Item B25M
C ounty of f Monroe
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BOARD OF COUNTY COMMISSIONERS
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Mayor George Neugent, District 2
The Florida. Ke Se
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Mayor Pro Tern David Rice, District 4
Danny L. Kolhage, District I
Heather Carruthers, District 3
Sylvia J. Murphy, District 5
County Commission Meeting
October 18, 2017
Agenda Item Number: B25
Agenda Item Summary #3402
BULK ITEM: Yes DEPARTMENT: Social Services
TIME APPROXIMATE: STAFF CONTACT: Sheryl Graham (305) 292 -4510
No
AGENDA ITEM WORDING: Ratification of Amendment #001 to Standard Contract #AA -1729,
Older Americans Act (OAA) between the Alliance for Aging, Inc., (AAA) and the Monroe County
Board of County Commissioners/Monroe County Social Services /In -Home Services and Nutrition
Programs for the contract period of 1/1/2017 through 12/31/2017 in the amount of $637,986.44.
This is an increase in funding of $14,721.94 which reflects 2016 Carry Forward Funding and new
2017 funding allocations.
ITEM BACKGROUND: The BOCC approved Amendment 00 Ito Contract #AA -1729 at the
August 16, 2017 regularly scheduled board meeting, however the contract that was included in the
agenda backup was incomplete due to a scanning error that deleted a portion of the contract. The
attached contract is the complete unedited contract.
PREVIOUS RELEVANT BOCC ACTION: Approval by BOCC on 12/14/2016 of Standard
Contract #AA -1729, Older Americans Act (OAA) between the Alliance for Aging, Inc., (AAA) and
the Monroe County Board of County Commissioners/Monroe County Social Services /In -Home
Services and Nutrition Programs for the contract period of 1/1/2017 through 12/31/2017 in the
amount of $637,986.44.
CONTRACT /AGREEMENT CHANGES:
Additional Funding
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
OAA Amend. #001 09 -05 -17
BACKUP OAA Contract Pages 1 -50
Backup OAA Contract Pages 51 -71
FINANCIAL IMPACT:
Effective Date: 1/1/2017
Expiration Date: 12/31/2017
Total Dollar Value of Contract: $637,986.44
Total Cost to County: 10% Cash Match
Current Year Portion:
Budgeted: YES
Source of Funds: Grant and Cash Match
CPI: NO
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: NO If yes, amount: N/A
Grant: YES
County Match: 10% Cash Match
Insurance Required: NO
Additional Details: N/A
08/16/17 NEW COST CENTER ADDED
125- 6153017
REVIEWED BY:
$637,986.44
Sheryl Graham
Completed
09/05/2017 1:52 PM
Pedro Mercado
Completed
09/05/2017 2:13 PM
Budget and Finance
Completed
09/05/2017 4:41 PM
Maria Slavik
Completed
09/05/2017 4:41 PM
Kathy Peters
Completed
09/05/2017 7:08 PM
Board of County Commissioners
Completed
09/20/2017 9:00 AM
Services
ReEH! LlnL
Non - curri
Totalincrease
Fersonal Care - Ills
VR Z
$2,867.61
$2,103.78
Nutrition Education - C1
$762.31
$237.69
$1,00A.Do
Nutrition Counseling - C1
$1,498.39
$467.21
$1,965.60
Home Delivered Meals - Hot C2
$1,126$4
$373.46
$1,500.00
Home Delivered Meals - Frozen C2
$416.33
$138.01
$554.34
Respite In-Facility - 3E
$1,153.72
$4,628.41
$5,782.13
Chore - SEC
$362.37
$1,45372
$1,816.09
TOTAL , 1 $14,721.94
U.S. Health and Human Services 1 93.044
FEDERAL AWARD
U.S. Health and Human Services
1 93,045
U.S. Health and fluman Services 1 93.045
U.S. Health and Human Services 1 93.052
The Alliance shall make payment to the provider for the provision of services up to a maximum number
of units of service and at the rate(s) stated on page two:
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Prepared on 07103/2017
AMENDMENT 001 CONTRACT AA -17 Pag
$2,103.78
$1,000.00
$1,96160
$1,5oo.00
$554.34
$5,782.13
$2,816.09
$14,721.94
Non-Recur Recurring
Nutrition Eclu. 1,000.00 0.34 237.69 762.30
Nutrition Coons. 1,965.60 0.66 467.21 1,498.39
2,965.60 1.00 704.90 2,260.69
HDNI - Hot 1,500.00
HDIVI - Frozen 554.34
Non-Recur Recurring
0.73 373.46 1,12654
0.27 138M 41633
2,054,34 LOO 511A7 1
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AMENDMENT 001 B.25.a
CON TRACT 1729 Pa
Service to be Provided
Service
Maximum Units of Service
Maxi
Unit Rate
Prl r Units
Additional
Total
Do llars
1i PE ri113
$25.
624
0
624
$15,589.42
Homemaker WE
$24.87
1,938
0
1,938
$48,203.91
Personal Cara 1110
$29.00
1,662
7
1,735
$50,307,70
25creeni &Assessment 1113
$26.22
59
0
59
$1,53$.06
n r ate r� is ia1
$9.25
15,773
0
15,773
$145,527.41
err r ate C i is r n C1
.$20.00
6
0
$1,925.00
cstritin �urrsIin ind l
$70.56
23
- 28 1 ' -
8
41
$2,891.60
Nutrition Education C1
$0.50
1,274
2,000
3,274
$1
Home Delivered Meals Frozen C2
$&53
32,111
85
32,196
$210,238.75
Fiore Delivered Meals Hot C2
$653
1,706
229
1,935
$12,638.22
t trition Can r�saii lnd
$70.56
3
0
3
$190,00
Mo nroe urn Board of County
Commissioners, Social Services/in-Home
Se rvi ce s
N AME: c
TITLE: MA�ic 91
D ATE: L l
ALLIANCE FORAGING, I
NBRERM
N AM E: M ax B. Rothman, JD, I.L.M.
TITLE: President & CEO
DATE
Packet' Pg. 506
AA -172
ALLIANCE FOR AGING, INC.
STANDARD CONTRACT
OLDER AiMERICANS ACT PROGRAM TITLE III
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." The term contractor for this purpose may designate a vendor,
sub - grantee or sub - recipient, the status to be further identified in ATTACHMENT III, Exhibit -2 as necessary.
WITNESSETH THAT:
WHEREAS, the Alliance has established through the Area Plan on Aging that it is in need of certain services as
described herein; and
WHEREAS, the Provider has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent contractor of the Alliance.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the
mutual covenants and conditions hereinafter set forth, the Parties agree as follows:
1. 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. Definitions
ADL — Activities of Daily Living
APS — Adult Protective Services
ADA — Americans with Disabilities Act
Alliance — Area Agency on Aging
APCL — Assessed Priority Consumer List
CIRTS — Client Information and Registration Tracking System
DOEA — Department of Elder Affairs (The Department)
I &R — Information and Referral
IADL — Instrumental Activities of Daily Living
MOA — Memorandum of Agreement
MOU — Memorandum of Understanding
OAA — Older Americans Act
PSAs — Planning and Service Areas corresponding to Miami -Dade and Monroe Counties
SPA — Service Provider Application
3. Incorporation of Documents within the Contract
The contract incorporates by reference attachments, proposal(s), solicitation(s), Provider's Service Provider
Application, and the current DOEA Programs and Services Handbook. Any and all contracts or agreements executed
between the Provider and the Alliance during the effective period of this contract shall be governed in accordance
with the applicable laws and statutes.
4. 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. 07: Release date, June 27, 2012;
(3) CFO memo No. 01: Release date, July 26, 2012; and
(4) CFO Memo No. 06: Release date, June 30, 2010.
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5. Term of Contract
This contract shall begin on January 1, 2017 or on the date on which the contract has been signed by the last party
required to sign it, whichever is later. It shall end at midnight, local time in Miami, Florida, on December 31, 2017,
unless renewed or extended as provided herein.
6. Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions of this contract in an amour
not to exceed $623,264.50 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.
7. Renewals
By mutual agreement of the parties, the Alliance may renew the contract for two additional one year. Contingent
upon satisfactory performance evaluations by the Alliance and the availability of funds, any renewal is subject to the
same terms as the original contract, with the exception of establishing unit rates which is described further in this
section. The original contractual unit rates are set forth in the bid proposal and 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 4092815- 1- PC -SCBS dated September 28"', 2015 and the approv&
Alliance's Reimbursement Rate Review Policy.
This contract may be extended upon mutual agreement for one extension period not to exceed six months to ensure
continuity of service. Services provided under this extension will be paid for out of the succeeding agreement
amount.
8. Compliance with Federal Law
8.1 This contract contains federal funds. The following shall apply:
8.1.1. The Provider shall comply with the provisions of 45 CFR 74 and /or 45 CFR 92, and other applicable
regulations.
8.1.2. If this contract contains federal funds and is over $100,000.00, the Provider shall comply with all
applicable standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42
U.S.C. 7401, et seq.), s. 508 of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251, et
seq.), Executive Order 11738, as amended, and where applicable Environmental Protection Agency
regulations 40 CFR 30. The contractor shall report any violations of the above to the Alliance.
8.1.3. The Provider, or agent acting for the Provider, may not use any federal funds received in connection with
this contract to influence legislation or appropriations pending before the Congress or any State
legislature. If this contract contains federal funding in excess of $100,000.00, the contractor must, prior
to contract execution, complete the Certification Regarding Lobbying form, ATTACHMENT 11. All
disclosure forms as required by the Certification Regarding Lobbying form must be completed and
returned to the Contract Manager, prior to payment under this contract.
8.1.4. In accordance with Appendix A to 2 CFR 215, the contractor shall comply with Executive Order 11246,
Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented
in Department of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
8.1.5. If this contract contains federal funds and provides services to children up to age 18, the contractor shall
comply with the Pro - Children Act of 1994 (20 U.S.C. 6081).
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AA -172Q
8.1.6. A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract
awards shall not be made to parties listed on the government -wide Excluded Parties List System, in
accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 and 12689,
"Debarment and Suspension." The Excluded Parties List System contains the names of parties debarred
suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or
regulatory authority other than Executive Order 12549. The Provider shall comply with these provision;
before doing business or entering into subcontracts receiving federal funds pursuant to this contract.
The Provider shall complete and sign ATTACHMENT V prior to the execution of this contract.
8.2. The Provider shall not employ an unauthorized alien. The Alliance shall consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324 a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. 1101). Such violation shall be cause for unilateral cancellation of
this contract by the Alliance.
8.3. If the Provider is a non - profit provider and is subject to Internal Revenue Service (IRS) tax exempt
organization reporting requirements (filing a Form 990 or Form 990 -N) and has its tax exempt status revoked
for failing to comply with the filing requirements of the 2006 Pension Protection Act or for any other reason,
the Provider must notify the Alliance in writing within thirty (30) days of receiving the IRS notice of
revocation.
8.4. The Provider shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
8.5. Unless exempt under 2 CFR Part 170.110(b), the Provider shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
8.6. To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number 11 -116,
Provider agrees to utilize the U.S. Department of Homeland Security's E- verify system to verify the
employment of all new employees hired by Provider during the contract term. Provider shall include in related
subcontracts a requirement that subcontractors performing work or providing services pursuant to the state
contract utilize the E- verify system to verify employment of all new employees hired by the subcontractor
during the contract term. Providers meeting the terms and conditions of the E- Verify System are deemed to be
in compliance with this provision.
9. Compliance with State Law
9.1. 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.
9.2. The Provider shall comply with the requirements of s. 287.058, F.S. as amended.
9.2.1. 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).
9.2.2. 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.
9.2.3. If itemized payment for travel expenses is permitted in this contract, the contractor will submit bills for
any travel expenses in accordance with s. 112.061, F.S., or at such lower rates as may be provided in this
contract.
9.2.4. 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 contractor in conjunction with this
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contract except for those records which are made confidential or exempt by law. The Provider's refusal
to comply with this provision shall constitute an immediate breach of contract for which the Alliance fo
Aging, Inc. may unilaterally terminate the contract.
9.3. 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.
9.4. Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, in
accordance with the provisions of s. 287.134, F.S.
9.5. The Provider will comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
9.6. In accordance with s. 287.135 F.S., any contractor on the Scrutinized Companies with Activities in Sudan Lis
or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created pursuaz
to s. 215.473 F.S., is ineligible to enter into or renew a contract funded through a DOEA contract for goods or
services of $1 million or more. The Alliance may terminate this contract if the 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 i
subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of
false certification. If this contract contains $1 million or more, the Provider shall complete and sign
ATTACHMENT H, Certification Regarding Scrutinized Companies Lists, prior to the execution of this
contract.
10. Background Screening
10.1. 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.
10.2. Further information concerning the procedures for background screening is found at
«.�l_useu , « iii -r_:;.��� ,piio
10.3. Background Screening Affidavit of Compliance - To demonstrate compliance with this contract, the Provider
shall submit ATTACHMENT D, Background Screening Affidavit of Compliance annually, by January 15th.
11. Grievance Procedures
The Provider shall comply with and ensure subcontractor compliance with the Minimum Guidelines for Recipient
Grievance Procedures, Appendix D, DOEA Programs and Services Handbook, to address complaints regarding the
termination, suspension or reduction of services, as required for receipt of funds.
11.1. Complaint Procedures
The Provider shall develop and implement complaint procedures and ensure that subcontractors 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 complaint, and the determination of each complaint.
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12. Audits, Inspections, Investigations, Public Records and Retention
12.1 The Provider shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the Alliance under this contract. Provider shall adequately safeguard all such assets and assure
they are used solely for the purposes authorized under this contract. Whenever appropriate, financial
information should be related to performance and unit cost data.
12.2 The Provider shall retain all client records, financial records, supporting documents, statistical records, and an
other documents (including electronic storage media) pertinent to this contract for a period of six (6) years aft
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 resolutic
of any audit findings or litigation based on the terms of this contract, at no additional cost to the Alliance.
12.3 Upon demand, at no additional cost to the Alliance, the Provider will facilitate the duplication and transfer of
any records or documents during the required retention period in Paragraph 12.2.
12.4 The Provider shall assure that the records described in Paragraph 12.2 shall be subject at all reasonable times 1
inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the Alliance.
12.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Alliance, DOEA
and Federal auditors, pursuant to 45 CFR 92.36(1)(10), shall 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, regardles
of the form in which kept.
12.6 The Provider shall provide a financial and compliance audit to the Alliance as specified in this contract and in
ATTACHMENT III and to ensure that all related parry transactions are disclosed to the auditor.
12.7 The Provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits
deemed necessary by the office of the DOEA's Inspector General pursuant to s. 20.055, F.S.
13. Nondiscrimination -Civil Rights Compliance
13.1 The Provider shall execute assurances in ATTACHMENT VI that it will not discriminate against any person ii
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 contractors, subcontractors, 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 agains
clients or employees because of age, race, religion, color, disability, national origin, marital status or sex.
13.2 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).
13.3 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.
13.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance, and are binding upon the Provider, its successors, transferees, and assignees for thf
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period during which such assistance is provided. The Provider further assures that all subcontractors, vendorE
or others with whom it arranges to provide services or benefits to participants or employees in connection wit]
any of its programs and activities are not discriminating against those participants or employees in violation o
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.
14. Provision of Services
The Provider shall provide the services referred to in ATTACHMENT VII in the manner described in the DOEA
Programs & Services Handbook and the Provider's Service Provider Application (SPA). In the event of a conflict
between the Service Provider Application and this contract, the contract language prevails.
15. Monitoring by the Alliance
The Provider shall permit persons duly authorized by the Alliance to inspect and copy any records, papers,
documents, facilities, goods and services of the Provider which are relevant to this contract, and to interview any
clients, employees and subcontractor employees of the Provider to assure the Alliance of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Alliance will deliver to the
Provider a written report of its findings and request for development, by the Provider, a corrective action plan where
appropriate. The Provider hereby agrees to timely correct all deficiencies identified in the corrective action plan.
16. Coordinated Monitoring with Other Agencies
If the Provider receives funding from one or more of the State of Florida human service agencies, in addition to
Alliance funding, then a joint monitoring visit including such other agencies may be scheduled. For the purposes of
this contract, and pursuant to s. 287.0575, F.S. as amended, Florida's human service agencies shall include the
Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities, the
Department of Veterans Affairs, and the Department of Elder Affairs. Upon notification and the subsequent
scheduling of such a visit by the designated agency's lead administrative coordinator, the Provider shall comply and
cooperate with all monitors, inspectors, and /or investigators.
17. Indemnification
The Provider shall indemnify, save, defend, and hold harmless the Alliance and its agents and employees from any
and all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the
execution of this agreement or performance of the services provided for herein. It is understood and agreed that the
Provider is not required to indemnify the Alliance for claims, demands, actions or causes of action arising solely out
of the Alliance's negligence.
17.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to
contracts executed between the Alliance and state agencies or subdivisions defined in s. 768.28(2), F.S.
18. Insurance and Bonding
18.1 The Provider shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or
subdivision as defined by subsection 768.28(2), F.S., the Provider accepts full responsibility for identifying an,
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. The Alliance shall be included as an additiona:
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 limits of coverage under each policy maintained by the
Provider do not limit the Provider's liability and obligations under this contract. The Provider shall ensure that
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the Alliance has copy of the most current written verification of insurance coverage throughout the term of thi;
contract. Such coverage may be provided by a self - insurance program established and operating under the law
of the State of Florida. The Alliance reserves the right to require additional insurance as specified in this
contract.
18.2 Throughout the term of this agreement, the Provider shall 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 all agreements and/or contracts incorporating this
contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by
the insurance company and consistent with good business practices.
19. 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.
20. 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).
21. Incident Reporting
21.1 The Provider shall notify the Alliance immediately but no later than forty -eight (48) hours from the Provider's
awareness or discovery of conditions that may materially affect the Provider or Subcontractor's ability to
perform the services required to be performed under any contract. Such notice shall be made orally to the
Contract Manager (by telephone) with an email to immediately follow.
21.2 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 the Provider,
Subcontractors, and their employees.
22. Bankruptcy Notification
If, at any time during the term of this contract, the Provider, its assignees, subcontractors or affiliates files a claim for
bankruptcy, the Provider must immediately notify the Alliance. 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.
23. Sponsorship and Publicity
23.1 As required by s. 286.25, F.S., if the Provider is a non - governmental organization which sponsors a program
financed wholly or in part by state funds, including any funds obtained through this contract, it shall, in
publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by (Provider's name),
the State of Florida Department of Elder Affairs and the Alliance for Aging, Inc." If the sponsorship reference
is in written material, the words "State of Florida, Department of Elder Affairs" and "Alliance for Aging, Inc."
shall appear in at least the same size letters or type as the name of the organization.
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23.2 The Provider shall not use the words "The State of Florida Department of Elder Affairs" or "Alliance for
Aging, Inc." to indicate sponsorship of a program otherwise financed, unless specific authorization has been
obtained by the Alliance prior to use.
24. Assignments
24.1 The Provider shall not assign the rights and responsibilities under this Contract without the prior written
approval of the Alliance, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer
otherwise occurring without prior written approval of the Alliance will constitute a material breach of the
contract.
24.2 The Alliance shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations
under this contract to another agency upon giving prior written notice to the Provider. In the event the Alliance
approves transfer of the Provider's obligations, the Provider remains responsible for all work performed and al
expenses incurred in connection with the contract.
24.3 This contract shall remain binding upon the successors in interest of either the Provider or the Alliance.
25. Subcontracts
25.1 The Provider is responsible for all work performed pursuant to this contract and the Service Provider
Application in response to the 2012 OAA RFP. Any subcontracts shall be evidenced by a written document
and subject to any conditions of approval the Alliance for Aging deems necessary. The Provider further agreeE
that the Alliance shall not be liable to the subcontractor in any way or for any reason. The Provider, at its
expense, shall defend the Alliance against any such claims.
25.2 The Provider shall promptly pay any subcontractors upon receipt of payment from the Alliance. Failure to
make payments to any subcontractor in accordance with s. 287.0585, F.S., unless otherwise stated in the
contract between the Provider and subcontractor, will result in a penalty as provided by statute.
26. Funding Obligations
26.1 The Alliance 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 in this agreement.
26.2 The Alliance shall not be liable to the Provider for costs incurred or performance rendered unless such costs
and performances are in accordance with the terms and conditions of any contract or agreement executed
between the parties, which incorporates this Contract, including but not limited to terms, governing the
Provider's promised performance and unit rates and /or reimbursement capitations specified.
26.3 The Alliance shall not be liable to the Provider for any expenditures which are not allowable costs as defined in
the C.F.R., Title 45, Parts 74 and 92, as amended, or which expenditures have not been made in accordance
with all applicable state and federal rules.
26.4 The Alliance shall not be liable to the Provider for expenditures made in violation of regulations promulgated
under the Older Americans Act, as amended, or in violation of applicable state and federal laws, rules, or
provisions of any contract or agreement incorporating in this Contract.
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27. Independent Capacity of Provider
It is the intent and understanding of the Parties that the Provider, or any of its subcontractors, are independent
contractors and are not employees of the Alliance and shall not hold themselves out as employees or agents of the
Alliance without specific authorization from the Alliance. It is the further intent and understanding of the Parties tha
the Alliance does not control the employment practices of the Provider and shall not be liable for any wage and hour
employment discrimination, or other labor and employment claims against the Provider or its subcontractors. All
deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds
and all necessary insurance for the Provider shall be the sole responsibility of the Provider.
28. Payment
28.1. Payments will be made to the Provider pursuant to s. 215.422, F.S., 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 section for budgetary approval and processing. Disputes arising over invoicing and payments will be
resolved in accordance with the provisions of s. 215.422 F.S.
28.2. The Provider agrees to submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre audit and post audit thereof The contractor shall comply with the particular requirements
under the following laws and guidelines that are applicable to the contracts or agreements incorporating in this
Contract by reference: (a) paragraph (16) (b) of section 216.181, F.S., regarding advances; (b) Rule 69I40.103
F.A.C. pertaining to Restriction of Expenditures from state funds; and, (c) the Invoice Requirements of the
Reference Guide for State Expenditures from the Department of Financial Services at:
bttp:/ N- NN NAv. mvfloridacfo ,com /aadi_r' refer,:r_ce gu G uide For State; h�enditur�e
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 Subcontractor invoices, and will be produced upon
request by the Alliance. The Provider will further certify that reimbursement requests are only for allowable
expenses as defined in the laws and guiding circulars cited in Sections 4 of this Contract, in the Reference
Guide for State Expenditures, and any other laws or regulations, as applicable.
28.3. The Provider and Subcontractors shall provide units of deliverables, including reports, findings, and drafts as
specified in the contracts or agreements and attachments which incorporate this Contract to be received and
accepted by the Contract Manager prior to payment.
28.4. Payments will be made to the Provider based on a complete and correct invoice, invoices that are incomplete or
with incorrect total will not be processed and will be returned to the Provider for correction. Fiscal staff will
not be able to correct or make changes to the invoices. Returning invoices for corrections may result in failure
to receive payment for that month. Invoices shall be submitted timely as per ATTACHMENT VIII in order to
avoid any payment delays.
28.5. Each service performed shall be recorded as specified in the client information and registration tracking system
(CIRTS) guidelines. Supporting documentation of services provided must be adequate to permit fiscal and
programmatic evaluation, and ensure internal management.
29. Return of Funds
The Provider will 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 this contract that were disbursed to the
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Provider by the Alliance. In the event that the Provider or its independent auditor discovers that an overpayment ha-
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, on behalf of the
Alliance, will notify the Provider by letter of such findings. Should repayment not be made forthwith, the Provider
will be charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after Alliance
notification or Provider discovery.
30. Data Integrity and Safeguarding Information
The Provider and its subcontractors shall insure 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 shall be routinely backed up to ensure recovery
from losses or outages of the computer system. The security over the backed -up data is to be as stringent as the
protection required of the primary systems. The Provider shall ensure all Subcontractors maintain written procedures
for computer system back -up and recovery. The Provider shall complete and sign ATTACHMENT IV prior to the
execution of this contract.
31. Computer Use and Social Media Policy
The DOEA has implemented a new Social Media Policy, in addition to its Computer Use Policy, which applies to all
employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third
parties, such as, but not limited to, Area Agencies on Aging and vendors. Any entity that uses the DOEA's computer
resource systems must comply with the DOEA's policy regarding social media. Social Media includes, but is not
limited to blogs, podcasts, discussion forums, Wikis, RSS feeds, video sharing, social networks like MySpace,
Facebook and Twitter, as well as content sharing networks such as Flickr and YouTube (ATTACHMENT Q. This
policy is available on the Department's website at: h ttp:,' ielderaffairs . state. fl_u /doe /f:nanc
32. Conflict of Interest
The Provider shall establish safeguards to prohibit employees, board members, management and subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of
interest or personal gain. No employee, officer or agent of the Provider or subcontractor shall participate in
selection, or in the award of an agreement supported by State or Federal funds if a conflict of interest, real or
apparent, would be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member
of his /her immediate family; (c) his or her partner, or; (d) an organization which employs, or is about to employ, any
of the above, has a financial or other interest in the firm selected for award. The Provider or any subcontractor's
officers, employees or agents will neither solicit nor accept gratuities, favors or anything of monetary value from
contractors, potential contractors, or parties to subcontracts. The 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 subcontractors must make the same disclosures described above to the Provider's board of directors. Compliance
with this provision will be monitored.
33. Public Entity Crime
Pursuant to s. 287.133, F.S., the following restrictions are placed on the ability of persons convicted of public entity
crimes to transact business with the Alliance. A person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any
goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the
construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real
property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or
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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.
34. Emergency Preparedness and Continuity of Operations
34.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the Provider shall,
within thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification
of an emergency preparedness plan (Continuity of Operations Plan.) In the event of an emergency, the
Provider shall notify the Alliance of emergency provisions.
35. Use of Contract Funds to Purchase Equipment
No funds under this contract will be used by the Provider to purchase equipment.
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].
36. The PUR 1000 Form is hereby incorporated by reference and available at:
litt : / /i _cones /vb /adoc /F774o PUR10
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.
37. 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.
38. 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.
39. Financial Consequences of Non - Performance
39.1 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 may apply financial consequences commensurate with the
deficiency as referenced in ATTACHMENT 1, Sec. 3.5.2. Financial consequences may also include 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.
39.2 The Provider shall not be charged with financial consequences, when a failure to perform arises out of causes
that were the responsibility of the Alliance.
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40. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
41. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Miami -Dade County, Florida.
42. Entire Contract
This contract contains all the terms and conditions agreed upon by the parties. No oral agreements or representation;
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.
43. Force Majeure
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.
44. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
45. 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.
46. Addition /Deletion
The Parties agree that, notwithstanding the terms of the procurement documents and actions leading to this contract,
the Alliance reserves the right to add or to delete any of the services required under this contract when deemed to be
in the best interest of the elder population targeted by the Area Plan and reduced to a written amendment signed by
both Parties. The Parties shall negotiate compensation for any additional services added.
47. Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract shall not constitute or
be deemed a waiver of the Alliance's right thereafter to enforce those rights, nor shall any single or partial exercise of
any such right preclude any other or further exercise thereof or the exercise of any other right.
48. 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.
49. Final Invoice
The Provider shall submit the final invoice for payment to the Alliance. as specified in section 3.3.6 (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.
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50. Renegotiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties.
51. Suspension of Work:
The Alliance may in its sole discretion suspend any or all activities under this Contract and any Contract or
agreement incorporating in this Contract, at any time, when in the best interests of the 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.
52. Termination
50.1 This contract may be terminated by either party without cause upon no less than thirty (30) calendar days'
notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice shall
be delivered by U.S. Postal Service or any expedited delivery service that provides verification of delivery or
by hand delivery to the Contract Manager or the representative of the Provider responsible for administration
of the contract.
50.2 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.
50.3 Termination for Cause
This contract may be terminated for cause by the Alliance 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.
50.4 Failure to have performed any contractual obligations with the Alliance in a manner satisfactory to the Alliancf
will be a sufficient cause for termination. To be terminated as a contractor 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 and failed to correct the unsatisfactory performance to the
satisfaction of the Alliance; or (2) had a contract terminated by the Alliance for cause.
50.5. 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.
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53. 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 contractor that
creates and retains electronic records and uses electronic signatures to conduct transactions shall comply with the
requirements contained in the Uniform Electronic Transaction Act, s. 668.50, Fla. Stat. All electronic records must
be fully auditable; are subject to Florida's Public Records Law, ch. 119, Fla. Stat.; must comply with section 28, Dat
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.
53.1. 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.
53.2. 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.
54. Special Provisions:
The Provider agrees to the following provisions:
54.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Provider or any Subcontractors and referred to a
governmental or investigatory agency must be sent to the Alliance. If the Provider has reason to believe that
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 Alliance immediately. A copy of all
documents, reports, notes or other written material concerning the investigation, whether in the possession of
the Provider or Subcontractors, must be sent to the Alliance's contract manager with a summary of the
investigation and allegations.
54.2 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.
55. Enforcement:
55.1 In accordance with Section 430.04, F.S., the Alliance may, without taking any intermediate measures available
to it against this Contract rescind this Contract if the Alliance finds that:
55.2 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 Master Contract by reference, or substantially
and negatively affected the operation of services covered under any contract or agreement;
55.3 The Provider lacks financial stability sufficient to meet contractual obligations or that contractual funds have
been misappropriated;
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55.4 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 Alliance standards;
55.5 The Provider has failed to continue the provision or expansion of services after the declaration of a state of
emergency; and/or
55.6 The Provider has failed to adhere to the ternis of any contract or agreement incorporating in this Contract.
55.7 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.
55.8 In making any determination under this provision the Alliance may rely upon the findings of another state or
federal agency, or other regulatory body. Any claims for damages for breach of any contract or agreement are
exempt from administrative proceedings and shall be brought before the appropriate entity in the venue of
Miami -Dade County.
56. Training
The Provider will attend all required trainings and meetings schedule by the Alliance.
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57. Official Payee and Representatives (Name, Address, 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 107th Ave, Suite 214
Miami, Florida 33172
(305) 670 -6500, Ext. 224
The name, address, and telephone number of the representative of the Contractor responsible for administration of the
program under this contract is:
Upon change of representatives (names, addresses, telephone numbers) by either parry, notice shall be provided in
writing to the other parry and the notification attached to the originals of this contract.
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The Contractor name, as shown on page 1 of this
Monroe County Board of County Commissioners,
A
contract, and mailing address of the official
Social Services /In -Home Services
1100 Simonton Street, 2 Floor
payee to whom the payment shall be made is:
Key West, FL 33040
305 -292 -4510
Sheryl Graham
The name of the contact person of the
Monroe County Board of County Commissioners,
B
Contractor and street address where financial
Social Services/In -Home Services
1100 Simonton Street, 2n Floor
and administrative records are maintained is:
Key West, FL 33040
305 -292 -4510
Sheryl Graham
The name, address, and telephone number of the
Monroe County Board of County Commissioners,
c
representative of the Provider responsible for
Social Services /In -Home Services
administration of the program under this
1100 Simonton Street, 2 Floor
contract is:
Key West, FL 33040
305 -292 -4510
Alliance for Aging, Inc.
The section and location within the AAA where
Fiscal Department
d
Requests for Payment and Receipt and
760 NW 107th Avenue, Suite 214
Expenditure forms are to be mailed is:
Miami, Florida 33172 -3155
305- 670 -6500
The name, address, and telephone number of the
Contract Monitor
Alliance for Agin Inc.
e
Contract Manager for the AAA for this contract
760 NW 107th Avenue Suite 214
is:
Miami, Florida 33172 -3155
605- 670 -6500
Upon change of representatives (names, addresses, telephone numbers) by either parry, notice shall be provided in
writing to the other parry and the notification attached to the originals of this contract.
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58. All Terms and Conditions Included
This contract and its Attachments, I through X, A, B, C, D, E, F, G, 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 71 page contract, to be executed by their undersigned
officials as duly authorized.
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS, SOCIAL
SERVICES /IN -HOME SERVICES
SIGNED BY:
NAME:
TITLE:
DATE:
ALLIANCE FOR AGING, INC
SIGNED BY:
NAME: MAX B. ROTHMAN, JD, LL.M.
TITLE: PRESIDENT AND CEO
DATE:
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INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT
ATTACHMENT DESCRIPTION
PAGE
ATTACHMENT I
STATEMENT OF WORK
19 -31
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
32
ATTACHMENT III
FINANCIAL COMPLIANCE AUDIT ATTACHMENT
33 -35
ATTACHMENT III
EXHIBIT 1
AUDIT REPLATIONSHIP DETERMINATION
36 -37
ATTACHMENT III
EXHIBIT 2
FEDERAL RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT
38
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
39
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS /SUBCONTRACTS
40
ATTACHMENT VI
ASSURANCES — NON - CONSTRUCTION PROGRAMS
41 -42
ATTACHMENT VII
CONTRACT BUDGET SUMMARY BY SERVICE AND TITLE
43
ATTACHMENT VIII
OLDER AMERICANS ACT CONTRACT REPORT CALENDAR
44
ATTACHMENT IX
REQUEST FOR PAYMENT
45
ATTACHMENT X,
EXHIBIT 1
RECEIPTS AND EXPENDITURES, TITLE IIIB, IIIC1, AND IIIC2
46
ATTACHMENT X,
EXHIBIT 2
RECEIPTS AND EXPENDITURES, TITLE IIIE
47
ATTACHMENT A
DEPARTMENT OF ELDER AFFAIRS' PROGRAMS & SERVICES
HANDBOOK (ON Alliance FOR AGING, INC. INTERNET SITE)
48
ATTACHMENT B
DEPARTMENT OF ELDER AFFAIRS' CIVIL RIGHTS COMPLIANCE
CHECKLIST AND INSTRUCTIONS
49 -54
ATTACHMENT C
DEPARTMENT'S COMPUTER USE POLICY AND ITS SOCIAL MEDIA
POLICY, PROVIDED ON CD INSTRUCTIONS
55
ATTACHMENT D
BACKGROUND SCREENING — AFFIDAVIT OF COMPLIANCE
56
ATTACHMENT E
VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
57
ATTACHMENT F
BUSINESS ASSOCIATE AGREEMENT
58 -64
ATTACHMENT G
ADRC POLICY AND PROCEDURES FOR OUTSOURCED FUNCTIONS
65 - 70
ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LIST
71
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Alliance FOR AGING, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION I: SERVICES TO BE PROVIDED
ATTACHMENT
1.1 Alliance For Aging, Inc. Mission Statement
The Alliance mission is to promote and advocate for the optimal quality of life for older adults and their families.
1.2 Program Specific Terms
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service
delivery system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the Olde.
Americans Act and DOEA instructions.
Area Plan Update: A revision to the area plan wherein the Alliance enters OAA specific data in the Client
Information and Registration Tracking System (CIRTS). An update may also include other revisions to the area
plan as instructed by the DOEA.
Child: An individual who is not more than 18 years of age or an individual with disability.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in -home and
community care to an older individual.
Frail: When an older individual is unable to perform at least two activities of daily living (ADLs) without
substantial human assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or
other mental impairment, requires substantial supervision because the individual behaves in a manner that poses
a serious health or safety hazard to the individual or to another individual.
Grandparent: A grandparent or step - grandparent of a child, or a relative of a child by blood, marriage or
adoption and who lives with the child; is the primary caregiver of the child because the biological or adoptive
parents are unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the
child, such as legal custody or guardianship, or is raising the child informally.
1.3 General Description
1.3.1 General Statement
The OAA Program is a federal program initiative that provides assistance to older persons and caregivers and
is the only federal supportive services program directed solely toward improving the lives of older people. The
program provides a framework for a partnership among the different levels of government and the public and
private sectors with a common objective, improving the quality of life for all older individuals by helping them
to remain independent and productive. The primary purpose of the OAA program is to foster the development
and implementation of comprehensive and coordinated systems to serve older individuals. The OAA program
uses these systems to assist older individuals to attain and maintain maximum independence and dignity in a
home environment and allows for the capability of self -care with appropriate supportive services.
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1. 3.2 Authority
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. 07: Release date, June 27, 2012;
(3) CFO memo No. 01: Release date, July 26, 2012; and
(4) CFO Memo No. 06: Release date, June 30, 2010.
1.3.3 Scope of Service
The Provider is responsible for coordinating and assessing the needs of older persons, and assuring the
availability of quality services. The services shall be provided in a manner consistent with, and described in,
both the current DOEA Programs and Services Handbook and the Provider's Service Provider Application(s)
submitted in response to the 2012 OAA RFP.
1.3.4 Major Program Goals
The major goals of the OAA program are to improve the quality of life for older individuals, preserve their
independence and prevent or delay more costly institutional care. These goals are achieved through the
implementation of a comprehensive and coordinated service system that provides a continuum of service
alternatives that meet the diverse needs of elders and their caregivers.
1.3.5 Leadership and Advocacy
As a designated Focal Point, a provider is encouraged to provide coordination of services for older individuals
The Provider must also provide community leadership on aging issues and serve as the advocate and focal
point for the elderly within the community in cooperation with agencies, organizations and individuals
participating in activities funded by the Alliance. Advocacy should include initiating positive changes in
public or private policies and attitudes towards older persons, taking action to improve, modify, or eliminate
situations which adversely impact on lives of older persons, or expressing support for older persons and their
interests. Advocacy activities may be broadly supportive of the general interests of older persons or may
involve specific activities on behalf of individuals."
1.4 Clients To Be Served
1.4.1 General Description
Preference shall be given to those with the greatest economic and social needs, with particular attention to low -
income older individuals, including those that are low - income minorities, have limited English proficiency,
and older individuals residing in rural areas.
1.4.1.1 OAA Title III, General Client Eligibility
Consumers shall not be dually enrolled in an OAA program and a Medicaid capitated long -term care
program, with the exception of consumers in need of OAA Legal Assistance services. Individuals
enrolled in SMMC LTC may receive congregate meals if coordinated by the managed care plan and
paid for by OAA funds, as per DOEA Notice of Instruction, NOTICE 4: 032515- 2- PC -SCBS.
Additionally, transportation funded through Title I1113 can be provided to SMMC LTC enrollees
attending congregate meal sites, in accordance with the Department's Programs and Services
Handbook.
1.4.1.2 OAA Title IIIB, Supportive Services, Client Eligibility
(1) Individuals age 60 or older
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1.4.1.3 OAA Titles IIIC1 and IIIC2, Nutrition Services, Client Edibility
General factors that should be considered in establishing priority for nutrition services include those
older persons who meet the following:
(1) Cannot afford to eat adequately;
(2) Lack the skills or knowledge to select and prepare nourishing and well - balanced meals;
(3) Have limited mobility which may impair their capacity to shop and cook for themselves; or
(4) Have a disabling illness or physical condition requiring nutritional support or have been screen(
at a high nutritional risk.
1.4.1.4 OAA Title IIIC1, Congregate Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in
ATTACHMENT I, Paragraph 1.4.1.3 individuals must be mobile, not homebound and physically,
mentally and medically able to attend a congregate nutrition program. Individuals eligible to receive
congregate meals include:
(1) Individuals age 60 or older; and
(2) Any spouse (regardless of age) who attends the dining center with his/her eligible spouse;
(3) Persons with a disability, regardless of age, who reside in a housing facility occupied primarily
by older individuals where congregate nutrition services are provided;
(4) Disabled persons who reside at home with and accompany an eligible person to the dining
center; and
(5) Volunteers, regardless of age, who provide essential services on a regular basis during meal
hours.
1.4.1.5 OAA Title IIIC2, Home Delivered Nutrition Services
In addition to meeting the general nutrition services eligibility requirements listed in
ATTACHMENT I, Paragraph 1.4.1.3, individuals must be homebound and physically, mentally or
medically unable to attend a congregate nutrition program. Individuals eligible to receive home
delivered meals include the following:
(1) Individuals age 60 or older who are homebound by reason of illness, disability or isolation;
(2) The spouse of a homebound eligible individual, regardless of age, if the provision of the
collateral meal supports maintaining the person at home;
(3) Individuals with disabilities, regardless of age, who reside at home with eligible individuals and
are dependent on them for care; and
(4) Persons at nutritional risk who have physical, emotional or behavioral conditions, which would
make their presence at the congregate site inappropriate; and persons at nutritional risk who are
socially or otherwise isolated and unable to attend a congregate nutrition site.
1.4.1.6 OAA Title IIIE, Caregiver Support Services, Client Eligibility
(1) Family caregivers of individuals age 60 or older;
(2) Grandparents (age 55 or older) or older individuals (age 55 or older) who are relative caregivers;
(3) Priority will be given to family caregivers who provide care for individuals with Alzheimer's
disease and related disorders with neurological and organic brain dysfunction and for
grandparents or older individuals who are relative caregivers who provide care for children with
severe disabilities; and
(4) For respite and supplemental services, a family caregiver must be providing care for an older
individual who meets the definition of the term "frail" in OAA, Section 102 Paragraph 22.
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SECTION II — MANNER OF SERVICE PROVISION
2.1 Service Tasks
In order to achieve the goals of the OAA program, the Provider shall ensure the following Service Tasks are
performed at the level specified in this contract.
(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 Contract.
(2) Targeting and Screening of Service Delivery for New Clients: The Provider shall develop and implement
policies and procedures consistent with OAA targeting and screening criteria.
(3) Delivery of Services to Eligible Clients: The Provider shall ensure the provision of a continuum of services
that meets the diverse needs of elders and their caregivers. The Provider shall ensure the performance and
report performance of the following services are in accordance with the current DOEA Programs and
Services Handbook. The services funded pursuant to this contract are in accordance with the OAA, Title III
Section 321, 331, 336, 361, and 373 as follows:
Section 321, Title IIIB Supportive Services;
Section 331, Title IIIC 1 Congregate Nutrition Services;
Section 336, Title IIIC2 Home Delivered Nutrition Services;
Section 373, Title IIIE Caregiver Support Services; and
(4) Use of volunteers to expand the provision of available services;
(5) Monitoring the performance of its subcontractors; and
(6) Document service delivery in accordance to the current DOEA Program and Services Handbook.
2.1.1 Supportive Services (IIIB Program)
Supportive services include a variety of community -based and home - delivered services that support the qualit3
of life for older individuals by helping them remain independent and productive.
2.1.1.1. Services include the following:
(1) Adult Day Care /Adult Day Health Care;
(2) Caregiver Training/Support;
(3) Case Aid/Case Management;
(4) Chore Services;
(5) Companionship;
(6) Counseling (Gerontological and Mental Health);
(7) Education/Training;
(8) Legal Assistance;
(9) Material Aid;
(10) Occupational Therapy;
(11) Outreach;
(12) Personal Care;
(13) Physical Therapy;
(14) Shopping Assistance;
(15) Skilled Nursing;
(16) Specialized Medical Equipment, Services, and Supplies;
(17) Recreation;
(18) Emergency Alert Response;
(19) Escort;
(20) Health Support;
(2 1) Home Health Aid;
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(22) Homemaker;
(23) Housing Improvement;
(24) Information;
(25) Intake;
(26) Interpreter /Translating;
(27) Referral /Assistance;
(28) Respite Services;
(29) Screening /Assessment;
(30) Speech Therapy;
(3 1) Telephone Reassurance; and
(32) Transportation
Services authorized under this contract are listed on ATTACHMENT VII, Contract Budget Summary by
Service and Title.
2.1.1.2. Congregate Nutrition Services (IIIC 1 Program)
Nutrition services are provided in congregate settings and are designed to reduce hunger and food
insecurity, promote socialization and the health and well -being of older individuals by assisting them
to gain access to nutrition and other disease prevention and health promotion services. Services
include the following:
(1) Congregate meals;
(2) Congregate meals screening;
(3) Nutrition education and nutrition counseling;
(4) Outreach.
Services authorized under this contract are listed on ATTACHMENT VII, Contract Budget
Summary by Service and Title.
2.1.1.3. Home Delivered Nutrition Services (IIIC2 Program)
In -home nutrition services are provided to reduce hunger and food insecurity; promote socialization
and the health and well -being of older individuals by assisting such individuals to gain access to
nutrition and other disease prevention and health promotion services. Services include the following:
(1) Home delivered meals;
(2) Nutrition education and counseling;
(3) Outreach; and
(4) Screening /Assessment.
Services authorized under this contract are listed on ATTACHMENT VII, Contract Budget
Summary by Service and Title.
2.1.1.4. Caregiver Support Services (IIIE Program)
The following services are intended to provide direct help to caregivers, assist in the areas of health,
nutrition and financial literacy and assist caregivers in making decisions and problem solving related
to their caregiving roles and responsibilities:
(1) Adult Day Care /Adult Day Health Care;
(2) Caregiver Training/Support;
(3) Counseling (Gerontological and Mental Health);
(4) Education/Training;
(5) Financial Risk Reduction (Assessment and Maintenance);
(6) Information;
(7) Intake;
(8) Outreach;
(9) Powerful Tools for Caregivers;
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(10) Referral /Assistance;
(11) Respite Services;
(12) Screening /Assessment;
(13) Stress - Busting Program for Family Caregivers; and
(14) Transportation.
Services authorized under this contract are listed on ATTACHMENT VII, Contract Budget Summary
by Service and Title.
2.1.1.5. Caregiver Support Supplemental Services (IIIES Program): The following services are provided to
complement the care provided by caregivers:
(1) Chore Services;
(2) Housing Improvement;
(3) Material Aid; and
(4) Specialized Medical Equipment, Services and Supplies.
Services authorized under this contract are listed on ATTACHMENT VII, Contract Budget
Summary by Service and Title.
2.1.1.6 Caregiver Support Grandparent Services (IIIEG Program): Services for grandparents or older
individuals who are relative caregivers designed to help meet their caregiving obligations include the
following:
(1) Caregiver Training /Support;
(2) Sitter.
Services authorized under this contract are listed on ATTACHMENT VII, Contract Budget
Summary by Service and Title.
2.1.2 Use of Volunteers to Expand the Provision of Available Services
2.1.2.1 Use of Volunteers to Expand the Provision of Available Services
The Provider shall make 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.
2.1.2.2. The Contractor shall submit an annual unduplicated report of volunteer hours on the format provided
by the Alliance. The data collection period is from January 1 — December 31 for each calendar year.
The data submission date is 15 days following the close of the contract period.
2.1.3. Monitoring the Performance of Subcontractors
The Provider shall conduct at least one monitoring per year of each subcontractor and/or vendors paid from
funds provided under this contract. The Provider shall perform fiscal, administrative and programmatic
monitoring of each sub - contractor to ensure contractual compliance, fiscal accountability, programmatic
performance, and compliance with applicable state and federal laws and regulations.
2.1.4. Subcontractor Outreach Reporting Requirements
The Provider shall document its performance of outreach activities, by submitting a uniform reporting format
provided by the Alliance that includes the following: number and type of provider events or activities; date
and location; total number of participants at each event or activity; individual service needs identified; and
referral sources or information provided. The Provider shall complete and submit this report on outreach
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activities at least semi - annually. Reports must be submitted by June 30 and December 31 of each contract
year.
2.2 SERVICE LOCATION
2.2.1 Service Times
The Provider shall ensure the provision of the services listed in the contract during normal business hours
unless other times are more appropriate to meet the performance requirements of the contract, and it shall
monitor its subcontractors to ensure they are available to provide services during hours responsive to client
needs and during those times which best meet the needs of the relevant service community.
2.3 DELIVERABLES
2.3.1 Services
The Provider shall provide the services described in the contract in accordance with the current DOEA
Program and Services Handbook. Units of service will be paid pursuant to the rates established in
ATTACHMENT VII.
2.4 REPORTS
The Provider is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the Alliance. The Provider must establish due dates for any subcontractors that
permit the Provider to meet the Alliance's reporting requirements.
2.4.1 Service Cost 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.
2.4.2 Surplus /Deficit Report
The Provider will respond to the consolidated Surplus /Deficit report in a format provided by the
Alliance to the Alliance's contract manager. Surplus /Deficit reports must be submitted with the
monthly request for payment. This report is for all services provided in this agreement incorporating
in this Contract between the Provider and the Alliance. The report will include the following:
(1) A list of all Services and their current status regarding surplus or deficit, and why they differ from
its original budget projections.
(2) A detailed plan on how the surplus or deficit spending exceeding the 1% monthly threshold will be
resolved. The plan must include specific budget numbers to reflect how the Provider plans to
address the variance.
(3) Number of clients currently on the waitlist (APCL).
(4) Number of ADRC outsource function contacts.
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2.5 CIRTS
2.5.1 Client Information and Registration Tracking System ( CIRTS) Reports
The Provider shall input OAA- specific data into CIRTS to ensure CIRTS data accuracy. The Provider shall
use CIRTS - generated reports which include the following:
(1) Client Reports;
(2) Monitoring Reports;
(3) Services Reports; and
(4) Outcome Measures Reports.
2.5.2 Program Highlights
The Provider shall submit Program Highlights referencing specific events that occurred in previous contract
year by September 15 of the current contract year. 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.
2.6 RECORDS AND DOCUMENTATION
The Provider shall maintain documentation to support Request for Payment that shall be available to the Alliance or
authorized individuals, such as DOEA and Department of Financial Services, upon request.
2.6.1. CIRTS Maintenance
The Provider will ensure the accurate collection and maintenance of client and service information
on a monthly basis from the CIRTS or any such system designated by the Alliance. Maintenance
includes valid exports and backups of all data and systems according to Alliance and DOEA
standards. The Provider must adhere to the Alliance CIRTS Data Integrity Policies & Procedures,
incorporated by reference, in order to ensure data accuracy.
2.6.2 Data Integrity and Back -up Procedures
The Provider shall anticipate and prepare for the loss of information processing capabilities. The
routine backing up of all data and software is required to recover from losses or outages of the
computer system. Data and software essential to the continued operation of contractor functions must
be backed up. The security controls over the backup resources shall be as stringent as the protection
required of the primary resources. It is recommended that a copy of the backed up data be stored in a
secure, offsite location.
2.7 PERFORMANCE SPECIFICATIONS
2.7.1 Outcomes and Outputs (Performance Measures) — At a minimum, the Provider must:
(1) Ensure the provision of the services described in this contract are in accordance with the current DOEA
Programs and Services Handbook and in the Manner of Service Provision described in this contract.
(2) Submit to the Alliance all information described in this contract.
(3) Develop and document strategies in the Service Provider Application (SPA) to support the Department's
performance outcome measures in the following criteria:
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a) 79.3% of elders assessed with high or moderate risk environments will improve their environment s
b) 66% of new service recipients with high -risk nutrition scores will improve their nutritional status.
c) 65% of new service recipients will maintain or improve their ADL assessment score.
d) 62.3% of new service recipients will maintain or improve their IADL assessment score.
e) 89% of family and family- assisted caregivers will self -report they are very likely to provide care.
f) 90% of caregivers will maintain or improve their ability to provide care after one year of service
intervention (as determined by the caregiver and the assessor).
2.7.2 Monitoring and Evaluation Methodology
The Alliance will review and evaluate the performance of the Provider under the terms of this contract.
Monitoring shall be conducted through direct contact with the Provider through telephone, in writing, and /or a
on -site 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:
a) Desk reviews and analytical reviews;
b) Scheduled, unscheduled, and follow -up on -site visits,
c) Client visits;
d) Review of independent auditor's reports;
e) Review of third -parry documents and /or evaluation;
f) Review of progress reports;
g) Review of customer satisfaction surveys;
h) Agreed -upon procedures review by an external auditor or consultant;
i) Limited -scope reviews; and
J) Other procedures as deemed necessary.
2.7.3 Remedies - Nonconforming Services
The Provider shall ensure that all participants served under this agreement are eligible for the program, and tha
all monthly and /or quarterly performance reports and financial records are maintained for each reporting perioc
and submitted as stipulated in 2.4, 2.5, 2.6, and 2.7.
Anv nonconforming program services, performance reports or financial records not meeting the requirements
of this Contract shall not be eligible for reimbursement under this program. The costs associated with hiring,
training, reporting and/or managing the program shall be borne solely by the Provider. The Alliance requires
immediate notice of any significant and/or systemic infractions that compromise the Provider's ability to
provide participant services, to achieve programmatic performance or to provide sound financial management
of the program.
2.8 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.8.1 Matching, Level of Effort, and Earmarking Requirements
The Provider shall provide match of at least 10 percent of the federal administrative funds received. The
Provider's snatch will be made in the form of cash, general revenue administrative funds, and/or in -kind
resources. The Provider will assure, through a provision in subcontracts, a match requirement of at least 10
percent of the cost for services funded through this contract. The Provider's match will be made in the form of
cash and/or in -kind resources. The Provider shall report match by title each month. At the end of the contract
period, the Provider must properly match OAA funds.
2.8.2 Consumer Contributions
Consumer contributions are to be used under the following terms:
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1) The Provider assures compliance with Section 315 of the OAA as amended in 2006, in regard to consume]
contributions;
2) Voluntary contributions are not to be used for cost sharing or matching;
3) Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
4) Voluntary contributions are to be used only to expand services.
2.8.3 Use of Service Dollars
The Provider is expected to spend all federal, state and other funds provided by the Alliance for the purpose
specified in the contract. The Provider must manage the service dollars in such a manner so as to avoid having
a wait list and a surplus of funds at the end of the contract period, for each program managed by the Provider.
Program surpluses must be reported to the Alliance.
2.8.4 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.
2.8.5 The Provider agrees to use funds as detailed in the Budget Summary, ATTACHMENT VII. Any changes in
the amounts of federal or general revenue funds identified on the Budget Summary form require a contract
amendment. Providers must adhere to Alliance's Modified Spending Policy, incorporated by reference, when
requesting changes to the budget Summary Form.
2.8.6 Title III Funds
The Provider assures compliance with Section 306 of the Older Americans Act, as amended in 2006, that funds
received under Title III will not be used to pay any part of a cost (including an administrative cost) incurred by
the Provider to maintain a contractual or commercial relationship that is not carried out to implement Title III.
2.9 ALLIANCE'S 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. The Providers must attend all required training session and
meetings.
SECTION III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The Method of Payment for this contract is a combination of fixed- fee /unit rate, cost reimbursement, and advanced
payments, subject to the availability of funds. The Provider shall ensure include only those costs that are in
accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in
instances where an independent audit is required.
3.2 Advance Payments
3.2.1 The Provider may request up to two months of advances at the start of the contract period, if available, to cover
program service costs. The payment of an advance will be contingent upon the sufficiency and amount of
funds released to the Alliance. The Provider shall provide the Alliance documentation justifying the need for
an advance and describing how the funds will be distributed.
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3.2.2 The Provider's requests for advance require the approval of the Alliance. If sufficient budget is available, the
Alliance will issue approved advance payments after January 1, 2017,
3.2.3 Requests for the first through the twelfth months shall be based on the submission of actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests, if available is shown on ATTACHMENT VIII of this contract.
3.2.4 All advanced payments made to the Provider shall be recouped in accordance with the Reporting Schedule,
ATTACHMENT VIII of this contract.
3.2.5 Interest earned on advances must be identified separately by source of funds, state or federal. Providers shall
maintain advances of federal funds in interest bearing accounts unless otherwise exempted in accordance with
45 CFR 74.22(k). Earned interest must be returned to the Alliance at the end of each quarter.
3.3 Invoice Submittal and Requests for Payment
3.3.1 All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA
forms 106A (ATTACHMENT IX), 105AS (ATTACHMENT X- EXHIBIT 1), and 105AE (ATTACHMENT
X- EXHIBIT 2).
3.3.2 The Provider shall submit all payment requests based on the submission of the Provider's actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests (when available) and invoices is ATTACHMENT VIII to this contract.
3.3.3 Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and
approval of all financial and programmatic reports due from the Provider and any adjustments thereto.
3.3.4 The Alliance will authorize payment only for allowable expenditures, which are in accordance with the limits
specified in ATTACHMENT VII, Budget Summary.
3.3.5 Monthly review of the Receipt and Expenditure Report and the Request for Payment Form by the
Alliance will focus on:
(1) Line item comparison of year -to -date expenditures with the budget to monitor rate of expenditures;
(2) Allowable total reimbursement, on a service by service level, does not exceed budgeted/contractual
amount (No unilateral modified spending authority.);
(3) Validation of service units reported against CIRTS.
3.3.6 In order to properly manage the program budget, the Provider must submit invoices for payment no later than
90 days after the end of the month in which the expense was incurred, except that invoices cannot be submitted
after Close Out Report date. Invoices submitted late will require the approval of the Alliance's contract
manager. Approvals must be requested prior to the invoicing deadline. Late invoices will not be paid unless
justification is submitted and approved by the contract manager.
3.3.7 Date for Final Request for Payment
The Provider shall submit the final request for payment to the Alliance no later than 45 days after the contract
end date.
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3.4 Documentation for Payment
The Provider shall maintain documentation to support payment requests that shall be available to the Alliance or
authorized individuals, such as Department of Financial Services, upon request. Supporting documentation of
services provided must be adequate to permit fiscal and programmatic evaluation and ensure internal management.
3.4.1 Payments will be made to the Provider based on a complete and correct invoice, invoices that are incomplete o
with incorrect total will not be processed and will be returned to the Provider for correction. Fiscal staff will
not be able to correct or make changes to the invoices. Returning invoices for corrections may result in failure
to receive payment for that month. Invoices shall be submitted timely as per ATTACHMENT VIII in order to
avoid any payment delays.
3.4.2 The Provider must enter all required data following DOEA's CIRTS Policy Guidelines for clients and services
in the CIRTS database. Data must be entered into CIRTS before the Providers submit their request for
payment and expenditure reports.
3.4.3 The Provider shall run monthly CIRTS reports and verify that 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 can be approved by the Alliance.
3.5. 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.
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.
3.5.1. Corrective Action Plan
1. Contractor shall ensure 100% of the deliverables identified in ATTACHMENT 1, Section II (Manner of
Service Provision) of this contract, are performed pursuant to contract requirements.
2. If at any time the Contractor is notified by the Alliance that it has failed to correctly, completely, or
adequately perform contract deliverables identified in ATTACHMENT I, Sec. II, the Contractor will have
10 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
Alliance Contract Manager. The Alliance shall assess a Financial Consequence for Non - Compliance on the
Contractor as referenced in ATTACHMENT I, Sec. 3.5.2. of this contract for each deficiency identified in
the CAP which is not corrected pursuant to the CAP. The Alliance shall also assess a Financial
Consequence for failure to timely submit a CAP.
3. If the Contractor fails to correct an identified deficiency within the approved time period specified in the
CAP, the Alliance shall deduct the percentage established in ATTACHMENT I, Sec. 3.5.2. of this
contract, from the payment for the invoice of the following month.
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4. If the Contractor fails to timely submit a CAP, the Alliance shall deduct the percentage established i
ATTACHMENT I, Sec. II.1. of this contract for each day the CAP is overdue. The deduction will be mad
from the payment for the invoice of the following month.
3.5.2. Financial Consequences of Non - Performance
The Alliance will withhold or reduce payment if the Contractor fails to perform the deliverables to th
satisfaction of the Contract according to the requirements referenced in ATTACHMENT I, Sec. I and Sec. II e
this contract. The following financial consequences will be imposed if the deliverables stated do not meet ii
part or in whole the performance criteria as outlined in ATTACHMENT I, Sec. II of this contract.
Delivery of services to eligible clients as referenced in ATTACHMENT I, Sec. 14 and Sec. 2.1 of thi
contract — Failure to comply with established assessment and prioritization criteria as evidenced in CIRT1
reports will result in a 2% reduction of payment per business day. The reduction of payment will begir
on the first business day following the Alliance's notification to the contractor that the identifiec
deficiency was not cured or satisfactorily addressed in accordance with the Alliance approved CAP.
referenced in ATTACHMENT I, Sec. 3.5.1.
2. Services and units of services as referenced in ATTACHMENT I, Sec. II of this contract — Failure to
Provide services in accordance with the current DOEA Programs and Services Handbook, the service tasks
described in section ATTACHMENTS VII and K, and submission of required documentation will result in
a 2% reduction of payment per business day. The reduction of payment will begin the first business day
following the Alliance's notification to the contractor that the identified deficiency was not cured or
satisfactorily addressed in accordance with the Alliance approved CAP, referenced in ATTACHMENT I,
Sec. 3.5.1.
Administrative duties as referenced in ATTACHMENT I, Sec, 2.4, 2.5, 2.6, and 2.7 of this con tract
a
—
Failure to perform the performance specifications and oversight of CCE Program operations will result
2% reduction of payment per business day. The reduction of payment will begin the first business day
following the Alliance's notification to the contractor that the identified deficiency was not cured or
satisfactorily addressed in accordance with the Alliance approved CAP, referenced in ATTACHMENT I,
Sec. 3.5.1.
4. Timely submission of a CAP — Failure to timely submit a CAP within 10 business days after notification of
the deficiency by the Alliance contract manager will result in a 2% reduction of payment per business day
the CAP is not received. The reduction of payment will begin the first business day following the
Alliance's notification to the contractor that the identified deficiency was not cured or satisfactorily
addressed in accordance with the Alliance approved CAP, referenced in ATTACHMENT I, Sec. 3.5.1.
5. Exceptions may be granted solely, in writing, by the Alliance.
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ATTACHMENT l
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, ai
officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator,
in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress,
or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form -LLL, 'Disclosure Form to Report Lobbying," in accordance
with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all
sub - awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative agreements)
and that all sub - contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by
section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.
Signature
Date
Name of Authorized Individual Contract Number
Name and Address of Organization
DOEA Form 103
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ATTACHMENT III ATTACHMENT 11
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Alliance to the provider may be subject to audits and/or monitoring by the
Alliance and/ortheDePartment as described in this section.
L 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 Alliance and /or the
Department staff, limited scope audits as defined by OMB Circular A -133, as revised, and/or other procedures. By entering into
this agreement, the Contractor agrees to comply and cooperate with any monitorin
by the Alliance. In the event the Alliance and /or the Department determines that a limited scopeaudit oft ee d
appropriate, the Contractor agrees to comply with any additional instructions provided by the A 1 I i a n c e a n d/ o r t h e
Department to the Contractor regarding such audit. The Contractor further agrees to comply and cooperate with any
inspections, reviews, investigations, or audits deemed necessary by the Alliance and /or the Department.
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 Contractor expends $750,000.00 or more in federal awards during its fiscal year, the Contractor must
have a single or program - specific audit conducted in accordance with the provisions of OMB Circular A -133, as revised.
EXHIBIT 2 to this agreement indicates federal resources awarded through the Alliance by this agreement. In determining the
federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards, including federal
resources received from the Alliance. 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 Contractor 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 I, the Contractor shall fulfill the requirements relative
to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
If the Contractor expends less than $750,000.00 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
federal awards in its fiscal year and elects to have an audit conducted in accordance with th eproviisi of OMB $Circular 0,00o
A - n
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
Contractor 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 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 and/or
the Department shall be fully disclosed in the audit report with reference to the Alliance 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 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 Contractor's fiscal year end.
PART II: STATE FUNDED
This part is applicable if the Contractor is a non -state entity as defined by Section 215.97(2), F. S.
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AA -172
In the event that the contractor expends a total amount of state financial assistance equal to or in excess of $750,000.00 in any
fiscal year of such Contractor (for fiscal years ending September 30, 2004 or thereafter), the Contractor must have a State single c
project - specific audit for such fiscal year in accordance with Section 215.97, F.S.; applicable rules of the Department of Financial
Services; and Chapters 10.550 (local govemine entities) or 10,650 (nonprofit and for -profit organizations), Rules of the Auditor
General. EXHIBIT 2 to this agreement indicates state financial assistance awarded through the Alliance by this agreement. In
determining the state financial assistance expended in its fiscal year, the Contractor shall consider all sources of state financial
assistance, including state financial assistance received from the Alliance, 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.
Inconnection with the audit requirements addressed in Part 11, paragraph I, the Contractor shall ensure that the audit complies with the
requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as defined by Section 215.97(2),
F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General.
If the Contractor expends less than $750,000.00 instate financial assistance in its fiscal year (for fiscal years ending September 30,
2004 or thereafter), an audit conducted in accordance with the provisions of Section215.97, F. S., is not required. In the event that
the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted
in accordance with the provisions of Section 215.97, F.S., the cost of the audit must be paid from the non -state entity's resources
(i.e., the cost of such an audit must be paid from the Contractor 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 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 shall be fully disclosed in the audit report
with reference to the Alliance agreement involved. If not otherwise disclosed as required by Rule 69I- 5.003, Fla. Admin. Code, the
schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with
the Alliance in effect during the audit period. Financial reporting packages required under this part must be
45 days after delivery of the audit report, but -no later than 12 months after the Contractor's fiscal year end for local submitted with in
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 Contractor's fiscal year end. Notwithstanding the applicability of this portion, the
Alliance retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this
document and pursuant to law.
II. 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
Contractor directly to each of the following:
The Alliance at each of the following addresses: Alliance for Aging, Inc.
Attn: Fiscal Department
760 NW 107 Avenue
Suite 214
Miami, FL 33172
The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of copies required by Sections .320
(d)(I) 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
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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 at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Department
760 NW 107 Avenue
Suite 214
Miami, FL 33172
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of
the Contractor directly to each of the following:
The Alliance at the following address:
Alliance for Aging, Inc.
Attn: Fiscal Department
760 NW 107 Avenue
Suite 214
Miami, FL 33172
Any reports, management letter, or other information required to be submitted to the Alliance pursuant to this agreement shall
be submitted timely in accordance with OMB Circular A -133, F.S., and Chapters 10.550 (local governmental entities) or
10.650 (nonprofit and for -profit organizations), Rules of the Auditor General, as applicable.
Contractors, when submitting financial reporting packages to the A 11 i a n c e 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 Contractor in correspondence
accompanying the reporting package.
III. PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of
six (6) years from the date the audit report is issued, and shall allow the Alliance and the Department or its designee, the
CFO or Auditor General Access to such records upon request. The Contractor shall ensure that audit working papers are made
available to the Alliance and the Department, or its designee, CFO, or Auditor General upon request for a period of six (6)
years from the date the auditreport is issued, unless extended inwriting by the Alliance.
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AA -1T,
ATTACHMENT III
FINANCIAL, AND COMPLIANCE AUDIT ATTACHMENT
EXHIBIT 1
PART 1: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part §200.500,
and/or Section 215.97, Fla. Stat. C o n t r a c t o r s who are determined to be recipients or subrecipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or
Part II of Exhibit I is met. C o n t r a c t o r s who have been determined to be vendors are not subject to the and it requirements
of2 CFR Part §200.3 8, and/or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, C o nt ra ct o r s
who have been determined to be recipients or subrecipients of Federal awards and/or state financial assistance must comply with
applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part §200 and /or Rule 691 - 5.006, FAC, Contractor has been determined to be:
Vendor not subject to 2 CFR Part §200.3 8 and /or Section 215.97, F. S.
Recipient/subrecipient subject to 2 CFR Part §200.86 and §200.93 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 Contractor is determined to be a recipient /subrecipient of federal and or state financial assistance and has been
approved by the Alliance to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I- .5006, FAC [state
financial assistance] and 2 CFR Part §200.330 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal
awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a
subrecipient must comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part §200.416- Cost Principles*
2 CFR Part §200.201- Administrative Requirements **
2 CFR Part §200.500- 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 § - .411 -Cost Principles*
2 CFR Part §200.100 - Administrative Requirements
2 CFR Part §200.500- Audit Requirements Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST
FOLLOW:
2 CFR Part §200.418- Cost Principles*
2 CFR Part §200.100- Administrative Requirements
2 CFR Part §200.500 -Audit Requirements Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, Hiles and regulations
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AA -17;
`Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2 CFR Part
§200.400(5) (c).
"For funding passed through U.S. Health and Human Services, 45 CFR 92; for funding passed through U.S. De
of Education, 34 CFR 80. g Department
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be
a recipient/subrecipient must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691 -5, Fla. Admin. Code
State Projects Compliance Supplement Reference Guide
for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
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ATTACHMENT III
FINANCIAL, AND COMPLIANCE AUDIT ATTACHMENT
EXHIBIT 2- FUNDING SUMMARY
Note: Title 2 CFR § 200.331, As Revised, and Section 215.97(5), Florida Statutes, Require That Information About Federal Programs and State
Projects Be Provided to the Recipient and Are Stated in the Financial and Compliance Audit Attachment and Exhibit 1. Financial and
Compliance Audit Attachment, Exhibit 2- Funding Summary Provides Information Regarding the Funding Sources Applicable to This Contra
Contained Herein, Is APrediction offending Sources and Related Amounts Based on the Contract Budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST Of
THE FOLLOWING:
PROGRAM TITLE
Older Americans Act Administration
Title IIIB — Support Services
Older Americans Act Administration
Title IIIC 1 — Congregate Meals
Older Americans Act Administration
Title III C2 — Home Delivered Meals
Older Americans Act Administration
Title III E — Caregiver Support Services
Title III ES — Caregiver Support Services
TOTAL FEDERAL AWARD
FUNDING SOURCE
CFDA AMOUNT
U.S. Health and Human Services
93.044 $113,535.31
U.S. Health and Human Services
93.045 $149,015.41
U. S. Health and Human Services
93.045 $226,625.63
U.S. Health and Human Services 93.052 $102,039.07
$32,049.08
$623,264.50
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
CONTRACT ARE AS FOLLOWS: PURSUANT TO THIS
FEDERAL FUND
2 CFR Part 200- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. OMB Circular
A -133, as amended- Audits of States, Local Governments, and Non -Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE
FOLLOWING:
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATEFINAN .IALAS4T Q TAN 1F.
Section 215.97, F. S., Chapter 69I -5, FL Admin Code, Reference Guide for State
rules and regulations. Expenditures, Od er fiscal requirenvits set forth in program laws,
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MATCHING RESOUCES FOR FEDERAL PROGRAMS
STATE FINANCIAL ASSITANCE SUBJECT TO sec. 215.97, F. S.
AA -1729
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE ATTACHMENT
FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the contractor named in the contract or agreement to which this form is an
attachment, hereby certifies that:
(1) The contractor and any sub - contractors of services under this contract have financial management systems capable o
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of eac
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 o
grant funds that have not been accounted for properly.
(2) Management Information Systems used by the contractor, sub - contractor(s), or any outside entity on which the
contractor is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be
capable of processing data accurately, including year -date dependent data. For those systems identified to be non-
compliant, contractor(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the
undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions
these products offered by the contractor (represented by the undersigned) and purchased by the State will be verified
for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that imped(
the hardware or software programs from operating properly, the contractor agrees to immediately make required
corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no
charge to the State, and without interruption to the ongoing business of the state, time being of the essence.
(4) The contractor and any sub - contractor(s) of services under this contract warrant their policies and procedures include o
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from
data integrity compliance issues.+
The contractor shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all sub - contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars
A -102 and 2 CFR Part 215 (formerly OMB Circular A -110).
Monroe County Board of County Commissioners, Social Services/In -Home Services
1100 Simonton Street, 2nd Floor
Key West, FL 33040
Signature Title
Date
Name of Authorized Signer
(Revised June 2008)
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ATTACHMENT
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency.
(2) Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
participant shall attach an explanation to this certification.
Signature
Date
Title -
(Certification signature should be same as Contract signature.) Agency /Organization
Instructions for Certification
1, The terms "covered transaction " "debarred," "suspended," "ineligible," "lower tier covered transaction " "
"primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections of rule
implementing Executive Order 12549. (2 CFR 180.5 - 180.1020, as supplemented by 2 CFR 376.10- 376.995). You may
contact the Contract Manager for assistance in obtaining a copy of those regulations.
2. This certification is a material representation of facts upon which reliance was placed when the parties entered into this
transaction. If it is later determined that the contractor knowingly rendered an erroneous certification, in addition to other
remedies available to the federal government, the department may pursue available remedies, including suspension and/or
debarment.
3. The contractor will provide immediate written notice to the Contract Manager if at any time the contractor learns that its
certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The contractor
may decide the method and frequency by which it determines the eligibility of its principals. Each participant to a lower
tier covered transaction may, but is not required to, check the Excluded Parties List System (EPLS).
�. The contractor will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -
Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier covered
transactions.
The contractor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by the
federal government.
If the contractor knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the
federal government, the department may pursue available remedies, including suspension, and/or debarment.
The contractor may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not
debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification
is erroneous.
Cel
7
(Revised June 2000)
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ATTACHMENT
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
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 sucl
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 t]
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 Standard;
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 VIII of the Civil
Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of
housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance
is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable treatment of persons
displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to
all interests in real property acquired for project purposes regardless of Federal participation in purchases.
S. 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.
a. 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. 0 El 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333),
regarding labor standards for federally assisted construction subagreements.
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Page 41 of 71
AA -1729
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protectio
Act of 1973 (P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the program and to
purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and Executii
Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738 (c) protection of E C
11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11 8 (e) assurance of project t cons stencyC
8
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 196
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.) pertainin€
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 governin,
this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
APPLICANT ORGANIZATION
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS,
SOCIAL SERVICESAN -HOME SERVICES
DATE SUBMITTED
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CONTRACT BUDGET SUMMARY BY SERVICE AND TITLE ATTACHMENT I
CIRTS SUMMARY FOR THE AGENCY
Service to be Provided
Service
Maximum
Units of
Maximum
Unit Rate
Dollars
No. of Clients
Chore 11113
$25.00 $25.00
624
$15,589.42
Homemaker IIIR
Page 43 of 71
AA -1729
ATTACHMENT VIII
OLDER AMERICANS ACT CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Report Number
Based On
Submit to Alliance
1
January Advance*
On This Date
January 1
2
3
February Advance*
January 1
4
January Expenditure Report
February
5
February Expenditure Report
March 5
March Expenditure Report
April 5
6
April Expenditure Report
May 5
7
May Expenditure Report
June 5
8
June Expenditure Report
July 5
9
10
July Expenditure Report
August 5
11
August Expenditure Report
September 5
September Expenditure Report
October 5
12
13
October Expenditure Report
November 5
14
November Expenditure Report
December 5
15
December Expenditure Report
January
ry
Final Expenditure and Request for Pa
q Payment
February 15
16
Close Out Report
February 29
Legend: * Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Department of
Financial Services (DFS) prior to January 1 or until the agreement with the Alliance has
been executed and a copy sent to DFS. Actual submission of the vouchers to DFS is
dependent on the accuracy of the expenditure report.
Note # 2: Report numbers 5 through 14 shall reflect an adjustment of one -tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the
agreement. The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT
IX).
Note 43: 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.
Page 44 of 71
AA -1729
ATTACHMENT
REQUEST FOR PAYMENT
OLDER AM ERICANS ACT
PROVIDER NAME, ADDRESS, PHONE AND FED ID NUMBER TYPE OF REPORT' THIS REQUEST PERIOD:
Advance Report #
Reimbursement Agreement #.
Agreement Period:
PSA:
CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terms and the purposes set forth in the above agreement.
Prepared By: Date: Approved By: Date:
PART A:
BUDGETSUMMARY
(1)
ADMIN.
(2)
III
(3)
IIIC1
(4)
IIIC2
(7)
Title IIIE
(6)
TOTAL
I. Approved
Agreement Amount.
0.00
0.00
0.00
0.00
0.00
0.00
2. Previous Funds
RECEIVED for
Agreement period.
0.00
0.00
0.00
0.00
0.00
0.00
3. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
4. Previous Funds
REQUESTED and
Not Received.
0.00
0.00
0.00
0.00
0.00
0.00
5. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
PART B:
FUNDS REQUESTED
1. ist -2nd Months
Request Only
0.00
0.00
0.00
0.00
0.00
0.00
2. Net Expenditures
For Month
0.00
0.00
0.00
0.00
0.00
0.00
3. Add'Rional
Cash Needs (Attach Doc.)
0.00
0.00
0.00
0.00
0.00
0.00
4. Total
PART C:
0.00
0.00
0.00
0.00
0.00
0.00
NET FUNDS REQUESTED:
1. Less: Over- Advance
0.00
0.00
0.00
0.00
0.00
0.00
2. Agreement Funds are
Hereby Requested For
0.00
0.00
0.00
0.00
0.00
0.00
Page 45 of 71
AA -1729
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
ATTACHMENT XEXHIBIT-
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source :
THIS REPORT PERIOD
FROM: TO:
IIIB
IIIC1
CONTRACT
IIIC2
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION : I certify to the best of my knowledge and belief that this report
is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date :
Approved by :
Date
PART A : BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
%
2. State Funds
$0.00
$0.00
$0.00
%
3. Program Income
$0.00
$0.00
$0.00
%
4. Local Cash Match (CCE, HCE and Other)
$0.00
$0.00
$0.00
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
%
6. Local In -Kind Match
$0.00
$0.00
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
%
PART B : EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Meals / Meal Agreements
$0.00
$0.00
$0.00
2. Service Subcontractor
$0.00
$0.00
$0.00
%
3. Other
4. Indirect Cost
$0.00
$0.00
$0.00
%
$0.00
$0.00
$0.00
5. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
PARTC : OTHER EXPENDITURES
(For Tracking Purposes only)
1. Match
a. Other and In -Kind
$0.00
$0.00
$0.00
%
b. Local Match
2. USDA Cash Received
$0.00
$0.00
$0.00
%
$0.00
$0.00
$0.00
%
3. TOTAL OTHER
$0.00
$0.00
$0.00
%
PART D: OTHER REVENUE AND EXPENDITURES
2. Addition Cost Alternative Program Income
3. Interest
1. Program Income (PI)
a. Approved Budget $
a. Earned on GR Advances $
a. OAA Unbudgeted PI Receipts YTD
b. Received YTD $
b. Return of GR Advance $
c. Expenditures $
c. Other Earned $
DOEA FORM 105as revised 11/09
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AA -1729
ATTACHMENT X EXHIBIT
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source :
THIS REPORT PERIOD
FROM: TO
CONTRACT
Title III E _
PERIOD:
CONTRACT#
REPORT#
-A#
CERTIFICATION : 1 certify to the best of my knowledge and belief that this report is complete
and all outlays
herein are for purposes set forth
in the contract.
Prepared by: Date :
Approved by :
Date
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This
Report
Year to Date
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
%
2. State Funds
$0.00
$0.00
$0.00
%
3. Program Income
$0.00
$0.00
$0.00
%
4. Local Cash Match
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
6. Local In -Kind Match
$a 00
$0.00
$0.00
%
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
%
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
A: Direct Services
Budget
For This
Report
Year to Date
Approved Budget
1. Personnel
2. Travel
$0.00
$0.00
$0.00
%
3. Building Space
$0.00
$0.00
$0.00
%
4. Communication / Utilities
$0.00
$0.00
$0.00
$0.00
%
5. Printing / Supplies
$0.00
$0.00
$0.00
6. Equipment
$0.00
$0.00
%
7. Other
$0.00
$0.00
$0.00
%
B : Agreement Services
$0.00
$0.00
$0.00
%
8. Services Subcontracted
$0.00
$0.00
$0.00
9. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
%
10. DEDUCTIONS
a. Total Local Match
$0.00
$0.00
$0.00
%
b. Program Income Used
$0.00
$0.00
$0.00
c. TOTAL DEDUCTIONS
$
$0.00
$0.00
%
11. NET EXPENDITURES
$0.00
$0.00
$0.00
%
PART C: EXPENDITURES ANALYSIS
A. Expenditures by Services Year to Date: 2. Units of Services Year to Date
3. Number of People Served Year to Date
1. Information .................... $0_00
........................ W.
2. Assistance ................... 0.00
..................... $000
.......................... 0.00
3. Counseling ..................... 0.00
.
�
........................
4. Respite ... ...................... $0$0_00
$0_00
..........................
5. Supplemental Services...... 0.00
.....
.... .............. .
........................ $0_00
...... .. ...... I ....... I... 0.00
6. TOTAL .......................... 0.00
.......................... 0.00
Part B Line 11, column 3 should be equal to this total.
PART D: GRANDPARENT SERVICES (reported by Federal Fiscal
Year)
FFY $ FFY
$
FFY
$
Match $ Match $
Match $
DOEA FORM 105AE revised 12/08
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ATTACHMENT A
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ATTACHMENT B
STATE OF FLORID DEPAR TMENT OF ELD
Program /Facility Name:
Monroe County Board of County Commissioners,
Social Services/In -Home Services
Address
Completed By
City, State, Zip Code I Date I Telephone
PART I.
READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH
WILL HELP YOU IN THE COMPLETION OF THIS FORM.
1. Briefly describe the geographic area served by the program /facility and the type of service provided:
2. POPULATION OF AREA SERVED. Source of data:
Total # % White %Black % Hispanic %Other % Female
3. STAFF CURRENTLY EMPLOYED. Effective date:
Total # % White %Black °lo Hispanic % Other % Female % Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date:
Total # %White %Black %Hispanic % Other % Female % Disabled % Over 40
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total # % White % Black % Hispanic % Other % Female % Disabled
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 NA or NO, explain.
7. Compare the staff composition to the population. Is staff representative of the population?
If NA or NO, explain.
NA YES NO
❑ ❑ ❑
NA YES NO
❑ ❑ ❑
8. Compare the client composition to the population. Are race and sex characteristics representative
of the Population? If NA or NO, explain.
CIVIL RIGHTS
COMPLIANCE
CHECKLIST
AFFAIRS
County: Dade I Alliance /Provider
NA YES NO
❑ ❑ ❑
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9. Are eligibility requirements for services applied to clients and applicants without regard to race
color, national origin, sex, age, religion or disability? If NA or NO, explain. NA YES No
AA -1729
10. Are all benefits, services and facilities available to applicants and participants in an equally effective
manner regardless of race, sex, color, age, national origin, religion or disability? If NA or NO, explain.
NA YES NO
❑ ❑ ❑
11. For in- patient services, are room assignments made without regard to race, color, national origin or
disability? If NA or NO, explain.
NA YES NO
❑ ❑ ❑
12. Is the program /facility accessible to non - English speaking clients? If NA or NO, explain.
13. Are employees, applicants and participants informed of their protection against discrimination?
If yes, how? Verbal ❑ Written ❑ Poster ❑ If NA or NO, explain.
14. Give the number and current status of any discrimination complaints regarding
services or employment filed against the program /facility.
15. Is the program /facility physically accessible to mobility, hearing, and sight- impaired
individuals? If NA or NO, explain.
NA YES NO
❑ ❑ ❑
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE
EMPLOYEES
16. Has a self - evaluation been conducted to identify any barriers to serving disabled individuals,
and to make any necessary modifications? If NO, explain.
Page 50 of 71
AA -1729
17. Is there and established grievance procedure that incorporates due process in the
resolution of complaints? 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
❑ ❑
FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000
PART IV. OR MORE.
21. Do you have a written affirmative action plan? If NO, explain.
YES ❑ NO ❑
Page 51 of 71
AA -1729
Alliance USE ONLY
Reviewed By
In Compliance: YES rim*
Program Office
*Notice of Corrective Action Sent
Date
Telephone
Response Due
On -Site Disk Review
Response Received ! /"
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.)
3. Enter the total number of full -time staff and their percent by race, sex and disability. Include
the effective date of your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the
program or facility, and list their percent by race, sex and disability. Include the date that
enrollment was counted.
Enter the total number of advisory board members and their percent by race, sex, and
disability. If there is no advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program
will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR
80. This is usually a standard part of the contract language for DOEA recipients and their
sub - grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For
example, if 10% of the population is Hispanic, is there a comparable percentage of
Hispanic staff?
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
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80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the
provision of services or employment? Evidence of such may be indicated in staff and client
representation (Questions 3 and 4) and also through on -site record analysis of persons who
applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care,
laboratory services, physical and recreational therapies, counseling and social services
without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles,
appointment scheduling and accuracy of record keeping must be applied uniformly and
without regard to race, sex, color, national origin, religion, age or disability. Entrances,
waiting rooms, reception areas, restrooms and other facilities must also be equally available
to all clients, 45 CFR
80.3 (b).
11. For in- patient services, residents must be assigned to rooms, wards, etc., without regard to
race, color, national origin or disability. Also, residents must not be asked whether they
are willing to share accommodations with persons of a different race, color, national
origin, or disability, 45 CFR 80.3 (a).
12. The program /facility and all services must be accessible to participants and applicants,
including those persons who may not speak English. In geographic areas where a significant
population of non - English speaking people live, 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,
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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. Sclf- evaluation
is a four step process:
❑ With the assistance of a disabled individual /organization, evaluate current practices and
policies which do not comply with Section 504.
❑ Modify policies and practices that do not meet Section 504 requirements.
❑ Take remedial steps to eliminate any discrimination that has been identified.
❑ Maintain self - evaluation on file. (This checklist may be used to satisfy this
requirement if these four steps have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that
incorporate appropriate due process standards and provide for the prompt and equitable
resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to
coordinate efforts to comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's
policy of nondiscrimination on the basis of disability. This includes recruitment material,
notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR
84.8 (a).
20. Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids
to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary
aids may include, but are not limited to, interpreters for hearing impaired individuals, taped
or Braille materials, or any alternative resources that can be used to provide equally
effective services, (45 CFR 84.52 (d).
21. Programs /facilities with 50 or more employees and 550,000 in federal contracts must
develop, implement and maintain a written affirmative action compliance program in
accordance with Executive Order 11246. 41 CFR 60 and Title VI of the Civil Rights Act of
1964, as amended.
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ATTACHMENT C
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Department's Computer Use Policy and its Social Media Policy
Available at the Department's website at http:/ cldcr .tit�*_e.fl.usidoea /fi, iancialph
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ATTACHMENT D
BACKGROUND- SCREENING
E L D ER
�A 1a Ii / %l - P1� Affidavit oaf , Compliance W Employer
37� el -Ode' FLe7ithIV,
AUTHORITY: This form Is required annually of art[ ikmployers to comply with the attestation
requirements sat forth in section 435.05(3�, Florida Statutes.
The term "ernp aye means any person ar entity recIaired oy law to conduct ba"grmnd screenirg,
including but not limiter to, area Agencies on Agi ^g, .Aging Resource Cem:ers, Aging, and Disabilit•5-
Resou-ce Congers, Lead Agencies, Long Term Cart Q„budsma Program, Serving Elea -tn I"urarce Needs.
of Elde -s Program, Service Providers, Diversion Providers, and a other person or entity which nire5.
c • ^pl cryces or nuns vol,Antca� s in se v who meat tnL: dL:T n it wi cal a dirttt scrvir.c provider, Se �§
415 02, 430 0402, FI:I SP at
P A d rt-iT. tirry ire provider is ",i per5o* ':tl Ve Of a84- ur Olde" w^�o, j)-Jr '44a1t TO 1 3 p'09r,l1I to nrnvid e
5erv1ce 'n :he Plderly ham Aire c, `ace -lo-Face rontact wl'h a client wh.le praviding sewic:es io The chant
and I'?as access t o the c tent's living area, fords, pprsonal property, ar persor.al ide ,trficeion informa -ion
as defined in s. 811 SGS. The term ncl"cles coordinatars, managers, ar supervisors of residential
facilities, and volunteers.." § 430.041D2(1I(bI, Fla_ Stat_
ATTESTATION -
A3 the duty authorized representative o�
located at
Emp( vier Ivarne
SEre2tAddress - city
5twte ZJP Code
I, do hereby affirm cinder penalty of perjury
N ame of Rejarieser^tatiiiw
that the above -earne=d i,-nployer is in cornloiiance with _ha p•ovisiors of Chapter 435 ana section
430.0402, Flnrida Statutp� rPgarrling level 2 background scref-ning.
Vgna`:r,re- of Respresfntative Date
STATE OF FLORIDA, COUN Y OF
Sworr to for afffir -ned) and subscrined aefore me th day of _ _ - - _ _ , 20_ _ , by
Mama a" Representative) whu r3 pe known
to me or prod ur _ _ _as proof of identification.
Pnrt '•pr:, o ^anF Cnm nlsvoned Marne at r, atatY PL n 11 Notary Ptrbl IC
0OFA for.. 335 A'r j,.vii it nE.! s.i a _rr.l, i"r. Ffr.,l:iv A1,61 ?012 Se~ t :in 13= 051,3; f S
Farm e- �bltar .. _._ .. LJ' .'L- .r4�- I_ .L e, dl. .u,
Page 56 of 71
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ATTACHMENT E
Verification of Employment Status Certification
As a condition of contracting with the Alliance for Aging, Inc.,
, hereby referred to as contractor, certifies
the use of the U.S. Department of Homeland Security's E- verify system to verify the employment
eligibility of all new employees hired by Provider 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)
Title
Company Name
Date
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ATTACHMENT F
Alliance for Aging, Inc.
Business Associate Agreement
This Business Associate Agreement is dated , 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) (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. Subpart C 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 Catch -all definition. The following terms used in this Agreement shall have the same meaning
as those terms in the HIPAA Rules: Access, Administrative Safeguards, Authentication,
Availability, Breach, Confidentiality, Data Aggregation, Designated Record Set, Disclosure,
Electronic Protected Health Information (ePHI), Health Care Operations, Individual,
Information System, Integrity, Malicious Software, Minimum Necessary, Notice of Privacy
Practices, Password, Physical Safeguards, Protected Health Information (PHI), Required By
Law, Secretary, Security Incident, Subcontractor, Technical Safeguards, Unsecured Protected
Health Information, and Use.
2.2 ARRA. The American Recovery and Reinvestment Act (2009)
2.3 Business Associate. "Business Associate" shall generally have the same meaning as the term
"business associate" at 45 CFR 160.103, and in reference to the parry to this Agreement, Monroe
County Board of County Commissioners, Social Services /In -Home Services.
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2.4 Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered
entity" at 45 CFR 160.103, and in reference to the parry to this Agreement, shall mean Alliance
for Aging, Inc.
2.5 HIPAA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and
Enforcement Rules at 45 CFR Parts 160 and 164.
2.6 HITECH. The Health Information Technology for Economic and Clinical Health Act (2009)
2.7 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning
as those terms in the HIPAA Rules.
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 under Subpart C of 45 CFR Part 164,
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 hannful 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, but not later
than ten (10) days following the discovery, 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
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(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
IN
(b) Business Associate agrees to make any amendment(s) to PHI in a Designated Record Set
CD
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.
E
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
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(c) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Care Operations).
3.15 To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s)
under the Privacy Rule, Business Associate agrees to comply with the requirements of the
Privacy Rule that apply to Covered Entity in the performance of such obligation(s).
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 as Required
By Law, as well as to perform functions, activities, or services for, or on behalf of, Covered
Entity as specified in any and all contracts with Covered Entity provided that such use or
disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum
necessary policies and procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement, Business Associate may
use PHI for the proper management and administration of the Business Associate or to carry out
the legal responsibilities of the Business Associate.
5.2 Except as otherwise limited in this agreement or any related agreement, Business Associate may
disclose PHI for the proper management and administration of the Business Associate, provided
that disclosures are Required By Law, or Business Associate obtains reasonable assurances from
the person to whom the information is disclosed that it will remain confidential and used or
further disclosed only as Required By Law or for the purpose for which it was disclosed to the
person, and the person notifies the Business Associate of any instances of which it is aware in
which the confidentiality of the information has been breached.
5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as
permitted by 45 CFR § 164.504(e)(2)(i)(B), only when specifically authorized by Covered
Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State
authorities, consistent with 45 CFR §164.5020)(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 www.allia fore g. 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.
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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 and HITECH 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 and HITECH shall be effective the later of
February 17, 2010 or the effective date of the earliest contract entered into between covered
entity and business associate that involves the use of PHI or ePHI.
8.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business
Associate, Covered Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end the violation and
terminate this agreement if Business Associate does not cure the breach or end the violation
within the time specified by Covered Entity;
(b) Immediately terminate this agreement if Business Associate has breached a material term
of this Agreement and cure is not possible; or
(c) If neither termination nor cure is feasible, Covered Entity shall report the violation to the
Secretary.
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section, upon
termination of this agreement, for any reason, Business Associate shall return all PHI and ePHI
received from Covered Entity, or created or received by Business Associate on behalf of
Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or
agents of Business Associate. Business Associate shall retain no copies of the PHI and ePHI.
(b) In the event that Business Associate or Covered Entity determines that returning the PHI
or ePHI is infeasible, notification of the conditions that make return of PHI or ePHI infeasible
shall be provided to the other party. Business Associate shall:
1. Retain only that PHI which is necessary for Business Associate to continue its proper
management and administration or to carry out its legal responsibilities;
2. Return to Covered Entity (or, if agreed to by Covered Entity, destroy) the remaining
PHI that the Business Associate still maintains in any form;
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3. Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part
164 with respect to the ePHI to prevent use or disclosure of the PHI, other than as provided for
in this Section, for as long as Business Associate retains the PHI;
4. Not use or disclose the PHI retained by Business Associate other than for the purposes
for which such PHI was retained and subject to the same conditions set out at Section 5.0
"Specific Use and Disclosure Provisions" which applied prior to the termination; and
5. Return to Covered Entity (or, if agreed to by Covered Entity, destroy) the PHI retained
by Business Associate when it is no longer needed by Business Associate for its proper
management and administration or to carry out its legal responsibilities.
The obligations of Business Associate under this Section shall survive 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 parry as follows (or to such
other place as any parry 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 Street, 2n Floor
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.
LO
(signature)
Date:
Business Associate:
Monroe County Board of County Commissioners,
Social Services /In -Home Services
(signature)
Date:
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ATTACHMENT G
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder Helpline
AGING AND DISABILITY RESOURCE CENTER (ADRC) — OUTSOURCED FUNCTIONS
I. If applicable, the provider agrees to the following:
A. Perform ADRC outsourced functions in accordance with the Alliance's policies and
procedures.
i. Policies and Procedures for Outsourced Function - Screening
ii. Policies and Procedures for Outsourced Function - Triage
iii. Policies and Procedures for Activation from Waitlist- Client Services
iv. Policies and Procedures for Termination from Waitlist- Client Services
B. Maintain wait lists in CIRTS in accordance with DOEA requirements.
C. Report number of client contacts to the Aging and Disability Resource Center.
D. Adhere to prioritization policy as set forth by DOEA on a monthly basis. Reference
DOEA Notice of Instruction: Assessed Priority Consumer List#: 062906- 1 -I-OVCS as
applicable.
E. Ensure the agency's Disaster Plan reflects ADRC Outsourced Functions, annually or as
needed to incorporate ADRC outsourced functions.
F. Ensure against conflicts of interest and inappropriate self - referrals by referring consumers
in need of options counseling or long -term care services beyond the provider's scope of
services to the Aging and Disability Resource Center.
G. Ensure that services provided are in the clients' best interest, are the most cost effective,
of high quality, and are responsive and appropriate to the assessed needs.
The Assessed Priority Consumer List (APCL) is maintained when services funded by the department
are not available. Contracted providers of registered services for Alzheimer's Disease Initiative (ADI)
and Older American's Act (OAA) maintain waiting lists in the CIRTS database for registered services
when funding is not available.
Registered Services for the above listed programs are as follows: Adult Day Care (ADC), Adult Day
Health Care (ADHC), Chore (CHO), Escort (ESC), Home Delivered Meals (HDM), Home Health Aide
(HHA), Homemaker (HMK), Model Day Care (MDC), Personal Care (PECA), Facility -Based Respite
(RESF), In -Home Respite (RESP).
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Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for Outsourced function — Screening
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that a comprehensive list of clients in need of services is maintained in CIRTS by
appropriate funding source and that the ADRC is thereby able to effectively gauge the level
of elder service need in Miami -Dade and Monroe Counties.
Policy: To obtain necessary information from clients in order to assist in determining level of need
and eligibility for DOEA funded services
Procedure:
1. ADRC Contracted Providers will collect information from callers and conduct a 701A
assessment. Alternatively, if a 701B assessment already exists or is provided from another
source (Le. CARES) the information from the 701B can be utilized.
Based on the information provided via the 70IA(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.
The caller will be provided with general information regarding the ADRC as well as the
ADRC Elder Helpline contact number.
The caller will be informed of the services and funding sources that they are being placed on
the wait list for in CIRTS.
7. ADRC Contracted Provider will create a client record in CIRTS (if there is no existing
record) and enter the services needed for the caller by funding source and service. [If there is
an existing record in CIRTS, the appropriate fields will be updated].
8. If the ADRC Contracted Provider determines that the caller may qualify for more than one
funding source, ADRC Contracted Provider is encouraged to enter the appropriate
information under multiple funding sources. [If there is an existing client record in CIRTS,
the client record in CIRTS will be updated with appropriate information].
9. ADRC Contracted Provider will inform caller that they will receive a follow -up call (or home
visit in case of active client) to check on their status based on DOEA Wait List Reassessment
Standards and encourage caller to contact the ADRC Elder Helpline with any questions.
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Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Outsourced function - Triage
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that clients in need of DOEA funded services receive services based on the highest
level of need, first, as funding becomes available.
Policy: To assist clients in obtaining DOEA funded services as funding becomes available, based on
level of need as determined by a CIRTS priority score.
Procedure:
1. ADRC Contracted Provider will conduct periodic follow -up calls (or home visit in case of active
client) to check on client status based on DOEA Wait List Reassessment Standards.
2. Based on the information provided via the 701A(B) assessment, the ADRC Contracted Provider
will update the client information in CIRTS specifically as it pertains to level of need for
services by funding source.
3. The ADRC Contracted Provider will ensure that the CIRTS prioritization score is accurately
maintained, according to DOEA Standards.
4. If the caller is in need of a service(s) that is not provided by the ADRC Contracted Provider, the
ADRC Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC
Referral Form and/or to an ADRC Contracted Provider that provides the needed service.
5. The caller will be informed of the services and funding sources that they remain on the wait list
for and/or have been removed from the wait list for.
6. ADRC Contracted Provider will advise client of any change in their CIRTS priority score based
on the updated information.
7. ADRC Contracted Provider will remind client of the ADRC Elder Help Line contact number
and to contact the ADRC Elder Help Line with any questions or concerns.
8. As funding becomes available, ADRC Contracted Provider will run CIRTS Prioritization Report
and activate clients according to DOEA Standards (refer to ADRC Client Activation Policies
and Procedures). The Contracted Provider will apply targeting criteria, as appropriate, to
prioritized clients to ensure activations meet programmatic requirements.
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Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Activation From Wait List — Clients /Services
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that elders in need of DOEA funded services in Miami -Dade and Monroe Counties
and on the CIRTS wait list begin to receive services as funding becomes available.
Policy: ADRC will work with ADRC Contracted Providers to ensure that clients waiting for DOEA
funded services begin to receive those services as funding becomes available.
Procedure:
1. ADRC Contracted Provider will activate clients on CIRTS wait list based on DOEA
prioritization polices and funding availability.
2. ADRC Contracted Provider will update CIRTS status by funding source and service for any
services being activated for the client using appropriate CIRTS codes.
3. Client may be left on wait list of a different funding source than the one being activated if
ADRC Contracted Provider determines that it is appropriate.
4. Client may also be left on wait list in CIRTS if they are being activated by the ADRC
Contracted Provider under a temporary non -DOEA funding source and ADRC Contracted
Provider determines that the clients' need will persist after the temporary funding source is
exhausted.
5. ADRC Contracted Provider will inform the client of any services /funding source that they are
being activated for as well as those services and funding sources that they will continue to be
wait listed for.
6. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have
any questions or concerns regarding the status of any of their services.
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AA -1729
Alliance for Aging, Inc.
Aging and Disability Resource Center /Elder Helpline
Policy and Procedure for
Termination From Wait List — Clients /Services
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that the comprehensive list of clients in need of services in CIRTS is appropriately
maintained by funding source and that the ADRC is thereby able to effectively gauge the
current level of elder service need in Miami -Dade and Monroe Counties.
Policy: ADRC will maintain an accurate and current list of clients in need of elder services in Miami -
Dade and Monroe Counties with the assistance of the ADRC Contracted Providers.
Procedure:
1. ADRC Contracted Provider will re- screen clients which the ADRC Contracted Provider initially
placed on the CIRTS wait list for services based on DOEA Reassessment Standards.
The re- screening may be in the form of a phone screening or a home visit depending on the
clients status (i.e. active /pending)
3. ADRC Contracted Provider will determine if the client is no longer in need (or eligible) for any
of the services they were wait - listed for.
4. ADRC Contracted Provider will terminate the client from the wait list (entirely or by specific
service) using the appropriate CIRTS termination code for any services or funding source for
which the client is determined to no longer be eligible for or no longer in need of
5. ADRC Contracted Provider will inform the client of any services /funding source that they are
being removed from the wait list for.
6. ADRC Contracted Provider will inform client of their ability to be re -added to the wait list if
their level of need should change.
7. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have
any questions or concerns regarding their wait list status.
8. Reference DOEA Notice of Instruction: Assessed Priority Consumer List4:062906- 1- I -OVCS as
applicable.
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AA -1729
Aging and Disability Resource Center
Monthly Client Data Report Instructions
NOTE: All Service Providers are required to submit the Client Data Report on a monthly
basis at the same time that they submit the Surplus Deficit Report and related expenditure
plan to the Contract Manager.
Total # of Personal Contacts (Calls, Walk -ins, Mail, E -mails or Faxes): This is a count of all contacts
during the reporting period from individuals seeking information, referral or assistance for themselves or
others received by the ADRC, satellite office, any outsourced entity, or, to the extent possible, all access
points with which the ADRC has an agreement. Contacts include telephone calls, walk -ins, mail, a -mails
or faxes for the entire planning and service area. These are communications related to ADRC functions,
including ADRC- related one -to -one outreach contacts when consumers are provided with information,
referral or assistance for themselves or others. They do not include ADRC public education activities.
Administrative and personal contacts are excluded. This number is not an unduplicated count.
Documentation for the total count by type of contact and source receiving the contact must be maintained
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AA -1729
ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
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 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 Provider 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 Provider understands that the contract to which this form is an attachment may be terminated by
the Alliance if the Provider 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.
Signature
(Same as contract signature)
Title
Company Name
Date
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