Item C7 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 7/16/14 Division: Social Services
Bulk Item: Yes X No Department: Social Services
Staff Contact Person: Sheryl am (305)292-45 10
wboh
AGENDA ITEM WORDING: Ratification of the Alzheimer's Disease riltiative Program
Contract#KZ 1497 between the Alliance for Aging,Inc. (AAA)and Monroe County Board of County
Commissioners(Social Services/In Home Services)for the contract period of 7/1/14 to 6/30/15, in the
amount of$83,407.00.
ITEM BACKGROUND: Approval of the ADI contract will enable Monroe County In Home
Services to continue providing services to Monroe County's elderly population under the Alzheimer's
Disease Initiative Program.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted by the BOCC on 4/16/14 for
amendment#003 to the Alzheimer's Disease Initiative(ADI)Contract 4 KZ1397,between the Alliance
for Aging,Inc.(AAA)and Monroe County Board of County Commissioners(Social Services/In Home
Services)for the contract period of 7/1/13 to 6/30/14.
CONTRACT/AGREEMENT CHANGES: n/a
STAFF RECOMMENDATIONS: Approval
TOTAL AMOUNT OF GRANT:$83,407.00
TOTAL COST: $8,340.70(cash) BUDGETED: Yes No
COST TO COUNTY: $8,340.70(cash) SOURCE OF FUNDS: Grant funds plus match dollars
REVENUE PRODUCING: Yes X No AMOUNT PER: MONTH: YEAR: $4.800
(client co-payments)
Ya
APPROVED BY: County Atty��
/Purchasing Risk Management
DOCUMENTATION: included x Not Required To Follow
DISPOSITION: AGENDA ITEM#
Revised 8/06
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with:Alliance For Aging, Inc. Contract: KZ1497
Effective Date: 7/01/2014
Expiration Date: 06/30/2015
Contract Purpose/Description: Ratification of the Alzheimer's Disease Initiative Program(ADI)
Contract#KZ 1497 between the Alliance for Aging, Inc.(AAA)and Monroe County Board of County
Commissioners(Social Services/In Home Services)for the contract period of 7/1/14 to 6/30/15,in the
amount of$83,407.00.
Contract Manager: Sheryl Graham 2924510 Social Services/Stop I
(Name) (Ext.) (Department/Stop
For BOCC_meeting on 7/16/14 Agenda Deadline: 7/1/14
CONTRACT COSTS
Total Dollar Value of Contract:approx.$83,407.00 Current Year Portion:$
—125-6153614
Budgeted: Yes No Account Codes: -
Grant:$83,407.00 —
County Match:$8,340.70(cash)
Additional Match:
Total Match$8,340.70(cash) A----D6-i7r`INj�L—COSTS
Estimated Ongoing Costs:$_/yr For.
(Not included in_-404ar value above) (e. Maintenance,:--- lities, 'toriaf,Wiwi etc)
CONTRACT REVIEW
Changes
Pate In Needed % . ...... Date Out
Division Director / j 1 , 1( 4",
4 'X
Yes li No fL >
Risk Management
Yes U No p"
O.M.BlPurchasing
Yes f No,,,/
County Attorney
Yes
Comments:
OMB Form Revised 2/2710! MCP#2
CONTRACT KZ- 1497 Page 1
ALZHEIMERS' DISEASE INITIATIVE CONTRACT 1A
2014-2015 Fiscal Year
JJIIS AGREENIEN-Fis entered into between the Alliance for Aging, Inc., hereinafter I-cferred
to as the "Alliance" and "Monroe County Board of Conirnissioners, Social Services/In-
I lome Services.", hereinafter referred to as the"provider,,, and collectively referred to as the "parties."
WHEREAS, theAlliaricc has been desh-mated as the area agency on aging for planning and Service ,Area
encompassing Miami-Dade and Monroe Counties, and
WHEREAS, the Florida Department of Elder Affairs(the "Department") has entered into a Contract with
the Alliance to administer the Alzheimer 's disease Initiative Program in Miami-Dade and Monroe
Counties, and
NOW THEREFORE, in consideration of the services to be performed and payments to be made,
together with the mutual covenants and conditions set forth in this Contract, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions
specified in this contract including all attachments and exhibits, which constitute the contract
document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant
Department of Elder Affairs handbooks, manuals or desk books, as an integral part of the contract,
except to the extent that the contract explicitly provides to the contrary. III the event of'conflict III
language among any of the documents referenced above, the specific provisions and requirements
of the contract document(s) shall prevail over inconsistent provisions In the proposal(s) or other
,general materials not specific to this contract document and identified attaclullents.
3. 'Term of Contract
Effective Date:
This contract shall begin on July 1, 2014 or on the date the contract has been signed by both
parties, whichever is later.
Delivery of services shall end at midnight, local time in Miami, Fl- on June 30, 2015. 'File
Alliance will not reimburse the provider for services provided after this date. however, the
parties recognize that they will need to perf*c)n-n continued activities relating to reporting),,
invoicing and payment in July of 2015 to tacilitate payment for services rendered by the provider
under this contract through and including the contract expiration date of July 15, 2015.
4.0 Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions ot'd-lis
contract III all 31110LInt not to exceed $ 83.407 or the rate Schedule, SLII.�jeCt to the availability of
I'Linds. Any costs or services paid for under any other contract or from any other source are not
eligible for paVIIICIIt under this contract.
4.1 Obligation to Pay
I-lie Alliance's performance and ohh'-'at1011 to J-KIV Under tills contract is contin(yent
�q)oll S111 annual appropriation by the Legislature to the Department and Cun(IIIIP
CCCCIc ed 17v the Alliance Under its contract kd Oil the Department.
4.2 Source of Funds
CONTRACT KZ- 1497 Page 2
The costs of services paid Linder any other contract or from rmy other source are not
cligible for re1111bL1rSC17C11t Under this colitract. 'l lie funds awarded to the pro%ider
Pursuant to this contract are in the state grants and il(tstl)l)ropi-i,.itiotis .iii(I consists
of the
Program Title Year Funding Source CSFA# Fund
Amounts
A 1)1 2014- General ReVenLleiTobacco S83,407
2015 Settlement Trust Funds
I I
TOTAL FUNDS CONTAINED IN THIS CONTRACT-. S83,407
5. Renewals
The contract may be renewed on a yearly basis for no more than four additional years. Such
renewals shall be contingent upon satisfactory performance evaluations as determined by the
Alliance and the availability of funds. Any renewal of a contract shall be Subject to mutual
agreement, confirmed in writing, and subject to the same terms and conditions set forth in the
initial contract. The renewal price, or method for deterrnining a renewal price, is set forth in the
bid, proposal, or reply. No other costs for the renewal may be charged.
6. Compliance with Federal Law
6.1 If this contract contains federal funds the following shall apply:
6.1.1 The Provider shall comply with the provisions of 45 CFR 74 and/or 45 CFR 92, and other
applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Provider shall comply with all
applicable standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended
(42 U.S.C. 7401, et seq.), s, 508 of the Federal Water Pollution Control Act as amended (33 U.S.C.
1251, et seq.), Executive Order 11738, as amended, and where applicable Environmental
Protection Agency regulations 40 CFR 30. The Provider shall report any violations of the above to
the Alliance.
6.1.3 The Provider, or agent acting for the Provider, may not use any federal funds received in
con-nection 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
S 100.000.00. the Provider must, prior to contract execution, complete the Certification Regarding
Lobbying form, vrr.w IENI ENT H. All disclosure fornis as required by the Certification
Regarding Lobbying f0rrn must be completed and returned to the Contract Manager prior to
payment Linder this contract.
6.1.4 In accordance with Appendix ,\ to 2 CFR 215. the Provider shall comply with Executive Order
11246. 11"CILIZil L".111PIOVInent Opportunity, as amended by EXCCLltl%'e Order 11375 and others, and as
supplemented In Department of Labor regulation 41 CFR 60 and 45 Cl`R 92. if applicable.
6.1.5 If this contract Contains 1ederal binds and pro%ides ser�iCCS to Children Up to 'hIC lei. the Provider
Comply with the Pro-Children Act of 1994 (-'() U.S.C. 6 0 S I ).
6.1.6 A contract aiward Mth am ami7unt CXIIeCtCCi to C(ILIA Or CXCCed S25.000.00 and Cert,1111 other
contract awards %r111 not be imide to parties listed on the Fxcluded parties List
S,,stcrii. M accordancc \�ith the ()MB 12LlidC1111CS M 2 CFR ISO that Implement FxcCut1%L: 01-dcrs
2
CONTRACT KZ- 1497 Page 3
1 254Q and 12089, Dcharment and SLISI)CIlSioll." The Fxcluded Parties List System, contains the
names of pm-ties debarred, suspended, or otherwise excluded by agmicles, as well as parties
&Clal-Cd IFIC11411ble trader statutory or rCu1UIat0rV a1.1010ritv other than FXCCLltlVC Order 12549, 1 Ile
Provider shall comply with these provisions before doing business or entering into subcontracts
receiving federal funds I)UrSLlallt to this contract. The Provider shall complete and shill
ATTACHMENT V prior to the execution of this contract.
6.2 The Provider shall not employ an unauthorized alien. The Alliance will consider the employment
Of unauthorized aliens a violation of the Immigration and Nationality Act (8 U,S.C. 13^)4a) and
the Immigration Reform and Control Act of 1986 (8 U.S.C. I 10 1). Such violation will be cause
for unilateral cancellation of this contract by the Alliance.
6.3 It' 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
Z,
Protection Act or for any other reason, the Provider must notify the Alliance in writing within
thirty (30) days of receiving the IRS notice of revocation.
6.4 The Provider shall comply with Title 2 CFR Part 275 regarding Trafficking, in Persons.
Unless exempt under 2 CFR Part 170.1 10(b), the Provider shall comply with the reporting
requirements of the Transparency Act as expressed in 2 CFR 170.
7. Compliance with State Law
7.1 "Phis contract is executed and entered into in the State of Florida, and shall be construed, performed and
enforced in all respects in accordance with the Florida law, including Florida provisions for conflict of
laws.
7.2 The Provider shall comply with requirements of s. 287.058, F.S. as amended.
7.2.1 The Provider shall provide units of deliverables, including various client services, and in sorne
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).
7.2.2 The Provider shall submit bills for fees or other compensation for services or expenses in sufficient
detail for a proper pre-audit and post-audit.
7.2.3 It'iternized payment for travel expenses is permitted in this contract, the Provider shall submit bills for
any travel expenses in accordance with s. 112.061. F.S., or at such lower rates as may be provided in
this contract.
7.2.4 "I he Provider shall allow Public access to all documents. papers, letters, or other public records as
defined in Subsection 119.01102), F.S., made or received by the Provider in conjunction with this
contract except for those records which are made confidential or exempt by law. The Provider's refusal
to comply with this provision will constitute an immediate breach of contract for which the Alliance
IMIV unilaterally terminate the contract.
7.3 If clients are to he transported under this contract, the Provider shall comply with the provisions of
Chapter-427, F.S., and Rule 4 1-2, F. A C.
7.4 1 he provider may not sLihcontract with any indlti Iduals or entities on tile discrilliniator-v, \candor 11"t
hecausc tilev may slot trall.sZiCt business %kith any 11LINIc C1111tV. 'ill acc0rdaJJCe wltll the pro %isions of"',
7,1 1 .S
3
CONTRACT KZ- 1497 Page 4
7.7 I'lie Provider shall comply %\-ith the provisions of s, 11 J)62, F.S., and s. 216.347, 1".S.. which prohibit
the expenditure of Contract funds to[- tile purpose of lobbying the legislature, judicial branch or a state
7.6 In accordance with ,, 2S7.135 F.S., any (..'ontractor on the Scrutinized Companies with Activities in
Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Fneri-,y Sector List
(Lists), created pursuant to s. 215.473 F.S,, is ineligible to enter into or renew a contract or agreement
with the Department for goods or services of S I million or more. Pursuant to s. 257.135 I S., the
Department may terminate this Contract and any contract or a(_Yreement incoij)orating, this Contract by
reference it'the Contractor Is found to have submitted a talse certification of its status on the Lists or
has been placed on the Lists. Further, the Contractor is subject to civil penalties, attorney's fees and
costs and any costs Cor investigations that led to the finding of false certification. If any contract or
agreement incorporating this Contract contains SI million or more, the Contractor shall complete and
sign ATTA(:HNITNT 14, Certification Regarding Scrutinized Companies Lists, prior to the execution of
this Contract.
8. Background Screening
The Provider shall ensure that, prior to providing services, all persons having access to vulnerable
elders and children. their livim, area, hands or personal properly, or protected health information
pertaining to such individuals, will pass a Level It criminal background screening in accordance with
the requirements of s. 430.0402 and Ch. 435, F.S., as amended. These provisions apply to employees.
Subcontractors, consultants, direct service providers and volunteers. Consequently, any commitment
for employment, purchase of services, or Volunteer program participation will be contingent upon the
passing of a Level It background check. The background screening will include employment history
checks as provided in s. 435.03(l), F.S,, and both local and national criminal record checks coordinated
through law enforcement agencies.
C
8.1 For purposes of this section, the term -direct service provider" means a person 18 years of age or older
who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a
client while providing services to the client or has access to the client's living areas or to the client's
funds or personal property. This term includes coordinators, managers, and supervisors of residential
8.2 facilities and volunteers.
Background Screening Affidavit of Compliance - To demonstrate compliance with section 6 of this
Master Contract, the Contractor shall submit ATTACHMENT G, Background Screening Affidavit of
Compliance annually, by January l5th.
8.3 Further information concerning the procedures for background screening is found at
lit t p:/ eldera ffai rs.state.fl.us,cloca/backgrouiidscreeiiing.php.
9. Grievance and Complaint Procedures
9.1 Grievance Procedure
I'lie Contractor shall comply with and ensure subcontractor compliance with the 'Onlifulull Guideline
for Recipient Grievance Procedures, Appendix D. Department of Elder Affairs Pro-rains and Services
I landbook, to address complaints regarding the termination, SUSPCnSiOn or reduction of services, as
required for receipt of funds.
9.2 Complaint Procedures:
-lie Contractor shall develop and implement coniptaitit procedures MW ensure that Subcontractors
de\elop and Implement complaint procedures to process and resolve client dissatist,lactioll %kith
('0111plairit procedures shall address the duality ,md timeliness of services, provider rind
direct ser%ice workcr complaints. or any other rid\Ice rclatcd to complaints other than tcrillinat1011,
or reduction in services that require the grievance process <Is described in Appendix 1).
4
CONTRACT KZ- 1497 Page 5
Department of L]der Affairs Programs and Serviccs Handbook. The complaint procedures shall
Include notification to all clients of the coniptaint procedure and Include tracking the date, nature of
the complaint and the determination of the complaint.
IU. Audits, Inspections, Investigations, Public Records and Retention
I The provider shall establish and maintain books, records, and documents (including electronic storak_ye
media) in accordance with generally accepted accounting procedures and practices that sufficiently
and properly reflect all revenues and expenditures of funds provided by the Alliance Linder this
contract. Provider a--rees to maintain records, including paid invoices, payroll registers, travel
vouchers, copy logs, postage logs, time sheets, etc,, as supporting documentation for sel-vice cost
reports and for administrative expenses itemized for relinbUl-Sell"Ient. '['his documentation will be
made available upon request for monitoring and auditing purposes. Whenever appropriate, financial
information should be related to performance and unit cost data.
10.2 The provider shall retain all client records, financial records, SLIPPOI-ting documents, statistical
records, and any other documents (including electronic storage
media) pertinent to this contract for a
period of six (6) years after completion of the contract or longer when required by law. In the event
an audit is required by this contract, records shall be retained for a minimum period of'six (6) years
after the audit report is issued or until resolution of any audit findings or litigation based oil the terms
of this contract, at no additional cost to the Alliance.
10.3 Upon demand, at no additional cost to the Alliance, the Provider shall facilitate the duplication and
transfer of any records or documents during the required retention period in Paragraph 10.2.
10.4 The Provider shall assure that the records described in Paragraph 10 will be subject at all reasonable
times to inspection, review, copying, or audit by federal, state, or other persormel duly authorized by
the Alliance.
10.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Alliance,
the Department and federal auditors, pursuant to 45 CFR 92.36(i)(10), will be allowed full access to
and the right to examine any of the Provider's contracts and related records and docurnents pertinent
to this specific contract, regardless of the form in which kept.
10.6 The Provider shall provide a financial and compliance audit to the Alliance as specified in this
contract and in ATTACHMEN'r III and ensure that all related third-party transactions are disclosed
to the auditor.
10.7 'The Provider shall comply and cooperate immediately with any inspections., reviews, investigations,
or audits deemed necessary by the office of the Inspector General pursuant to s, 20.055, F.S.
10.8 The Provider shall maintain and file with the Alliance such progress, fiscal arid inventory and other
reports as the Alliance may require within the period of this contract.
10.9 The Provider shall submit management, program, and client identifiable data, as specified by tile
Department of Elder Affairs and/or the Alliance. The provider must record and submit program
specific data in accordance with the Department's Client Information Registration and Tracking
System(CIR-IS) Policy Guidelines.
10.10 It'. under anv contract or agreement incorporating this Contract by reference. tile Contractor is
providitw, services and is actin,-, on behalf of the Department of Elder Affairs or the Alliance t()r
Auffl(-" Inc. is provided Linder section 119.011(2), Florida Statutes. the Contractor, :subject to the
tcnils of section '187.058(1)(c). Florida Statutes, and any other applicable legal and equitable
rclllcdics. shall:
M Kecp and Illaintaill public records that ordinarily and necessruily WOUld be required hV the I)LI1111c
,igmicy In order to perfOrin the services.
5
CONTRACT KZ- 1497 Page 6
11) Provide the Public With aCCCSs to public records on the same terms and conditions that the
Dcpartment ofI_lder .;\ft'alrs or the \lllatice f0r ,,\olng, Inc. would provide the records and at cost
Z� - I
that does not exceed the cost provided in Chapter 111), Florida Statutes, or as otherwise provided by
law.
C) Ensure that public records that are exempt or confidential and exempt frOln public records
disclosure requirements are not disclosed except as authorized by law,
(1) kfeet all requirements for rctainill(IZ* public records and transfer, at no cost, to the Department of
Flder Affairs or the Alliance for Aging, Inc. all public records in possession of the Contractor upon
tennination or expiration of any contract or agreement incorporating this Contract by reference and
destroy any,duplicate public records that are exempt or confidential and exempt from public records
disclosure requirements. All records stored electronically must be provided to the Department of
10.11 L"Ider Affairs or the Alliance for Aging, Inc. in a format that is compatible with the information,
technology systems of the Department.
The Alliance for Aging, Inc, may unilaterally cancel this Master Contract, and any contract or
agreement incorporating this Contract by reference, notwithstanding any other provisions of this
Contract, for refusal by the Contractor to comply with Section 8 of this Contract by riot allowing
public access to all documents, papers, letters, or other material made or received by the Contractor in
conjunction with the contract or agreement incorporating this Contract by reference, unless the
records are exempt from Section 24(a) of Article I of the State Constitution and Section 1 19.07(l),
Florida Statutes.
11. Nondiscrimination-Civil RiLyhts Compliance
11.1 The Provider shall execute assurances in ArrziLcHMENT VI that it will not discriminate against any
person in the provision of services or benefits under this contract or in employment because of age,
race, religion, color, disability, national origin, marital status or sex in compliance with state and federal
law and regulations. The Provider further assures that all Providers, Subcontractors, subgrantees, or
others with whom it arranges to provide services or benefits in connection with any of its prograrns and
activities are not discriminating against clients or employees because of age, race, religion, color,
disability, national origin, marital status or sex.
11.2 During the term of this contract, the Provider shall complete and retain on tile a timely, complete and
accurate Civil Rights Compliance Checklist (AT'rACHMENT B).
4��
11.3 The Provider shall establish procedures pursuant to federal law to handle complaints ot'discrimination
involvin- services or benefits through this contract. "these procedures will include notifying clients,
employees, and participants of the right to file a complaint with the appropriate federal or state entity.
11.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit
frorn federal financial assistance, and are binding upon the Provider, its successors, transferees, and
assignees for the period during which such assistance is provided. The Provider further assures that all
subcontractors, vendors, or others with whom it arranges to provide services or benefits to participants
or employees in connection with any of its programs and activities are not discrinlinatiril, at-,ainst those
participants or employees in violation of the above statutes, regulations, guidelines. arid standards. In
z�
the event of failure to comply, the Provider understands that the Alliance may. at its discretion. seek a
court order rcquiring, compliance with the terms of this assurance or seek other appropriate-Judicial or
,,ldjrlijljSnat'\r , but not limited to� termination of arid deni,-. ance.
I e relief. includiniz iI of further assist
12. Pro%ision of Services
Vile 11ro\ider shall prop;ide ,ervices in the manner described in in ATTACHMENT I of this agreement
1111d in the Service Pro \Ider Application (SPA). In the event of Conflict between the Set-,ice Provider
\ppticatlon and this contract, the contnict language prevails.
6
CONTRACT KZ- 1497 Page 7
13. Monitoring, by the Alliance for At4in
The Alliance will perform administrative and prograininatic nionitoring, of the provider to ensure
contractual cornpliance, fiscal accountability, performance, and compliance with
prograinniatiic I
applicable state and federal laws and regulations.
13.1 The provider will supply progress reports, including data reporting requirements as specified by the
Alliance or the Department to be used for rnonnoning, progress or performance of the contractual
scr%ices as specified in this contract. Following the norms set down by the Department, the Alliance
%\,III track performance on a monthly basis, throu(0i desk reviews ofavailable fiscal. CIRTs, and
research production reports and any other system or process designated by the Alliance. Examples of
review criteria are SLII-PILls,,deficit, independent audits, internal controls, reimbursement requests,
Subcontract inon toring. targeting. prograrn cligibili 1 1 Z7 t, Z7 I_,I lty� OLItCOIlle Measures, service provision to clients
designated as -high, risk- by the Department of Children & Families, Adult Protective Services
program, data integrity, co-payments, client satisfaction, correspondence, and client file reviews.
13.2 The provider shall permit persons duly authorized by the Department or the Alliance to inspect and
copy any records, papers, documents, facilities, goods and services of the provider which are relevant to
this contract, and to interview any clients, employees, and subcontractor employees of the provider to
be assure the Alliance of the satisfactory perfon-riance of the terms and conditions of this contract.
Following Such review, the Alliance will deliver to the provider a written report of its findings and
request for development, by the provider, of a corrective action plan (CAP) where appropriate. The
Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as
determined by the Contract Manager.
13.3 Extraordinary Reporting
The provider shall notify the contract manager for the Alliance immediately, but no later than within 48
hours, from the provider's awareness or discovery of conditions that may materially affect the
provider's ability to perform, such as problems, delays, or adverse conditions which may impair the
provider's ability to meet the objectives of this contract or that may affect the health, safety or well-
beiric,of clients. The notice shall include a brief summary of the problem(s), a statement of the action
taken or contemplated, time frames for implementation, and any assistance needed to resolve the
Situation.
Examples of reportable conditions may include:
• proposed client terminations
• provider financial concerns/difficulties
• non-payment or untimely payment reported by vendors
• service documentation problems
■ au ureement non-compliance
• service quality problems and consumer complaint trends
• I 11PAA violatl()Tls
• Potential fraud allegations or accusations of malfeasance by board members,
employees, volunteers, or other associates
I'lle \Illance shall 111vestl'-'ate alleLations re,-,ardinu, falsification of,cliclit 111torinatioll. service records.
J%iVrI1CIlt requests. grad Other related 111fol-IllatiOn. Substantiated al legat lolls shall be reported to tile
Departnient*s contract manager and to law cliforceinclit Is "Ippropriale.
7
CONTRACT KZ- 1497 Page 8
In IIIC CVCIIt that a SItUatI011 results in the cessation of services by a subcontract, the provider retains the
responsibility for performance of all services covered by this contract and MUSt ensure that clients
continue receiving services WIHIOLIt Interruption, e. exercising their* emergency procurement
procedures, temporary aSSLI'nptiOfl of the direct provision of services, etc.
14. Coordinated Monitoring with Other ,k_-encies
If the Provider receives funding from one or more of the State of Florida other human service
agencies, in addition to the Department of Elder Affairs, then a joint monitoring visit including such
other agencies may he scheduled. For the purposes Of this contract, and pursuant to s. 2287.0575. F.S.
as amended, Florida's human service agencies shall include the Department ot'Children and Families,
the Department of Health, the Agency for Persons with Disabilities, the Department of Veterans
Affairs, and the Department of`Elder i tfairs. U'pon notification and the Subsequent scheduling Of Such
a visit by the desigiated agency's lead administrative coordinator, the Provider shall comply and
cooperate with all monitors, inspectors, and/or investigators.
15. Indemnification
"'Elie provider shall indemnify, defend, arid hold harmless the Department and the Alliance and their
officers, agents, and employees from any claim, loss, damage, cost, charge, or expense whatever
nature or character arising out of any acts, actions, neglect or omission, action in bad faith, or violation
of federal or state law by the provider, its agents, employees, or subcontractors during the performance
of this contract, whether direct or indirect, and whether to any person or property. It is understood and
agreed that the provider is not required to indemnify the Alliance for claims arising Out of the sole
negligence of the Alliance.
The provider's obligation to indemnify, defend, and pay for the defense or, at the Department's and
or the Alliance's option, to participate and associate with the Department and/or the Alliance in the
defense and trial of any claim and any related settlement negotiations, shall be triggered by the
Department's and/or Alliance's notice of claim for indemnification to the provider. The provider's
inability to evaluate liability or its evaluation of liability shall not excuse the provider's duty to defend
and indemnify the Department and or the Alliance, upon notice by the Department and/ or the
Alliance. Notice shall be given by registered or certified mail, return receipt requested. Only in
adjudication or judgment after the highest appeal is exhausted specifically finding the Alliance solely
negligent shall excuse performance of this provision by the provider. The provider shall pay all costs
and fees related to this obligation and its enforcement by the Department and/or the Alliance. The
Alliance's failure to notify the provider of a claim shall not release the provider of the above duty to
defend and indemnify.
15.1 Except to the extent permitted by s. 768.28. F.S., or other Florida law. Paragraph 15 is not applicable
to contracts executed between the Alliance and state agencies or subdivisions defined in s. '/68.28(2),
F.S.
16. Insurance and Bondin
16.1 The provider MLISt carry adequate liability insurance and worker's compensation Insurance coverage, on
a comprehensive basis, and InLISt hold such liability and worker's compensation insurances at all times
durin.g, the effective period of this contract and any renewal(s) or extension(s) of this contract. -rhe
Alliance shall be included as an additional insured on the provider's liability insurance policy or
policies and a copy of the Certificate of Insurance shall be provided annually or NNhen any
chances —occur. I he provider accepts full responsibility f)r identifying and deterininintz the type(s)
and extent of liability insurance necessary to provide reasonable tinancial protections tier the provider
and the Clients to he SCIAed under this contract. (.Tpon execution of this contract. the pro%ider shall
Curnish the ,\11 i'llice written verification fICZIti0I1 ',!Ij)p0FtiI11_1 both the determination and CXIStCI1CC Of SLICII
HISLII",'InCe co4craiue. the limits of'co%er.n_,e under each policy maintained by the provider do not limit.
8
CONTRACT KZ- 1497 Page 9
the provider's liability and obll(lat'011S under this contract. The provider shall ensure that the All', I I I lance
has the most Current written verification of insurance co%crLl(,e throu�,hout the term of this contract.
t, -
The Department and the Alliance reserve the right to rccluire additional 111SUranCe where appropriate.
z'
16.2 ThFOL11-1110LIt the term Of this contract, the provider must maintain all insurance bond from a responsible
C011111lerclal l'llSUrallCC COMIXIlly CO\Crilit, all officers, directors, employees and agents of tile provider,
z7
authorized to handle funds received Or disbursed under this contract. in all amount commensurate with
the funds handled, the degree of risk as determined by the insurance company and consistent with good
business Practices.
16.3 If the provider is a state agency or subdivision as defined by section 768.28, F.S., the provider shall
furnish, upon request, written verification of liability protection in accordance with section 768.28, F.S.
Nothing herein shall be construed to extend any party's liability beyond that provided in section 768.28,
F.S, (See also Indemnification clause.)
17. Confidentiality of Information
"The Provider shall not use or disclose any information concerning a recipient of services under this
contract far any Purpose prohibited by state or federal law or regulations except with the written
consent of a person legally authorized to give that consent or when authorized by law.
18, Health Insurance Portabilitv anal Accountability Act
Where applicable, the Provider shall comply with the Health Insurance Portability and Accountability
Act (42 USC 1320d.), as well as all regulations promulgated thereunder(45 CFR 160, 162, and 164).
19. Incident Reporting
19.1 The Provider shall notify the Alliance immediately, but no later than forty-eight (48) hours from, the
Provider"s awareness or discovery of conditions that may materially affect the Provider or
subcontractor's ability to perform the services required to be performed under this contract. Such
notice shall be made orally to the Contract Manager (by telephone) with an email to immediately
follow.
19.2 file 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 oil the statewide
toll-free telephone number (1-800-96A.BUSE). As required by Chapters 39 and 415, F.S., this
provision is binding upon both the Provider and its employees.
20. Bankruptcy Notification
During the term of this contract. the Provider shall immediately notify the Alliance if the Provider, its
assignees, subcontractors or affiliates file a claim t()r bankruptcy. Within ten (10) days after
notification, the Provider must also provide the following information to the Alliance: (1) the date of
film(, 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) tile name,
address, and telephone number of the bankniptcy attorney.
21. Sponsorship and Publicity
21.1 .Any nongovernmental organization which sponsors a prourarn financed partially by state funds or
fluids obtained from a state au'elicV shall, In publicizing, advertising, or describiril-I the sponsorship of
the program, state: hy, the State of Florida, Department ot'Elder Aft'airs and Alliance for
Aging Inc.*' If the sponsorship reference is in written material. the words -State of Florida,
I)Qparinicnt off.."Ider Affairs and the Alliance for A-in11_r" shall appear in the same size letters or type
'I's 111C name of the M'k-lalll I/atioll (ref.: section 2S0,25, F, S,). [111S shall 111CILIde. but IS, not limited to,
11W1 eorr,.:spondence or other publication or broadcast that refers tO SLIC11 proorani.
9
CONTRACT KZ- 1497 Page 10
21.2 I-lie pro\ldcr -,,hall not use the words -State of` Florida, Department of` Elder Affairs-and/or -Elie
Alliance f'or A�-,lriu, Inc." to indicate sponsorship of a program otherwise financed unless specific
authorization has been obtained by the Alliance prior to use.
22. Assi(-Innlellts
22.1 The provider shall not assign its rights and responsibilities under this contract without the prior
written approval of the Alliance. All contracts or agreements incorporating this Contract by
reference shall remain binding.; upon the successors in interest of either the Contractor or the
Alliance for Agin-, Inc,
22.2 No approval by the Alliance of'any assignment or subcontract shall be deemed in any event or in
any manner to provide for the incurrence of any obligation of the Alliance in addition to the dollar
amount agreed upon to this contract.
22.3 The State of Florida is at all times entitled to assign or transfer, in whole or part, its rights, duties,
or obligations under any contract or agreement to another L,,overnmental agency in the State of
I'lorida, upon giving prior written notice to the Contractor. In the event the State of Florida
approves transfer of the Contractor's obligations, the Contractor remains responsible t'(-)r all work
perforlued and all expenses incurred in cormection with the contract or agreement.
23. Subcontracts:
23.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to
this contract, whether actually furnished by the Contractor or its subcontractors. Any subcontracts
shall be evidenced by a written agreement sutZiect to all applicable terms and conditions of this
contract. Alliance approval of the service application presented by the provider shall constitute
Alliance approval of the provider's proposed subcontracts if the subcontracts follow the service and
funding information identified in the provider's service application. All other Subcontracts
proposed to be funded under this contract must be approved in advance by the alliance. The
provider agrees that the alliance shall not be liable to any Subcontractor in any way or for any
reason. The provider, at its expense, will indemnify and defend the Alliance against any
subcontractor claims.
23.2 The provider shall promptly pay any subcontractors. Failure to pay subcontractors pursuant to any
subcontract or as required by law may result in enforcement action under this contract.
23.3 The provider maintains responsibility for the monitoring and performance of all subcontracts M
accordance with all applicable federal and state laws.
23.4 The Contractor shall have a procurement policy that assures maximum free and open competition.
Such procurement policy must conform. as applicable, with Federal and State contracting and
procurement regulations, as set forth in Title 45 Code of` ederal Regulations (CFR) part 74- Sub-
Part C, Ch.287.057 Florida Statutes (F.S.), U.S. Office of Management and Budget (ONIB)
Circular 110, Florida Department ot'vlana(yernent Services(DMS) Rule 60A-1, Florida
Administrative Code, and with the Department ot'Llder Affairs program and Services Handbook
I()I".
23.5 The Contractor Shall Submit annually to the Alliance service cost reports, which reflect actual costs
of prw,1dlng each service by program. This report provides intorniation for planning and
iic�zotiatin- unit rates.
24. Independent Capacity of Provider
24.1 lhe prodder will he acting in its independent capacity and not as an employee. �iucnt Or
1'ellresclItatlVe of,the Alliance or the Dcparilllelit. The provider Shall not he deemed or construed 10 he
ti111 employee. a,-,ent Or l"CPrcSclltati%e of, tile Alliance or tile Department t'or any purpose
10
CONTRACT KZ- 1497 Page 11
Nothing contained in this contract is intended to, or shall he C011SIFLIed in anv manner, as creating or
establishing the relationship ofcniployer,employee between the parties.
24.2 The provider shall be responsible for completely supervising and directing the %vork Under this
contract whether performed by the provider or by any subcontractor that it may Litilize. The provider
shall be responsible for all subcontractors who perforrn work under this contract. File prop ider agrees
that It is as fully responsible for the acts and omissions of Its subcontractors and of'persons employed
by them as it is for the acts and omissions of its own employees.
24.3 It is further understood that the Alliance does not control the employment practices of the provider
arid shall not be liable for any wage and hour, employment discrimination, or other labor and
employment claims against the provider or its subcontractors. All deductions for social security,
withholding taxes, income taxes, contributions to unemployment compensation funds and all
necessary insurance for the provider shall be the sole responsibility of the provider.
25. Pavinent
25.1 Payments shall be made to the Provider as services are rendered and invoiced by the Provider, The
Alliance's Contract Tanager will have final approval of the invoice for payment, and will approve the
invoice for payment only if the Provider has met all terms and conditions of the contract, unless the
bid specifications, purchase order, or this contract specify otherwise. The approved invoice will be
submitted to the Alliance's finance section for budgetary approval and processing.
25.2 Pavnient Documentation Required
The provider shall maintain documentation to support payment requests which shall be available
to the Comptroller, the Department, or the Alliance upon request, Invoices must be Submitted in
sufficient detail for a proper pre audit and post audit thereof The provider shall comply with all
state and federal laws governing payments to be made under this contract including, but not
limited to the following: (a) paragraph (16) (b) of section 216.181, F. S., regarding advances; (b)
Rule 691-40.103 F.A.C. pertaining to Restriction of Expenditures from state funds; and (c) the
Contract Payment Requirements sub-section of' section C of the Reference Guide for State
Expenditures from the Department of Financial, Services
guidc�').
The provider shall maintain detailed documentation to support each item on the itemized invoice
or payment request for cost reimbursed expenses, including paid subcontractor Invoices, and will
be produced upon request by the Alliance. 'The provider shall only request reimbursement for
allowable expenses as defined in the laws and guiding circulars cited in this agreement, in the
Reference Guide for State Expenditures, and any other laws or regulations, as applicable, and that
administrative expenses do not exceed amounts budgeted in the provider's approved service
application.
The Contractor will certify that detailed documentation is available to support each Item oil the
itemized invoice or payment request for cost reimbursed expenses, fixed rate or deliverables
contracts or agr
eements incorporating this Contract by reference, including paid Subcontractor
invoices, and will be produced upon request by the Department. The Contractor will Further
certify that reimbursement requests are only for allowable expenses as defined in the laws and
� Llidin(_, circulars cited in Sections 6 and 7 of this Contract, in the Reference Guide for State
FXPCIldItLIres. and any other laws or regulations, as applicable, and that administrative expenses
do not exceed amounts budLeted in the Contractor's approved area plan as de%eloped in
;iccordal`ICC With and PLIrSLIJIlt to section 106(a) of the Older Aniericans Act of 1965. as amended.
25.3 Limit on Funding Obligations
I"he AI hance for Inc. acknowledges its obligation to pay the Contractor t'()I-tile pel-1,01"Inance
CONTRACT KZ- 1497 Page 12
of the: Cont r,,ic t or's ChAtICS and rCSpouSlhlll[iCS Set t'01-111 in any contract oraurceirient incOrporatilh-Y
this Contract by reference.
'I'lic Alliance shall not he liable to the provider for costs incurred or performance rendered unless
such costs and performances are strictly in accordance with the terms of this contract, Including but
not Illilitcd to tennis 00%crillih-1 the P1_0v PrOill'Sed performance and unit rates arid,or
reirribursernent capitations specified,
The Alliance shall not be liable to the provider for any expenditures which are not allowable costs
as defined by applicable federal or state law, or which expenditures have not been made in
accordance with the fiscal guidelines and requirements outlined by the Department.
The Alliance shall not be liable to the provider for expenditures made in violation of regulations,
the Older Arnericans Act, Department rules, Florida Statutes, or this contract.
26. Return of Funds
The Contractor shall return to the Alliance any overpayments due to unearned funds or funds
disallowed and any interest attributable to such funds Pursuant to the terrns and conditions of any
contract or agreement incorporating this Contract by reference that were disbursed to the
Contractor by the Alliance. In the event that the Contractor or its independent auditor discovers that
an overpayment has been made, the Contractor shall repay said overpayment immediately without
prior notification from the Alliance. In the event that the Alliance first discovers an overpayment
has been made, the Contract Nlanager will notify the Contractor in writing of such findings. Should
repayment not be made forthwith, the Contractor shall be charged at the lawful rate of interest on
the outstanding balance pursuant to s. 55.03, F.S., after Alliance's notification or Contractor
discovery.
27. Data Integrity and SafeLyuardint! Information.
The provider shall ensure an appropriate level of data security for the information the provider is
collecting or using in the performance of this contract. An appropriate level of security includes
approving and tracking all provider employees that request system or information access and
ensuring that user access has been removed from all terminated employees. The provider, among
other requirements, must anticipate and prepare for the loss of information processing capabilities.
All data and software must be routinely backed Lip to insure recovery from losses or outages of
computer systems. The security over the back-up data is to be as stringent as the protection
required of the primary systems. The provider shall insure all subcontractors maintain written
procedures for computer system backup and recovery. The provider shall, prior to execution of
this agreement, complete the Data Integrity Certification forni, ATTACHMENT IV.
28. Computer Use and Social Media Polic
The Departillent of Elder Affairs has implemented a new Social Media Policy, in addition to its
Computer Use Policy, which applies to all employees, contracted employees, consultants, CAPS and
\olunteers, including all personnel affiliated with third parties, such as, but not limited to. Area
Agencies on Aging and vendors. Any entity that uses the Department's computer resource systems
must comply with the Department's policy rcoarding social media. Social Nledia Includes, but is
not limited to blogs. podcasts. discussion t6rurns, Wikis, RSS feeds, video sharing, social networks
like NlySpace, Facebook and "I"witter, as well as content sharing networks Such �.IS llickr and
You I'Llbe (This policy is available on the Department's website at:
http://elderaffairs.state.fl.us/does/flnancial.p lip),
79. Conflict of Interest
I lie Provider shall establish SaCCI-ILlards to prohibit elliplo"ces. bo�lrd members, wanat zenient ,ind
subcontractors t'roill usill,_, their positions f0r a IN11-170Se that C01IStitUtCS Or j)l'CSClltS the a ppeara lice
12
CONTRACT KZ- 1497 Page 13
ot'personal or organizational conflict of interest or personal gain. No employee, officer or agent of'
the Provider Or SLII)COIltraCtOr Shall participate in selection, or in the awaird of an aureenient
supported by state or federal Cunds it' 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 gamily; (c) his or her partner, or; (d) an organization which employs. or IS abOLIt to
employ, ally of the above, has a financial or other interest in the firm selected f'(-)r award. The
Provider or subcontractor'.., 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 111LISt 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.
30. Public Entity Crime
Pursuant to s. 287.133, F.S., a person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not submit a bid, proposal, or reply on a
contract to provide any goods or services to a public entity-, may not submit a bid, proposal, or
reply oil 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 perfonn work as a contractor, supplier, subcontractor, or consultant under a
contract with any public entity, and may not transact business with any public entity in excess of
the threshold amount provided in s. 257.017, F.S., for CATEGORY TWO for a period of 36
months following the date of being placed on the convicted vendor list.
The provider represents and warrants that the provider, its officers, directors, senior management,
partners, employees or agents have not been convicted of any public entity crimes within the last 36
months. If the provider or any of its officers or directors is convicted of a public entity crime during
the period of this agreement, the provider shall notify the Alliance immediately. `Ton-compliance
with this statute shall constitute a breach of this agreement. The provider must ensure that it does
not enter into with any subcontractor on the convicted vendors list or otherwise prohibited from,
contracting for state funds pursuant to section 287.133, F.S.
31. Purchasing
Procurement of Products or Materials with Recycled Content.
Reusable materials and products shall be used where economically technically
feasible.
32. Patents, Copvri2hts, RoNalties
If this contract is awarded state funding and if any discovery, invention or copyrightable material is
developed produced (.)I- for which ownership was purchased in the course of or as a result of work
or Services performed under this contract, the Provider shall refer the disco%ery, invention or
material to the Alliance to be referred to the Department of State. Any and all patent rights or
copyrights accruing under this contract are hereby reserved to the State of Florida ill accordance
with Chapter 2S6, F.S,
33. Enier<,�enc% Preparedness and Continuitv of Operations
33.1 1 lic Provider shall, within thirty t
'"I)) calendar cla%'s of'the eXCCLIt101I Ot'this contract. ,UbIllit to the
Contraict %Iamwcr verification of tan emergency preparedness plan. III the cent of an cillengellcv,
13
CONTRACT KZ- 1497 Page 14
the Pi-(.)%ider shall notify the Alliance ot'emergency pro%IsIons.
33.2 In the event a situation rCSLIlts ill a ccs'satloll of, ser-,ices by a subcontractor, the provider shall
retain 'bil'ty COr j)ert*)I-nIaIICe, Under this contract and must follow procedures to ensure
etaill responst t I
COMMUItV of'olicrations W1010LIt interruption.
33.3 In preparation for the threat of an emergericv event as defined in the State of Florida
Comprehensl\e Eryicrgenc%, Management Plan, the Department may exercise authority over an
area agency or service provider a(uency to Implement preparedness activities to improve the safety
of the elderly in the threatened area and to secure area agency and service provider facilities to
minimize the potential impact of the event. These actions will be within the existing roles and
responsibilities of the area agency and provider.
resporisl 1 Z"�
33.4 In the event the President of the United States or Governor of the State of Florida declares a
disaster or state of emergency, the Department may exercise authority over an area agency or
service provider agency to implement emergency relief measures andlor activities.
Z��
14
CONTRACT KZ- 1497 Page 15
34. Equipment
34.1 I'Lluipment illeans: (a) an article ot'nonexpendable, tangible personal property havin,, a useful
Life of' more than one year and an acquisition cost which CCILMIS or exceeds tile lesser of' the
capitalization level established by the organization for the financial statement purposes, Or
S�JMOJA) [for federal Funds], or (b), nonexpendable, tangible personal property of a non-
consumable nature with .in acquisition cost ot'S 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 (Yeneral public, with
a Value or cost of S250.00 or more [for state funds].
34.2 Contractors and Subcontractors who are Institutions of Hiolier Education, Hospitals. and
Other Non-Profit Organizations shall have written property management standards in compliance
with 2 CFR Part 215 Administrative Requirements (formerly OMB Circular A-I 10) that include:
(a) a property list with all the elements identified in the circular; and, (b) a procedure for
conducting a physical inventory of equipment at least once every two years. (c) a control system to
insure adequate safeguards to prevent loss, damage, or thett of the equipment; and (d) maintenance
procedures to keep the equipment in good condition. The property records must be maintained on
file and shall be provided to the Alliance upon request. 'File Contractor shall promptly investigate,
fully document and notify the Contract 'Manager of any loss, damage, or theft of equipment. The
Contractor shall provide the results Of tile investigation to the Contract Manager.
Z7
34.3 The Contractor's property management standards for equipment acquired with Federal funds
and federally-owned equipment shall include accurately maintained equipment records with the
following information:
(I) A description of"the equipment;
(2) Manufacturer's serial number, model number, federal stock number, national stock number, or
other
identification number;
(3) Source of the equipment, including the award number;
(4) Whether title vests in the Contractor or the federal government;
(5) Acquisition date (or (late received, if the equipment was furnished by the federal government)
and
cost,
(6) Information from which one can calculate the percentage of federal participation in the cost of
the equipment (riot applicable to equipment furnished by the federal govcrrrrnent);
(7) Location and condition of the equipment and the date the information was reported;
(8) Unit acquisition cost; and
(9) Ultimate disposition data, Including (late of disposal and sales price or the method used to
determine
C'Urrent fair market %,IlUe ",here a Contractor compensates the federal awarding agency for its
4.4 F(julpinent purchased with federal l'unds with all acquisition cost over S-5,000.00 and
,2(jUIprYlC1lt purchased with state fUlldS With an dCqLIISltion cost over 5 1.00,00 that is specifically;,
idelltltled In the area plan approved by the Department is part of the Cost 01' CJI-IA111�_1 Out the
11CM111cs and functions of tile I INIlit iMards and Title (o%kilership) will vest III the ('oil t ractor.
subject to the conditions of,-, CUR Part 215 Administrative Requirements (16rinerly (AIR Circular
CONTRACT KZ- 1497 Page 16
1-1 10), Subpart C, paragraph 34. LqUipInCIlt purchased under these thresholds is considered
supplies and is not subject to property standards. Equipment: purchased with funds idcntificd in the
bUdUlCt attachments to a,yrccrricnts covered by any contract or agreenient Incorporating this
Contract by reference, or IdcrItIf-1Cd III the sub-agreernents with Subcontractors (toot included In 11
cost methodology), IS subject to the conditions ot' section 273, 1-'. S. and 60A-1.0017. F. A. C. or
.Title �;3 ('I,'R Part 74
equipment or materials provided
35.5 The Contractor shall not dispose of any by the Alliance, or
purchased with funds provided through any contract or agreement incorporating this Contract
without first obtaining tile approval of the Contract Manager. When disposing of property or
equipment the Contractor must submit a written request for disposition instructions to the
respective Contract Manager. 'file request should Include a brief' description of' the property,
purchase price, fundluL),' Source, and percentage of'state or federal participation, acquisition date and
condition of the property. 'The request should also indicate the Contractors proposed disposition
(i.e., transfer or donation to another agency that administers federal programs, offer tile items for
sale, destroy the items, etc.).
35.6 'The Contract ,Manager will issue disposition instructions. If disposition instructions are not
received within 120 (lays of the written request for disposition, the Contractor is authorized to
proceed as directed in 2 CFR Part 215 Administrative Requirements (formerly OMB Circular A-
I I()).
35. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon
the Provider or political subdivision granting to the state a security interest in the property at least
to the amount of state funds provided for at least 5 years from the date of purchase or the
completion of the improvements or as further required by law.
36. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager,
who shall reduce the decision to writing and serve a copy on the Provider.
37. Financial Consequences of Non-Performance
If the Provider fails to meet the rninit-nurn level of service or performance identified in this
agreement, or that is Customary for tile industry, then the Alliance must apply financial
consequences commensurate with the deficiency. Financial consequences may include, but are not
limited to, contract suspension, refusing payment, withholding payments until deficiency is cured,
tendering only partial payments, and/or cancellation of contract and reacquiring services from ail
alternate source.
37.1 The Provider will not be charized with financial consequences, when a failure to perform arises out
of'causes that were the responsibility ofthe Alliance.
38. No klVaiver of Sovereilln Immunity
Nothinu contained in this aLreenicrit is nitended to serve as a waiver of sot Immunity by any
entity to which sovereign immunity may lie applicable,
16
CONTRACT KZ- 1497 Page 17
39. Venue
If any dispute arises Out of this contract, the, VC11LIC of SUCII 1(21.11 recourse will lie Miami-bade
County, Florida.
39. Entire Contract
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements
or representations shall be valid or binding, upon the Alliance, or the Provider unless expressly
contained herein or by a written amendment to this contract signed by both Parties.
40. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances
beyond their control, provided the party experiencing the force ma jeure condition provides
immediate written notification to the other party and takes all reasonable efforts to cure the
condition.
41. Severability Clause
The Parties agree that if a court of competent.jurisdiction deems any term or condition herein void
or unenforceable; the other provisions are severable to that void provision and shall remain in full
force and effect.
42. Condition Precedent to Contract: Appropriations
The Parties agree that the Alliance's perfonnance and obligation to pay under this contract is
contingent upon an annual appropriation by the Legislature to the Department and a corresponding
allocation under contract from the Department to the Alliance.
43. Addition/Deletion
The Parties agree that the Alliance reserves the right to add or to delete any of the services required
L,
under this contract when deemed to be in the State of Florida's best interest and reduced to a
written amendment signed by both Parties. The Parties shall negotiate compensation for any
additional set-vices added.
44. Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract will
not constitute or be deemed a waiver of the Alliance's right thereafter to enforce those rights, nor
will any single or partial exercise of any such right preclude any other or further exercise thereof or
the exercise of any other right.
45. Compliance
The Provider shall abide by all applicable current federal statutes, laws, rules and regulations as
well as applicable current state statutes, laws, rules and regulations. The Parties agree that failure
of the Provider to abide by these laws shall be deemed an event of default Of the Provider, and
subject the contract to immediate, unilateral cancellation of the contract at the discretion of the
wall iar7ce,
46. Final Invoice
The Provider shall submit the final invoice for payment to the ,\111ance as specified in Para,'raphs
.3.4.1 and 3,4.1 !date for final request for payment! of;%'rT.kC11.N1ENT 1. If the Pro \i(ler f"'Ills
fir SU111111t filUll FCqUCSt for payment by tile deadline, then tall rl,ghts to payment may be forfeited and
tile \11janCC jjja%r not honor any t'C(ILIeStS submitted after the aforesaid ilme period. \ny payment
due under the terms of this contract may be withheld U11111 all reports due from the Pro%ider and
17
CONTRACT KZ- 1497 Page 18
nCCCSS,'lr-,1 adJUStInCrItS thereto have been appro%ed by the i\lliatice,
47. Rene(.,ofiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been
to writing The rate of payment ind the total
reducedand duly signed by both parties. M
dollar amount rnav be adjusted retroactively to reflect price level increases and changes In
the rate of payment when these have been established through the appropriations process
and subsequently identified in the Alliance's operating budget.
48. Termination
48.1 This contract may be terminated by either party Without Cause upon tic) 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 tor administration of the contract.
48.2 In the event funds fbr 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 ]land delivery to the Contract Manager or the representative
of the Provider responsible for administration of the contract. The Alliance will be the final
authority as to the availability and adequacy of funds. In the event of termination of this contract,
the Provider will be compensated for any work satisfactorily completed prior to the date of
termination.
48.3 This contract may be ten-ninated for cause upon no less than twenty four (24) hours' notice in
writing to the Provider. Waiver of breach of any provisions of this contract shall not be deemed to
be a waiver of any other breach and shall not be construed to be a modification of the terms and
conditions of this contract. The provisions herein do not limit the Alliance's or the Provider's
rights to remedies at law or)it equity.
48.4 Failure to have performed any contractual obligations with the Alliance in a manner satisfactory to
the Alliance will be a sufficient cause for termination. To be terminated as a Provider under this
provision, the Provider must have(1) previously failed to satisfactorily perform in a contract with
the Alliance, been notified by the Alliance of the unsatisfactory performance, placed by the
Alliance under a corrective action plan and failed to correct the unsansCiactory performance to the
satisfaction of the Alliance as outlined in the corrective action plan, or(2) had a contract
tenninated by the Alliance for cause.
48.5 Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other
breach and shall not be construed to be a modification of the terms and conditions of this contract.
fhe provisions herein do not limit the Alliance's right to remedies at law or to damages of legal
or equitable nature,
48.6 Suspension of%Vork:
If the Department ofJ-'1derAt*f.,lirs determines in its sole discretion suspend any or all activities
Under this Contract and any Contract or agreement incorporating this Contract by reference. at anv
tilllc, %k hell in the best interests of the State to do so. the Alliance will suspend the contractor's
\v M,k, As the Department provides the Alliance kvi th r,t,,l IlOtICC OW11111112' the INIFtiCLILU'S of
,LISpCIIS1011, these I-Ca1;011S will he coillillullicated to) the Contractor by the Alliance. [:xamples of
the I-CI.Soll 1'01- SLISpellSi011 HICILRIC. hLit care not IMINCd to, budgetary constraints. declaration of
18
CONTRACT KZ- 1497 Page 19
cmergericy. Or other such cirCLHIIStIIICCS. .After receiving a suspension notice, the('ontractor shall
CoMPIV With the notice and shall Trot accept any purchase orders. 'Nithin ninety 6ys. Or any
loiiuer period agreed to b,, the Contractor, the .Alliance shall either(1) issue a notice authorizil"121
I-CSLIMPtIO11 Oi'��Ork, at Which tMIC lCti\ItV 'ShLIII reSLI111e. Or (2) terminate the Contract or purchase
Order. Suspension of work shall not entitle the Contractor to any additional corripciis.itiori.
49. Successors
This Contract shall reni.iiii binding upon the successors in interest of' either the Alliance or the
provider.
50 Electronic Records and Signature
The AAA authorizes, but does not require, the Contractor to create and retain electronic
records and to use electronic signatures to conduct transactions necessary to carry Out the
terms of' this Contract. A contractor that creates and retains electronic records and uses
electronic signatures to conduct transactions shall Comply with the requirements contained
in the Ln fiwm Eleco-onic Ttwnsuction Act, s. 668.50, Fla. Stat. All electronic records must
be fully aUditable; are subject to Moi-i(hi 's Public Rccot-Is Law, ch. 119, Fla. Stat., must
comply with section 28, Data Intent-in and Sale''t 0�uw-ding Iq/' t-mation; must maintain all
confidentiality, as applicable; and must be retained and maintained by the Contractor to the
same extent as non-electronic records are retained and maintained as required by this
Contract.
50.1 The AAA's authorization pursuant to this section does not authorize electronic transactions
between the
Contractor and the AAA. The Contractor is authorized to conduct electronic transactions
with the
AAA only upon further written consent by the AAA.
50.2 Upon request by the AAA, the Contractor shall provide the AAA or DOEA with non-
electronic (paper) copies of records, Non-electronic (paper) copies provided to the AAA of
any document that was originally in electronic form with an electronic signature must
indicate the person and the person.s capacity who electronically signed the document on
any non-electronic copy of the document.
51
Special Provisions
The Contractor agrees to the following provisions:
5 1.1 Investigation of'Crinunal Allegations:
Any report that implies criminal intent on the part of the Contractor or any Subcontractors
and reterred to a governrental or irivestu4atory agency must be sent to the Alliance. Ifthe
Conti-actor has reason to believe that the allegations will be referred to the State Attorney, a
law entorcernent agency. the United States Attorneys office. or other governmental
agency. the Contractor shall notifv the contract mana-
--er. A COPY Ofall documents, reports.
notes or other written material concerning the itivestignition. whether in the possession of
the Contractor or Subcontractors, must he sent to the Alliance's contract niana(-Ter with a
'SLIIIIIII,IrV of the: IM eStI(_'MIOII and allcoulOns.
71.2 VOILIrItCerS:
19
CONTRACT KZ- 1497 Page 20
The Contractor 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 Contractor shall %vork in coordination with organizations that have experience
in providing training, placement. and stipends for volunteers or participants (sAlCfl as
organizations carrying out federal service programs administered by the Corporation for
t" I - 11.1�
National and Community Sel-VICC), in conimunitv service settings.
C,
51.3 Friforcernent:
51.3.1 In accordance with Section 430.04, F.S.. the Alliance may, without taking any
zn
intermediate measures available to it against the Contractor, rescind the Conti-actors
designation as an area agency on aging, ifthe Alliance finds that:
1= 11_�
5 1.3.2 An intentional or negligent act of the Contractor has materially affected the health,
welfare, or safety of clients served pursuant to any contract or agreement incorporating this
Conti-act by reference, or substantially and negatively affected the operation of services
covered under any contract or agreement;
51.3.3 The Contractor lacks financial stability sufficient to meet contractual obligations or
that contractual funds have been misappropriated;
51.3.4 The Contractor has committed multiple or repeated violations of legal and
0
regulatory standards, regardless of whether such laws or regulations are enforced by the
Alliance, or the Contractor has committed or repeated violations of Alliance standards;
5 1.3.5 The Contractor has failed to continue the provision or expansion of services after
the declaration of state of emergency-, and/or
51.3.6 The Contractor has failed to adhere to the terms of any contract or agreement
incorporating this Contract by reference.
51.3.7 In the alternative. the Alliance may, at its sole discretion, in accordance with
section 430.04, F.S.. take immediate measures against the Conti-actor, including: corrective
action, unannounced special monitoring, temporary assumption of the operation of one or
more contractual services. placement of the Contractor on probationary status, imposing a
moratorium on Contractor action, imposing financial penalties for nonperformance, or
other administrative action pursuant to Chapter 120, FS.
5 1.3.8 In making any determination under this provision the Alliance may rely upon the
findings of another state or tederal a,,encv, or other regulatory body. Any claims for
darna(_,es for breach of any contract or agreement incorporating this Contract by reterence
are exempt from administrative proceedings and shall he brOWTht before the appropriate
entity in the venue of'Miarni-Dade County
20
CONTRACT KZ- 1497 Page 21
51. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
The name, address, and telephone number of the representative for the Alliance t*(-)t- this contract
i S:
Jkix B. Rothinan, JD, LL.J1.
Pi-csickitt and CE0
760 NW 107"' Ave, Suite 214
Miami, Florida 33172
(305) 670-6500, Ext. 224
The name;, address, and telephone number of the representative of the provider responsible for
administration of the program under this contract is:
it. contract, and mailing address of the official payee to NIONROE COUNTY BOCC;SOCIAL,SERVICES IN HOME-File Contractor name, as shown on page I of this
SERVICES
whorn the payment shall be made is: 500 WHITEHEAD STREET-CURKS OFFICE
KEY WEST,Ft,0RIDA 33040
The name of the contact person and street address KINI WILKES WEAN-COMPLIANCE MANAGER
b. where Financial and administrative records are 1.100 SIMONTON STREET,SUITE 190
maintained is: KEY WEST, FLORIDA 33040
C. The name, address, and telephone number of the SHERYL GRAFIAM-SR DIRECTOR
representative of the Contractor responsible for 1100 SIMONTON STREET, SUITE 2-257
administration of the program under this contract is: KEYW WEST,FLORIDA 33040
I'lle section and location within the AAA where Associate Vice President Finance
cl• The
for payment and Receipt and Expenditure 760 NW 107th Avenue, SUite214
forms are to be mailed is: Miami, Florida 33172-3155
Contract Manager
The name, address, and telephone number of the Alliance for Aging, Inc.
e. Contract Manager tor the AAA for this contract is: 760 NW 107th Avenue, Suite 214
Nfianii. Florida 33 172-3 155
Upon change of representatives (narnes, addresses, tCICPIIO)le numbers) by either party, notice shall be provided in
writing to the other party and the lionticattion attached to the originals of this contract.
In the event different representatives are designated by either party after execution of this contract, notice
Ol'the name and address ot'the stew rcprescntati�e will be rendered in writing ting to the other party and ""aid
notification attached to originals ol'this contract.
21
CONTRACT KZ- 1497 Page 22
51. All Terms and Conditions Included
This contract and its Attachments, I dirou-1-i X, A, B, C, D, E, and any exhibits referenced in said
attaChrilell(S together with any documents incorporated by reference, contain all the teens and
Z7 1
conditions a(-,reed upon by the Parties. There are no provisions, tennis, 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.
C, -
IN WITNESS 'THEREOF, the Parties hereto have caused this 67 page contract, to be executed by their
undersigned officials as duly authorized.
Contractor Monroe County Board of
Commissioners, ALLL"CE FOR AGING, INC.
SIGNED BY: SIGNED BY:Z�a
NAME: ROMAN GAs"rESI NAME: MAX B. ROTHMAN,JD, LL.M.
TITLE: COUNTY ADMINISTRATOR TITLE: PRESIDENT AND CEO
DATE: le 261 /4 DATE:—
f
-1y ,I Ly
MON' E COUN
OXE
G
22
CONTRACT KZ- 1497 Page 23
INDEX TO ATTACHMENTS
Attachment I SERVICE PROVISIONS ALZHEIMER'S DISEASE INITIATIVE PROGRAM
Attachment 11 CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND AGREEMENTS
Attachment III FINANCIAL AND COMPLIANCE AUDIT
Attachment IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,
GRANTS, LOANS AND COOPERATIVE AGREEMENTS
Attachment V CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
Attachment VI ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII CONTRACT REPORT SCHEDULE
Attachment VIII ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Attachment IX REQUEST FOR PAYMENT FORM
Attachment X RECEIPT AND EXPENDITURE REPORT
Attachment A DOEA HANDBOOK
Attachment B CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C DOEA COMPUTER USE POLICY
Attachment D BACKGORUND SCREENING AFFIDAVIT OF COMPLIANCE
Attachment E E-VERIFY
Attachment F BUSINESS ASSOCIATE AGREEMENT
Attachment G AGING AND DISABILITY RESOURCE CENTER(ADRC)—OUTSOURCED FUNCTIONS
Attachment H CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
23
CONTRACT KZ- 1497 Page 24
ATTACHMEN'r I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. STATEMENT OF PURPOSE
The Alzheimer disease Initiative (A\Dl) Program is focused on caring for persons IS - with memory
disorders.
11. SERVICES TO BE PROVIDED
A. Services:
1. ,The provider's service provider application for state tiscal year 2014 and any revisions
thereto approved by the Alliance and located in the contract manager's file, are
incorporated by reference in this contract between the Alliance and the provider, and
prescribe the services to be rendered by the provider,
1 Consumers may riot be enrolled in a Department of Elder Affairs' state general revenue
funded program, including ADI, who are also enrolled in a Medicaid capitated long-
term care health plan or program.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the provider's
service provider application for state fiscal year 2014 and the 2013 Department of Elder
Affairs Home and Community Based Services Handbook. In the event the 2013 handbook
is revised, such revision will automatically be incorporated into the contract and the provider
will be given a copy of tire revisions.
111.INIETHOD OF PAYMENT
A. The method of payment in this contract is based oil a fixed rate reimbursement for approved
services. 'File provider must ensure fixed rates 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 all independent audit is required. All requests for payment
and expenditure reports submitted to support requests for payment shall be on DOER forms
106Z and 105Z. Duplication or replication of both forms via data processing equipment is
V
permissible, provided all data elements are in the same format as included on departmental
forms.
B. 111VOiCCS must be submitted no later than 90 days after the end of the month oil which the
expense Was Incurred, except that invoices can riot he submitted after close out report date
t usually July I 5th.) Invoices submitted late will not pay. Fxceptions to this rule are at the
discretion of the Alliance, on a case by case bask such exceptions must be requested prior to
ilie expiration of the invoicing deadline. In inaking, a determination ofthe exception the
\Iliaiicc will consider- %%hether the disruption to the billing cycle was beyond the control of
lie proti ider, the frequency with which such exceptions are I-C(JUCSTed by the prop;ider, and
lictlier the .alliance caii request reimbursement at a late date from I)(-*1',,V
24
CONTRACT KZ- 1497 Page 25
I'lle provider shall 111,11,11tain docU11IC11tal3'011 to Support payinent requests which shall be
available to the Comptroller, the Department of Elder z6liirs, or the Alliance upon request.
D. I'lle provider shall maintain documentation to support payment rCCILICSIS which '.,,hall be
available
val able to the Alliance, the Department of Elder Affairs or the Comptroller upon request.
E. 'rhe provider may request a Monthly advance for service costs for each of the tirst two
months ot'the contract period, based on anticipated cash needs. Detailed documentation
JUStifyin-cash needs for advances must be submitted with the signed contract, approved by
4-
the Alliance, and maintained in the contract manager's file. All payment requests for the
third tltrotah the twelfth 111011ths shall be based on the submission of monthly actual
expenditure reports beginning with the first month of the contract. The schedule for
submission of advance requests is ATTACHMENT 11 to this contract. Reconciliation and
recOLlpill" of advances made under this contract are to be completed by March and April. All
advance payments are Subject to the availability of funds.
F. Advance funds may be temporarily invested by the provider in an insured interest bearing
account. All interest eanied on contract fund advances must be returned to the Alliance
within thirty (30) days of the end of the first quarter of the contract period.
G. The Alliance shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rate(s) stated below:
Service Maximum j Maximum
Service to be Provided Unit Rate Units of Dollars
Service
In Flonie 1 -cspite----- S24.03 3,471 S83,407
H. ,-kiiy payment due by the Alliance under the terms of this contract may be withheld pending
the receipt and approval by the Alliance of complete and accurate financial and
programmatic reports due from the provider and any adjustments thereto, including any
disallowance not resolved.
IV. SPECIAL PROVISIONS
.k. State Laws and Regulations:
The provider agrees to comply with applicable parts ofRL11C 5,Sf)-1, Florida Administrative
Code promulgated tier administration ot'Sections 430.�01 through 430,504. Florida Statutes,
and the Department off"Ider Affairs Client Home and Community Based Services
I landbook dated 07 -'M 1.
B. .\ssessnicnt and Prioritization for Service Delivery for New Consumers:
25
CONTRACT KZ- 1497 Page 26
The followln,-, are the criteria to prioritize 11CW Consumers for service delivery. It is riot the
Intent of the Department of Elder Affairs to remove existing clients from any program in
order to serve new clients being assessed and prioritized for service delivery.
I Priority Criteria f0r Service Delivery:
a. individuals in nursing 110111CS under Medicaid who could be transferred to the
coininurilty,
1). Individuals in riursing homes whose Medicare coverage is exhausted and may be
diverted to the community;
c. individuals in nlirsliwy homes which are closing and can be discharged to the
coininunitv. or
d. An individual whose mental or physical health condition has deteriorated to the
degree self care is not possible, there is no capable caregiver and institutional
placement will occur within 72 hours.
2. Priority Criteria for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means of
service delivery. Functional impairment shall be determined through the department's consumer
assessment form administered to each applicant. The most frail individuals not prioritized in groups
one, two or three above, regardless of referral source, will receive services to the extent funding is
available,
C. Co-payment Collections:
I. The provider will establish annual co-payinerit goals. 'Fhe Alliance also has the option
to withhold a portion of the provider's Request for Payment if goals are not met
according to the Department of Elder Affairs' co-payment guidelines,
2. Co-payments include only the amounts assessed consumers or the amounts consumers
opt to contribute in lieu of an assessed co-payment. The contribution must be equal to
or greater than the assessed co-payment.
D. Evaluation, Statistics and Reports
The provider agrees to respond to requests for evaluation infori-riation and statistical data
concerning its Consumers based on information requirements of the Memory Disorder Clinics and
Brain Bank. The provider will ensure Model Day Care Centers supported by this contract
develop innovative therapies and interventions which can be shared With other Alzheimer's
disease Initiative health and social services personnel via training. Model Day Care Centers
supported by this contract must report to the provider all training activities provided to health care
and social service personnel and caregivers, as well as scree as a natural laboratory for service
related applied research by Memory Disorder Clinics. An annual Model Day Care' Center
'Fraining Report, ATTACIBILNT VV. is due by JL1tV 5, 2017.
F. Collaboration 'VFriflj Mernory Disorder Clinics:
26
CONTRACT KZ- 1497 Page 27
Mcniory Disorder('11mcs are required to pro%idC f0l.ir hours ofin-service training to all respite and model day Care
centers in their designated service areas. The provider agrecs to collaborate with Memory Dl order Chilies to assist ill
this CIT61-1.
F. Service Cost Reports:
The provider will submit annual service cost reports which reflect actual costs of providing each service by program.
This report provides information for planning and negotiating unit rates.
G. Reporting:
The provider need to provide the Alliance with an expenditure plan by July 15 or two weeks after contract has been
signed, a monthly update due on the 21 of each following month.
-rhe expenditure plan and updates must follow the format provided by the Alliance.
27
CONTRACT KZ- 1497 Page 28
ATTACIENIEN"I' ll
('ER'I'IFIC,-kTI0,N' REGARI)I�G LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS .AND
AGREEMENTS
The undersigned cenifies, to the best ot'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 fcdcrat agency, a member of congress, ,Ili
officer or employee of congress, all employee of a member of congress, or all 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 cooperzititie
agreement, and the eXtellSi011, 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, all officer or employee of congress,
or all employee ot'a member of congress in connection with this federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and Submit Standard Form-LI-L., "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, arid contracts under grants, loans arid cooperative agreements) and
17
that all sub-contractors shall certify and disclose accordingly.
"I'llis 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 shalt be subject to a civil penalty
of not less than S 10,000.00 and not more than$100,000.00 for each such failure.
Signature )ate
ROMAN GASJf1`SI-COUNTY ADMINISTRATOR KZ 1497
Name of Authorized Individual Application or Agreement Number
COUNTY B0,ARD OF CQUNJY CO3%EMISSIONERS
Name and Address of 0r(-1an1zatl01l
� .
DOLA I term 103
28
CONTRACT KZ- 1497 Page 29
,VFTACI I NI ENT III
FIN,kNCIALAND COMPLIANCE AUDIT
The adiiiinlstration of resources awarded by the Department of Elder .,,\ffairs or the .-Mhance Inc, to the providcr
may be subject to audits and Or monitorim, by the Department of'Elder Affairs or the Affiance for Aging, Inc., as described ill
tills section.
MONITORING
In addition to reviews of audits Conducted in accordance with 0,MB ClrCLllarA-I 33, as revised, and Section 21 5.97, F.S., (see
"AUDN'S" below), monitoring procedures may include, but not be Ili-tilted to, on-site visits by the department of staff, limited
scope audits as defined by 01NIB Circular A- 133, as revised, and/or other procedures. By entering into this agreement, the
provider aorees to comply and cooperate kvith any monitoring procedures/processes deemed appropriate by the Department of
Elder Affairs or the Alliance for Aging, file. In the event the Department of Elder Affairs or the Alliance for Agingy. Inc,
determines that a limited scope audit of the provider is appropriate, the provider agrees to comply with any additional
instructions provided by the Department of Elder ikffairs or the Alliance for Aging, Inc. to the provider regarding such audit.
The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed
necessary by the Chief inancial Officer(CFO) or Auditor General.
AUDITS
PART 1: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non-profit organization as define([ in OMB Circular
A-13 3, as revised.
fit the event that the provider expends $500,000 or more in Federal awards during its fiscal year, the provider must have a
single or program-specific audit conducted in accordance with the provisions of ONIB Circular A- 133, as revised. EXI-IIBI'I'
I to this agreement indicates Federal resources awarded through the Department of Elder Affairs or the Alliance for Aging
Inc. by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall consider all sources of
Federal awards, including Federal resources received from the Department of Elder Affairs or the Alliance for Aging, Inc.
The deten-nination of amounts of Federal awards expended Should be in accordance with the guidelines established by OMB
Circular A-1 33, as revised. Ali audit of the provider conducted by the Auditor General in accordance with the provisions of
OMB Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part 1, paragraph 1, the provider shall fulfill the requirements relative
Z:�
to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
if the provider expends less than S500,000 in Federal awards in its fiscal year, an audit conducted in accordance with the
provisions of OMB Circular A-133, as revised, is not required. fit the event that the provider expends less than S500.000 in
Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-
133, as revised, the cost of the audit must be paid from non-Federal resources (i.e- the cost Of such audit must be paid from
provider resources obtained front other than Federal entities.)
All audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to requirements, i any
with the Department of Elder Affairs or the Alliance for Aging, Inc. shall be based
oil the agreement's requirements, rules. reuulations. or statutes referenced in the aorecirient. f'he finaticial
-ill disclose whether or not the trimc requirement applicable
statements I Ill irernent was met for each . able ageernent. AH questioned
costs and liabilities due to the Department of'Elder Affialrs or the Alliance for Aging. Inc. sliall be fully disclosed in the audit
report with reference to the Department ofFider Affairs or the Alliance for ,A(-'lllg, file. agreement 111%oked. If Clot otherwise
disclosed ens required by Section .310(h)(2) Of OMB C1'1'CLIIir A-133, as revised. tile schedule Of' CXj)elld1tLll-CS of I�cdeml
Awards shall idclitif expenditures by agreement riLiniher for each agrecinent with the Department of' I-Ider :Affairs Or the
29
CONTRACT KZ- 1497 Page 30
Alliance for Auin Inc, in effect during, tile audit period, Financial reporting packages required under this PM1 Must be submitted \kithla
-
the earlier of'30 days after receipt of the audit report or 9nionths,after the end of the provider's ider*s fiscal year end.
PART 11: STATE FUNDED
'Illis part is applicable ifthe provider is a nonstate entity as defined by Section 215,977(2). Florida Statute.,;
In the e�cut that the provider expends a total amount of state financial assistance equal to or in excess of S500.000 in any fiscal \car of
SUCh provider(for fiscal years ending September 2004 or thereafter), tile provider must have a Stateg single orpro- t - ject-specific audit for
.such fiscal year in accordance with Section 215.07, Florida Statutes: applicable rules of the Department of Financial Services: and
Chapters 10.550 (local ('overrullenta
I entities) or 10.650 (nonprofit and for- profit organizations), Rules of the Auditor General. EXHIBIT
I to this agreement indicates state financial assistance awarded through the Department of Elder Affairs or tile Alliance for Aging. Inc. by
this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state
financial assistance. inClUdill" state financial assistance received fi-orii the Department of Elder Affairs or the Alliance forAging. Inc .
Z, Aging,
other state aoencies. and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and
reSOLirces received by a nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part 11, paragraph I, the provider shall ensure that the audit complies with the
requirements of Section 215.97(8), Elorida Statutes. This includes submission of a financial reporting package as defined by Section
2 15.9 IV), Florida Statutes. and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations). Rules of
the Auditor General.
If the provider expends less than $500,000 in state financial assistance in its fiscal year (fear fiscal years ending September 30, 2004 or
thereafter), an audit conducted in accordance with the provisions of Section 2 15.97, Florida Statutes, is not required, In the event that the
provider expends less than$500,000 in state financial assistance in its fiscal year and elects to have all audit conducted in accordance with
the provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the nonstate entity's resources (i.e., the cost of
such an audit must be paid from the provider resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover tile entire organization for the organization's fiscal year. Compliance findings
related to agreements with the Department of Elder Affairs or tile Alliance for Aging Inc. shall be based oil the agreement's requirements,
including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement
was met for each applicable agreement. All questioned costs and liabilities due to the Department of Elder Affairs or the Alliance for
Aging, Inc. shall be fully disclosed in the audit report with reference to the Department of Elder Affairs or the Alliance t*(.)r Aging Inc.
agreement involved. If'not otherwise disclosed as required by Rule 691-5.003, Fla. Admin. Code, the schedule of expenditures of state
financial assistance shall identify expenditures by agreement number for each agreement with the Department of Elder Affairs or the
Alliance for Aging, Inc. in effect during the audit period. Financial reporting packages required under this part must be submitted within
45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities.
Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9
months after the provider's fiscal year end. Notwithstanding the applicability of this portion, the Department of Elder Affairs or tile
Alliance for Aging, Inc. retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout
this document and pursuant to law.
PART Ill: 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-]33,as revised,by or on behalf of the provider directly
to each of the following:
I lie Alliance for A,_,in-. Inc.:
Alliance for Acying, Inc.
Attn: Fiscal Manager
760 NW 107" Avenue. Suite 214
Miarni, Fl,33172-3155
The Federal Audit Clearill,(1110LISe. in ( )\113 Circular A-I V', as rev iSed (111C M1111hCr OCCOPiCS FC(FAII-ed by SCORMS
"0 ((I)( I ) alld (2). (AI 13 ("I-CUlar I 33. as revised. should be submItted to the Federal, Audit Ocarim-,house). at the
I'011owim-, address:
00
CONTRACT KZ- 1497 Page 31
Federal Audit Clearinghouse
&I
Bureau of the Census
1201 East 10"' Street
Jeffersonville, IN' 47132
Other Fedcral tiocncics and pass-through entities in accordance with Sections .320 (c) and (C), ON113 Circular A-113, as
rev iscd.
Pursuant to Sections 320(f), 0%113 (,'Ircular A-133, as revised, the provider shall submit a copy of the reporting package
described in Section .320(c), 0013 Circular A-133, as revised, and any managernent, letter Issued by the auditor, to the
Alliance for A(mi,!. Inc. at each of the folloNvin(y addresses:
Alliance for Aging, Inc.
Attn: Fiscal Manager
760 NW 107 1h Avenue, Suite 214
Miami, Ell, 33172-3155
Additionally, copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or on behalf'of
the provider dLireglal ,to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Manager
760 NW 107 1h Avenue, Suite 214
Miami,.FL 33172-3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
'Tallahassee, Florida 32399-1450
Any reports, management letter, or other intbrination required to be submitted to the Department of Elder Affairs pursuant to
this agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes. and Chapters 10.550
(local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable.
Providers, when submitting financial reporting packages to the Department of Elder Affairs for audits done In
accordance with OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and
for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was
delivered to the provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider Shall retain sufficient records demonstrating its compliance with the terns of this agreerricrit for a period ot'six
%,cars froni the date the audit report is issued, and shall allow the Alliance for Aging. Inc. or its designee. the CFO or Auditor
(ierlel'al aCCeSS to Such records upon rCLILICSt. The provider shall ensure that audit working papers are made available to the
Alliance f0r Atzing, hic. . ()r its deslunce. CFO, or Auditor General Upon request fir a period of six ,,cars 1roin the date the
audit report IS iSSLIcd. unless extended in writing by the Alliance for Aging. Inc..
31
CONTRACT KZ- 1497 Page 32
ik'IJA C I I I I E NT III
EXHIBIT I
1. STATE RESOURCES AWARDED TO THE SU'BRECIPIENT PURSUANT TOTHIS
AGREEMENT CONSIST OFTHE FOLLOWING:
PROGRAM TITLE
FUNDING SOURCE I CSFA# AMOUNT
---------- ---------
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT' TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOT,-IL STA TEA W4RD
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97, F.S.
PROGRA,NITITLE FUNDING SOURCE CFDA AiNIOUNT
ADI
-----------------
TOT-IL AJV,lRD S83,407
32
CONTRACT KZ- 1497 Page 33
ATTAC I INI ENJ' III
EXHIBIT
PAR I' l: At.D1 Y RLI-AtIONSH I P DETFRMIN1,AHON
Providers who receive state or federal resources may or may not tie subject to the audit requirements (,)I'(),\—IB ircular A-133. as re%iseJ.
and.or Section 2 115.97. I.I a. St at, Providers %k I to are deternii tied to tie recipients or SUbrecipie tits of'federal awards and.or state financial
assistance may be subject to the audit requirements it'the audit threshold requirements set forth in Parr I and,or Part 11 of Exhibit I are
met. Prodders who ha%e been determined to be \endors are not subject
ject to the audit requirements of'0,%—IB Circular A-1 33, as revised.
and or Section 2 15,97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to tie
recipients or SLIbrecipients of Federal awards and.or state financial assistance, must comply with applicable programmatic and fiscal
compliance requirements.
In accordance with See, 210 of OMB Circular A-I 33 anctor Rule 691-5.006, FAC, provider has been determined to be:
Vendor or exempt entity and n t subject to O,%IB Circular A-133 and,or Section 2 15,97, F.S.
Recipient subrecipient SUbJect to ONIB Circular A-133 arid or Section 2 15.97, F.S.
NOTE: If a provider is determined to be a recipient,subrecipient of federal and or state financial assistance and has been approved by the
department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 691-.006(2), FAC [state financial assistance] and
Section 400 OMB Circular A-13 3 [federal awards 1.
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE :MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state
matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and
regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian'Tribal Governments(Formerly ONIB Circular A-87)*
OMB Circular A-102 --Administrative Requirements
OMB Circular A-133 —Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-I 22 -- Cost Principles)*
2 CFR Part 215 Administrative Requirements(Fon-nerly OMB Circular A-I 10Administrative Requirements)
Requirements)
OMB Circular A-133 -- Audit Requirements;
Reference Guide for State Expenditures
Other-fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF sT.vrE OR LOCAL GOVERNMENT) ;MUST FOLLOW:
2 (rTR Part 220 Cost Principles for Educational Institutions ONIB (Fornierly Circular A-2 I - Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly ONIB Circular A-110 --Administrative Requirements)
ONIB Circular A-133 -- Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
t,
*Some Federal programs may he exempted from compliance with file Cost Principles Circulars as noted in the OMB (.'ircularA-
133 Compliance Supplement, Appendix 1.
STvrE FINANCIAL ASSISTANCE. Providers Mio receive ,,rate financial assistance and %kho are determined to he a
recipient,suhrecipient. Must comply with tile f)lIowjjj,.! fiscal laws. rules and regulations:
'section
Chapter 601-5. Ha. Adnini, Code
State Projects (compliance 'supplement
Reference(111idc for State FXpendullres
)iher fiscal reqLlu'CMCIVS ',Ct forth in prograin laws, rules and regulations
33
-3 t4
lea LJ+
CONTRACT KZ- 1497 Page 35
ATTACHNIFNTIV
CERTIFICATION REGARDING, DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS. LOANS AND
(,'()()PER,k'1'1\'E .-1(",12EE.'\IEN'I'S
The undersigned. an authorized reprcsctitati,�,e of the contractor named in the contract or agreement to which this form is zn Z� � ,M
attachnient, hereby certities that:
(1) The contractor and any sub-COntractors of services Under this contract have financial management systems capable of
providing certain information, including: (1) accurate, cut-rent, and complete disclosure of the financial results of each
-rant-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.
J'he inability to process information in accordance with these requirements could result in a return of grant funds that
have not been accounted for properly.
(2) Management Information Systems used by the contractor, sub-contractor(s), or any outside entity on which the contractor
is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of
processing data accurately, Including year-date dependent data. For those systems identified to be non-compliant,
contractor(s) will take immediate action to assure data integrity.
(3) If this contract Includes the provision of hardware, software, firmware, microcode or imbedded chip technology, tile
undersigned warrants that these products are capable of processing, year-date dependent data accurately. All versions of
these products offered by the contractor (represented by the undersigned) and purchased by the State will be verified for
accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede
the hardware or software programs from operating properly, the contractor agrees to immediately make required
corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge
to the State, and without interruption to the ongoing business of the state, time being of the essence.
(4) The contractor and any sub-contractor(s) of services Linder this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data
integrity compliance issues.
The contractor shall require that the language of this certification be included in all subagreements, subgrants,
and other agreements and that all sub-contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB
Circulars A-102 and 2 CFR Part 215 (formerly OMB Circular A-1 10).
,%,IONROECOUN'I'YB(')ARDOFCOM,',,IISSIONERSIIOOSfMON'I'ONS'I SUITE 190 KEY WEST, FL.33040
game and ,,.' Ji�__s f,,Contractor
ADMINISTRATOR
Si<_,nature fide Datel
W)%I.A,N GASTFSI
I __------------—----------- __---------- ................
Name 0fAUthorizcd Signer
RO 1"'d
35
CONTRACT KZ- 1497 Page 36
,VFLXCILNIENTV
CER,rIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY .,ol)
VOLUNTARY EXCLU'SION FOR LONVER ,rIER 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) "'here the prospective contractor is unable to certify to any of the statements in this certification, Such prospective
participant ,,hall attach .in explanation to this certification.
C",
/I—
Sit.lnatl.ire Date
'Y
ROMAN GAS'FESI-COUNTY ADMINISTRATOR MON ROE COUNTY CC,
Y,
Title A(lency/Organization
('Certification signature should be same as Contract signature)
Instructions for Certification
,J,
I. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person,"
"primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections
of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by 2 CFR 376.10-
376.995). You may contact the Contract Manager for assistance in obtaining a copy of those regulations.
1 ']'his 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
(E 11 L S).
4. The contractor will include a Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
41� --
- Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier
covered transactions.
5. The contractor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who i I knowingly I I is
debarred, Suspended, determined Ineligible or voluntarily excluded from participation, unless otherwise authorized
by the federal glov,cr-nnient.
6. if the contractor knowingly enters Into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the
federal government, the department may pursue available remedies, including suspension, and/or debarment.
7. 1 lie contl-,WtOr 111.1%, rely upon a certification of prospective participant in a lower tier co%cred transaction that it 1-s
not dcharred, 1,L1SpC11dCLL HICII.gible, or %01U11t,'1J-11V CXClUdCd fi-0111 the CoNered t!"'InSaCtIOn. L1111css it knows that the
certification Is eIT011COUS,
36
CONTRACT KZ- 1497 Page 37
ATI-ACIENIENT NJ
ASSURANCE S—NON-CON ST RUCTION PROGRAMS
Public reporting burden for this collection of information Is estimated to avcra,e 45 rilinutes per response, including time 1'(,)r relit %ving
instructions. tiearclnn ,, existirw data Sources, oatherint, and maintainino the data needed and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, su including ggestions for
Z
red.1.46110 this burden, to tile Office ofMana-ernent 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 ITTOTHE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If
such is the case, you will be notified.
I. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds
Sufficient to pay the non-Federal share of project cost) to ensure proper planning, management, and completion of the project
described in this application.
2. Will give tile 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.
1 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 LJ.S,C. 4728-4763) relating to prescribed standards for merit
Z�
systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System ot'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 tile basis
of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on tile basis
of handicaps: (d) the Age Discrimination Act of 1975. as, amended(42 I,J.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 ('' rn oprehensive \Icohol Abuse arid 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 Ifealth 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 Vill of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing. (I)any other nondiscrimination provisions in the specific statute(s) under
which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may
apply to the application.
7. -itles 11 arid III of the uniform Relocation Assistance arid Real
Will comply. or has already complied. with the requirements of I
Property Acquisition Policies Act of 19710 (P.L. 9 1-646) which provide for fair and equitable treatment of persons displaced or %l hose
property is acquired as a result of Federal or federally assisted prograins. I'liese requirements apply to all interests in real property
acquired for protect purpose,; regardless of'Federal participation in purchase,,;.
\VIII conipl,", as applicable, %k ith the provisions of the. Hatch Act (5 U.S.C. I SO I -I S08 and 71 IIICIl limit the pryJjtiCjl
'1cm Itics of hose principal eniplo%ment acnvitics� are funded in %%hole or in part with I-ederal funds.
37
CONTRACT KZ- 1497 Page 38
9. will comply, as applicable. with the pro%isions of the, Dw,is-Bacon Act (40 U.S.C'. 270a to 176a_7). the Copeland Act (40 U,S,C
270c and 18 [J,S.(.:, 874) and the Contract Work Flours mid Safety Standards Act (40 U'S'C. 3'7-331), rcoardim-, labor
standards for federalk,assisted construction subaureeinents.
10, Will comply. it'applicable, with flood insurance purchase requirements ot'Section 102(a) of the Flood Disaster Protection Act of 19`3
(1)'L. 93-2 14) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance it
the total cost of insurable construction and acquisition is S 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 (111. 91-190) and Executive Order (EO) 11514: (h)
notification of violating facilities pursuant to E0 11 738: (c) protection of wetlands pursuant to EO I 1090 (d) evaluation Of flood
hazards in floodplains in accordance xith E0 11988, (e) assurance of project consistency with the approved State management
program developed under the Coastal Zone Nfanagement Act of 1972 (16 U.S.C. 1451 et (1) 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
seqj, (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523): and (h)protection of endangered species under the Endangered Species Act of 1973, as amended. (P.L. 93-205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13, Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974(16 U.S.C. 469a-I et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities
Supported by this award of assistance.
15, Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the
care, handling, and treatment of warn blooded animals field for research, teaching, or other activities supported by this award of.
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (421 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-]33, Audits of States, Local Governments,and Non-Profit Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
COUNTY ADMINISTRATOR
ROMAN GASTESI
APPLICANT ORGANIZATION DATE SUBMITTE
Monroe County Board of Commissioners.
38
CONTRACT KZ- 1497 Page 39
ATTACHMENT VII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
CONTRACT REPORT CALENDAR
Report L3ased-Qn Submit
Number to the Alliance
Qnjbls--?ate
1 July Advance * .............................. .......................... ... July 1
2 August Advance * .... .................. ......... July 1
3 July Expenditure Report ...1/12 Advance Reconciliation ......... August 10
4 August Expenditure Report ...1/12 Advance Reconciliation ...... September 10
5 September Expenditure Report ...1/12 Advance Reconciliation October 10
6 October Expenditure Report ...1/12 Advance Reconciliation ... November 10
7 November Expenditure Report ...1112 Advance Reconciliation December 10
8 December Expenditure Report ...1/12 Advance Reconciliation January 10
9 January Expenditure Report /...1/12 Advance Reconciliation February 10
10 February Expenditure Report ...1/12 Advance Reconciliation March 10
11 March Expenditure Report ......1/12 Advance Reconciliation April 10
12 April Expenditure Report ...1/12 Advance Reconciliation .......... May 10
13 May Expenditure Report ...1/12 Advance Reconciliation .......... June 10
14 June Expenditure Report...1/12 Advance Reconciliation .......... July 10
16 Final Expenditure and Closeout Report .-..... ................ July 20
Legend: Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Alliance prior to July 1 or until the
contract with the Alliance has been executed. Actual submission of the vouchers to the Department
of Elder Affairs is dependent on the accuracy of the expenditure report.
39
CONTRACT KZ- 1497 Page 40
ATTACHMENT VIII
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Printed Name of Person Signature of Person Date Executed
Completing Report Completing Report
The purpose of each model day care program must be to provide service delivery to persons suffering from
Alzheimer's disease or a related memory disorder and training for health care and social service personnel in the
care of persons having Alzheimer's disease or related memory disorders. This report documents the required
training for the State Fiscal Year July 1 st through June 30th.
Number Number Total
Actual Training Event(s) Health Care Social People
Professiona Services Trained
Is Trained Personnel
Trained
Training Title:
Date:
Training Su mary:
40
CONTRACT KZ- 1497 Page 41
,ATT,k(:11N, l ENT IN
REQUEST FOR PAYMENT
LOCAL SERVICE PROGRAM
RECIPIF14T!IAME,ADCRESS,PH,14E*and FE14 TYPE OF PAYMENT REQUEST `his Request Pemd
PSA#
P aport
Regular Cc"Act a
`Contract Penod
Advance
I I
CERTfICATICN I hereby cet,ff Who best JTY Kna (edge thwhis rsquost m con pets and conect and conforms with the terms and the puiposos of tee above contract,
'•',evared by,. Cate Approved by: Cats
PART A. SUDGET SUMMARY LSP TOTAL
I AnVovsd Contract Amami S000 50.00
I Previous Funds Race,ed for Contras Period 50,00 3000
3 Contract Balance Mine I mm"hro 2) $0 L)D �00
4 Previous Funds Requested and Not Received for Contract Paned $0100 S000
5 rontract PAlamc a d,re 3 mmus trna 4) S0,00 S000
PART 8 CCNRAC.T FOOS REOUEST
I Anticipated Cash Needs(lSf•2nd month.Attach justification) S000 S000
2 Net P perd h ras For Month woo $0 00
iDCEA Form I QSL Part B.cre 6)
3 TOTAL SO 00 SO 00
PAPTC NET FUNDS REQUESTED
I 1.@%S Advance Applied 50.00
2 (-omnct Fund:are Hereby Rewesiao �x 00 SQ an
dart B.t,ro 3 nmus Part C,Lnv I I
Of.lerlces/Ills i Rites P'N sled,See attained report.
EA"ORM ;'bt
41
CONTRACT KZ- 1497 Page 42
.X'I"J'.ACPNIEN'T X
RECEIPT AND EXPENDITURE REPORT
LOCAL SERVICE PROGRAM
PIRCVIDER NAME ADDRESS,PHONE and FE01 Prcgrairr,Fuming Source !THIS REPORT PERIOD:
From To
§ADVANCE CONTRACT PERIOD:
CONTRACT4
REGULAR
IREPCRT#
CERTIFICATION: I certify to the best of my knowledge and belief that the report is complete and correct and all outlays
herein are for purposes set forth in the contract.
�(Prepared by Approved ny Date
PART BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4 Percent of
Budget For This Report Year to Date Aeproved Budget
1 State Funds 50.00 50.00 $0.00 #DIV!0!
2 Program Income 50.00 $000 $0.00 #DIV(01
3,Local Cash Match 50,00 $0,00 $0,00 #D1V101
4 SUBTOTAL:Cash Receipts $000 $000 $000 '4DIWO!
5,Local In-Kind Match $0,00 $000 $0.00 #DIV10!
6.TOTAL RECEIPTS $0,00 $000 $000 #DIV,'0'
I
IPART B:EXPENDITURES(From Approved Budget) 1 Approved 2,Expenditures 3.Expenditures 4 Percent of
Budget For This Report_ Year to Date A2kroved Bud et
1.Administrative Services MOO $0.00 $0.00 #DIVr01
2.Meals,'Meals Agreements 50,00 50.00 $0,00 40IViO!
3,Service Subcontractors 50,00 $0.00 $0.00 #DIV10!
4 Fixed Price SHO 50,00 50.00 4DIVI;Of
5.Indirect Costs i 50.00 S000 $0.00 #DlVfO!
6 TOTAL EXPENDITURES 50.00 50,00 SO.00 IDIV 0!
'PARTC OTHER REVENUE AND EXPENDITURES
I.interest If.Advance Recoupment I
Earned on GR Advance S
2 Return of GR Advance 1 Advance Recouped
3 Ct-er Earned 3
42
CONTRACT KZ- 1497 Page 43
.,k'rr,kcnNIEN'I* A
Department of Elder Affairs Programs & Services Handbook,
Z--
Available at the Alliance for Aging Internet site under, "Downloads",
43
CONTRACT KZ- 1497 Page 44
ATTACIINIENT It
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name County arel AANContractor
Address I I C)5�y •`� fi`5_;�4e_ t 1�<) Completed By 14zm
Cii Y, State, Zip Code 3�04C�, Date Telephone 3U5_—,qqQL.
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: -r-1,je_
12-n
2. POPULATION OF AREA SERVED Source of data: 2(�Ic) us C-e-el'gu_Q
Total
% Hispanic'7 % Black1:2 L2 Ca 0/"U % Other % Female
.,�
3 1
STAFF CURRENTLY EMPLOYED. Effective date:
Total
# %White % Black go I % Hispanic I % Other % Female % Disabled
4
CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date:
Total 1�, 1 116 *7 1 0CN
'Iab5- I %White % Hispanic % Other T %7emale % Disabled % Over40
5
ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total 1 0
# %White % Black % Hispanic % Other % Female % Disabled
5- 1
PART
It. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. NA YES
6 NO
Is an Assurance of Compliance on file with DOEA? If NA or NO, explain.
7. Compare the staff composition to the population. Is staff representative of the NA YES
population? If NA or NO, explain. NO
..........................
—---------- .............
8, Compare the client composition to the population. Are race and sex characteristics NA YES
representative of the Population? If NA or NO, explain, NO
-------------------............... ................................................................... ...... .............
................
------------- -------___11-11------- -------------
44
CONTRACT KZ~ 1497 Page 45
Q. Are eligibility requirements for services applied to clients and applicants without regard to
nace, cm|or, national ongin, sex, age, religion or disability? |fNApr NO, explain,
^m YES
NO
10, Are all benefito, services and facilities available to applicants and participants in an equally effective manner regardless of
naoe, sex, mdor, aAa, national ohgin, religion or disability? If NA or NO, explain.
NA YES NO
[� �� [�
�
`� ~* `
11. For in-patient aemiooe, are room assignments made without regard to name, color, national origin or disability? If NA or
NO, explain.
NA YES NO
�� [� [�
�
= `� `
12. Is the program/facility moneeaib|e to non-English speaking clients? If NA or NO. explain.
13, Are employees pp|ican1* and participants informed cJ their protectionagainst discrimination?
if yes. *,
how? Verbal [�� VVri�ten F�� Pos�er F�� 'if NAorN(]. explain.
14. Give the number and current status of any discrimination complaints regarding services or
employment filed against the program/faoi|ity.
_
15, Is the program/facility physically accessible to mobility. heenng, and sight-impaired individuals? If NA or
NO, explain.
wA vES :43
45
CONTRACT KZ- 1497 Page 46
PART Ill, THE FOLLOWING QUESTIONS APPLY TV PROGRAMS AND FACILITIES WITH 15Og MORE EMPLOYEES
16. Has a self-evaluation been conducted to identify any barriers to serving disabled individuo|a, and to make any
necessary modifications? |f NO, explain.
17. Is there and established grievance procedure that incorporates due process in the resolution of
complaints? If NO, explain.
YES NO
|� [�
------------
18. Has a person been designated to coordinate Section 504 compliance activities? |f NO, explain.
YES NO
_
19. DV recruitment and notification materials advise apdkmnto, employees and participants of
nondiscrimination on the basis of disability? |f NO, explain,
20. Are auxiliary aids available to assure accessibility of services to hearing and sight impaired
individuals? If NO, explain.
YES NO
U
PART FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50.000 OR
|V. MORE.
21 Do you have a written affirmative action YES NO
plan? if NO, explain.
~� u
46
CONTRACT KZ- 1497 Page 47
AAA USE ONLY
Reviewed By YES In Compliance: NO`
Program *Notice of Corrective Action Seni:3
Office
-L V,
Response
Date l a. Telephone Due
Response
Desk Review Received1� —
DOEA Form 10 1-A, Revised May 2008 Page 2 of 2
5
7
47
I 14q-1 �, L�YD
' 1
CONTRACT KZ- 1497 Page 49
,�VTTACIINIENT B
INSTRUCTIONS FOR THE CIVIL RlGwrs comPLIANCE CHECKLis,r
1, Describe the geographic service area such as a district. county, city or other locality. lf' the prograin. racilltv,
serves a specific tar,_,ct population such as adolescents, describe the target population. Also, define the type of
service provided.
1 Filter 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 India rL/A las kan 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. Filter the total number of clients who are enrolled, registered or currently served by the prograin or facility, and
list their percent by race, sex and disability. Include the date that enrollment was counted,
5. Filter 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 aSSIStalICC must have on file an assurance that the program will be conducted ill
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOER recipients and their sub-grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 100" of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
Is. 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 detennine the reasons for such variation and take whatever
action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are
sanctioned to serve target populations such as elderly or disabled persons,45 CFR
80.3 (b)(6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment'! Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on-site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a)
and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies. COUnSelilWy and social services Without regard to race, sex, color, national origin.
religion, aye 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, v,,aitlng
roorns. reception areas. restroorns and other facilities must also he equally available to all clients. 45 FR
03 (by
11. For in-patient services, residents rust be assigned to rooms, WardS, etc.. without reward to race, color, national
ol,l,gln or disability. AIso, residents must not be asked whether they are willing to share accommodations
persons of different race. color, national origin, or disability, -45 CFR 80.3 (a).
12. I lie prograin. facillo., and all services 111LISt be accessible to participants and applicants, 61CILI(finL' those pel-SOIAS %V110
Inav not speak, ["n-lish. In .!cographic ,areas where a sigriilw3nt population of 11011-l"111-11IS11 SpCak'111(_1 people 11%e,
49
CONTRACT KZ- 1497 Page 50
program accessibility inav include the employment of hillilnial staff. in other areas, it is sufficient to leave a policy
or plan for service, such as a current list of names and telephone numbers oftillingual Individuals Who NVIII assist III
the provision of services, 45 (,TR 80.3 (a).
13, programs,facilities must make information regardinu the nondiscriminatory provisions of Title VI avaikible to their
participants, l ent ticiaries or any other interested parties. This should Include Information on their riuht to file a
complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of I 111S.
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 Cited against the prograril,"Tacility. Indicate the basis, e.g., race, color,
creed, sex, age, national origin, disability, retaliation, the issues involved, e.(,., 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, restroorn facilities, water fountains, information and ach-nissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restroorns, 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, beat, ventilation, fire alarms, arid other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self-evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
With the assistance of a disabled individual/organization, evaluate Current practices and policies which do not
comply with Section 504.
Modify policies and practices that do not meet Section 504 requirements.
Take remedial steps to eliminate any discrimination that has been identified.
Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or- more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any
action prohibited by Section 504.45 CFR 84.7 (b).
is. 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).
Continuing steps must be taken to notify employees and the public of the proorram,�facilitv's policy of
nondiscrimination on the basis of disability. ]'his includes recruitment material, notices for hearings. newspaper
ads
,s, and other appropriate written communication, 45 CFR 84.8 (a).
20. programs/facilities that employ 15 or more persons 111LISt provide appropriate auxiliary aids to persons with
impaired sensory, Manual or speaking skills where necessary. NLIXiliary aids may Include, but are not limited to.
interl-)rcters for hearing impaired individuals, taped or Braille materials. or any alternative resources that call he
used tee provide equally effective services. (45 (.'I:fZ 54.5-1 (d).
1. nipl ,Ind S-50,000 in t' deral
Proumims f"'icilities Vkrith or more eo%ces e contracts must (levelop, Implement and
maintain a written affirivati\c action Compliance program in accordance with Fxecuti%e Order 11-146. 41 (A]z 60
dud title VI of the:("I%it R11-111tS ,yet Of 1964, as amended.
50
CONTRACT KZ- 1497 Page 51
,Vff.kCIINIENTC
Department's Computer Use Policy and its Social Media Policy
Available at the Alliance for Aging Internet site Linder, "Downloads".
51
CONTRACT KZ- 1497 Page 52
.XTTACUKIENT FD
H PAR 1 M1 1i
BACKGROUND SCREENING
E 1, D E R
.,,l I"1 r`2\1 RS Affidavit of Compliance - Employer
%TATLI Or YLORMA
AUTHORIM This form Is required annually of all employers to comply with tho attestation
requirements set forth in section 435,05(3), Florida Statutes.
- 7rF,, term "empi"w" means a" pecan or entity requind ny ow to mr%" baAgai vrrenQ,
hckdmg but not hnnhed tm Area Aeenrfes on Rine, 40rg Rescume Cenvem, Aprg and DhabHvy
Rmaume Cerams, Lead Agencws, Longlum Cue OmInudsm'I'l Prrglwrl' Servina He'On'Insurance Needs
M EhAn NaWwM Sciuke Pmmery Dvecwn PruwavW and any uOmr pecan or err oN Wkh we-,
or 11,1S io vino weet ce providcr, 5ce
=n2,41=02JO SW
e A I m,ofva- orovtder i-: ",i pvca,in 18 of :i&, or Adt-f vvno, pjrai r't to *i pfogr;ini to oroviAe
!11R- oldefly, has Wmo fneiwhict- (nnt.acr vi (I ent "Viale,ort*'1%,ldl+,ig "0 f:he3lt
uld h l—.access.To the Ow"A WW9 area, NA, pnwnM property, to pi+rior.il iJ&-,t,fi'--anon informa-icii
a jefin d Irt ;. ,it/ '68. rhe 'ef-rn ndjdes (0ordirt'itors, triart,-.jt4efs, inn sate-�isors of rpsfdenual
s f- � ,
fa att=and wokinwer," 1 40bW410L VA Mat
ATTFSTAVON,-
As the e.July authorized representative of
ErnpbWrhunne
R)hereby ,affirm under oenalty of peijunj
,hiat the dbo,i iarned crnplayer is M WnOuance ~with the priovisiors of Chapter 435 and VULWI
<110,11402, Florida Statutr,.s, rpgarding kyei 2 barkRrourld screening.
rn3tUrP nJ Rppro.—,entativa
SIAFE OF I-LOMDA,COUNIV OF
lumn to Or Wrrred) -Ifirt >,ln~,crinpd h,.Lefore rri- rnir, d liv t-J by
lNune of Rupms,entAwel who a unswirally known
'is prout tit ident,ficjt1com,
52
CONTRACT KZ- 1497 Page 53
ATTACIBI ENTE
Verification of Employment Status Certification
As a condition ofcontracting with theAlliance for Aging, [tic.,
MWP,v� Qcu-�N/ '8 o Cr— , hereby referred to as contractor, certifies the
use of the I.I.S. Departmeit of Homeland Security's E-verify system to verify the employment eligibility
of all new employees hired by Contractor during the contract term to perform employment duties
pursuant to this Agreement and (b) that any subcontracts include an express requirement that
subcontractors performing work or providing ser-,Jces 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 Date
(Same as contract signature)
Company Na"rne
53
CONTRACT KZ- 1497 Page 54
ATTACHMENT F
Alliance for Aging, Inc.
AssociateBusiness
dated th Alliance for Aging, Inc (°CovorodEnUty') and
("Business Associade^), o not-for-profit Florida
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).
12 Covered Enhty, recognizes the requirements of the Health Insurance Portability and
Accountability Act of 1896 (H|PAA) and has indicated its intent to comply in the Coun1y'a Policies
and Procedures.
1.3 H|PAA naQu|ohono establish specific conditions on when and how covered entities may shore
information with contractors who perform functions for the Covered Entity.
1.4 H|PAA requires the Covered Entity and the Business Associate to enter into e contract or
agreement containing specific requirements to protect the confidentiality and security of patients'
PH!, as set forth in, but not limited to the Code of Federal Regulations (C.F.Rj. specifically 45
C.F�R. §§ 164.602(e). 164,504(m). 104.308(b). and 164.314(a-b)(2010) (ea 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 (2OO9) and Pod | — Improved Privacy Provisions and Security
provisions located at 42 United States Code (U.S.C.) §§ 17031 and 17934 (2010) require
business associates of covered entities to comply with the H|PAA Security Ru|e, as set forth in,
but not |innibad to 45 C.F.R, §§ 164�308. 164.310. 164.312. and 164.318 (2009) and such sections
shall apply to e business associate of o covered entity in the same manner that such sections
apply to the covered entity.
The parties therefore agree as follows:
2.0 Definitions. For purposes of this agreement, the following definitions apply:
2.1 Access. The ability orthe means necessary to road, write, modify, or
communicate data/information or otherwise use any system resource.
2.2 Administrative Safeguards. The administrative aohnna, and policies and
prooadunes, to manage the selection, development, imp|ementation, and
maintenance of security rneeaunas to protect electronic Protected Health
Information (ePHI) and to manage the conduct of the covered entity's workforce
in relation to the protection of that information.
2,3 ARR/4, The American Recovery and Reinvestment Act (2009)
2.4 Authentication. The corroboration that o person is the one claimed.
2.5 Availability, The property that data or information is accessible and useable upon demand by an
authorized person
2.6 Breach, The unauthorized aoquisihoo, access, use, or disclosure cfPHI which
54
CONTRACT KZ~ 1497 Page 55
compromises the security or privacy of such information.
2.7 Compromises the Security. Posing a significant risk of financial, neputabonai
or other harm to individuals.
2�8 Confidentiality, The property that data or information is not made available or
disclosed to unauthorized persons orprocesses.
2.9 Electronic Protected Health |nforrnadion.(ePH|) Health information as specified in 45 CFR
§180.103(1)(i) or
(1)(ii). limited to the information created or received by Business Associate from or on behalf of
Covered Entity.
2.10 H|TECH The Health Information Technology for Economic and Clinical Health
Aot(20OQ)
2.11 Information System. An interconnected set of information resources under the
same direct management control that shares common functionality. Aeyotem
normally includes hardware, software, informadon, data, applications,
communications, and people.
2.12 Integrity. The property that data or information have not been altered ur
destroyed inon unauthorized manner.
2,13 Malicious software. Sofhwore, for example, e virum, designed to damage or
disrupts osystem.
2.14 Part !. Part | — Improved Privacy Provisions and Security provisions located et
42 United States Code (U.S.0 §§ 17931 and 17034 (2010).
2.15 Password. Confidential authentication information composed ofa string of
characters.
2.18 Physical Safeguards, The physical meoaures, policies, and procedures to
protect o covered entity's electronic information systems and related buildings
and equipment, from natural and environmental hazards, and unauthorized
intrusion,
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health
Information ot45CFR Port 180and Part 164. subparts Aand E.
2.18 Protected Health Information. (PHI) Health information emdefined in45CFR
§160.103, limited to the information created or received by Business Associate
from oron behalf of Covered Entity.
219 Required By Law. Has the same meaning as the term "required by law" in
45CFR § 164�103,
2�20 Secretary, The Secretary of the Department of Health and Human Services or
his or her designee.
2.21 Security incident. The attempted or successful unauthorized aoceos, use,
disclosure, modification, or destruction of information or interference with ayaLem
operations inon information system.
55
CONTRACT KZ- 1497 Page 56
222 Security mrSecurity measures. All of the adminis\nahve, physical, and technical
safeguards inan information system.
223 Security Rule. The Security Standards for the protection of Electronic Protected
Health Information ot4GCFRpart 164. mubpartC. and amendments thereto.
2.24 Technical Safeguards. The technology and the policy and procedures for its
use that protect electronic protected health information and control access to it.
Z25 Unsecured PHI. Protected health information that is not secured through the use
of technology or methodo|ugyspecified by the Secretary in guidance issued
under42 U.S.C. section 17932(h)(2),
226 All other terms used, but not otherwise defined, in this Agreement shall have the
same meaning as those terms in the Privacy Rule.
3.0. Obligations and Activities of Business Associate.
3.1 Business Associate agrees to not use or disclose PHI other than as permitted or
required by this agreement orum Required byLaw.
3,2 Business Associate agrees to:
(a) Implement policies and procedures to prevent, de(ed, contain and
correct Security violations in accordance with 45 CFR § 164.386;
(b) Prevent use or disclosure of the PHI other than om provided for bythis
Agreement uraa required bylaw;
(o) Reasonably and appropriately protect the conhdendaUty, integrity, and
availability ofthe ePH| that the Business Associate oreotem, naoeiveo,
maintoino, or transmits on behalf ofthe Covered Entity; and
(d) Comply with the Security Rule requirements including the Administrative
Safeguards, Physical Safeguards, Technical Safeguards, and policies
and procedures and documentation requirements set forth in4GCFR§§
164,308. 164.310. 184312. and 164.316.
13 Business Associate agrees to mihgaUa, to the extent practicable, any harmful
effect that is known to Business Associate of use or disclosure of PHI by
Business Associate in violation of the requirements nf this Agreement.
3.4 Business Associate agrees tu promptly report to Covered Entity any use or
disclosure of the PHI not provided for by this Agreement of which itbecomes
aware, This includes any requests for inopection, copying or amendment nfsuch
information and including any security incident involving PHI.
15 Business Associate agrees to notify Covered Entity without unreasonable delay
of any security breach pertaining to:
(a) Identification o/any individual whose unsecured PHI has been, or is
reasonably believed by the
Business Associate tohave been, acceusod, auquired, or disclosed during such security
breach: and
56
CONTRACT KZ- 1497 Page 57
(b) All information required for the Notice to the Secretary ofHHS of Breach
of Unsecured Protected Health /nhzrn7mbon.
3,6 Business Associate agrees to ensure that any aQant, including a subcontraotor,
to whom it provides PHI received from, or created or received by Business
Associate on behalf of Covered En1ity, agrees to the same restrictions and
conditions that apply through this Agreement to Business Associate with respect
to such information
3.7 |f Business Associate has PHI in Designated Record Set:
(o) 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 (}FR §164.524; and
(b) Business Associate agrees to make any amendment(s) to PHI in
Designated Record Set that the Covered Entity directs oragrees to
pursuant to 45 CFR§ 184.526 at the request of Covered Entity oran
Individual within 10 business days of receiving the request.
3.8 Business Associate agrees to make internal praohoes, buoks, and renordn,
including policies and procedures and PH|, relating to the use and disclosure of
PHI received from, or created or received by Business Associate on behalf of
Covered Ent|ty, 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.
3.8 Business Associate agrees to document such disclosures of PHI and information
related to such disclosures aswould be required for Covered Entity torespond
toa request byan individual for on accounting of disclosures of PHI in
accordance with 45 CFIR§ 164.528.
3.10 Business Associate agrees to provide to Covered Entity or an individuo|, upon requeat,
information collected in accordance with Paragraphs h and i above, to permit Covered Entity
to respond to a request by an Individual for an accounting of disclosures of PHI in accordance
with 46 CFR § 164.528 and ARRA & 13404.
3.11 Business Associate specifically agrees to use security measures that reasonably
and appropriately protect the cnnfidenbmUty, intogrity, and availability ufPHI in
electronic or any other form, that it omyoteo' receives, maintaina, or transmits on
behalf ofthe Covered Entity.
3,12 Business Associate agrees to implement security measures to secure passwords
used to access ePH| that it acceases, main1ains, or transmits as part ofthis
Agreement from malicious aofh*ano and other man-made and natural
vulnerabilities to masuna the avai|abi|ity, integrity, and confidentiality ofsuch
information.
3.13 Business Associate agrees hz implement security measures Vo safeguard ePH|
that it accesses, maintains, or transmits aa part of this agreement from malicious
software and other man-made and natural vulnerabilities to assure the
avai|abiUty, iniegnty, and confidentiality ofsuch information,
3.14 Business Associate agrees ko comply with:
(a) ARRA § 13404 (Application of Knovv|edge Elements Associated with
Contracts),,
57
CONTRACT KZ- 1497 Page 58
(b) ARRA § 134O5 (Restrictions on Certain Disclosures and Sales ofHealth
Information); and
(c) ARRA § 134O8 (Conditions on Certain Contacts as Part ofHealth Cane
Operations).
4,0 Permitted Uses and Disclosures byBusiness Associate. Except as
otherwise limited in this Agreement or any related agreement, Business
Associate may use or disclose PHI to perform functions, activities, or services
for, or on behalf of, Covered Entity as specified in any and all contracts with
Covered Entity provided that such use or disclosure would not violate the Privacy
Rule if done by Covered Entity or the minimum necessary policies and
procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except os 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.
52 Except oa 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 os Required By Law or for the purpose for which itwas
disclosed to the person, and the person notifies the Business Associate of any
instances of which itis aware in which the confidentiality of the information has
been breached.
5.3 Business Associate may use PHI to provide data aggregation services io
Covered Entity as permitted hy4GCFR §1G4.5O4(e)(2)(i)(B).on|ywhen
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 45CFR §1G4.5U2(])(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
PH|, by providing a copy ofthe most current Notice of Privacy Practices (NPP)
10 Business Associate em Attachment | to this Agreement. Future Notices and/or
modifications Uo the NPp shall be posted on Covered Entity's vvebsihaat
.
8.2 Covered Entity shall notify Business Associate of any restriction to the use or
disclosure cf PHI that Covered Entity has agreed toin accordance with 45CFR
§ 164.522. to the extent that such restriction may affect Business AamuouUs'e
uae *r disclosure ofPHI.
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 kz use ordisclose PHI in any manner that
58
CONTRACT KZ~ 1497 Page 59
would not be permissible under the Privacy Rule if done by Covered Entity.
80 Effective Date and Termination.
81 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 aafollows:
(u) These Business Associate Agreement provisions, with the exception of
the electronic security provisions and the provisions mandated by
ARRA. H|TECH and Part | shall be effective upon the later of April 14.
20O3. or the effective date ofthe earliest contract entered into between
Business Associate and Covered Entity that involves the use ofPHI;
(b) The electronic security provisions hereof shall be effective the later of
April 21. 2OO5or the effective date of the earliest contract entered into
between Business Associate and Covered Entity that involves the use of
PHI; and
(o) Provisions hereof mandated byARRA. H}TECH and/or Part | shall be
effective the later of February 17. 201Oor the effective date cdthe
earliest contract entered into between covered entity and business
associate that involves the use uf PHI orePH|.
8.2 Termination for Cause. Upon Covered Entity's knowledge ofa material breach
by Business Associate, Covered Entity shall either:
(a) Provide an opportunity for Business Associate h) cure the breach orend
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
(u) |f neither termination nor cure is feasible, Covered Entity shall report the
violation to the Secretary.
83 Effect mfTermination, 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 ofCovered Entity.
(a) This provision shall apply to PHI and ePH| that iain the possession of
subcontractors or agents of Business Associate. Business Associate
shall retain no copies of the PHI and ePH|.
(b) |n the event that Business Associate or Covered Entity determines that
returning the PHI or aPH| is inkaaeib|e, notification of the conditions that
make return of PHI nrePH| infeasible shall be provided to the other
party, Business Associate shall extend the protections of this Agreement
\o such retained PHI and ePH| and limit further uses and disclosures of
such retained PHI and ePHi for a minimum of six years and so long es
Business Associate maintains such PHI andePHi but no less than six
(6) years after the termination of this agreement.
59
CONTRACT KZ~ 1497 Page 60
90 Regulatory References. /\ reference in this agreement to a section in the
Privacy Rule or Security Rule means the section then in effect oraa may be
amended in the future.
10�O Amendment. The Parties agree to take such action asim necessary hoamend
this agreement from time k) time aeia necessary for Covered Entity tocomply
with the requirements of the Privacy Rule, the Security Rule and the Health
Insurance Portability and Accountability Act of1g8G. Pub. LNo. 104-181.
11.0 Survival. Any term, condition, covenant ur obligation which requires
performance by either party hereto subsequent ho the termination ofthis
agreement shall remain enforceable against such party subsequent tosuch
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 byreference. Any future new naquinement(o). changes or
deletion(s) enacted in federal law which create new ordifferent obligations with
respect toH|PAA privacy and/or security, shall be automatically incorporated by
reference to this Business Associate Agreement on the respective effective
date(e).
14.0 Notices. All notices and communications required, necessary or desired hom*
given pursuant to this agreement, including a change of address for purposes of
such notices and communications, shall bein writing and delivered personally io
the other party or sent by express 24-hour guaranteed courier or delivery service,
orby certified mail of the United States Postal Service, postage prepaid and
return receipt requested, addressed to the other party oefollows (or to such other
place as any party may by notice to the others mpecify):
Tu Covered Entity: Alliance for Aging, Inc.
Attention: Max B. Rothman, JD, LLK4.
780NVV107dl Avenue, Suite 214
K8kami, Florida 33172-3155
To Business Associate: /
Any such notice nhm|| 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 mf Florida, without giving effect to
principles of conflict of laws. govern all matters arising under this agreement.
16.0 SeverabiUty. |f 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 uoenforceabi/ityand will be enforceable to the fullest extent
permitted bylaw.
17O Successors, Any successor to Business Associate (whether by direct orindirect
or by purchase, merger. conao!idabon, or otherwise) is required to assume
Business Associate's obligations under this agreement and agree toperform
them in the same manner and to the same extent that Business Associate would
60
CONTRACT KZ~ 1497 Page 61
have been required to if that succession had not taken place, This assumption
by the successor of the Business Associate's obligations shall bebywritten
agreement satisfactory h) Covered Entity.
1&0 Entire Agreement. This agreement constitutes the entire agreement of the
parties relating to the subject matter ufthis 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:
By: Date: �
Business Associate:
By: uona:
(signature) G4STE-.Sl
AI-
01
CONTRACT KZ- 1497 Page82
ATTAC8NI ENTG
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder H8lDline
AGING AND DISABILITY RESOURCE CENTER /ADRC\ — OUTSOURCE[] 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 OutsourcedFunction-Screening
ii Policies and Procedures for DutsounrodFunction-Triage
iii. Po|iciesondProoedunasforAodvabonhnmVVaidist- C|ient Services
iv. Policies and Procedures for Termination from VVaidist- Client Services
B. Maintain wait lists in CiRTS in accordance with O{}EA requirements.
C. Report number of client contacts to the Aging and Disability Resource Center.
D. Adhere to prioritization policy as set forth by DOEAon a monthly basis. Reference 00EA Notice
of Instruction: Assessed Priority Consumer List#:062906-1-1-OVCS as applicable.
E. Ensure the agency's Disaster Plan refeotoAORC Outmounoed Funodone, annually oras needed
to incorporate AORCoutmoun:edfunctions.
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 ofservices to the
Aging and Disability Resource Center,
G. Ensure that services provided are in the clients' best interest, are the most cost effeutive, 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 A|zheimer'o Disease Initiative (AD|) and Older
American's Act ([)AA) maintain waiting lists in the C|RTS 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). Eacort (ESC). Home Delivered Mea(s (HOK4). Homo Health Aide (HHA). Homemaker
(HIVIK). Model Day Core (MDC). Personal Care (PECA). Facility-Based Respite (RESF). In-Home Respite
(RESP),
62
CONTRACT KZ- 1497 Page 63
Alliance for Aging. Inc.
Aging and Disability Resource Center/Eider Ha|p|ine
Policy and Procedure for
Outmourcedfunction - Scneening
Creation Date: March 5. 2OO8
Revision Date: [Way2O12
Objective: To ensure that a comprehensive list of clients in need of services is maintained in C|RTS by
appropriate funding source and that the ADRC is thereby able to effectively gauge the level of elder
service need 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 OOEA funded services
Procedure:
i ADRC Contracted Providers will ooU*ot information from callers and conduct a 701A assessment.
Alternatively, |fe7O1B assessment already exists oris provided from another source (i.e CARES) the
information from the 7O1B can beutilized.
2. Based on the information provided via the 701A(B) assessment, the ADRC Contracted Provider will
make a determination as to the services that the caller is in need of receiving .
3. The ADRC Contracted Provider will determine the appropriate funding source(s) that provides the
needed services.
4. If the caller is in need of service(e) that is not provided by the ADRC Contracted Provider, the ADRC
Contracted Provider will refer caller to the ADRC Elder He|p|ine utilizing the ADRC Referral Form
and/or toan ADRC Contracted Provider that provides the needed service.
5. The caller will be provided with general information regarding the ADRC as well aa the ADRC Elder
Hm|p|ine contact number.
S, The caller will be informed of the services and funding sources that they are being placed on the wait
list for in C|RTS.
7. ADRC Contracted Provider will creeks a client record in C|RTS (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
C|RTS. the appropriate fields will beupdated].
8 If the ADRC Contracted Provider determines that the caller may qualify for more than one funding
Soupce. ADRC Contracted Provider isencouraged to enter the appropriate information under multiple
63
CONTRACT KZ- 1497 Page 64
funding sources. [If there is an existing client nyoond in QRTS, the client record in C|RTS will be
updated with appropriate information],
8 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 O(JEAVVoit List Reassessment Standards and
encourage caller to contact the ADRC Elder He|p|ine with any questions.
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CONTRACT KZ- 1497 Page 65
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder He|piine
Policy and Procedure for
Out000roedfunction - Triage
Creation Date: March 5. 2008
Revision Date: KXay2012
Objective: To ensure that clients in need of DOEA funded services receive services based on the highest level of
need, first, ae funding becomes available.
Policy: To assist m|ianba in obtaining D0EAfunded services as funding becomes avai|ab|e, based on level of
need os determined byaC|RTS priority score.
Procedure:
1. ADRC Contracted Provider will conduct periodic follow-up oaUa (or home visit in case of active client) to
check on client status based onDDEA 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 C|RTS 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 DOEAStendando.
4, If the caller is in need of a service(s) that is not provided by the ADRC Contracted Provider, the ADRC
Contracted Provider will refer caller to the ADRC Elder He|pUne utilizing the ADRC Reharn*| Form and/or
toan 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 C|RTS 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 orconcerns,
8� As funding becomes available, ADRC Contracted Provider will run C|RTS Prioritization Report and
activate clients according to DOEA Standards (refer 1oADRC Client Activation Policies and Procedures).
The Contracted Provider will apply targeting ontena, as appropriate. to prioritized clients to ensure
activations meet programmatic requirements.
Alliance for Aging, Inc.
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CONTRACT KZ- 1497 Page 66
Aging and Disability Resource Center/Elder He|pUne
Policy and Procedure for
Activation From Wait List— C|ients/Services
Creation Date: March 5. 2008
Revision Date: 0ay2O12
Objective: To ensure that elders in need ofDDEAfunded 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 ao funding becomes available.
Procedure:
1. ADRC Contracted Provider will activate clients on C|RTSvvmit list based on DOEA prioritization polices
and funding availability.
2. ADRC Contracted Provider will update C|RTB status by funding source and service for any services
being activated for the client using appropriate C|RTScodes.
I Client may be |e# on wait list of e different funding source than the one being activated if AQRC
Contracted Provider determines that itimappropriate.
4� Client may also be left on wait list in C|RTS if they are being activated by the AORC 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 isexhausted.
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.
G. ADRC Contracted Provider will inform client to contact the AORC Elder He|p|ine if they have any
questions mr concerns regarding the status of any of their services.
66
CONTRACT KZ- 1497 Page 67
Alliance for Aging, Inc.
Aging and Disability Resource Center/Eider He|p|ine
Policy and Procedure for
Termination From VVad Lis±—Chento/Services
Creation Date &1uroh 5` 2008
Revision Date: May2012
Objective: To ensure that the comprehensive list of clients in need of services in C|RTS is appropriately
maintained by funding source and that the ADRC is thereby able to effectively gauge the current level
nf elder service need in Miami-Dade and Monroe Counties.
Policy: ADRC will maintain on accurate and current list of clients in need of elder services in Miami-Dade and
Monroe Counties with the assistance nf the ADRC Contracted Providers.
Procedure:
1. ADRC Contracted Provider will re-screen clients which the ADRC Contracted Provider initially placed on
the C|RTG wait list for services based onDOEAReassessment Standards.
2. The re-screening may be in the form of phone screening ora 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
oen/ioae 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 C|RTQ termination code for any services o, funding source for which the client is
determined tono longer be eligible for orno longer in need of.
5. ADRC Contracted Provider will inform the client of any services/funding source that they one being
removed from the wait list for.
G, ADRC Contracted Provider will inform client of their ability to he re-added to the wait list if their level of
need should change.
T ADRC Contracted Provider will inform client to contact the ADRC Elder He|p|ine if they have any
questions or concerns regarding their wait list status,
8. Reference O[)EA Notice of Instruction, Assessed Priority Consumer Liyt#�OG2QO8-1-|-[>VCS as
applicable.
67
CONTRACT KZ- 1497 Page 68
Aging and Disability Resource Center
Monthly Client Data Report Instructions
NOTE: All Sen/|oa 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 iso count of all contacts during
the reporting period from individuals seeking infnrmation, referral or assistance for themselves or others received
by the AORC. satellite offina, anyoutoounoed endty, or, to the extent possib|e, all aouemo points with which the
ADRC has anagreement. Contacts include telephone calls, wo|k-ina. mail, e-mai|aor 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 AORC public education activities. Administrative and personal contacts are excluded. This
number in not an unduplicated count, Documentation for the total count by type ofcontact and source receiving
the contact must be maintained by the ADRC.
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CONTRACT KZ 1497 Page 69
ATTACIINIE.N'T 11
CERTIFICATION REG,-kRDIN, (; SCRUTINIZE'D COMPANIES LISTS
The undersigned, an authorized representative oftlic Contractor named in the contract or agreement to
which this form is anattactiment. hereby cerilfics that:
(I) The Contractor understands that pursuant to s, 187.135 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 Fider Affairs (Department) for goods or services of S I million or more.
(2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false
certification is subject to civil penalties, attorneys fees and costs and any costs for investigations that
led to the finding of false certitication.
(3) The Contractor understands that the contract to which this form is an attachment may be
terminated by the AAA if the Contractor submits a false certification or has been placed on the Lists.
This certification, required by Florida law, is a material representation of fact upon which reliance was
placed when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction.
SiCnature
cbq,5-w S.
(Same as contract signature)
Title
W
T
Company Name
69
Amendment 003 CONTRACT KZ 1397 � ' Page 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred
to as the "Alliance", and Monroe County Board of Commissioners, Social Services/In-Home
Services.
The purpose of this amendment is increase the amount allocated under contract by
$13,384.00 for a total allocation of$83,407.00. The increase is for Respite services.
METHOD OF PAYMENT:
All provisions in the contract and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the contract are hereby amended to conform with this amendment.
This amendment and all its attachments are hereby made a part of the contract. This
amendment and all its attachments are hereby made a part of the contract.
IN WITNESS WHEREOF, the parties hereto have caused this 1-page amendment to be executed
by their undersigned officials as duly authorized.
PROVIDER:
Monroe County Board of ALLIANCE FOR AGING, INC.
Cgfnmi1ssioners, Social
SwSrvis/Irt=Hprrie Services.
2-2
SIGNE�-BY, � . IGNED BY:
.
Sylvia f ' `""
NAME
. Y ,, Y ���° ,�;�� � z B. Rothm� ��JD, LL,"M.
NAME:
President & CEO
TITLE: Mayor TITLE:
DATE: DATE:
f .
"s" 'V .
"
i.