR 376.10- 376.995). You may contact the Contract Manager for assistance in obtaining a copy of
those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties
entered into this transaction. If it is later determined that the Provider 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 Provider will provide immediate written notice to the Contract Manager if at any time the Provider learns
that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances. The Provider 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 Provider 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 Provider 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 Provider knowingly enters into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the federal government, the Department may pursue available remedies, including
suspension, and/or debarment.
7. The Provider may rely upon a certification of a prospective participant in a lower tier covered transaction that
it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows
that the certification is erroneous.
37
i _ ' °
E.. .. E_ � xa. s V Y ..._ w, ✓.
(Revised June 2008)
ATTACHMENT VI
ASSURANCES -NON- CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-
0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND 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.
1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds
sufficient to pay the non - federal share of project cost) to ensure proper planning, management, and completion of the project
described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and
will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 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 Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil
Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. 1681 -1683, and 1685- 1686), which prohibits discrimination on the
basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 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 Vlll of the Civil Rights Act of 1968 (42 U.S.C.
3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s) under which application for federal assistance is being made; and 0) the
requirements of any other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501 -1508 and 7324 - 7328), which limit the
political activities of employees whose principal employment activities are funded in whole or in part with federal funds.
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. 276a to 276a -7), the Copeland Act (40
U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333),
regarding labor standards for federally assisted construction sub - agreements.
38
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental
quality control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and Executive Order (EO) 11514;
(b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of
flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity
of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended
(42 U.S.C. 7401 et seq.). (g) protection of underground sources of drinking water under the Safe Drinking Water Act of
1974, as amended, (P.L. 93 -523); and (h) protection of endangered species under the Endangered Species Act of 1973, as
amended, (P.L. 93 -205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 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
APPLICANT ORGANIZATION
DATE SUBMITTED
Monroe County Board of County Commissioners, Social Services /In -Home
Services
Gato Building, Board of County Commissioners
9
ATTACHMENT VII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
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:
40
Service
Maximum
Maximum
Service to be Provided
Unit Rate
Units of
Dollars
Service
Case Management
$50.51
150
$7,576.50
Respite In- Facility
$10.70
10,188
$109,011.30
Respite — In Home
$24.03
2,000
$48,060.00
TOTAL
$164,647.80
40
f -Sr
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE
INVOICE REPORT SCHEDULE
Report Number
Based On
Submit to Alliance on
this Date
1
July Advance*
July 1
2
August Advance*
July 1
3
July Expenditure Report
August 10
4
August Expenditure Report
September 10
5
September Expenditure Report + 1 /10 advance reconciliation
October 10
6
October Expenditure Report + 1 /10 advance reconciliation
November 10
7
November Expenditure Report + 1 /10 advance reconciliation
December 10
8
December Expenditure Report + 1 /10 advance reconciliation
January 10
9
January Expenditure Report + 1 /10 advance reconciliation
February 10
10
February Expenditure Report + 1 /10 advance reconciliation
March 10
1 1
March Expenditure Report + 1 /10 advance reconciliation
April 10
12
April Expenditure Report + 1 /10 advance reconciliation
May 10
13
May Expenditure Report + 1 /10 advance reconciliation
June 10
14
June Expenditure Report+ 1/10 advance reconciliation
July 10
15
Final Expenditure and closeout
July 10
Legend: * Advance based on projected cash need.
Note 1: All advance payments made to the Provider shall be returned to the Alliance as follows:
One -tenth of the advance payment received shall be reported as an advance recoupment on each
Request for Payment, starting with report #5. The adjustment shall be recorded in Part C, Line 1
of the report (Attachment IX).
Note 2: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Alliance, payment is to accompany the report.
41
i °Q
ATTACHMENT IX
REQUEST FOR PAYMENT
AIZHEIMERS DISEASE
INITIATIVE PROGRAM
REC RENT NAME, ADDRE SS, PHOME #and FEID#
TYFEOFREPORT
This Request Period
PSA #
A. PAAENT REQUEST:.
Report#
Regular
Supplemental
Contract#
B. METHOD OF PAYMENT
Contract Period
Advance
Reimburserne t__
CERTIFICATION: 1 herebyceftifyta the best of myl knowledge that this request is complete and correct and conforms with the terns and the purposes of the above contract.
Prepared by Date
Approved by
Date
(1)
(2)
PARTA BUDGET SUMMARY
Respite
Model Day Care
TOTAL
1. Approved Contract Amount
$000
$0.00
$0.00
2 Previous Funds Received for Contract Period
$0.00
$000
$0.00
3. CortractBalance (ine 1 mnus line 2)
$0.00
50.00
$0.00
4. Previous Funds Requested and Not Received for Contract Period
$0.00
$0.00
$0.00
5. Contract Balance (line 3 minus line 4)
$000
$000
$000
PART B: CONTRACT FUPI)S REQUEST
1. Anticipated Cash Needs (1 st- 2nd month, Attach Justification)
$0.00
$0.00
$0.00
2 Net E)penditures For Morth
$0.00
$0.00
$0.00
(DOEA Form 1052 Part B. Lire 3)
3. TOTAL
$000
$0.000
$0.00
PART C. NET FUNDS REQUESTED
1 Less Advance Applied
$0.00
$000
$0.00
2 Contract Funds are Hereby Requested for (Part B. Line 3
$0 00
$000
$000
minus Part C, Line 1)
List of Services /Units ? Rates provided - See attached report.
DOER FORM 10 6Z
Reed 54!12
42
I .. T
RECEIPT AND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
Attachment =X
PROVIDER NAME, ADDRESS, PHONE # and FE1 DO
Program Funding :
THIS REPORT PERIOD
From
To _
Respite
CONTRACT PERIOD:
Model Day Care _
CONTRACT #
REPORT #
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that the report is con and correct and all outlays
herein are for purposes set forth in
the contract.
Prepared by: _____Date ._
_ Approved by
Date
_
PART A : BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1 State Funds
S000
$000
$0.00
#DIVr01
2. Program Income
$0.00
$0.00
$0,00
#DIV10t
3 Local Cash Match
$0.00
$000
$0.00
#DIV /Or
4. SUBTOTAL: CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
$0.00
$0.00
$000
4DIVI01
PART B: EXPENDITURES
1_ Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administrative Services
$0.00
$0.00
$0.00
#DiV,01
2. Service Subcontractor(s)
$0.00
$000
$0.00
#DIV?01
3 TOTAL EXPENDITURES
$000
$0.00
$0.00
4DIVl01
PART C : OTHER REVENUE AND EXPENDITURES
11. Interest:
Ill. Advance Recouped
1 Program I name (PI)
1 Earned on GR Advance $
1. ADI: PI Collected YTD $
2. Return of GR Advance $
(Includes co- payments collected)
3. Other Earned
$_
PART D: CO- PAYMENTS
CURRENT MONTH
YEAR -TO -DATE
1. Total of Co- payments assessed
2. Total of Go- payments collected
$_
$
(For Tracking Purposes only)
DOE FORM i @5Z
Revised 5,25�2Q 10
43
.17
ATTACHMENT A
Title: Department of Elder Affairs Programs & Services Handbook
Department of Elder Affairs Programs & Services Handbook
http : / /ww�v.allianceforagiria.org (see Providers /Program Documents) or
http:// elderaffairs .state.fl.us /doea/nois.php (notices of instructions)
..
la
ATTACHMENT B
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS
FORM.
1. Briefly describe the geographic area serve by the program /facility and the type of service provided:
ram_
With "m e" t4.rbw charm SKCS. SL%V( s L6 h,. tol e4 � G =HS W(0%1
q,fo, e 45
2 nn� — t - - p da — 'fie
2. POPULATION OF AREA SERVED. Source of data:
Total # % White % Black % Hispanic % Other % Female
't3 I� Ii. c. -7 - G
3. STAFF CURRENTLY EMPLOYED. Effective date: (p I y O
Total # I % White I % Black I % Hisoamc 1 % Other % Female % Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
N/A
YES
Total #
%White
% Black
% Hispanic
% Other
% Female
% Disabled
% Over 40
5
31
8. Compare the client composition to the population. Are race and sex characteristics representative of
the population? If N/A or NO, explain.
N/A
❑
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total #
% White
% Black
% Hispanic
% Other
% Female
% Disabled
f<G O
O
N/A
❑
YES
K
NO
❑
O
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? If N/A or NO, explain.
N/A YES
NO
7M 0 :� ■
7. Compare the staff composition to the population. Is staff representative of the population?
If N/A or NO, explain.
N/A
YES
NO
8. Compare the client composition to the population. Are race and sex characteristics representative of
the population? If N/A or NO, explain.
N/A
❑
YES
�.
NO
❑
9. Are eligibility requirements for services applied to clients and applicants without regard to race, color,
national origin, sex, age, religion or disability? If N/A or NO, explain.
N/A
❑
YES
K
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 N/A or NO,
explain.
N/A
❑
YES
NO
❑
11. For in- patient services, are room assignments made without regard to race, color, national origin
or disability? If N/A or NO, explain.
N/A
9
YES
n
NO
❑
Revised August 2010, Page 1 of 2
45
12.
Is the program/facility accessible to non - English speaking clients? If N/A or NO, explain.
N/A
YES
NO
13.
Are employees, applicants and participants informed of their protection against discrimination? If
YES, how? Verbal ❑ Written §q Poster ❑ If N/A or NO, explain.
N/A
❑
YES
X
NO
❑
14. Give the number and current status of any discrimination complaints regarding services or
employment filed against the program/facility.
N/A
❑
NUMBER
d
15.
Is the program /facility physically accessible to mobility, hearing, and sight- impaired individuals? If
N/A or NO, explain.
N/A
❑
YES
NO
❑
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES NYITH 15 OR MORE EMPLOYEES.
16. Has a self - evaluation been conducted to identify any barriers to serving disabled individuals, and to
make any necessary modifications? If NO, explain. YES
NO
17.
Is there an established grievance procedure that incorporates due process in the resolution of
complaints? If NO, explain.
YES
X
NO
❑
18.
Hasa person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES
9
NO
❑
19.
Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination on the basis of disability? If NO, explain.
YES
NO
20.
Are auxiliary aids available to assure accessibility of services to hearing and sight- impaired
individuals? If NO, explain.
YES
NO
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00
21. Do you have a written affirmative action plan? If NO, explain. YES
X
OR MORE.
NO
❑
Revised August 2010, Page 2 of 2
W,
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE
CHECKLIST
1. Describe the geographic service area such as a district, county, city or other locality. If the
program/facility serves a specific target population such as adolescents, describe the target population.
Also, define the type of service provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in
the geographical area for which services are provided such as a city, county or other regional area.
Population statistics can be obtained from local chambers of commerce, libraries, or any publication
from the 1980 Census containing Florida population statistics. Include the source of your population
statistics. (`Other" races include Asian /Pacific Islanders and American Indian/Alaskan Natives.)
Enter the total number of full -time staff and their percent by race, sex and disability. Include the
effective date of your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or
facility, and list their percent by race, sex and disability. Include the date that enrollment was counted.
Enter the total number of advisory board members and their percent by race, sex, and disability. If there
is no advisory or governing board, leave this section blank.
Each recipient of federal financial assistance must have on file an assurance that the program will be
conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is
usually a standard part of the contract language for DOEA recipients and their sub - grantees, 45 CFR
80.4 (a).
Is the race, sex, and national origin of the staff reflective of the general population? For example, if
10% of the population lis 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 origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy
of record keeping must be applied uniformly and without regard to race, sex, color, national origin,
religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must
also be equally available to all clients, 45 CFR 80.3 (b).
11. For in- patient services, residents must be assigned to rooms, wards, etc., without regard to race, color,
national origin or disability. Also, residents must not be asked whether they are willing to share
accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants, including those
47
persons who may not speak English. In geographic areas where a significant population of non- English
speaking people live, program accessibility may include the employment of bilingual staff. In other
areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone
numbers of bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a).
13. Programs /facilities must make information regarding the nondiscriminatory provisions of Title VI
available to their participants, beneficiaries or any other interested parties. This should include
information on their right to file a complaint of discrimination with either the Florida Department of
Elder Affairs or the U.S. Department of HHS. The information may be supplied verbally or in writing
to every individual, or may be supplied through the use of an equal opportunity policy poster displayed
in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program /facility. Indicate the basis, e.g.,
race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or
employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been
violated along with the name and address of the local, state or federal agency with whom the complaint
has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate,
failure to cooperate, under review, etc.
15. The program/facility must be physically accessible to disabled individuals. Physical accessibility
includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to
entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions
offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias,
restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators
should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat,
ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility
impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance
conduct a self - evaluation to identify any accessibility barriers. Self - evaluation is a four step process:
a. With the assistance of a disabled individual /organization, evaluate current practices and policies
which do not comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self - evaluation on file. (This checklist may be used to satisfy this requirement if these four
steps have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints
alleging any action prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate
efforts to comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings,
newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a).
20. Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons
with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are
not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative
resources that can be used to provide equally effective services, 45 CFR 84.52 (d).
48
21. Programs /facilities with 50 or more employees and $50,000.00 in federal contracts must develop,
implement and maintain a written affirmative action compliance program in accordance with Executive
Order 11246, 41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended.
DOEA Form 101 -B, Revised August 2010
THE REST OF THIS PAGE WAS LEFT BLANK INTENTIONALLY
ATTACHMENT C
ADRC OUTSOURCED FUNCTIONS
L Under this Contract, the provider agrees to the following:
A. Perform ADRC outsourced functions in accordance with policies and procedures developed by
the Alliance for Aging. Refer to the following attachments:
i. Attachment C EXHIBIT l: Policies and Procedures for Outsourced Function -
Screening
ii. Attachment C EXHIBIT 2 Policies and Procedures for Outsourced Function -
Termination from Waitlist- Client Services
iii. Attachment C EXHIBIT 3: Policies and Procedures for Triage
iv. Attachment C EXHIBIT 4 Policies and Procedures for Activation from Waitlist-
Client Services
B. Maintain wait lists in CIRTS in accordance with DOEA requirements.
C. Report number of client contacts to the Aging Resource Center.
D. Adhere to prioritization policy as set forth by the Department of Elder Affairs.
E. Update the agency Disaster Plan to incorporate ADRC outsourced functions.
F. Ensure against conflicts of interest and inappropriate self - referrals by referring consumers in need
of options counseling or long -term care services beyond the provider's scope of services to the
Aging Resource Center.
G. Ensure that services provided are in the clients' best interest, are the most cost effective, of high
quality, and are responsive and appropriate to the assessed needs.
The Assessed Priority Consumer List (APCL) is maintained when services funded by the department are not
available. Contracted providers of registered services for Alzheimer's Disease Initiative (ADI), Older
American's Act (OAA), and Contracted Services (CS) maintain waiting lists in the CIRTS database for
registered services when funding is not available. Note: OAA3E is an exempt funding source for ADRC Wait
List purposes. For services provided through OAA3E, no CIRTS client data entry is required.
Registered Services for the above listed programs are as follows: Adult Day Care (ADC), Adult Day Health
Care (ADRC), Chore (CHO), Escort (ESC), Home Health Aide (HHA), Homemaker (HMK), Model Day Care
(MDC), Personal Care (PECA), Facility -Based Respite (RESF), In -Home Respite (RESP).
50
�r
ATTACHMENT C Exhibit 1
Alliance for Aging, Inc.
Aging & Disability Resource Center /Elder Helpline
Policy and Procedure for
Outsourced function - Screening
Creation Date: March 5, 2008
Revision Date: May 2017
Review Date: April 2014
Objective: To ensure that a comprehensive list of clients in need of services is maintained in CIRTS by
appropriate funding source and that the ADRC is thereby able to effectively gauge the level of elder service need
in Miami -Dade and Monroe Counties.
Policy: To obtain necessary information from clients in order to assist in determining level of need and eligibility
for registered services funded through ADI, OAA, and LSP programs.
Procedure:
1. ADRC Contracted Providers will collect information from callers and conduct a 701S assessment.
Alternatively, if a 701A(B) assessment already exists or is provided from another source (i.e. CARES)
the information from the 701 B can be utilized.
2. Based on the information provided via the 701 A(B) assessment, the ADRC Contracted Provider will
make a determination as to the services that the caller is in need of receiving.
3. The ADRC Contracted Provider will determine the appropriate funding source(s) that provides the
needed services.
4. If the caller is in need of a service(s) that is not provided by the ADRC Contracted Provider, the
ADRC Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC Referral
Form and /or to an ADRC Contracted Provider that provides the needed service.
5. The caller will be provided with general information regarding the ADRC as well as the ADRC Elder
Helpline contact number.
6. The caller will be informed of the services and funding sources that they are being placed on the wait
list for in CIRTS.
7. For non -case managed programs, the, ADRC Contracted Provider will create a client record in CIRTS
(if there is no existing record) and enter the services needed for the caller by funding source and
service. [If there is an existing record in CIRTS, the appropriate fields will be updated].
8. If the ADRC Contracted Provider determines that the caller may qualify for more than one program
for which the provider is funded, ADRC Contracted Provider is encouraged to enter the appropriate
information under multiple funding sources. [If there is an existing client record in CIRTS, the client
record in CIRTS will be updated with appropriate information].
51
9. ADRC Contracted Provider will inform caller that they will receive an annual re- assessment based on
DOEA Wait List Reassessment Standards and encourage caller to contact the ADRC Elder Helpline
with any questions.
52
ATTACHMENT C Exhibit 2
Alliance for Aging, Inc.
Aging & Disability Resource Center /Elder Helpline
Policy and Procedure for .
Termination From Wait List — Clients /Services
Creation Date: March 5, 2008
Revision Date: February 2013
Review Date: May 2017
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.
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)
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.
ADRC Contracted Provider will inform the client of any services /funding source that they are being
removed from the wait list for.
6. ADRC Contracted Provider will inform client of their ability to be re -added to the wait list if their
level of need should change.
7. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have any
questions or concerns regarding their wait list status.
8. Reference DOEA Notice of Instruction: Assessed Priority Consumer List #:062906- 1- I -OVCS as
applicable.
53
ATTACHMENT C Exhibit 3
Alliance for Aging, Inc.
Aging & Disability Resource Center /Elder Helpline
Policy and Procedure for
Outsourced function - Triage
Creation Date: March 5, 2008
Revision Date: May 2017
Review Date: April 2014
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 annual reassessments based on DOEA Wait List
Reassessment Standards.
2. If there is no current 701 A or B in CIRTS, the provider will conduct the annual reassessment (701 S)
as appropriate. Based on the information provided via the 701 S /A(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. If a significant change has occurred prior to the annual re-
screening, the Contracted Provider must re- screen. Definitions and examples of significant change
are documented in the DOEA Programs & Services Manual Chapter 2.
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.
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.
5. 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.
6. As funding becomes available, ADRC Contracted Provider will run CIRTS Prioritization Report and
activate clients according to DOEA Standards (refer to ADRC Client Activation Policies and
Procedures). The Contracted Provider will apply targeting criteria, as appropriate, to prioritized clients
to ensure activations meet programmatic requirements.
54
ATTACHMENT C Exhibit 4
Alliance for Aging, Inc.
Aging & Disability Resource Center /Elder Helpline
Policy and Procedure for
Activation From Wait List — Clients /Services
Creation Date: March 5, 2008
Revision Date: February 2013
Review Date: May 2017
Objective: To ensure that elders in need of DOEA funded services in Miami -Dade and Monroe Counties and on
the CIRTS wait list begin to receive services as funding becomes available.
Policy: ADRC will work with ADRC Contracted Providers to ensure that clients waiting for DOEA funded
services begin to receive those services as funding becomes available.
Procedure:
1. ADRC Contracted Provider will activate clients on CIRTS wait list based on DOEA prioritization
polices and funding availability.
2. ADRC Contracted Provider will update CIRTS status by funding source and service for any services
being activated for the client using appropriate CIRTS codes.
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.
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.
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.
55
Nu` r 1 97
ATTACHMENT E
Alliance for Aging, Inc.
Business Associate Agreement
This Business Associate Agreement is dated JLAfQ ?. 2011 ' by the Alliance for Aging, Inc.
( "Covered Entity ") and Monroe County Board of County Commissioners, Social Services /In -Home Services,
(`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.
56
d l' K f
2.6 Breach. The unauthorized acquisition, access, use, or disclosure of PHI which compromises the security
or privacy of such information.
2.7 Compromises the Security. Posing a significant risk of financial, reputational, or other harm to
individuals.
2.8 Confidentiality. The property that data or information is not made available or disclosed to
unauthorized persons or processes.
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.C.) §§ 17931 and 17934 (2010).
2.15 Password. Confidential authentication information composed of a string of characters.
2.16 Physical Safeguards. The physical measures, policies, and procedures to protect a covered entity's
electronic information systems and related buildings and equipment, from natural and environmental
hazards, and unauthorized intrusion.
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part
160 and Part 164, subparts A and E.
2.18 Protected Health Information. (PHI) Health information as defined in 45 CFR §160.103, limited to
the information created or received by Business Associate from or on behalf of Covered Entity.
2.19 Required By Law. Has the same meaning as the term "required by law" in 45 CFR § 164.103.
2.20 Secretary. The Secretary of the Department of Health and Human Services or his or her designee.
2.21 Security incident. The attempted or successful unauthorized access, use, disclosure, modification, or
destruction of information or interference with system operations in an information system.
2.22 Security or Security measures. All of the administrative, physical, and technical safeguards in an
information system.
2.23 Security Rule. The Security Standards for the protection of Electronic Protected Health Information at
45 CFR part 164, subpart C, and amendments thereto.
2.24 Technical Safeguards. The technology and the policy and procedures for its use that protect electronic
protected health information and control access to it.
57
th 7U-
2.25 Unsecured PHI. Protected health information that is not secured through the use of technology or
methodology specified 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 breach; and
(b) All information required for the Notice to the Secretary of HHS of Breach of Unsecured Protected
Health Information.
3.6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI
received from, or created or received by Business Associate on behalf of Covered Entity, agrees to the
same restrictions and conditions that apply through this Agreement to Business Associate with respect to
such information.
3.7 If Business Associate has PHI in a Designated Record Set:
(a) Business Associate agrees to provide access, at the request of Covered Entity during regular
business hours, to PHI in a Designated Record Set, to Covered Entity or, as directed by Covered Entity,
to an individual in order to meet the requirements under 45 CFR § 164.524; and
58
(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 to permit Covered Entity to respond to a request by an Individual for an accounting of
disclosures of PHI in accordance with 45 CFR § 164.528 and ARRA § 13404.
3.11 Business Associate specifically agrees to use security measures that reasonably and appropriately protect
the confidentiality, integrity, and availability of PHI in electronic or any other form, that it creates,
receives, maintains, or transmits on behalf of the Covered Entity.
3.12 Business Associate agrees to implement security measures to secure passwords used to access ePHI that
it accesses, maintains, or transmits as part of this Agreement from malicious software and other man -
made and natural vulnerabilities to assure the availability, integrity, and confidentiality of such
information.
3.13 Business Associate agrees to implement security measures to safeguard ePHI that it accesses, maintains,
or transmits as part of this agreement from malicious software and other man -made and natural
vulnerabilities to assure the availability, integrity, and confidentiality of such information.
3.14 Business Associate agrees to comply with:
(a) ARRA § 13404 (Application of Knowledge Elements Associated with Contracts);
(b) ARRA § 13405 (Restrictions on Certain Disclosures and Sales of Health Information); and
(c) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Care Operations).
4.0 Permitted Uses and Disclosures by Business Associate. Except as otherwise limited in this Agreement
or any related agreement, Business Associate may use or disclose PHI to perform functions, activities, or
services for, or on behalf of, Covered Entity as specified in any and all contracts with Covered Entity
provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the
minimum necessary policies and procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement, 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
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Law or for the purpose for which it was disclosed to the person, and the person notifies the Business
Associate of any instances of which it is aware in which the confidentiality of the information has been
breached.
5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as permitted by
45 CFR §164.504(e)(2)(i)(B), only when specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State authorities,
consistent with 45 CFR §164.5020)(1).
6.0 Obligations of Covered Entity.
6.1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of
Covered Entity in accordance with 45 CFR § 164.520, to the extent that such limitation may affect
Business Associate's use or disclosure of PHI, by providing a copy of the most current Notice of Privacy
Practices (NPP) to Business Associate as Attachment XI to this Agreement. Future Notices and/or
modifications to the NPP shall be posted on Covered Entity's website at ww� \.allianceforaging.org
6.2 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI
that Covered Entity has agreed to in accordance with 45 CFR § 164.522, to the extent that such
restriction may affect Business Associate's use or disclosure of PHI.
7.0 Permissible Requests by Covered Entity. Except for data aggregation or management and
administrative activities of Business Associate, Covered Entity shall not request Business Associate to
use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by
Covered Entity.
8.0 Effective Date and Termination.
8.1 The Parties hereby agree that this agreement amends, restates and replaces any other Business Associate
Agreement currently in effect between Covered Entity and Business Associate and that the provisions of
this agreement shall be effective as follows:
(a) These Business Associate Agreement provisions, with the exception of the electronic security
provisions and the provisions mandated by ARRA, HITECH and Part I shall be effective upon the later
of April 14, 2003, or the effective date of the earliest contract entered into between Business Associate
and Covered Entity that involves the use of PHI;
(b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or the
effective date of the earliest contract entered into between Business Associate and Covered Entity that
involves the use of PHI; and
(c) Provisions hereof mandated by ARRA, HITECH and /or Part I shall be 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
.1
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(c) If neither termination nor cure is feasible, Covered Entity shall report the violation to the
Secretary.
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section, upon termination of this
agreement, for any reason, Business Associate shall return all PHI and ePHI received from Covered
Entity, or created or received by Business Associate on behalf of Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or agents of
Business Associate. Business Associate shall retain no copies of the PHI and ePHI.
(b) In the event that Business Associate or Covered Entity determines that returning the PHI or ePHI
is infeasible, notification of the conditions that make return of PHI or ePHI infeasible shall be provided
to the other party. Business Associate shall extend the protections of this Agreement to such retained
PHI and ePHI and limit further uses and disclosures of such retained PHI and ePHI, for a minimum of six
years and so long as Business Associate maintains such PHI and ePHI, but no less than six (6) years after
the termination of this agreement.
9.0 Regulatory References. A reference in this agreement to a section in the Privacy Rule or Security Rule
means the section then in effect or as may be amended in the future.
10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement from time to
time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule, the Security
Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104 -191.
11.0 Survival. Any term, condition, covenant or obligation which requires performance by either party hereto
subsequent to the termination of this agreement shall remain enforceable against such party subsequent to
such termination.
12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to comply
with the Privacy Rule and Security Rule.
13.0 Incorporation by reference. Any future new requirement(s), changes or deletion(s) enacted in federal
law which create new or different obligations with respect to HIPAA privacy and /or security, shall be
automatically incorporated by reference to this Business Associate Agreement on the respective effective
date(s).
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 Rothman
760 NW 107 Avenue
Miami, Florida 33172
To Business Associate: Monroe County Board of County Commissioners, Social Services /In -Home
Services
1100 Simonton 2 -257
Key West, FL 33040
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Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery
thereof is refused, delivery will be deemed to have occurred on the date such delivery was attempted.
15.0 Governing Law. The laws of the State of Florida, without giving effect to principles of conflict of laws,
govern all matters arising under this agreement.
16.0 Severability. If any provision in this agreement is unenforceable to any extent, the remainder of this
agreement, or application of that provision to any persons or circumstances other than those as to which
it is held unenforceable, will not be affected by that unenforceability and will be enforceable to the fullest
extent permitted by law.
17.0 Successors. Any successor to Business Associate (whether by direct or indirect or by purchase, merger,
consolidation, or otherwise) is required to assume Business Associate's obligations under this agreement
and agree to perform them in the same manner and to the same extent that Business Associate would
have been required to if that succession had not taken place. This assumption by the successor of the
Business Associate's obligations shall be by written agreement satisfactory to Covered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement of the parties relating to the subject
matter of this agreement and supersedes all other oral or written agreements or policies relating thereto,
except that this agreement does not limit the amendment of this agreement in accordance with section
10.0 of this agreement.
Covered Entity: Alliance for Aging, Inc.
By: ' Date: CO 1 �
(signature)
Business Associate: Monroe County Board of County Commissioners, Social Services /In -Home Services
By: Date: 6 1241 .2017
(signa ure c mg County AaminisINWr
1--�
SIGNED BY:
NAME:
TITLE:
DATE:
George Neugent v
s
MAYOR
62
ATTACHMENT F
Verification of Employment Status Certification
As a condition of contracting with the Alliance for Aging, Inc.,
Mp htrn- nu�'Nti Sociaj '9A-U Ie.eS , hereby referred to as contractor, certifies the
use of the U. Department of Homeland Security's E- verify system to verify the employment
eligibility of all new employees hired by Contractor during the contract term to perform employment
duties pursuant to this Agreement and (b) that any subcontracts include an express requirement that
subcontractors performing work or providing services pursuant to this Agreement utilize the E- verify
system to verify the employment eligibility of all new employees hired by the subcontractor during the
contract term.
Signature
(Same as contract signature)
AA Shev. - Y 1 C# aQ-K& -t
Title
Date
t
63
ATTACHNI ENT G
I '
BACKGROMD—SCREE K 4r. ra--
ELDEW
'AFFAIRS! Affidavit of Compliance - Employer
Ws form Is raot*4 aintwistly of aA otivilployors to tong* with the 0"o , stabon
it forth In sealon 43&06(3), FIorfd*
the term 'employer' means any person or eattly requited by Law* to Condwt background s(reemneg.
Includmg but not litDited to, Area Agencies on Alofi;C Agin$ Resource centers, Aging and Mabilly
Pieuwitr CLivirts, team Agrotip , tool -Trial Carr 0"Ibud'onarl P1061 AM, Srrvirag ate atih to wawr W444S
of Men, Plogiam, 'wivke PM.Ader% Diwf%ion Provider%, mW any rAhri lwf-an or entity whirb trivet
en~es or hac volunteer; in service who meet the definition of a ditKI service pinvoev Ser
43$.02,430.0402, Fla- Stat.
> A dir v-tvke I"ovidet is 'A fWt-.on 18 yraft of W_ or oklrr who, pursuant to 4 program to ptovik
srrvitrs ter the elderly, has direft, fare fsa fare etwttart with a ckerxt while
am has access to the client's living area, funds. personal ptopc-dy, or personal WerildicitlDn information
as defined in s, 817.56& The term includes coot4aiatofs, nunagets, and utoer•Aw*s of residential
44100-4W(1)(b), flit, %#
AUISMON
As the duty authorized representative of MD1JrQtf, ODUfCfV 5A.1
1100 Sff"dbtJ - C *. 2 2s- WLU Ute-S.+ VL . .3-3.040
Sheef Adrkeu Gry State ZIP radr
L do hereby affirm under penalty of perjury
that the above named employee is in tom.phanot with tl* provisions of Chapter 435 and wLion
utes, repirding level 2 background sueening-
te 1 9
STATI! OF RORWA, COUNTY Of Honclo
Sworn to (or affirmed) and subscribed before m Yf JL4taf_ 21D_M by
kfry 1 1 C
{Name of Reptv"ritative) who personally known
ton* or produced as proof of identification,
T
M.
'ov
J M. MASS5'UPi
i
-State of Florida -Notary
Commission# GG 11
My Commission Expi-
June 11,1021
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"12 r(dl 1 - 77
[on
ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
The undersigned, an authorized representative of the Contractor named in the contract or agreement to which
this form is an attachment, hereby certifies that:
(1) The Contractor understands that pursuant to s. 287.135 F.S., any company at the time of bidding or
submitting a proposal for a new contract or renewal of an existing contract, that is on the "Scrutinized
Companies with Activities in Sudan List" or the "Scrutinized Companies with Activities in the Iran Petroleum
Sector List (collectively, "the Lists ") is ineligible for, and may not bid on, submit a proposal for, or enter into
or renew a contract pursuant to which funding is provided by the Department of Elder Affairs (Department)
for goods or services of $1 million or more.
(2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false certification
is subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of
false certification.
(3) The Contractor understands that the contract to which this form is an attachment may be terminated by the
Alliance for Aging, Inc. 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.
'a, &12 ( p 201
Signature Date
(Same as contract signature)
Spew- . 41L03ftIa."
AC- A ►JiS - fYafo2..
Title
,buf 0e-.. ecuoj-
Company Name
65
[ontra(�NurnberK31797
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