Item C9 BOARD OF COUNTY COMMISSIONERS
ACENDA ITEM SUMMARY
Meeting Date: 10/17/14 Division: Coninitinitv Services
Bulk Itern: Yes X No Department: Social Services
Stafl'ContactPersoti:.--Sher.vl (-J...i-ali..a..iiif 30,55, 292-4510
AGENDA ITEM WORDING: Requesting approval of Amendment 4001 of the Home Care for the
Elderly (I ICE) Contract 4KI-I 1472 between the Alliance for Aging, Inc. (AAA) and Monroe County
Board of County Commissioners (Social Services/In Home Services) for the contract period of7/1/14
to 6/3 0/15.
ITEM BACKGROUND: As per Section 111, 3.2 of' the HCE contract, non-profit providers may
request a monthly advance for service costs for the first two months of the contract period., based on
anticipated cash needs. The schedule for submission of advance request is detailed in Attachment VIII
of the contract. The purpose of Amendment #001 of the IICE contract is to amend the contract
language regarding Attachment VIII, Invoice Report Schedule, to read one tenth of advance
reconciliation starting with report #5, September.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted by the BOCC on 7/16/14 for
ratification of the Home Care for the Elderly Contract (I ICE) # KI-I 1472, contract year 14/15.
CONTRACT/AGREEMENT CHANGES: Attachment VIII, Invoice Report Schedule is amended
to read one tenth (1/10) advance reconciliation for the reporting months of September(45) to June
(#14).
STAFF RECOMMENDATIONS: Approval
TOTAL COST: $12,694.00 BUDGETED: Yes No
COST TO COUNTY: 10% CASH MATCH SOURCE OF FUNDS: Grant funds
REVENUE PRODUCING: Yes No X AMOUNT PER: MONTH: $ YEAR: S
C ek o",
APPROVED BY: County Att OMB/Purchasing Risk Management
DOCUMENTATION: Included x Not Required____ 'To Follow
DISPOSITION: AGENDA ITEM
Revised 8/06
MONROE COLINTY BOARD OF COUNTY COMMISSIONF'RS
T
CONTRACT St
Contract with: Alliance For Aging. Inc. Contract: KII 1472
Effective Date: 10/117/2014
Expiration Date: 0 6/3 0/20 15
Contract Purpose/Description: Requesting approval of Amendment 4001 of the home (.'are for the Elderly
(I ICE)Contract 4KH 1472 bet"een the Alliance for Aging, Inc. (AAA)and Monroe County Board of COUI`It}
Commissioners (Social Services/In Home Services') for the contract period of 7/1/14 to 6/30/15.
Contract Manager: Sheryl Graham (3105) Social Services/Stop I
42;�a 292-4510
(Name) (Ext.) (Department/Stop #)
For BOCC meeting on 10/17/2014 Agenda Deadline: 9/30/2014
CONTRACT COSTS
Total Dollar Value of Contract: approx. $12,694,00 Current Year Portion: $
125-6153914-1----
Budgeted: Yes IJ No Account Codes:
County Match: $10% CASI-I MATcFl
Additional Match:
Total Match $ 10%CASH MATCH ADDITIONAL COSTS
Estimated Ongoing Costs: $- .—/vr For:
(Not included in dollar value above) (e.g.NiTnt!7nance,utilities,,jatiitoi-ial,-salaries.-etc)
CONTRACT REVIEW
e c Changes Date Out
D�te�n Needed ey i,e -,r,,
Division Dirtor
J Yes : No '
IN,
Risk Management
Yes' No,-" L L
O.M.B./Purchasing �c,r Yes NOV"
-6—cNic, "t
County Attorney Yes 1 No�j*
Comments:
-------------
.............. .......... ------
OMB Form Revised 2/27/01 MCP #2
CONTRACT KH 1472 ORIGINAL
fkmendment 001 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-florae
Services.
The purpose of this amendment is to amend the contract language regarding Attachment
Vill. This contract is hereby amended to read one-tenth instead of one-twelfth of advance
reconciliation starting with report# 5. See Attached.
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.
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.
Commissioners, Social
Services/In-Home Services.
SIGNED BY: SIGNED BY:
Max B. Rothman, JD, LL.M.
NAME: SYVLIA MURPHY NAME:
President & CEO
TITLE: MAYOR TITLE:
DATE: 10/17/2014 DATE:
Contract Number KH-1472
ATTACHMENT Vill
HOME CARE FOR THE EDLERLY
INVOICE REPORT SCHEDULE
Report Number Based On Submit to Alliance on
this Date
1 July Advance* July 1
2 August Advance* July 1
3 July Expenditure Report August 15
4 August Expenditure Report September 15
5 September Expenditure Report +1/10 advance reconciliation October 15
6 October Expenditure Report +1/10 advance reconciliation November 15
7 November Expenditure Report +1/10 advance reconciliation December 15
8 December Expenditure Report +1/10 advance reconciliation January 15
9 January Expenditure Report +1/10 advance reconciliation February 15
10 February Expenditure Report +1/10 advance reconciliation March 15
11 March Expenditure Report +1/10 advance reconciliation April 15
12 April Expenditure Report +1/10 advance reconciliation May 15
13 May Expenditure Report +1/10 advance reconciliation June15
14 June Expenditure Report +1/10 advance reconciliation July 15
15 Final Expenditure and closeout July 15
Legend: * Advance on projected cash need.
jI jCt \ - 1� - 1472
IL t r, Lijillici ,I I
tj 1E CIRE, FOR THE ELA)ERLY LE-ID VENCYCONTRWl'
20140015 Fiscal Year
rIIIS C031FILWT is ancind into between Me AHimice for Agirtg hw., hercWher referred to as the -Alkaiwe:* and
Alonroc County Board of Commissioners, Social Servicevin-donne Services, hereinafter referred to as the pRn ider-
and i-cferred to as the "pirti s
Wachavants, 1. 11, HL IV, V. VI. VIL VIT IT X, A, B. C, D, F. G and 11 are Awor-porawd herein and We a pan of this
Contract.
TVIIEREAT die Alliance has keen designated as the area agency on aging for Planning and Scr-,ice Area 11
encompassing Nliand-Dade and Nlywoe Qnrmies: and
WHEREAS, We Florida Department of Elder .\ftairs (the "Department") has emend into a Contract with the Vlhance to
Ind commuth, cue service s;stems in NIAnd-Dade and Monroe Counties; and
NNIIERE,kS, in accordance with Section 430103. Florida Statutes, the ?Alliance has designated the provider as a Lead
,a 11 gency for the Floi ne Care for the F,Iderl y ( CE) prograni,
NOW IN ERE FORE, in conAderaHon 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 f011ows:
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 attache eats 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
f".'Ider Affairs handbooks, manuals or desk books, as an integral part of the contract, except to file extent that tile
contract explicitly provides to the contrary. In the event of conflict in language among any of the documents
referenced above, the specific provisions and requirements of the contract docurnent(s) shall prevail over
inconsistent provisions in the proposal(s) or other general materials not specific to this contact document and
identified attachments.
3. 'rerni of Contract
Effective Date:
This contract shall begin on July 1, 2014 or on the(late the contract has been signed by both parties, whichever is
Inter.
Delivery of services shall end at midnight. local We in Miami- FL on June 30, 2015. The \Iliance will not
reimburse the provider for services provided after this date, llowever, the parties recognize that they will need
to perforni continued ,activities relating to reporting, invoicing and payment in July of 2015 to facilitate payment
for services rendered by the provider under this contract through and irlClUding the contract expiration date of
Rdy 15. 2015.
4.0 Contract Nnount
Ile AHK=c agnes to pay for contracted services accmxling to the terms and Conditions of this contract in an
�1111()unt not to exceed 5 12694 kw the rue schedule. Nufnect to We availability of Wk. Uy coins or ;en ices
;mird Air LUIder any other Cahn CT koni any other vqiNe me no choble for pavnient ander this contract.
A! Ohhgadon to Pa)
I he Thandw pemvnmrce and obhunnon to pay Under Us antract is cominuent if wi
a1,j)1'0!11-MthM K> dw lvqnhaurc to die I)qvarnat; and funIna rocca%ed h) the \Hance
1!h fhc
Source of Funds
1 he COON k",Cn > r)ald under 'Itly o1i1m conYact or 11-01"1 111l odzcr �OUIVC are not i.:h,-nNC t6l-
:cintlmiracnient raidor this ckl"Wt. I he 1AM!, Mkald�:d !11 {11c: r11-0%ider j)Ln's,Uant tO thl�i cllntra�:T
('clntrLac Nutnl-rcr (�l1- 1�7,
ltl`c' IPl 911e >tntc: i_'1't't11t5 find ttlllti :117I�r1711r1;?tic7llti tlitcl ec�tlSt5I5 t7(' f:1e tt�lii7l11it4,'.:
Praa„franl C'itle N it I till" Source CS V; lFund Amounts �
I fo-", (..'wire t,ol- the o 1 1- I(lem2ra1 RC:v cnu4 fobacco
I:Cde 1, '()1 ; Sc.tticment (rust funds
IOTAL FUNDS CONTAINED DINED IN THIS CONTRACT: � S12,691
a. Renewals
The contract may be renewed on a yearly basis for no more than tour additional years. Such renewals shall be
Conting ent upon satisfactory pertormance evaluations as determined by the Alliance and the availability of funds.
, ny renewal of a contract shall be subject to mutual agreement. confirmed in writing, Lind subject to the same
terms and conditions set firth in the initial contract. '1Iie renewal price, or method for determining a renewal
price, is set forth in the bid, proposal, or reply. No other costs for the renewal may be charged.
6. Compliance with Federal Lure
6.1 Ifthis contract contains federal funds the following shall apply;
6.1.1 The Provider shall comply with the provisions of 45 CFR 74 ancLor 45 CFR 92, and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $1.00,000.00, 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 sect.), s.
SOS 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.
,.1.3 The Provider, or went acting for the Provider, may not use any federal hands received in connection with this
contract to influence legislation or appropriations pending before the Congress or any state legislature. If this
contract contains federal funding in excess of $100,000.00, the Provider must, prior to contract execution,
complete the Certification Regarding Lobbying form, xrTACHINIENT 11. All disclosure forms as required by
the Certification Regarding Lobbying form must be completed and returned to the Contract Manager prior to
payment under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 215, the Provider shall comply with Executive Order 11246, Equal
Employment Opportunity. as amended by Executive Order 1 1375 and others, and as supplemented in Department
of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
6.1.; If this contract contains t'ederal hands and provides services to children up to age IS, the Provider shall comply
with the Pro-('hildren Act of 1994 (20 U.S.C. 6051).
6.1.6 A contract award with an arnount expected to equal or exceed S25.000.00 and certain other contract awards will
not be made to parties listed on the t.�o%ernnient-wide Excluded Parties List System, in accordance with the ()%113
,iuidcliries at 2 (:FR I SO that implement f xecutive ()rders 1?5-49 mid 12659, -Debarnient and Suspension." five
1ACILde(l Parties List System eontains the names of parties debarred. Suspended, or othenkise excluded by
�leIIc,tes, ras well as p;irtics declared ineli<.tible under statutory or re-ulator'G' authority other than Fxecume Order
i2319 Elie l'ro%lder S11a11 comply with these pro%ls,Iolis `)ef«re doirat.! flusmess or enterin.: into sLJI;<.intract;
rccc:i%m- federal funds pursuant to this contract_ I he Provider shall conip[etc and s it*n ;VTTACFI"N1FNT V prit�r
ro the exeeutloll of tills contr,lCt.
1 he PTV IdA.T till, ll Ilt�t c'?111110% J11 l he AIIIXII :e V' 111 :011SIdel' (I':C CMD10 111�21!t 0I
��17Slltk'IC�rl"Cd 21 '.wldrt1on of the het I.. .SS_(. . 1 the lnilll1_'r�11!Ol?
�lild i.ontrol .het t t i 0"O 1'11115,C POr Ulltl;lter4ll '.il.Cc'1 :ttLrC1 t7t till,
:�,�11r,1et Iic the Vhl wcc°.
C ontract tnllbcr KI-I- 147''
6.3 1!'tlle Provider i, rt lion-profit pro%icler ,lald is suhlect to Intcrrulb Rcvcallae Service (IRS) tax cxctnl)t �lrt�anization
rcpe'ntinU' reduirenlertts (tiling a Form QQ(1 or Form QQO ti) ;and lla.s its (,ax exempt status rc%Acd for t"iilinl,7 to
coillply with the tiling, rctlutrenacnts elf Cite 2006 Pension Protection :Act or tOr amv other rc:ascm, the Provider
nutst notifti the Alliance in writil7� %%ittim thirty 13t)) dLIVS 01,1'eccivim-, the IRS 110tice 0t,IV%oc tti011,
Fllc Provider shall corllpl% is ith Title 2 (TR Part -1 5 rc,,ardinu T'r�al'ticking, in Persons,
6.4
l.''iless exempt under ' CFR Part 170 110(b), the Provider shall comply with the reportin�� recluircanents of the
Transparency :'act as expressed in 2 CF'R 170,
7. Compliance %�ith State Law
7.1 This contract is executed and entered into in the State of I=lorida, and shall be construed, perf )rued 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, 287.05S, F.S. as amended.
7.2.1 The Provider shall provide units of deliverables, including various client services, and in some instances may
include reports, findings, and drafts, as specified in this contract, which the Contract Manager must receive; and
accept in writing, prior to payment in accordance with s. 215.971, F.S. (I') and (2).
7.2.2 The Provider shall submit bills for fees or other compensation tar services or expenses in sufficient derail for a
proper pre-audit and post-audit.
7.2.3 If itemized payment for travel expenses is permitted in this contract, the Provider shall submit bills for any travel
expenses in accordance with s. 1 12,061, F.S., or at such Lower rates as may be provided in this contract.
7.2.4 The Provider shall allow public access to all documents, papers, letters, or other public records as defiried in
Subsection 1 19.01 1(12), F.S., made or received by the Provider in conjunction with this contract except for those
records which are made confidential or exempt by law. The Provider's refusal to comply with this provision will
constitute an immediate breach of contract for which the Alliance may unilaterally terminate the contract.
'.3 If clients are to be transported under this contract, the Provider shall comply with the provisions of Chapter 427,
F.S., and Rule 41-2, F. A. C.
7.4 The provider may not subcontract with any individuals or entities oil the discriminatory vendor list because they
may not transact business with any public entity, in accordance with the provisions of s. 287.134, F.S.
7.5 The Provider shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state agency.
7.6 In accordance with s. 257.135 F.S., any Contractor oil the Scrutinized Companies with Activities in Sudan List or
the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List (Lists), created pursuant to s.
215.473 F.S., is ineligible to enter into or renew a contract or ar(2reement with the Department for foods or
services of SI million or more. Pursuant to s. 287.135 F.S., the Department may terminate this Contract and any
contract or agreement incorporating this Contract by reference if the Contractor is found to have submitted a false
certification of its status oil the Lists or has been placed on the I-ists. Furrtller, the Contractor is subiect to civil
penalties. attorley's fees and costs and any costs for investigations that led to the finding, of false certitication. If
tanv contract or agreement incorporating this Contract contains SI million or more. the; (..'ontractor shall complete
,and sign ATTACIIMFNT 1-1. Certification Rc<,arding Scrutinized Companies Lists. prior to the execution of this
Contract.
�. Back_.,round Sereenine*
Vile Provider ;Mail cn ure (hat. prior to providing, services. ,ill l)c.rsons llaviaai! ,IC ess to %ulaler,ahle ciders �md
children. their Irving area. t'lands or post>nal property. or protected health int'ormation pertainin' to >tach
�lclid ieiarais. %e 111 s ;l I c%cl I1 crimilml 1,%lck,.m and "crecni€atF ira ,tc,:Ordrance %' itlt the rcgr.aar4ntents of >.
Cif. _` T.S.. wr, :3f11tr1GIc'el, I llesc pr.0%1'l !IS ripply to emplo,\ce,, dtreet
c;s'.ICc; pr,)%1dc'rti rand \edulltec'r, t. oit"egl1c'ittly, Gild" Ccrlllnll�tPll alt for r ICc',. Ot
�olmitcer rang pru-ticip,ation wall 1)c contirl�lcrlt open the ha:,,intr Ot �l 1 0 Ci 11 I),ickl,ro Ulld cltce:k. I Ile
ae( =roua)ci scrcenutt, will illcLadc clllplovlilent lii,td)ry cIl cks ;Is pro%ided in s. 4." ai3( I 1, 1� S., rind holh local
old nratwtl;il eraC1111ml record CI)ccks tllroU,_,l1 lraw en!orcc;lleltt ;t'_'t11e1cs.
'0 1 It raCt \Ll I I I h Cr K I 1- 1 -2
4 1 -
- i -- cnr� ol, :igc or older ',\ho,
101- j1Lltj)01C� Ot �1111 �'CctWl)� �hk: !C"Ill dl�cct "elAICC
tO sCl-\Iccs k) the eldelly, llI.� direct. %cIdl a cheat Mitic
t I c F%I c c s I c c I I c!I t k c4 c,s !o t 11 eL 11c1 I t c 11 t er% soi-g �-Ij tI -cs doer nttoia lt hFei ciclt cctist'IsI lldt'm%odlU iotr ep-e,
ison,il
")rorcrt p 8.2 Screel"Im-, Ait-id,1\1t of, Comphclllcc - To e:olllpl kt lice %\ith section 6 ot* this
Conti"lct, tile ("olitr'letor shall C', 13r1ck,-117OUIld SCrCCMIl,-, Al'tIILMt ot, CoIlIj)1I1IIlce
L
8.3 FLIFthCr ItIforillation C011cernIM-1 the procedures )r hzickground screening S found It
9. Grievance and Complaint Procedures
9.1 Grievance Procedure
The Contractor shall CoInplV With and ensure Subcontractor compliance with the Millil"111,1111 Guideline for
Recipient Grievance Procedures. Appendix D, Department of Elder Affairs Programs and Services Handbook-. to
address complaints regarding the termination, suspension or reduction of services, as required for receipt of
Cull(K
9.2 Complaint Procedures:
The Contractor shall develop and implement complaint procedures and ensure that Subcontractors develop and
Implement complaint procedures to process and resolve client dissatisfaction with services. C:omplaitlt
procedures shall address the quality timeliness tieliness of services, provider and direct service worker complaints, or
any other advice related to complaints other than termination, suspension or reduction in services that require the
grievance process as described in Appendix D, Department of Elder Affairs Programs and Services Handbook.
The complaint procedures shall include notification to all clients of the complaint procedure and include tracking
the date, nature of the complaint and the determination of the complaint.
0. Audits, Inspections, Investiaafions, Public Records and Retention
10.1 The provider shall establish and maintain books, records, and documents (including electronic storage media) in
accordance with generally accepted accounting procedures and practices that sufficiently and properly reflect all
revenues and expenditures of funds provided by the Alliance under this contract. Provider agrees to maintain
records, including paid invoices, payroll registers. travel vouchers, copy logs, postage logs, time sheets, etc., as
supporting docurneritat loll for service cost reports and for administrative expenses itemized for reimbursement.
This documentation will be made available upon request Cor monitoring and auditing purposes. Whenever
appropriate, financial int*orniatlon should be related to performance and unit cost data.
10.2 file Provider shall retain all client records, financial records, supporting documents, statistical records, and any
other documents (including electronic storage media) pertinent to this contract for a period of six (6) years after
completion of the contract or longer when required by law. In the event an audit is required by this contract,
records shall be retained Cor a t'llillillILlin period of six (6) years after the audit report is issued or until resolution
I,)t any audit findings or litigation based on the terms of this contract, at no additional cost to the Alliance.
10.3 (-.'pon demand, at no additional cost to the Alliance. the Provider shall facilitate the duplication and transt,cr of
any records or documents during the required retention period In Paragraph 10.1
10.4 File Provider S11,311 a sure that the record,,, described in Paragraph 10 Will he sUhJCCt at all reasonable times to
M�TCCIIOII, review. coping, or audit by federal, state. or other personnel dLaly aWthorized by tile All'K111ce,
10.5 \t <ulj times I'Or as lomi as records are m,,imU1II1Cd, j)CrS0IlS' duly authorized by the Alliince. the
Dcpllrltnellt :iml Ceiicrnl tiudltor'. pursuzint to -45 (TR 92.16w( 10). e' ill he A!(med i'UH ,iccess to and the right to
"t, (1,C Pro% rebated rccord,ti WIrld doctllilcw-y rcl-T!m:nt to 011; ;')Celtic
10.6 1 lie PT",% !udit to Allmlice Ili
L:n.�urc Il,ljt jjj rLd,jtcd 111il-Ij-;1,111%
I o.7 f he Pro%I&I. ,hall conirk 'lliIi oll jjI,, [C%tc\I, illti Or
ece:,"I r", !)% tit e CC tk I F (I elk'l<I! I)LI I",11a I It tO 21
1 S
�t)IItI-,ICt N''Un111C1I 11.111- 1 l�2
10's itl} the AtI',IIlCc 'xticlI rro,-,Fc:ss. rise<11 otter invcllk)I'% I iil ollicr I-C I-ts as the
\1liancc. Itlll� rccluirc r~~ttlliri tltc perit�ti of this c��ntract. ry .
-10.9 l lic Provider s11a11 submit hrujw1I1l, 'Ind client Identi€ia1hte t1lt.l. rs ,pcci'ried h. the Dcl%irtntcllt of
f:'tier \ft"tilts t111(1 or tllc \llitlncc. l he plo%ldcr MUSt 1'ec0i'd and, ubnut program )pccit t: data III tlec rdtin c
%%till the Dep'Irtniclit's (:'Bent lrlforrllamoll Rcgl� tr"ltloll Tmt:ki1I,! % tenl ((,IR FS) Pohcv (itliciclirres.
10.11) It, "Inner �111% conlrtlCt Or li_'rtcrtlellt €ticol-pomtMIL, this (..mtmct by r'cter—crIc . the (. ontr Ictor is providing serl lees
�tnd is tictirl t:?Ia 1>ehalf c>l the [7epartl:let�t c,t I::Icier . t't' it's or the Alliance for Aging, Inc. its pro%Idled under
sectttait 1 19.111 1(2). Florida `atatutcs, the Contractor, subject to the terms of'section 2`s7.05'S(I)(c). Florida
statutes. tend ,Inv taller- tipplicable legal rind equitable remedies, .shall:
a) Keep and nlail.tairl puhhc records that ordinarily and Necessarily WOUld be required by the public a1=ency ir7
order to perform the services.
b) Provide the public with access to public records oil the same terms and conditions that the Department of'
F:Idcr Affairs or the Alliance for \4Oilh', Inc. would provide the records and at a cast that does not exceed the cost
prO ,,ided in Chapter 119, Florida S(atLatfa, or as otherwise provided by law.
C) Ensure that public records that are exempt or confidential and exempt from public records disclosure
requirements are not disclosed except as authorized by law.
(I) Meet all requirements for retaining public records and transfer, at no cost, to the Department of Elder Affairs
or-the Alliance for.din , Inc. all public records in possession of the Contractor upon termination or expiration
ofany 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 Elder Affairs or the Alliance for Aging, Inc. in a format
that is compatible with the information technology systerns of the Department.
10-11 The Alliance for Aging;, Inc. may unilaterally cancel this Master Contract, and any contract or agreement
incorporating this Contract by reference, notwithstanding any other provisions of this Contract, for refusal by
the Contractor to comply with Section 8 of this Contract by not allowing public access to all documents, papers,
letters, or other material made or received by the Contractor in conjunction with the contract or agreement
incorporating this Contract by reference, unless the records are exempt from Section 24(<a) of Article I of the
State Constitution and Section 1 19.07(1). Florida Statutes.
11. Nondiscrimination-Civil Rights Compliance
11.1 'The Provider shall execute assurances it, krrACHNIENT V1 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 orit-in, marital status or sex in compliance with state and federal law and regulations. T"he
Provider further assures that all Providers, subcontractors, subgrantees, or others with whom it arranges to
provide services or benefits in connection with any of its programs and activities are not discriminating against
clients or employees because ofaµae, race, relitgion, color. disability, national origin, marital status or sex.
1.1.2 Durins: the term of this contract. the Provider shall complete and retain on file a timely. complete and accurate
Civil Rights Compliance Checklist (:1"1'TAC111MENT B).
11.3 Fhe Provider shall establish procedures pursuant to federal law to handle complaints of'1liscrimination involvim.li
crvices or benetits throe<uh this contract. These procedures «i11 include notifyint(t clients, employees. Ind
j%irticipants of the rig=Ilt to file a complaint %~ith the,appropriate federal or suite entity.
11.4 11' 111is ct'Iil mct contmns federal funds. these assurances tiro a condition Ot'C011tinued receipt of or henctit tiom
c'ticral t111atIC1t11 ti :5(yfancc, tlnd �Irc Madill!! riporl rile Pro%ldcr, it-; sUCCeSSOI-S, tr'an�terees, rind ti,.tiit„glees for the
l)criod c1111.1111U 'A 1.11C11 UL:17 :Isslsrallee IS pro%!dcd. I he Pr %Ider" tlLr"tiler CtsstirCS that t111 UhC0IIIMct0rS, eI1t.1c7f'y. or
�Ahom It .1rr41it ca fo prtltl�fc �er%iccs or 11c'ilclrtS to 171ar'tiCipt111ts Or elllplo%cc:s III c0llncctI0II l%"Ith <111\
dts t7lf'�_'f'aniS '1111i ffe I10t or :111"llo%ccS Eli 1012lt!0[71 Ot the
�Q�` c' �t.'ul;tc' l _'1rt,itlC�ils. LLlICtc:�l[l ">. !tile{ st:}ilti.irlls. ill I�'i c' CIl€ twt ::fl{Lil'ti t41 Ci9i.1171`. t11C 1'r'ttlticr Lt11C1 1"titailcls
a( 1CIC c°c"k li a:o 11E o!-- icr 1' I[h !lie (cMIS Ot tills "l� ltr�lIlc�c
51171�R'111`1.Ilc ;tidl,'1,11 or OUt lint IiIMhed tee. %'r1I11P1kit1UII Ot 1111d dc'ni:ll
� l Ellrthel' ;lti,>i7Paf1c'4'.
)I It rI C t �\tj I I 11)e 1 7
12. ProN ision of SCI-N ices
Tile lll-o% Ider shall J)r0\Ide services in the manner descrilied it,, III ATTACHNI ENT I ot'thl, r11_lrcclllcllt and III the
Scr�ice Pro%ider Application 1 SP III the e%ent ofzl contlict hetwecti the Ser%ice Provider Application and thl";
.owr"ict. llic con'tc"Ict
13, '\j()jjjtOj-jjj(_, J)N the alliance for A(_,ink
The -\111,111ce will pert'Orin admillistrm1%e auld programmatic monl1orlm-, of tile pr0%I(ler to el)SLUC C0ntrICtU"II
COMPILMICe, t_1sCII LICCOLIIltablllty, Jiro(-)rartill-lat 1c pert'ormance, and compliance with applicable state rind federal
laws and rc�_,ulatlOrls.
13.1 '1 lie pro,,I(Icr %%Ill supply progress reports, including data reporting requirements as specified by the Alliance or
the Department to be Used for ITIOnItOrIM.T progress or pet-Cormance of'the contractual services as specified in this
contract. Following the norms set down by the Department, the Alliance will track performance oil a monthly,
basis, throu,_,h desk rL\te%%S of available fiscal. CIRTS, and research production reports and any other system or
process designated by the Alliance. Examples of'review criteria are SUrPILls,deficit, independent audits, Internal
controls, reimbursement requests, subcontract monitoring, tarlyeting, program eligibility, OUtCOnle 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, dOCURICIItS, facilities, goods and services of the provider which,are relevant to this contract, and
to interview any clients, employees, and subcontractor employees of the provider to be assure the Alliance of the
satisfactory performance of the terms and conditions of this contract. Following such review, the Alliance will
deliver to the provider a written report of its findings and request for development, by the provider, of a
corrective action plan (CAP) where appropriate. The Contractor hereby agrees to correct all deficiencies
z�
identified in the CAP in a timely manner as determined by the Contract Manager.
13.3 Extraordinary Reporting
`File provider shall notify the contract manager for the Alliance Immediately, but no later than within 48 hours,
from the provider's awareness or discovery of conditions that may materially affect the provider's ability to
perform, such as problems, delays, or adverse conditions which may Impair the provider's ability to meet the
objectives of this contract or that may affect the health, safety or well-being of clients. The notice shall include a
brief summary of the problern(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
• agfrcernerit non-compt ia[ice
• service quality problems and consumer complaint trends
• IIIPAA %IoL)tI0IIs
• I'Otelltlll tr,'ILId allot tattoaa or Ot'll'I'lifeasance b%, ilo'ird Illembers, cllljplo%ecs
%olurteer,', or other,as-,ocifles
I \(1!x1cC h lll t,CL�,Irdlllu ta1sIticatlk)li ot,cilent ;cT%Ice records, J,4I%11-lent
h1ll 11C rq)"l-ted to 1he Pc;);Irtnlellt" colltri!ct
PrV%?der Fet:llns Chc
of ,Ill C!Ak,:e CO%t�:rcd 'Ind 11"ll"t C11"U!'c tlMt eflt5 4:OCIIIIUIC
PIVCU;-CII!C!It tCMI)0I-JI'%
Contract Nutaaber K11- 1.47'
",ttlilpCloll t1l C11C llli'CCC pro i,li?I1 of "c;r` IccS. etc.
14, Coordinated Ntonitoring +Kith Other .A«encies
lf` the Provider receive, t`undin�x fr���ill one or IIII?re of tilt Suite of Florida other hunmil service afencies, ill
alddition to the 1)ep<lrttllent of 1;lder .'affairs, thc;n a j�:)int monitoring- ��i�s,it inclild 1lsz such Other l��ellctes ill�l�� he
scheduled. for tile. purposes of tills contract, and pur cant to s. -IS '.05 7 5 1�.S. , <lmendel Flor d 1 , l}unl i
;ertiice a'-'encies "hall include the Department of'Children and Families, the Department of Health, the yf ency for
Persons with Disabilities, the Deptu-tment of Veterans Affairs.. and the Department of Elder Affairs. t..'pon
rlotificati m Lind the subsequent ,chedulin..= of such a visit by the desi;nated a4aency's lead administrative
coordinator, the Provider shall comply and cooperate with all monitors, inspectors, and.or investiiTators.
15. Indemnification
Tile provider shall indemnify, defend, and hold harmless the Department and the Alliance and their officers,
agents. and employees from any claim, loss, damage, cost. charge, or expense whatever nature or character
a rising out of any acts, actions, neglect or omission, action in bad faith, or violation of federal or stag 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 a�areed that the provider is not required to
Indemnify the Alliance for claims aarising out of the sole negligence of the Alliance.the prove er's obligation to indemnify, defend, and pay for the defense or, at the Departments and/ or the
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 i or Alliance's
-File provider's inability to evaluate liability or its evaluation of
notice of`claitaa for indemnification Co the provider.
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 re47istered or certified mail„ return
receipt requested. Only an adjudication or judgment after the highest appeal is exhausted specifically finding the
\Iliance 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
inderllnify.
15.1 Except to the extent permitted by s. 768 28, F.S., or other Florida law, Paragraph 15 is riot applicable to contracts
executed between the Alliance and state agencies or subdivisions detined in s. 768.28(2), F.S.
16. insurance and Cioncfin9
16.1 The provider must carry adequate liability insurance and workers compensation insurance coverage, oil a
comprehensive basis, and must hold such liability and worker's compensation insurances at all times during the
effective period of this contract and any renewal(s) or extension(s) of this contract. The Alliance shall be
included as an additional insured on the provider's liability insurance policy or policies and a copy of the
Certificate of Insurance shall be provided annually or NN hen any changes --occur. File provider accepts toll
respoalsibility for identifyin,, and detenlurlirnz the type(s) and extent. e served Linder
necessary to provide
reasonable financial protections for the provider mid file clients tc e "eed rlcl4r this contract. C'porl exeCntlon
of this contract. the prodder shall tiarnisll tie Alliance written verification supportmg, bath the detemiiriatiora 'llid
cKltifenle of srac: l et.74erilce. the lilalits of Cmera�ae under each policy nuaintMiled by the prilvider do
not limit the prouder; hahllity ami obh,gati lls under this contract. i'he pro%Ider shall ca ure that the Allialnee
iC1�Ul"ailCc
IE:1 the mkiC ,t Cul-rent %%r1rcn %entic:ltton of 11ISUT'3nCe throughout file toile kit' tills colltM t. Ilie
1)epaninent anCi the .Vhance re,er%c: the rt'"lit to J"iditwnal ill"uralnce %khere <lpproprlate.
10.2 1 " e ' i'il' of till, tl'ltrrtet IhLl hrk",Ider Mlitit it slnCtllI11111 1 1�c1riillCe h0lld Iromll re th):1 sill
l f., I t l t
liel ;fYl Il;-�lld`ullic.'e' cIlit7<111'W et1.�f,i1�T ,l'tl clttl ti, tlSl c"tC'll'�, t71t)1c5tia` > 'Ind <i Cdlt" t'�t tale pro%ldcr. <1Li`l1c'I'1/e'cl
11,1l1cl�C 1Llncf, reeCl`,eel car cf'itillk(r c.$ illicit 1111" .t�i�'i'llet. II1 ;1:1 �1111k lit ConllllClitiLlrllCe with the f'�lT f� Ulail�'cl, tllc:
4a ree dot i l,k J", s.lCt4:illlned iIv the c:cili"p 11",% 1II1t1 4"0l? Ytiteflt ,GItll 17I'ACilee°.ti.
10.3 1t`lie t-k)% !cicr' f el ~lilt ' :1Weilcv it, I"Ioll IS dt:IHled h% cc!toll S., the hrok icier yh,d1 lLlr"tllsh, Uj),ill
e t. ~trifle( 1�'i'Itit:atlon of 11"Ibillt`. 1)rote4al<1i1 In ateCord<tn4e 11Vth "c.'Ctloli l)�-2S. l'. titYthln'_' liel'e121 ,nail
(,*()I It raCt \U In I)Cr K I I- 1472
b: :on"trued to C\tclld any p�jrte's h,a!)ihly, beyond &0 pro,Wed in OCAMI 7hS 2K F S, (See Aker
Clause.)
17, Confidentiality of Information
Be Pro%Aer shall w use or Kcloc miy a recipient of -;er,,icca iinder this c0litract, for
any purpose prohibited by state or federal law or reguhnons except x%ith the written consent of a PCN011 legally
authonzed to give that coIbent or when authohzed by law,
18. Health Insurance Portability anti mcountabilliry :act
""ere applicable. the Provider shall comply with the Beall Insurance Portability and Accountability Act (42
t-'SC 1320&), as well as all reguWiorls plomwigmed thereunder(45 CUR IN), 102, and 164).
19. Incident IRT P o rKi nn gg
III 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 pertonned Linder this contract. Such notice shall be made orally to the Contract
Manager(by telephone) with an email to immediately follow.
1%2 The ProWder shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a
child, aged personty or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (I-
5OOA6ABUSEY As required by Chapters 39 and 415, RS, this provision is binding upon both the Provider and
its employees.
20. LBarAkrypiNNY441,610wWO Kppt�v N fificaltiOP
During the term of this contract, the Provider shall immediately notify the Alliance if the Provider, its assignees,
subcontractors or affiliates tile a claim for bankruptcy. Within ten (10) days after notification. the Provider must
also provide the following information to the Alliance: (I) the date of filing of the bankruptcy petition; (2) the
case number; (3) the Court name and the division in which the petition was Filed (e.g., Northern District of
Florida, Tallahassee Division); and, (4) the name, address, and telephone number of the bankruptcy attorney.
21. Sponsorship and Publicity
21.1 Any nongovernmental organization which sponsors a program. financed partially by state funds or funds obtained
from a state agency shall, in publicizing. advertising, or describing the sponsorship of the progratil. state:
`.Sponsored by the State of Florida, Department of Elder Affairs and Alliance for Aging Inc." If the sponsorship
reference is in written material. the words**State of Florida, Department of Elder Affairs and the Alliance for
Aging- shall appear in the same size letters or type as the name of the organization (ref.: section 286.25, F. Sj.
This shall include, but is not limited to, any correspondence or other writing, publication or broadcast that refers
to such program.
21.2 The provider shall not use the words -State of Florida, Department of Elder Affairs"and/or "Hie Alliance for
Amn, Inc." to indicate sponsorship of a program otherwise financed unless specific authorization has been
obtained by the Alliance prior to use.
22. ,\ss s ih_:Y!n umn e nint s
211 The provider shall not assign As rights arxi respOlISHOIRICS Linder this contract witluna the prior wnuen approval
of,the Alliatice. AH commas or agreements incorporating ills Contract by reference ,hall remain binding u['1011
the successors in nHnem of dher We Contractor or the Alliance for A,!Al, I g. llc
221 NoaMYo\aI Q the Alliance of.Inv assIgnment orsakwomnict MwH be deemed in any event or in any nianner to
pro%lde l'or the Alliance in jddkion to to dolhranwum agreed upm in dus
.wHrnct.
223 1 he 9,0, of F 1,nda 15 it aH I ures cnnomt to my qn, tT wais Or. i n %\h,de or pllrt, it, r1,01ts. c!Wlcs, or oN iil'i!1,711,
Ai) icr J11v :Oil�!rCt 01, to Jllcthcr ill !!Ie ',tCitc of I lorl�ii. Ipol',
1011CC 10 !lie Ontr1k.'iOF In the mcm the "suite of Honk ;Wpinr cs lranstcr A !he
the (''ontroic"or rellianIS 1'e"11011'sINC !,or !H pertolnlcd ;Wd ill 111CMI-ed In :0M1CCt101I
I It I'�I C t Q 1'e e I I),e I I t-
C.'canfract `�umlacr IkFf- 1472
23. Sultco lit racts:
23A The C' inranor is responsible fur all %v, !*k performcd <ind for all cotaanloditics produced I,attrst.lant to this
contract, %ehethc:r actually furnishcd by the C". mHrac for or its stthcontractors. My subcoiltracts shall he
ec idcn"d by a "Men tagactuctit ,gect to Al .7E.1piicable wmis and com.liYns ofHas con"aa. .A kince
approval ofthe scar%ice appli;:ation presented by the provider shalt constitute Alliance appro%jai of tine pro%ider's
propo"cd ,uhcc lltr"Icts if[Ile sulaccatatrac s tallow the service and thuhn , information identified in the provider's
set-ice application, All other sul7colltt, Proposed
roped to he f`undmi under this contract must he appro%ed in
E E� � rac c
trdvance by the alliance. Ile provider a aces that the alliance shall not be liable to any, subcontractor in any
wav or for any reason. �Fhe pro%ider, at its expense. %k ill indemnity and defend the Alliance zigainst any,
subcontractor claims.
231 The pro%Her shall promptly pay any subcontractors. Failure to pay subcontractors pursuant to any subcontract
or as required by law may re tdt in enforcement action under dais contract.
23.3 The provider maintains responsibility for the monhoring and performance of all subcontracts in accordance with
all applicable federal and We laws.
214 The Contractor shall have a procurement policy that assures maximum free and open competition. Such
reui tt asascsli:t forth in I itle �I7 Code of Federal tt�c:Federal
atie and State contracting and procurementC'lt r
procurement p y"
7 ans (C FR) part 74 - Sub-Put C, 28T0S7 Florida
Statutes (F.S.), U.S. Office of Management and E3 Wgo (OMB)Circular 110, Florida Department of
i4tanauetnent Services (DNIS) Rule 60A4, Florida Administrative Code, and with the Department of Elder
Affairs Prourarn and Services Handbook 2012.
215 The Contractor shall submit annually to the Alliance service cost reports, which reflect actual costs of providing
each service by program. "This report provides information for planning and ne<xotiatirt," unit rates.
24. Independent Capacity of Provider
211 'The provider will be acting in its independent capacity and not as art employee, agent or representative of the
Alliance or the Department. The provider shall not be deemed or construed to be all employee, went or
representative of the Alliance or the Department for any purpose whatsoever. Nothing contained in this contract
is intended to, or shall be construed in any manner, as creating or establishing the relationship of
employer/employee between the parties.
24.2 The provider shall lie responsible for completely supervising and directing the work under this contract whether
performed by the provider or by any Subcontractor that it may utilize. The provider shall be responsible for all
subcontractors who perform work under this contract. The provider agrees that it is as fully responsible for tlae
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 tlae (Alliance does not control the employment practices of the provider and shall not
be liable for any wage and hour, employment discrimination, or other labor and employment claims against the
provider or its subcoruractom. All deductions for social security, withholdings taxes, income taxes. contributions
to unemployment compensation funds and all necessary insurance for the provider shall be the sole
responsibility of the provider,
25. Pas meat
25.1 Payments shall be made to the Provider as serf ices are rendered and invoiced by the Pro'v Her. I he .Alliance's
(_'contract AI'mager will have final approval of the imolce AW payment, and will approve (he imoice for paymcnt
Oltly it the Pro,,ldcr has islet till terms and conditions of the cc'trumo. unless the bid ,pccitic:anon,,. purchase order.
or tla ,, onu'aet 511ccily Othcl-\%i,e, I he aE'tined Hnoice "W he suhriducd to dw Nhatace s finalwe sc non wi
1)ud�ac'tary Ippro%al ,Iad procc,,,Imr
212 PaNnient DOCUlatCntation Rcquired
9 A pw%Id_ .,I 'h;Ill n to Uppoll pat IEcnI (1'C)L C'r, \4 iIIClI -h,lll Ile ;I% IiIili�lt' to lilt'
o nptr�dicr, tide 1)epttrtnacnt, or the .Aillaiwe Upon rct uc. 't� MU"t he tiUmnaTcd ill dclall for a
11,0per }>rc ;Iudit clad po"'t audit thereon. (lie pro%ldcr 'hall :oltlpl� %kith all t.lte and Feces( �'2o% rrain11
�atiilaetats to 17e I,a<icie asiacicar thi; c:c�tatr;ati°t ilac:lnhnq, but FIN binned to Whe tti) ( Itsi 11'1) Est
�r
('01 It I%ICt N Llm h cr K t I- 14 7")
30.151, F, S- tc,-,ardt I I,-, �Ikklances, ()I) Rule Old-40.It), pertmn I nu, to Rt2stt I ct I on of Lxlletidmlrcs
E'rolli "I'Itc t I umk: rind (C) the Colltl-,Ict ll'lylnent Requirements ot, sC:Ctloll (' of the Reference (Juldc
1k)r st� tc froth ( e )Call 'cit t, t I i� I c I�I I Sc-vicc
din!
ke prof Ider shall maintain detailed docull-1clItX1011 to "UpTlort each Item on the Itemized invoice or pEiviiiew
rcqucst I or cost rctmbulscd expense including paid IMOtceS, rIlld will he produced upon retlUeSt
by the AII lancc, I lie provider shall only I-CeJLIC,t reirtllaursctticrtt f,Or al lo%�able expenses zis det-,ned III the law;; and
auiditl circulars tCd In this in the Reference Guide f'Or State Expenditures, and .tray other laws or
rel-'U!XiMIS, as rlppliCa111C. and that administrative expenses CIO not exceed amounts I)Ll(,I'.!etecf III the pro\Ider's
approved service application.
The Contractor will certify that CICtalICLI (IOCLIfflent3tiOn Is available to Support each item on the itemized invoice
Of' payment request for cost reimbursed expenses, fixed rate or deliverables contracts or agreernents
Incorporating this Contract by reference, Including paid Subcontractor invoices, and will lie produced UpOrl
rCCILIC'St by the Department. The Contractor will further certify that reimbursement requests are only for allowable
expenses as defined in the laws and guiding circulars cited in Sections 6 and 7/ of this Contract, in the Reference
Guide for State Expenditures, and any other laws Or regulations, as applicable, and that administrative expenses
do not exceed aIII0LITItS budgeted in the Contractor's approved area plan Its developed in accordance with and
pursuant to section 306(a) of the Older Americans Act of 1965, as amended,
25.3 Limit on Funding,Obligations
The Alliance for Aging, Inc. acknowledges its obli-ation to pay the Contractor for the performance of the
Contractor's duties and responsibilities set forth in any contract or agreement incorporating this Contract by
reference.
The Alliance shall not be liable to the provider For costs Incurred or performance rendered unless Such costs and
perfort-nances are strictly in accordance with the terms of this contract, including but not limited to terms
I specified.
governing the provider's promised performance and unit rates and/or reimbursement capitations specifie
`rhe Alliance shall not be liable to the provider for any expenditures which are not allowable costs as defined by
applicable federal or state law, or which expenditures have not been made in accordance with the fiscal guidelines
and requirements outlined by the Department.
The Alliance shall not be liable to the provider for expenditures made in violation of' regulations, the Older
Americans Act, Department rules, Florida Statutes, or this contract.
26. Return of Funds
The Contractor shall return to the Alliance any overpayments due to unearned funds or funds disallowed and any
interest attributable to Such funds pursuant to the terms and conditions of any contract or agreement incorporating
this Contract by reference that were disbursed to the Contractor by the Alliance. fri the event that the Contractor or
its independent auditor discovers that in overpayment has been made, the Contractor shall repay said overpayment
i11In1Cdi2te1V without prior notification from the Alliance. In the event that the Alliance first discovers an
O\erpayinent has been made, the Contract `vlanager will notify the Contractor in writing of such findings. Should
repayment not he made forthwith. the Contractor shall be charued at the lawful rate of interest Oil the 01.1t.Stalldil`12
1,aLIIICC pursuant to s. 55-033. 1: S.. after Alliance's notification or Contractor discovery.
17. Data [ritegrity and Safe,-ruardin(_)r,Information.
I lie pro%sdcr shall eIISLII-C an nppropririte lc\ci of data sccurlty t'Or the in[Ormitioti the provider is collectim-, or
in the pertorm;ince of this contract. An appropriate level of security Includes appron inu rued trackim-, r111
pro%idcr etnplo,.ccs tl%It t'C�JLICNt sCei21 Or MI'orm'ItIon "111d that LI-,cricC:css his been remo\ed
role III IerltllnatCd clnrlo)":es, I lie pro%idcr. oilicr 11111"I aliticlrlatc '111d pt-cp'Ire for the loss
U 'Lit'l 'Ind mu,"t he rouClrlcN 17,3C:ked lq) k) t'(1,40�k:11,4
,rOM OF ol coirmIM, I !I-,c ccurw, t1kc 1%ick-up dit,i i.s !o fle Jl� itile
of the Pf"OcIdcr ,�llttcll
I
lie pro%ld I- 1. pm r to C\CC1141 1011 ol, Ill',
,�,,Irrlcte the 17ata 1!ltc~lrlty ( crt I fiC:'ItIon 10rlil. I I I IMF", I IV
trstct NulalOer
28. Con►pater (_'se and -Social Media f olicv
Clle L. er•Irtll)cllt ot, Llder .A('!'airs Il.as illlplCincilted a Ile,,~ social Media Policy. in .Iddition to its ("olrlputcr
l'c�1i y, %%hich apphes to all etllplL gees, contracted cnlplo ees'. Consultants. ()PS and yoluntcers, includin" t111
perSonna:l .aftih:ltcd `ti ith third p,srtics. �Llc:h As, but nor Imlited to, AI-ctia can Auiml �wd ` elldors An"
itity that Ll,�,es the l)elmli pent Ct?Il`;llUtcr' 1'e'"fir"ce tiS' ttr11 must comply ,ylth the Department's policy re!gardmi,
,'OCIal IlledM, ti lc1l11 NIC(lIL1 111t:Iude`.s, but is not 11miled to blous. podcasts, discus"'lon forulli`r, ` l i`, RSS fecc.ls.
tiIdeo Sh.ar'inz, social net�korks like M%Space, Fzlcebook and Ccyitter, as well as content shsari.l( net%tiorks Such &
tlickr' arid YOU FLIhC CThis policy is available on the Department's website at:
lattp:/%el(lernt`fairs.state.fl.usl(Ioertltinancizal.php).
2t). Conflict of Interest
'Flee provider sklall establish safeguards to prohibit employees, board members, management and subcontractors
from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest or personal gain. No employee, officer or agent of the Provider or Subcontractor shall
participate in selection, or in the award ot'an agreement supported by state or federal funds if a conflict of interest.
renal or apparent, would be involved. Such a conflict would arise when`. (a) the employee, officer or aI-Tent; (b) ariy
member of his,her immediate family; (c) his or her partner, or; (d) art organization which employs, or is about to
employ, any of the above, has a financial or other interest in the firm selected for award. The Provider Or
subcontractor's officers, employees or agents will neither solicit nor accept gratuities, favors or anything of
monetary value frorn contractors, potential contractors, or parties to subcontracts. The Provider's board members
and management must disclose to the Alliance any relationship which may be, or may be perceived to be, a
conflict of interest within thirty (30) calendar days of an individual's original appointment or placement in that
position, or if the individual is serving as an incumbent, within thirty (30) calendar days of the commencement of
this contract. The Provider's employees and subcontractors must make the sarne disclosures described above to
the Provider's board ot'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 hollowing a
conviction for a public entity crime may not submit a bid, proposal, or reply oil a contract to provide any goods or
services to a public entity: may riot submit a bid, proposal, or reply on a contract with a public entity for the
construction or repair of a public building or public work; may not submit bids, proposats, or replies oil leases of
real property to a public entity: may riot be awarded or perform work as a contractor, supplier, subcontractor, or
consultant under a contract with any public entity; and may not transact business with any public entity in excess
of the threshold amount provided in s. 287.017, F.S., for CATEGORY TWO for a period of 36 months following
the date of being placed oil the convicted vendor list.
The provider represents and warrants that the provider, its officers, directors, senior management, praalraers,
employees or agents have not been convicted of any public entity crimes within the last 36 months. If the provider
or any to ' its officers or directors is convicted of a public entity crime durin4- the period of this agreement, the
provider shall notify the Alliance immediately. Non-compliance with this statute shall Constitute a breach of this
atreement. The provider must ensure that it does not enter into with any subcontractor on the convicted vendors
list or Other%vise prohibited from contracting tar state funds pursuant to section 287.133, F.S.
3(, Purchasinw
ProctlrCI11Crlt of Products Or M.itcritals w ah Recycled Content.
1 cu>.ah(e materials and prodacts shall he used `A here cconomlcally tccllrlicnlly fcaSihle.
32. Patents, Cotavri,-!hts, Roialties
lk' tl1i, cc�Iltrlct is a�.yarLlcci suatc ttiltciin�u .alct at .Illy d:,cll�c;rti, in`.c;:tlt�cpra ter c��pyritrlat.ab?e 11a.ueria9 i� cic~vcic�pcd
K1r I. iC11 cal' 1C1, 1Ip Lt<a 4 ( LI!'U'11:1jAi i'1 C11c Ct14kI',e cif0 1 1 rc'sL l 1"N ICGS ertiart11ed 111dtar
"11ti i . '}EI'.1C1. f�ac= II;IiI IC!k:r ?he cll n%elltl0la OF lie 11,111cc tip he rctcrrcd to the
ullder t1�11, �t�Citri@Ct ;aa"e 'lcl'c:�71 :'t°,tiCa``.Cd tO
`.`Cale l lol-]da lil sa :4'ttii 1t111 l Itl1 ( iYlpt "i' f7, I .`5.
33. Vnier-lencs Prepa red[less and Continuith of t)perations
ll
(_'ontracC 1� [1- 1-172
33.1 1 he Provider shall, "A hin thirty (30) calendar days of Me cxccwion of this contract, submit to the (.Amtract
'tItTImger %Wncmion of an cmu�-,cnc� l)rcparedness plus. In the evclit of an ernergcricy. the Provider Aull ivyif%
the.\lhaIICe 4.)f cIIIC'ri'CP,Cy pT'O lSit)IIS.
31 In the c%Tnt a Sltuatlon results in a c"sathm of services hya sulnoturactor, the PrLividu shall ream wspowbilQ
for perfornh41ncc LlIhder this contract ,find must follow proc dares to ensure continuity of operations "kithout
PilteC`rlPptl(.Pn.
33.3 In preparation for the threat of an emergency cent as defined in the State of Flotida ('omprehenAc Fmegency
;Management Plan, the Department may exercise authority o%er an area agency or service provider agency to
implement prcpmcdncss activities to improve the safety of tie elderly in the threatened area and a) secure area
agency and service pn)Oder facilities to minimize the potential impact of the event. 'These actions will be within
the exis6n4a roles and responsibilities of the area agency and pro%ider,
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 Dcpartmou may exercise authority over an area agency or service proleider agency to implement
emergency relief measures and/or activities.
34. Equipment
34,1 Fquipment means: (a,) an article of none.xpendable, tangible personal property having a useful life of more
than one year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by
the organization for the financial statement purposes, or 55,000.00 [for federal funds], or (b): noncxpendable,
tangible personal property of a non-consumable nature with an acquisition cast of 51,000.00 or more per unit, and
expected useful life of at least one year: and hardback bound books not circulated to students or the general public.
with a value or cost of 5250.00 or more [tor state funds].
34.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations shhall have written property management standards in compliance with 2 C)=R Part 215
Administrative Requirements (fornherly ONIB Circular A-1 10) that include: (a) a property list with all the elements
identified in the circular; and, (b) a procedure for conducting a physical inventory of equipment at least once every
two years. (c) A control system to insure adequate safeguards to prevent loss, damage, or theft of the equipment;
and (d) maintenance procedures to keep the equipment in good condition. The property records must be
maintained on file and shall be provided to the Alliance upon request. The Contractor shall promptly investigate,
fully docurnent acid notify the Contract Manager of any loss, damage, or theft of equipment. The Contractor shall
provide the results of the investigation to the Contract :'Manager.
34.3 The Contractor's property rnanagernent standards for equipment acquired with Federal funds arid federally-
owned equipment shall include accurately maintained equipment records with the following information:
(1) A description of tile. 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:
(-t) Whether title vests in the Contractor or the federal government:
(5) Acquisition date (ar dare received, if the equipment was furnished by the federal governnient) and
c( st:
(f)) hit orniation thou 1',hicih cube can calculate the percentage of federal participation in the cost of Me egwpment
mot .hpphcahle to cgmpriwnt MOW by tile thleral Inernnh m):
i I oc,alon ,Mild condi(ion of the c'gmprllent inxi the Live the llhfhnnation "as reported:
�f I. (?It ,talu0own C4'kE ind
1 f_It,matc ancludim= d,itc ot'c:isposal whd sale, price or to nw Todused to dct runic
i1rrcllt I;IIr inarka %i lie where a Contractor compensatc_s the 1,:dc'ral 4114 tOr It,, ;harc.
12
C'ontr�ict \u mbcr Kit- 1472
f. 1 Lquipment purcilascd v�ith (edcra} I'ullds till <111 Ltccllli;itWll k:0"t oval, `5,000 0) 'Ind CgtIi1711lcttt pclrchasc��-1
4 ith >ttltc I'tulds %v 101 an acquisition cast over `Sl.t)I)t).Utt that is identified in the lrc,l pltsll rIppro%cd hl
the Depm-tlllent is part of the cost of Cmt-vill.! out the 'rC11y1ties and fcitictions of the _,rant awards rllld Fit!C
(ownership) %\.ill oest in tilt: Colltl<lctor. s,ubiect to the Condition's of 2 C1 R P<Irt '15 Adtllinistrl ,,C Require€tlellts
(tc�rntIerI t)M13 ( ircul€Ir A-1I()), Subpart aUraph ,-1. 1 A ILtiplllcnt Ircllascd utader thcae thresholds ss
cOn,tclered yullplics alld is Ilot subject to pro7perty st;l€tdarcls. E c}uil.>mcalt purc}tascd %c€ill flnld> identified itl tl,c'
hudget ;tttttchiments to aijeernents Co%tired iiy any contract or atreement t€lcorporattng rids Contr tet by refcrenc:e.
or identified in the sub if reed tints %pith Subcontractors (not included ill t.t cost tnethodoEo v), is ubiect to ill'
conditions of section 273. F. S. and OHA-1.001 i, F .,V C, or Titic -45 C"C..R Part ?-l.
35.5 The Contractor shall not dispose of any equipment or materials provided by the Alliance, or purchased vk itil
funds provided through any contract or at-,reetnent incorporating this Contract without first obtaitling the approyti it
of,the Contract Mallauer. When disposing, cif property or equipment the Contractor must submit tit written request
for disposition instructions to the respective Contract Manager. The request should include a hrlef description of
the property, purchase price, fundinlc source. and percentage of state or tederal participation, acquisition date and
condition of the property. "file request should also indicate the Contractors proposed disposition (i.e., transfer or
donation to another agency that administers federal prograrms, offer the items for sale, destroy the items, etc.).
35.6 The Contract Manager will Issue disposition Instructions. If disposition instructions are not received tivithin
120 days of the written request for disposition, the Contractor is authorized to proceed as directed in 2 CFR Part
215 Administrative Requirements (for-nerly ONIB Circular A-I 10).
35. Use of State hutids 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 Man t< er, who shall reduce
the decision to writing and serve a copy on.the Provider.
37. Financial Consecuences of Non-Performance
If the Provider fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the Alliance must apply financial consequences commensurate with the
deficiency. Financial consequences may include, but are not limited to, contract suspension, refusing payment,
withholding payments until deficiency is cured. tendering only partial payments, anddor cancellation of contract
and reacquiring services tram an alternate source.
37.1 The Provider will not be charged with financial consequences, when a failure to perform arises out of Causes that
were the responsibility of the Alliance.
38. No «'ah,er of Sovereign Immunity
Notllin,� Contained in tills a,!rcement is intended to ser,,e as a v%dicer of so%ereifm i€xlmurlity lav anv entity to which
so�crcit:!n ininlunity may lie applicable.
39. Venue
I!,x1% chsl'utc arises oul, Ot,this Ci 111!'J t. rite %etlue 01'sLICII }(:2ttl rccoursC .cI!I be Minnll-Dade (") Illty. Florida.
tc). FI)Iire C(;rltract
l Illy (r:'!et �ilt:3fCt5 ;i } t�1e t('rt17s ;Hid k'O;It.t1tions LIroll j)'% Ilie llllrties. No grill 111cclllclltS ��r
Cprc'sc'Ilta(lolls "hzliI he %:111d or h� it 1111ad ullon the ,A11Glllce or the ProA Icier. Lill1e55 cCprc: 51 et-711t;1111t'iI 11C1'e(I1 or 1)',
I.
('o lit ralCt `Junlber h1-1- 1472
rittell "Il cmill"Clit to tiltscclfl tact �IL[1cC11, A' boll'➢ l'.4rtic,ti.
40. Force Majeure
l lye 1'�lrtiea will rlelt Ile liai)!t for 4rrly delaws or Failures in perfl)rm.incc due to cirCLim.,, aces bevond their olatrol,
pro%Ided the party tine FOI'c:C ua4,jeure Cc)nditioll provicic:S inlmeLiMte %%1'ltterl I"WItic'ati011 to the otiler
parity tmd tAc:s all ieasotmNe eff()rts tO cure the c.onditi011.
41. Severability Clause
The Parries atMree that if a Court of Competent jurisdiction deems tlll%' term or Comiltiorl herein wIlitl or
ualenfor-ccablc: the other pro%isu)ras are severable to that %old provision and Shall renlain ill C1111 fierce and effect.
42. Condition Precedent to Contract. Appropriations
the Parties agree that the .,\Illance's performance and obligation to pay under this contract is ColItink7ent Upon all
annual appropriation by the Leg islatLire to the Department and a corresponding allOCation under contract from the
Department to the Alliance.
43. ,addition/Deletion
'Tile Parties a<aree that the Alliance reserves the right to acid or to delete any of the services required under this
contract when deemed to be in the State of f'lorida's best interest and reduced to a %%ritten amendment si4rned by
both Parties. The Parties Shall negotiate compensation for any additional services added.
44. "Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract will not constitute or
be deemed a waiver of the Alliance's right thereafter to enforce those rights, nor will any single or partial exercise
of any such right preclude any other or further exercise thereof or the exercise of any other right.
45. Compliance
The Provider shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable
current state statutes, laws, rules and regulations. The Parties agree that failure of the Provider to abide by these
laws shall be deemed an event of default of the Provider, and subject the contract to immediate, unilateral
cancellation of the contract at the discretion of the Alliance.
46. Final Invoice
The Provider shall submit the final invoice for payment to the Alliance as specified in Paragraphs 3.4, 3.4.1 and
3.4.2 ('date for final request for payment) of.XTTACIENIENi" F. If the Provider fails to submit final request for
payment by the deadline, then all rights to payment may be forfeited and the Alliance may not honor any requests
submitted after the aforesaid time period. :any payment due under the terms of this contract may be wvithheld until
all reports due from the Provider and necessary adjustments thereto have been approved by the Alliance.
47. Renegotiations or :"Modifications
%lodifications of the provisions of this contract shall be valid only when they have been reduced to
wvriting and duly signed by both parties. The rate of payment and the total dollar amount may be
reflect price level increases and changes in ww the rate of payment heri these have
adjusted retroactively to
been established through the appropriations process and subsequently identified in the Allitance*s
operatin4o budl;et.
48. "Termination
48.1 1111S coiimun imi% lie terminated by dither party ,vit1,,out Ciidrse trpora do less tilran thirty calendar claw;' notice
m %w'ritrlln to t11e otiier p�irt% llilles s tiI coler tIMC t 11 ulu:Illb .i�.rrccrd upoll Ill %vrltlm-,. ``),Il(i notice 'il:Ill 1�e
,lc'liwc"rtcl 111 l i�i� t21 ?c'Mce Or ;111% e\pe' llted cIc�h% titC'�kee tl1(1C plo%lcicti wCi'itlC;atl�.'�Il ��t dch%c'r% car law
d �kc.il`.et tO 1lie >Ilt tlil.7tei' or 11,c {"ti('7rt:yen':lt1%e tit {lye Pros idl:r lk'T1 tit Clle
4:i�flll`act.
48.2 Ila the p a` m1 -111 pule>liwailt tcl this wiolitr�let 11:Colnc ttilt .�lll,lilct lll.av icy"r1711iaYe lllY
."oiltr:lct ur)OIl lao lc-, Ihan t\went`+'-!o7 it (2 I lwtir` {wlicc in lwritIII- to tllc L''10%1clef, `said llotICC ilG fl l)e del iwertci
7ti 1, s. 1 o,l ll service or lillV %critic;111oll ol"Ieliwcrw or h) lltind citliwCrw
l4
Ctlntraict Numher Kf 1- 1-471
to OIC (.'ontf'ticC or the C of tilt." Pro%idc`r 101' 11dlIlIlllstratlol'I of the Conn-atct. I lit
lliarnce is ill he the flnal alrltlorlp, is to the av iilll)lhtv and idequLiCv ut funds. In the c%Cut of termination of tills
Contraict, file Pro%Ider tellI he Co):npensalted for'Illy %cork ,,ltist-,'lCtorily eo mplCted prior to the d"itc ot,ter171in,Iti��n.
18.3 l ilia ontract dliav be terlrlinaltcd for cause U'VII no 1CSS thain tticc;W% CMir !lours' notice In to the
Pro%i'lcr. W'aliser of hreaich ot,aIIy pro%i,ion; of this Contract ,hall not he deellic:d to he I Cr ol, <111v other
hrcaicln and shall not lie construed to he a nx>dificatlorl of, tile, ter-ills and conditions of thl, contract. The
provisions herein do not limit the 1lhalll e', or the fro%iCler'.s n-lits to remediei at kiw or in equity.
48.4 hililure to have pertornled any contractual ohli�wations with the Alliance in a manner satisfactory to the Alliance
Will be a sufficient cause for tennination. I'o be terminated as a Provider under this provision, the l'ros ider inust
lease ( I) pre.%IOUsly failed to satisfactorily perfiirnn in a contract ith the Alliance, been notified by the Alliance
of,the Lill Satisfactory performance, placed by the Alliance under a corrective action plan aIrnd [,Bled to correct the
ulnsati,factory performance to the satisfaction of the Alliance as Outlined in the corrective action plan: or(2) had a
contract terminated by the:Alliance for Cause.
48,5 Wal%cr of breach of any provisions of this contract shall not he deemed to he a waiver of any either breach and
shall not be construed to be as nnoditication of the terms and conditions of tliis contract. The provisions herein do
not limit tine Alliarnce's right to remedies at law or to damages of a legal or equitable nature.
48.6 Suspension of Work:
If the Department of Older Affairs determines in its sole discretion suspend any or all aetiVitC-',S under this
Contract and any Contract or agreement incorporating this Contract by reference, at any time, when in the best
interests of the State to clo so, the Alliance will suspend the contractor's work. As the Department provides the
Alliance with written notice outlining the particulars of suspension, these reasons will be communicated to the
contractor by the Alliance. Examples of the reason for suspension include, but are not limited to, budgetary
constraints, declaration oPemergency, or other such circumstances. After receiving a suspension notice, the
Contractor shall comply with the notice and shall not accept any purchase orders. Within ninety days, or any
longer period agreed to by the Contractor, the Alliance shall either(1) issue a notice authorizing resumption of
work, at which time activity shall resume, or(?) terminate the Contract or purchase order. Suspension of work
shall not entitle the Contractor to any additional compensation.
49. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the provider.
50 Electronic Records and Si«►nature
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 Uiiitc)f'rrt h7cco-onic D nrsaction Act. s. 668.50, Fla.
Stat. All electronic records must be fully auditable: are subject to b7oi-iclu *S Public Re orcls Lair. Ch, 10,
and Fla. Stat.: must comply with section 28. Dota blh,�Wlt.v ctric! l 1lormcr mi. must maintain
all Coritidentiality, as applicable: and must he retained and maintained by the Contractor to the same
c\tent as non-electronic records are retained and maintained as required by this Contract.
O,I The AAA's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and tine .`AAA. 1-11e Contractor is autllririred to conduct elecu'onic transactions with the
AAA only upon further written consent by the AAA.
50.2 1 11011 rCtlue-t h%� the AAA. tine hall pros ide the AAA or DOI:A kith non-eleetronie t paper)
��>l"iCS cif 1'CCo!'d,. �t�rl-CIC t9'onl (paiper) 'MNCS pro%lded tO the AAA 0. ' AHV 110CUInCilt !halt t` Js
��Clt Itlall III elcc:tivnic;. fol-Ill ',1Ith :ill n1Uti1[ 111dICattC the ;)Cl-tiOn :111d the I`Ci'ti'on S
u;Ip6lCn� yr ho CICCtrolllCall,\ ')I"_'nett file doc:unlent On anW nl�ln C�CCtrl'�filC C:opv lit the docunlCllt.
;I Special PI-oxisions
I �
t_ OIItI,IcI .NLIIIII)CI IN,I I- I +i
111e C'oiltr Aor a,,rcts to the: lollkm ill,_ ploy isio nsi
l .1 [nvesti'-,atIO11 ofCrilnina t'lolls:
\m rcl,)ort that implies Criminal intent can the hart ot,the Contractor or 'Itly Subcontractors '111d referred to
a �0%cl-rzrnental or imCSti1_1at0r% a1encv rrzrIst he sent to the Alliance, if the Contractor has reason to
believe that the allvuatlons \t ill be reterred to the `Mate attorney, a la%� eriforcement a4aency, the united
States Attorneys ot'fice, or other governrrlental agency, the Contractor shall notify the contract inanaya,er.
\ copy of,all documents, reports. notes or other written material concerninu the M%estivation, vOiether in
the possession ot`the. Contractor or SUbcOrltraCtOCs, must be sent to the ,-"\Iliance's contract manager with a
surnmary of file investigation and allegations.
51.2 VOlt,rrltCerS:
The Contractor shall ensure the use oftrained volunteers in providing direct services delivered to older
Individuals and individuals with disabilities needing such services. If possible, the Contractor shall work
in coordination with on,,anizations that have experience in providing training, placement, and stipends for
volunteers or participants (such as organizations carrying out federal service programs administered by
the Corporation for National and Community Service), in community service settings.
51.3 Enforcement:
51.3.1 In accordance with Section 430.04, F.S., the alliance may, without taking any intermediate
measures available to it against the Contractor, rescind the Contractors designation as an area agency on
aging, if the Alliance finds that:
51.3.2 An intentional or negligent act of the Contractor has materially affected the health, welfare, or
safety of clients served pursuant to any contract or agreement incorporating this Contract
by reference, or substantially and negatively affected the operation of services covered under any contract
or agreement;
51,3.3 The Contractor lacks financial stability sufficient to meet contractual obligations or that
contractual furids have been misappropriated;
5 I.3. G The Contractor has committed multiple or repeated violations of legal and regulatory standards,
re,ardless of whether such laws or regulations are enforced by the Alliance, or the Contractor
has committed or repeated violations of Alliance standards;
5 l.3.5 The Contractor has failed to continue the provision or expansion of'services after the declaration
ot`a state of emeroencv; and,or
51 .3.6 The Contractor has failed to adlicre to the temis of any contract or a(.�rcernent I lick)rpo rat Intia this
Contract by reference.
51 .3.? In the alternative. the Alliance may. at its sole discretion. in accordance %ti ith >ection 430.04.
1: S.. take immediate rrleasures a,,ainst the Contractor, including: cor-rect1%e action, ullanr[OUIIced
,I)CC1a1 Illollitorinu. tCillporarV asstiml)ticrrl Of the operation Ot one or rn()rC Contractual str" ICeS.
plaCerllk nt of the L wltraCtor rill pn)hatiollary status. 11111)(:7sillru, a iiloratol-luill on C olltl'actt)r �IiJwll.
lhc�tiiil!' iln�l61 'i ll penaltleti IClr 11011pC'4 t(1lfnanCc. O!'i.,[Ilc.r' ;iCI[1'14I14 trail C.' S1,A1011 pursuant to
f. 11,1111cr I_01 1' S.
In Illakin" aII% dCterrllinatl(lrl tlndel' tlllti p[YO 1.1;1011 the .A1h:Ir1Ce lilal reli" Lillon (Ile I111din'.?s Ot
\11WIlcr t)r<)[Ilcr re�,ulator% Hod%. .A11v Claims for danla,�es tG)r breach �)t'
I(,
l_ClntraCt .AI.II)I PCr hrt- 14/v
flrty contract car 31-11,`c111CIII, incorporating this Contract 1y\ reference are exempt fWtaa
<ldlaaitlistrative proceedinv>s and shall he brotiolat before the appropriate entity itt the ycnuc 01'
MkIIIai-DAe Cmmty
51. 01'Iicial PaFee and Representatives (Names. :V, I- ses, and Telephone Ntttltlaers}:
The name, address. and telephone number of'the representative fir the Alliance for this contract is:
,1 fox 13. Rothmon, JD. L L. 1 L.
pre.vic ent card(TO
760 N W 107`' Ave, Suite 214
,N(liami, Florida 33172
(305) 670-6500, East. 224
The narne, address, and telephone number of the representative of'the provider responsible for administration of'
the program tinder this contract is:
G 1
The Contractor name, as shown on page I of this MONROE COUNTY SOCIAL., SERVICES
a. f contract, and mailing address of the official payee to 1 100 SIMONTON ST. SUITE 2-257
whom the payment shall be made is: KEY WEST, FL,. 33040 �
-he name of the contact person and street address KIM W WEAN, COMPLIANCE MANAGER
-
b, where financial and administrative records are 1100 SIMONTON ST. SUITE 190
maintained is: KEY WEST, FL 33040
The name, address, and telephone number of the SHERYL, GRAHAM, SR DIRECTOR SOCIAL SERVICES
C. I representative of the Contractor responsible for 1100 SIMONTON s'r. SUITE 2-257
administration of the program under this contract is: KEY WEST, FL... 33040
The section and location within the AAA where Associate Vice President Finance
d. Requests for Payment and Receipt and Expenditure 760 NW 107th Avenue. Suite214
forms are to be mailed is: Miami. Florida 33 1 72-3 155
Contract Manaeer
c The name. address. and telephone number of the Alliance for Aging. Inc.
760 NW 107th Avenue. Suite 214
Contract Mana(-,er for the AAA f'Or this contract is:
Miami. Florida 33172-3155
1,'pon change of representatives (names, addresses, telephone numbers) by either part\. notice shall he pro ided i1)
�yritina to the other party and the notitication attached to the originals ofthis contract.
III
the eyeilt �jItf'crent by either patty after execution ofthi; Contract, notice (4dw ntiutte �llld
t�ldress oI the t) VCpre>cnt�lti�e y111 Ile rcllleretl in ~~ruing to the odor party 111d 1a1(1 ncrtificati01t attached it) 1>ri inal�
f tltl, cntr�rct.
17
( orttract :NUtl IOCr K t t- 14
ST. All Terns and Conditions T whined
I'ltiti Contract and its Attachnicnts, I through X. .-V B, C, 1), E:, and anc eyhihns referenced in >aid attachnwnt>
toL7ether vpith ails doCunter1ts incorporated b; reference. contain all the terms and conditions agreed upon h, 01,
Parties. there are no prokisions. termv condithum orobfitigations odor than these contained herein. and this
4r11 previous colnarrtn:icatiolls, representations or, agreements, either %�ritten or %erhal het%vicen thl
shall sul,�ersede.
Parties.
Bw s gnin4g this cMntract. the Parties agree that the, have read and agree to the entire contract.
IN %VI INESS THEREOF. the Parties hereto ha\e caused this 18 page contract, to be executed b\ their undersigned ofticiak :t
duN' authorized.
Monroe County Board of
Contractor : Commissioners, Social Services/In-Home ALLIANCE FOR AGING, INC.
Servi --
SIC;NED BY: �' ~ f ✓' SIGNED BY:A �•-,
NAME: RO'NIAN GASTE:SI NAME: MAX B. ROTHMAN,JD, I-L.M.
TI'T"LE: COUNTY ADMINISTRATOR TITLE: PRESIDENT AND CEO
DATE: Z.'5 I DATE: %
Jame: -
Sylvia Murphy
-itle: Mayor
)ate:
1S
('()ntrract N LlIIIhC1' 1,.1-1- 14
INDEX TO ATTACHMENTS
Attachment I SERVICE PROVISIONS HOME CARE FOR THE ELDERLY
Attachment II CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND AGREEMENTS
Attachment III FINANCIAL AND COMPLIANCE AUDIT
Attachment IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,
GRANTS, LOANS AND COOPERATIVE AGREEMENTS
Attachment V CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
Attachment VI ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII BUDGET SUMMARY
Attachment VIII INVOICE CONTRACT REPORT SCHEDULE
Attachment IX REQUEST FOR PAYMENT FORM
Attachment X RECEIPT AND EXPENDITURE REPORT
Attachment A DOEA HANDBOOK
Attachment B CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C REFERRAL PROTOCOL AGING AND DISABILITY RESOURCE CENTER(ADRC)—
OUTSOURCED FUNCTIONS
Attachment D DOEA COMPUTER USE POLICY
Attachment E BUSINESS ASSOCIATE AGREEMENT
Attachment F E-VERIFY
Attachment G BACKGORUND SCREENING AFFIDAVIT OF COMPLIANCE
Attachment H CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
I�)
('rnatract \wtthcr KI1- 14-17 ,
:�rL.�cu�IENr I
HOME; C AIZE FO R TIIE ELDERLY PROGRAM
1. Sh.IZt"I(TS TO BF PROVIDE�.D
1. Scol)e of Service and Individuals
1,1 the ,crvicc,, to lie prov ided, .are those described in the pro%ldcr's service pro%ider application submitted in
response to the 201 I CCF Lead .\_relic," application and <as described in this contract, the 1lorne Clare fOr the
Elderly (IICL) Program errcvU I'ages the pro isic)n of cure in family-type li%ini-T utrrallillelnellts in pri%atc homes
on a not for profit basis as an alternative to nursing hortae or- other institutional care,
1.2 The provider's service provider application submitted in response to the 2011 1ICE Lead :ygencv REP as well
as the RIT itself is incorporated by reterence in this contract between the .Alliance and tlae provider and made a
part of this contract.
1.3 Individual Eligibility
In order to receive services Lander this contract, an applicant must:
{t) Be at least 60 years of age;
(2) Have income and assets which do not exceed the !Medicaid Institutional Care Program limits;
(3) Be Functionally impaired and rat risk of nursing home placement as determined through the initial
comprehensive assessment, and
(4) have an adult caregiver living in the home that: (a) is willing and able to provide care and assist in
arranging services for the client arid, (b) is qualitied as air I-ICE caregiver based on the client's choice
and the case manager's assessment;
(5) Eligible applicants must be screened, prioritized and referred to tine provider by the ,Aging Resource
Center prior to enrollment.
SECTION It. MANNER OF SERVICE PROVISION
2.0 Conditions
2.1 All services under this contract will be provided in a manner consistent with tire conditions set forth in the
2013 Florida Department of Elder :Affairs Programs and Services Handbook or any subsequent
revisions made to the Handbook and the provider's service provider application submitted in response to
the 2011 Cw'C E Lead Agency REP (SPA). In case of conflict between the SPA.and the Handbook, tlae
I andbook prevails.
2.1.1 Client access to services, assessment and eligibility deterraaination must conform to the protocols listed in
.\fT ACI INI EN'r C.
2.1.2 the provider will offer services hosed on clients' service plans.
2.2 Service Tasks
2.2.1 Dcll%ery cif Service to f.ltgible Clients
1 he prov Ider shall pro%idea continuum of Seri ices that mects the dl%crse needs of E'unctionallv illapaired ciders,
l 1ie provider ,hall pertOrm .Ind rcpOrl per!I011aaance cif the t'(illo%�In�-, scr ices in %%Itka the C:LIITelIt
I)( )FA I l r. ,r,�n�, an�� f Set-lice,,, 1{anC(bot?h. I lie tic`r"t ICCti 11'1cfUtle 111e (c�l 8111-1 i:.1Cct!G Wies'
t 1) l.';ttie iaarin4c�;eliacnnt:
Co Il tr"Ic t \'Lill I bcr K I 1- 1
The provider Si 1n1 I ldclit 11'%' ilk c(!lCI Id el 1 t�INC t k-T, lei lts <llld Ve ter t hCSC I Mil\idi.1,'i IS I'Or :ipp ll�,It 1011
)r N I Ck I I e,11 d W LI I%C r se I.\I Lcs
,.2.3 In,-, ()Ut Ck I!IS"i I Ile I
2.2.3.1 .\it )ut" coll'sulliers will he referred by to the ADRC f'Or enrollment Into the corrcpomfing, iged
by the Allltfflce.
2.2.3.2 Coll'suillers "Ictl%c In the CCDA and IICDA progaills that are turning 60 and are c1l,gible t'(,)r C(T.11' and or 110E
will be opened In the Corresponding aged prograin managed by the AIllance it' Rending l.s a%allable. It' fundim-7
is available, these consumers will be Ill dc active. If fuliding Is Ilot available, they \%,III be waltllstcd for these
prourallis but will be given priority f'or aetivation once funding is available.
Consumers active in the Medicaid Waiver, upon turning age 60, will continue to be ellgible for arid receive
Medicaid Waiver services.
2.3 SERVICE rl.NIES AND LOCATION
2.3.1 Service Times
The Provider shall ensure the provision of the services listed in this contract is available at times appropriate to
meet client service needs at a ininli-IlUrn, during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00ani to 5:00prn.
2.4 REPOR,rs
2.4.1 The Provider sliall respond to additional routine and./or special requests for information and reports required by
the Alliance in a timely manner as determined by the Contract ".tanager. The Provider shall establish due
dates for any Subcontractors that permits the Provider to meet the Alliance's reporting requirements.
2.4.2 Client Information and Registration Tracking System (CIRTS) Reports
The Provider shalt input HCE specific data into CIRTS to ensure CIRTS data accuracy
2.4.2.1 The recipient Must ensure all data for I-ICE subsidies are entered in the CIRTS by the l5th of' each month.
IJCE subsidy data entered into the CIRTS by the I 5th of the month will be for payments incurred between the
I 6th of the previous month and the 15tli of the current month. Case management data entered into the CIRTS
by the I 5th of the month will be for units of service provided during the previous month from the I 6th and up
to and including the I 5th of the current month or case mana-ement units of service may be entered according,
to the recipient schedule, in aggregate on the 31 st or daily, weekly or monthly.
2.4.2.2 The recipient will ensure data entry for I ICE Subsidies will cease on the I 5th. of the month and the CIRTS
,%lonthly Service Utilization Report. by consumer and by worker identification is run.
2.4.2.3 The recipient will ensure the Monthly Utilization Report, by Consumer and by %korker identitication is %crified,
corrected. certified no later than the 20th of the. month in which the report is generated.
2.4.2.4 1 Ile recipient will ensure curcgl\ers determined eligible fOr the fICE basic '.,LJhSIdV after the I,5th ot'a month.
ill be processed to begin el]2il,)IillV f'Or the 11( F h2SIC subsidy orl the I st day oaf the i1ext Illonth,
2.4.3 Service Costs Reports
[lie Pro\idcr Lihinit tc7 1he Alllrlllce 'e!Ill-tiII11LI'd sCr ECc cost reports. It high rct1cct actual cost, of
Fh]-, rc:)ort :111o\T(ics 111tOrill;mo!l 1,01- 1)iw 11 ill(.1 :lnd llc, ot 1tlt t li,-, 111),it r'Itc.,
2.4.4 SurplusiDeficit Report
I lk�er %�jj 1,jl)1Jjlt j ��!T)Jlj, let- ldcd hc Ahi�llie�: lk, Ellc
I 1 11, I !�:lt !'CP()I1 ill a k111�lt rro%
onIr,lk:t NLIIItILet- 0% litc 15 oi, molvil, I 11li-, IN 101' ill ;llld Or hCt%\Ccll the
Pro\ 1&1- 111,ci the A1111,11%:e. I Ile 1-ClIM-1ticill 111,:iUdc the t.ollo"\wL':
C 0 1 It r,I C t N umber K I I- 1472
I) CUITC11t stiltLls SUI'plils or deficit:
(2) the Wo%ider's detailed plan on how the surplus or det'icit spcnkhn�' excecding, a t"o percent thrcslloid
d I he rcoq%ed:
(3) Recommendations to trinstcr Funds to resoke surplus dwick spendmg�
(4) Input Nom the I W RIC s Board of D Wc to rs mi reso I uthm issues, if Lipp I iciib I e:
2A5 the Viame reserves the right to aqnBt the total award as well as the contracted unit nac R) reflect pRnhicr
costs and UtIdZatiOn rates based On active client,, enrolled in the prograrn.
2.4.6 Tile :\IlianCe may %kithIwId payment under the terms of this contract. pending the receipt and appnnal by the
20 Unce of complete and accurate financial and program-matic reports due from the provider and any
adjusnnents thereto, including any disallo%varrce not resolved,
2.4.7 The provider shall pro%ide the :Mince with an expenditure plan by July 15 or two weeks after this contract
has been signed; a monthly update is due on the 214 day of each following month. The expenditure plan and
updates must Allow the format provided by the Alliance.
2A8 'Ibe provider shall respond to SUI-PlUs/deficit inquiries and will provide ad-hoc reports as requested by the
Alliance.
2.4.9 Surplus Recapture.
III accordance with its surplus-'deficit management policies, in order to maximize available funding and minimize
the little that Potential clients must wait for services, the AAA in its sole discretion can reduce funding awards if'the
Contractor is riot spending according to monthly plans and is projected to incur a surplus at the end of the year.
23 ELECTRONIC RECORDS AND DOCUMENTATION
'The provider will ensure the collection arid maintenance of client and service information oil a monthly basis
frorn the Client Inforination,and Registration Tracking System (CIRTS). Maintenance includes valid exports
and backups of all data and systems according to Alliance and Department standards.
2.5.1 Timely Data Entry
The provider must enter all required data per the Department's CIRTS Policy Guidelines for consumers and
Services in the CIRTS database. 'The data must be entered into CIRTS before the provider submits its request
for payment and expenditure reports to the Alliance. The Alliance shall establish time fi-arnes to assure
compliance with due dates for the requests for payment and expenditure reports to the Department.
2.5.2 Data Accuracy
'file provider will run monthly CIRTS reports and verify client and service data in (ARTS is accurate. This
report Must be submitted to the Alliance with the monthly request for payment and expenditure report and
InUSt he reviewed by the Alliance before the provider's request 16r payment and expenditure reports can be
approved by the Alliance.
233 Failure to Maintain citurs Database
Wilure to ensure the collection and maintenance of the (ARTS data may result in the Alliance enacting the
-EnAnneirick' clause tf IV agreement (see 220 including delaying or withholding payinent until the
problem IS CATUICI
23A Computer S stem Backup and Recovery
I.iR:h ilr )%Ider. 11,110111, other requirements. 111Ust t111ticipate inuf prepare An the Wn of 10manon pInvesyng
oWaNlyin. I he nnome hnkmu up oi'dwa ami W"arc is required I,) rcc�) c"r from k),,scs Ur oi the
,� 'M;)Utcr 'k ac!n, Ilya and "'A"Wo: Cssemud k, Me cmumuccl kTcmtwn AlvoWn hunywm mist he
";p. I !R! 'Lvurn�' r'%Cr tl-:e h"'Clkup I-(:"Mr"s Atoll he as trim-,cnt a the I'eL1UIYo:d lIt
lh': Immar,, It I, reakunnwihicd thm a cilo KKR.: ha"cd up data he �,10[Cd In a CL:UrC. oll.sl!e
I h,,: provider 00 inalrytnn %o i'llIcIl p0licle') proccolurcs 1")r-compiner 1)ilckup :Ind rcco cry
I 11cc and proccdttFc" 11,111 I)c made 'I"allahle I,) Ike Alliance upon
'0111 1*�I Ct \L III III Cr K I 1- 1 47
2.6.1 Outcomes
1-he Prop ider 'li'lit tilliely �a"Ibllllt to the All"ITICC all reports described III A FFMA VNI ENT 1, SECTION
2.5 REPORTS.
(2) The llro�Idcr shall timely 'ubltlit to ll-,c Alh�mcc all Mf'Oniiatlon de,crlbcd it, .� rr.�cim i,
SECTION 1.6 RECORDS AND DOCLI'MENTATION:
(3) The Provider shalt CIISLII'e cervices In this contract are in accordance with the current D(I)FA Prograllls and
Services I landbook.
2.6.2 Tl I e perf0miance of the Provider in providing the sen'Ices described in this contract shall be measured by the
CUrMit, Area Plan strategies for the followinu criteria:
(1) Percent of most frail elders who remain at home or in the corninunity Instead of -oin(-, Into a nursinu
home:
(2) Percent of ATS referrals who are in need of Immediate services to prevent further harm who are sened,
within 72 hours,
(3) Average monthly savings per C011SUrner Cor home and community-based care versus nursing 110ITIL care
for comparable -group clients;
(4) Percent of elders assessed with high or moderate risk environments who Improved their environment
score;
(5) Percent of new service recipients with high-risk nutrition scores whose nutritional statLIS improved;
(6) Percent of new service recipients whose ADL assessment score has been maintained or unproved;
(7) Percent of new service recipients whose 1ADL assessment score has been maintained or Improved;
(8) Percent of family and farnily-assisted caregivers who self-report they are likely to provide care;
(9) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention(as determined by the caregiver and the assessor),,
(10) Average time in the CCE Program for \,Icdlcaid Waiver probable customers, and
(11) Percent of customers who are at imminent risk of nursing home placernent who are served with
community based set-vices,
2.7 Compliance and Enforcement
2.7.1 The Provider shall comply with all the terms and conditions set-tortli in this contract, the CCE RFP pursuant to
which this contract was awarded, the Service Provider Application and the 2012 Department of Elder Affairs
Programs and Services Handbook. 1-he provider is also responsible to respond to any fiscal or programmatic
monitoring items issues Within the tiniefraine stipulated by the Alliance. "vlonitoringy IterlIS/lSsUes may Include
Corrective Actions, Reportable Conditions or(.duality Improvement Recommendations provided by the
Alliance. The provider is also responsible to provide timely response to any inquiry related to program
expendItLINS including, bUt not llinited to, addressing pros rarn surplus or deficit and corresponding progrart'i
,peed-out plan.
Failure to mect any of the contractual requirements or compliance items mentioned above will result in the
iIllpo-,It loll ot I sanctions Lind or other enforcement actions by the Alliance.
2.7.2 Enforcement:
bile A111"Ince Til'I" I'lke 1I"ter11ICdMte I1,Ca',UrCS agtaima>t the pro ider. :orrecti\c action. 11111,111110MIC"I
tk:H'1P0I"II_V tatiSt1m1lilt1011 cat the 0 k:MtWll Of011c Or M01'C pLiceincit eat the
ldcr :M1011. 1m1IPo"'I1I'_1 !111;lncl�d for
';1(2 11or I"",1 0 1 Pc'r : PPI'Op�1t It e "I C!lo!I 11efindsI i I'It:
0 j Wc;l"I I)II'd ter I 'Ict cat the !'ro%I dcr lIti1 III;Itc:r:[1.1% It 1A e;!,Ire, or of
,T%ed pul-'tIIllt to [ill,, '.ol%IfI-"Ic:L or 'Illd lIltectcd tile orcr.lfl()ll Ot
c!'%ICCS co\Ck.'d ullde'l. 11111s contl'tiIct_
Contract Ntttaaber KIf- 1 471
• the prov ider Licks kmmictal -;ul Iic1cnt to 111cet Or tllat Contr�lctll,I
rands 1141ve heen IIIlsappropriatcd.
• the pros ldcr htl's Conlillittcd multiple or rcpeatcd v ioLitions cat lc._,aC and rcgulatorv' stand.,irds,
re��arcllcss ol'tlrc etlt`Orcemctit ol'such Ll%% s or relauLltiorls.
• the pro`:ider has tallcd to contimle tilt prop,1titotl or c\11LI IS1011 of tier% ices after the declaration of a
St�ltc of e[11eC f ncv',
the provider has i"Illed to adhere to the terms of this contract.
+ the provider consistently misses performance measure targets, or does not demonstrate to the
Sati: faction of the \lliancc that a Program budget surplus deficit problem is being addressed in order
to avoid closing out the contract year with a budget %ariance of more, than two percent.
III making any determination Linder this provision the Alliance may rely upon tide firidings of another state or
federal attyency, or other regulatory body.
SECTION III. METHOD OF PAYMENT
3.1 General Statement of Method of Payment
Tile method of payment in this contract is based on a fixed unit rate for approved services. The provider must
ensure fixed unit rates include only those costs which are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an independent audit is
required. All requests for payment and expenditure reports submitted to support requests for payment shall be
on Department forms 106C and 105C, included as ATTACHMENTS IX and X. Duplication or replication of
both forms via data processing equipment is pemiissible, provided all data elements are in the same format as
included on department forms.
3.1.1 provider invoices shall be Submitted, no later than 60 days after the end of the month on which the expense was
incurred, except that invoices cannot be submitted beyond the date for final invoicing, as stated in this contract.
Invoices submitted late will not pay. Exceptions to this rule are at the discretion of the Alliance, on a case by
case basis, such exceptions must be requested prior to the expiration of the invoicing deadline. In making a
determination of the exception tine Alliance will consider whether the disruption to the billing cycle was beyond
the control of the provider, the frequency with which such exceptions are requested by the provider, and
whether the Alliance can request reimbursement at a late date from DOEA. Exceptions for invoicing late after
the closeout date will not be made.
3.2 Advance Payments
Non-profit providers may request a monthly advance for service costs for each of the first two months of the
contract period, based oil anticipated cash needs. Detailed documentation justifying cash needs for advances
must be submitted with the signed contract. approved by the Alliance, and maintained in the contract manager's
tile. All payment requests for the third through the twelfth months shall be based on the submission of monthly
,actual expenditure reports beginning with file first month of the contract. I-lie schedule for submission of
advance requests is ATTACHMENT "VIII to this contract. Reconciliation and recoupint!of advances made
under this contract are to be completed by October. All advance payments are subicct to the availability of
funds.
3.3 \dvance tilrrd.s may he temporarily Imcstcd by the provider ill an Insured interest hearing, account. All interest
t'arne:d on Contract fund advances must be returned to the. AHlallce v' Rhin thirty J.>(,o days of the rand eof the first
qu,iticr of the contract period.
3.4 Final Regttest for Payment:
3, 4,I l 11t' 1 IV%ItiLT I11U t 7tIhlnit tllc 11P131 recluc,t for lti%!Imlt to tile. AIlf:ln,:C no ltttcr til<'111 Jul\ 1 ti 21)1 ;t thQ,
l71'o%i ier to do wo, all [hilt to p,111 e"It 1, 'Ind the :Allr;lllwc At Ill not 11t'llOt" J11d E'4'lltiCsl ,Jhillkred
ire(' tilt 4'tforCs�loc! ttllle pel-!O( .
3.4.2 1Ct11c contract lS 1r.'V"minlitc:d prI"'r to the CoIIImct e I I d d'Itc m, June ,1l), 'dip�, tiled the I,1ro%Idel, 1111U.wt ;,uh!lllt `hc?
i 1n:31 fe(ILICSt for pati nlCl1t to the .A!(lancc Ilk) 11101'c t11,111 4" daAti alic:r the t:0n FICt 1s tenllin;ited, llut 1lo Liter t11:111
,4
Contr;tct \tullbcr I'll- 1-Ii-
ul% 15, Wil t 5. If the provider fails to do so, all rk.;ht to pa'N ment is forfeited, and the alliance N%ill not
honor any requests submitted after the aforesaid time period.
,.5 Documentation for Payment
Vile Contmetor ,t III in,mitairt t.ioi rCile Ctt<litora to "Upport play illellt rcilUeats thllt u111111 I,e 1callahlc to the
DCi%lrttlletlt or rIuthorizee.I indllvldulals, such as Department ot,F mancial `Scr%I'CCS, ULx011. ree ucst.
3.i.I The C otitractor must require subcontractors to alter- tall required delta per the Department's (ARTS PoCicy
Guidclines for clients and serf ices in the CIRTS database. The data tllust be entered into the CIRTS before the
subcontractors sL�rbmit their request for payment and
expenditure reports to the Contractor, fllc Contractor shall
cstablish time t'ramcs to assure compliance with due Mates for the requests for payment tend expenditure reports
to the Department.
33,2 The Contractor must redtaire subcontractors to run 1110t1011y CIRTS reports and verify client and service data in
the CIRTS is accurate. "I"his report must lie submitted to the Contractor with the monthly request t<ir payment
and expenditure report and must tie reviewed by the Contractor before the subcontractor's request for payment
and expenditure,reports can be approved by the Contractor.
3.6 Level of Effort, Co-pay and Cost Sharing
3.6.1 Matching, Level of Effort, and Earmarking Requirement
The provider will assure a match requirement of at least 10 percent of the cost for all CCE services. The
match will be made in the form of cash and/or in-kind resources. At the end of the contract period, all CCE
funds expended must be properly matched. State funds cannot be used to match another state-funded
program.
3.6.2 Cost Sharing and Co-payments
'The provider in conjunction with the Alliance shall establish an annual co-payment goal (amount to be
collected from clients). Using the method prescribed in the 2012 Department of Elder Affairs Program and
Services Handbook, the provider shall project the annual co-payments to be collected from each active client
in all. income ranges prior to the start of each fiscal year. The provider is required to meet at least 90 percent
of the goal. Co-payments collected in the CCE program can be used as part of the local match.
'File Alliance For Aging Inc. will hold back 5°40 of the provider's contract amount. The amount held back
shall be released to the provider rafter 5011A0 of the adjusted annual goal is collected, but no later than February
I5th of the fiscal year. hold back amounts not earned by providers as of February 15th will be reallocated to
other providers meeting or exceeding 50"47 of their annual goal, except when no provider agency is meeting
or exceeding its annual uoal, or when an agency that is sleeting or exceeding such goal affirms that it lacks
the capacity to receive additional funds.
3.6.3 .this contract is Ior services provided beginning July 1, 2014 through June 30, 2015. However. the; parties
recognize that they will need to perform continued activities relating to reporting. invoicing and payment i11
July of 2014 to facilitate payment for services rendered by the provider under this contract tlarorrgh and
irlcludin[.� the contract expiration date of July 15. 2015. Sen ices provided after June 30, _'015 will not be
reimbursed Under this contract.
SECTION 1V Invoicing and Additional Reporting Requirements
4.1 II d"C Allimlee lldls sallctiolled the pro%ldcr. Mlile the itSnetiorls are: III ettt ct, at the rc(ILIc"t e t the AH11111Ce,
the Pf'0%ldcr utia� prow ldc, oll a lnoilt i % 7i1St�, i le pro%€dc r,s trnanclal utatelllcnts that 1'etle ct the current, un-
tLIdIted re'\Cmucs ;md the l)ri? Ic1er ti c1a;h 1)0",111011 11s e'.c'Il ;a� J11ti Other tlnLlll Idl� ,fuel t'�r Of"o�r:1111I17attC
�Ctlrll tltlilil'�C1 plat Ilia" P)e rcquestcd h% the ,Vllmce.
t.2 1! he pro%leler 6a rCclu11-ed to prc.'hlt c a I%C :1cC1011 (7i lll ear 1C,Ptond 10 J I'lacal ;md or 1'r�7u1','<Ca1na;,aC1e
dle'1111tk 11F! 11Ild1111-1, till1)1)O[I11L cic 1ent;ll1011 :1`, r'CtILICurcd 1)VV EI11C t11lane:e ,flail !'C 1)lo\ldcd %k 1;il111 the tIIl1C
11:une >tipullltcd by the .A11i11rlce.
Contract Number KI 1- 1472
V_F E,k IINIFNT II
CERTIFICATION' R E G A R 1)1 N'G 1,0 13 BYING
TION FOR CON'TRA(rs, GIZANTS, LOANS AND
CERTIFICA
AGREE NIENTS
The 1111der"huned certifies, to the het of'his or her knkm ledge and heliet; that:
(1) No t'ederal appropriated fIlIldS have been paid or %v I I I be paid, by or on behalf of the Undersigned. to anti I)el-S(,)Il 1`01,
IlItILICIMM-1 or attelliptim, to influence all olticer or emplo\ce ot'anv state or tederal agenc,_ a member of'Conures,", an
officer or employee of conoress. all cmplo\ee of a member of congress. or an ot'ficer or employee of the state
legislator. in connection with the awarding of ativ federal grant, the making of all,,, t'ederal loan, the entering into of
a11\, cooperative ak_lreement, and the extension, Continuation, renewal. amendment, or modification of anv 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 in officer or employee of any agency, a member of congress, an officer or employee of
congress, or ,in employee of a member of congress in connection with this federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LI.A., "Disclosure Form to Report Lobbying,"
in accordance with its instructions.
(3) The undersigned
ned shall require that the language of this certification be included in the award documents for all SO-
awards at all tiers (Including Subcontracts, sub-grants, and contracts Linder grants, loans and cooperative agreements)
and that all subcontractors shall certify and disclose accordingly.
This certification is a material representation of fact upon 'which reliance was placed when this transaction was made
or entered into, Submission of this certification Is a prerequisite for making or entering into this transaction Imposed
by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty o'f—tiorrs than $10.000 and not more than $100,000 for each such failure.
Signature Date
__ RQ1yJA,N GASTES1—COUNTY ADM IN ISTRA f OR K11-1472
Narne Ot'Authorized Individual Application or Agreement Number
MONROE COUNTY BOCC
Name and Address of Or�_,anization
ell
orm u;
Io
Contrast Nun ivi- KI1- 147-
AT`IM_ IINIEN'T III
1,'INANC:IAL AND COMPLIANCE AUDIT
' �Flicx itditiinist rat loll of, resc'nrr:cs awarded by the A111ance for Auilmi. Inc. to the pro%idcr may lie subiect to audits and,or
Monitorin,�: by thy; Alhi lllcc or title Florida Dcprrrmic:nt of I"lder At'.'urs, ;its described in this section.
MONITORING
Ili addition to re%icws of audits conducted in accordance with 0y113 Circular A-I33, as revised. and Section 215.97, F.S..
(see "A1w'I:)1'FS" belo%t). monitoring procedures may include. but not be limited to, on-site visits by the Department of
staff, limited scope audits as defined by ( %IB Circular A-I33. is revised, ancior other procedures. Fay entering into this
agreement, the provider agrees to comply and cooperate with any monitoring procedures;processes deerned appropriate by
the Alliance or the Department of Elder Affairs. In the event the Alliance for Aging. Inc. determines that a limited scope
audit of the provider is appropriate, the provider agrees to comply with any additional instructions provided by the
Alliance for Aoin!.;, Inc. to the provider regarding such audit. The provider further agrees to comply and cooperate with
any inspections, reviews, investiklations, or audits deemed necessary by the Chief Financial Officer (CF0) or Auditor
General.
AUDITS
PART 1: 1=EDERALLY FUNDED
This part is applicable it' the provider is a State or local government or a non-profit organization as defined in ONII3
Circular A-133, as revised.
In the event that the provider expends S300,000 or more in federal awards during its fiscal year, the provider must have a
single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised.
EXHIBIT l to this agreement indicates federal resources awarded through the Department of Elder Affairs and the
,Alliance by this agreement. In determining the federal awards expended in its fiscal year, the provider shall consider rill
sgurces of federal awards, including federal resources received from the Alliance or the Department of Elder Affairs. The
determination of amounts of federal awards expended should be in accordance with the guidelines established by 0NIB
Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions
of 0MF3 Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part 1, paragraph 1, the provider shall fulfill the requirements
relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
If the provider expends less than S700,000 in federal awards in its fiscal year, an audit conducted in accordance with the
provisions of 01M13 Circular A-133, as revised, is not required. In the event that the provider expends less than S500,000
in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 0MF3
Circular A-I 33, as revised, the cost of the audit must be paid from non-federal resources (i.e., the cost of such audit must
be paid from provider resources obtained from other than federal entities.)
.fit audit conducted in accordance with this Liar shall cover the entire organization for the oruanization's fiscal year.
t:ompliance findirIgs related to agreeirtents with the Alliance f'or :yging, Inc. Shall be bused on the a,_,reenient's
rCclurirerttCnts. 111cluclint-1 4iny rules, rct,11.1lati011s. or statutes referenced in the atzreernent. File firlancial �,t:rtenlerlts Shall
dlscloi c %%hether or not the matchin�a requirement tivas met for- eac17 aJppllCable ,igrecnient. 11 que5tioncd Cost:; and
iiabilitics due to the A111atice ['Or IitC. ,hall lie f lily diSCoScd in the tieudit repot with reference to the ;alliance for
Vilml-'. (nc. �Iurccmctit smoke& If itc t Othcr*v' Ii ;e disclosed as required by Section 310(h)(2') of UNIFY (..`irctultir A-133. 4is
!,e%l e(.f. the Cl1edLdC ot_ Cyj)CndltL1l_eS of E'ederal iclentifw ltureellient iiumber t�'Or ,:,'tell
c.esticrit tvuii the Aihf incc' lk .yuin�a, IEic:. isi ett4Ct dtiriiia r isle iiudit period. Finrrnci�ll rcporttnt prick<t�c, required under
1, __ .__ -'tl dL345 (lifer r'ecelpt of Elie �ludlt report or �) Iiloillhs awer the chid apt the
��lt-€ itu.,t he �tli�rtttttecl �citl�liii nic c�trflcr ot,
rovidc r,, fiscal �car cticl.
Coiltr.lct N,L11,11her Kit- 1472
PART II: STATE FUNDED
T!I Is part Is <Ipplicahlc if t I I e p rov I dcr is II I W I 1stzltc e I It Itv as def'I I icd bw Section 21� Q-(2,). 1,lorld"I statutes.
es.
I) thle C%C!lt th,:It the provider expends a total 1111101.111t of state +IIIWIICIa1 equal to or W C\Ccss of'S50(),000 III arty.
t I sc;l I year I C!I provider 1,01- fiscal .ears ending Se p te I I I I-)er 30, _2004 or thereafter), fIIe i-lro%ik I cr I Ii ust I I I1%e Il State
-1 -d th Section 21 5�Q-7. Florida Statutcs; applicable rules of,
or pro'ect—pecittC for �,L;Cil f scal year In accordance %\I I
tile Dcpartmcnt Cot' Flmuicril Seriiccsl- and Chapters 10.550 (local go%crlimental cmitics) or 10,650 notiprotit ind COr-
prot-it or(-'allizatiolls). Rules of the Auditor General. EX H 113 IT I to Oils a,_,reement indicates state financial assistance
a%uardcd throu,_,h the Alliance for Agln,g, Inc, by this agreement. In deternmuni! the state financial assistance expended III
its fiscal veal% the provider "'hall Consider all ,ourccs of I state financial assistance, including, state 1-111allclal assistance
received from the Alliance far Aging, hic., other state agencies, and other nonstate entities. State imancial assistance does
not ilICIUde federal direct or pasS-011701,11-111 awards and resources rccel�ed by a nonstate entity for federal prograrn matchIM-Y
requirements.
In connection with the audit requirements addressed in Part 11, paragraph 1, the provider shall ensure that the audit
complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporillh,
package as defined by Section 215,97(2), Florida Statutes. and Chapter 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit orgalliZatiOIIS), Rules of the Auditor General.
If the provider expends less than S500,000 in state financial assistance in its fiscal year-(for fiscal years ending September
30, 2004 or thereafter), all audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not
required. In the event that the provider expends less than S500,000 in state financial assistance in its fiscal year and elects
to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit
must be paid from the nonstate entity's resources (i.e., the cost of such all audit must be paid from the provider resources
obtained from other than State entities),
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
ornpliance findings related to agreements with the Alliance for Aging, file. shall be based oil the agreernent's
t*cquirernents. IncludiriC, any applicable rules, regulations, or statutes. The financial statements shall disclose whether or
not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the
Alliance for Auill(!, Inc. shall be fully disclosed in the audit report with reference to the Alliance for Aging, Inc.
agreement involved. If not otherwise disclosed as required by Rule 691-5.003, Fla. Admin. Code, the schedule of
expenditures of state financial assistance shall identify expenditures by agreement number for cacti agreement with the
4n
Alliance t or Aging, Inc. in effect (luring 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 uovernmental entities. Non-profit or tor-profit organizations are required to be submitted within 45 days after
delivery of the audit report. but no later than 9 months after the provider's fiscal year end. Notwithstanding the
applicability of this portion. the Alliance and the Department off"'Ider Affairs retain all riol-it and obligation to monitor and
o%ersee the performance of this agreement as Outlined throughout this document and pursuant to law.
PART III: REPOR,r SUBMISSION
Copies of reporting packages for audits Conducted In accordance with ON113 Circular A-I 13, as revised, zliid required by
PAR I I of this d2reellicilt "hall he ;uhrllutCd. when I-CclLllred by Section 320 (d), OMB Circular A-I 13, as revised, by or
oll Hc hal I'of tile pl_Oe IdCT dIrQCt1V to each Of tile
Ilie .V I i:i nc e !'Or Inc. at each o t'I h e 1'0 1 lw,v III- addresses:
\Iliance for A�jn(_,, file.
\tm: Viscal tiIanat,,er
-60 \X� 107"' \Ne. Suite 214
\Iiarrii, H_ 3317-1-3155
1 11C I edcrad III I )NIB Clrcuiar ,A-I 13. a> !.C\1scd (the imillier ot c:omcs required
Cont ract N L1 I I I h er K I I- 147`
Sect knis .320 W( H and (2). ()N I I i (.'hWar A-1 33. As re%iscd. slhqOd he suhnutted N) the F"Wral VW A LTwnq&wuscL at
the "'olkm ul,., addres,,:
g
Federal AudU Clearinghouse
Bureau of the Census
1201 Fas
t
I()1h Street
Jeffersonville. IN -17132
Other federal agencies and pass-through entities inaccordance with Sections .320 (c) and (f), ONIB Circular A-I 33, A,-',
revised.
Pursuant to Sections .320(tl 0NIB Circular A-I 33, as revised, the provider shall submit a copy of the reportirig package
described in Section .320(c), 0NIB Circular A-133, as revised, and any nmnagement letter issued by, the auditor, to the
Alliance for AgAy. Inc, at each of We following addresses:
Alliance for Aging, Inc
Attn: Fiscal Manager
760 NW 107"' Ave. Suite 214
Miami, FL.33172-31550
Additionally, copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or on
behalf of the provider directly to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc
Attn: Fiscal I'vIanager
760 NW 107 1h Ave. Suite 214
Nliami, FL. 33172-3155
The Auditor General's Wfice at the Collowing address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Niadison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Alliance for Aging, Inc. pursuant to
this agreement shall be submitted timely in accordance with 0NIB Circular A-I 33, Florida Statutes, and Chapters 10.550
(local governmental entities) or IOA50 (nonprofit and for-profit organvizatiomy Rules of the Auditor Gcneml, as
applicable.
Providers, when submitting financial reporting packages to the Alliance for Aging. Inc. for audds done in accordance xvith
AIB Circular A-I-33 or Chapters 11550 (local govenunerlml entities) or 10,650 (nonprofit and for-profit organizations).
JZulcs of the Auditor General, should indicate the date that the reporting package %vas dclisered to the pro%ider in
,:orre,p -eporiling pa k i,ondence iccoinpanying, the i L c Z�e
J),\RT IV: RECORD RETENT10N
'hiall sill 'uti"cicilt '"CC01"ds conlphancc \onn ills" lclul') tit'(All s :0r, ilcl'lo(i of
ljon, ills' dAte the audw rcpni is i,ucd, and AKAI ills''" We VKhm AT \cult. ho �v its dnonce, AW ( I ( ) (,I,
, ,
�Udltor 6cner'll to 5u,'h !cco!"d,, Upon lelacst. I he 1m)%ldcr �IIAII elltiLll-e !hat 'ludil \\ol-kin'- � apers Are nl;lkfe
0 WAYe to the Tliance im Agmyt, hw, or as tiennywc. We Dellartulcut Or or Vadltor (icncl-Ai 11pon
t61- A j)erWd 4 WN )Caw Inmi Me doe !he nudir Wport in issued. unless cxniWcd in ;%nnnq 1q Mlle Wilwe f&
WIMU. Inc.,
111-,1 Ct \U I I I tl C r K I I- 1-4 7 2
ATTACMIEN'T III
EXHIBIT — 1
Df�PIAL pf- M R,(, VA \M)f D fo I M BREONF\F pt- RS, \\I M FWSAORLP'll I ( ()V'I"I (A lei : ff)l t()%�1m)
...........
PROGRAM TITLE FUNDING SOURCE CI DA VN 10 U NT
i6FAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AW kRDED
PURSUANT TOTIJIS AGREEMENT' MIRE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUkN'F 'fO THIS kGREE.NIEN,rCONSIST
OFTIIE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
F—P-R-6-q�R AN I T I,f L E FUNDING SOURCE CF u
'TOTAL STATE AWARD
STATE FINANClAL ,,kssisT.ANCE SUBJECT TO Sec. 215.97, F.S.
PROG RAMTITI,E FUNDING SOURCE C SE A AMOUNT
('0111111LIllitV ( are Co the Fldcrlv flro-,ram General Revenue o olo S12,694
..........
------------
---------- ------ --------- ............
TOTALANVARD 12,094
-------------
IZVOUIRENMN I-S ,\111"LICABLE 1-0 STA I-V IZESOUI2CF-S AWARDED P1 R.SUANT YO
'
Col I trClct \u III 11cr K I 1- 141
A 1-FACI LNI ENT I I I
PART LAL DITRELATIONSIIII' DE I'ERMIN kHON
pro%ldcr .oho Cc'c:cJt`-.e �Iatc' or t'cdcr:ll 111,1V or Illati 110t be UPjeC[ tO the ALIdtt rzqulrements of0\113 ('ircular .A-Ill.
re%ised. and for Sectron '115 �)-- 1-1A1 Stat. Pro iders ,%ho are cletcrinined to be recipients or uhrecipients of federal a',.kards and or st tte
financial assistance Ina-, he subject to the audit reqL1IreI1ICIIt.1, it the aullt threshold requirement,, !,et f)rth in part I andor Part If of
hIlIbit I are Inet, Providers %%)I,) have been determined to he ,endors are not subject to tile 31.1dit requIrCl1lCntS k)t'()%IB Circular A.-
133, as rev ised. and or Section 2 1 5.9- Fla, Stat, Regardless of r.hether the audit I-CLILlirenients are met. providers \e ho have been
determined to be recipients or subrccipients of federal awards and or state financial assistance, must comply %kith Applicable
programmatic and fiscal COMPIldnCe requirements.
In accordance kith Sec. 210 of0\113 (..'ircular A-133 and or Rule 69 1-5.006, FAC, provider has been determined to be:
Vendor or exempt entity and riot subject to (,,').\IB Circular A-133 and or Section '15,97, F.S.
X-- Recipient SLIbreCIPICTIt sl.lbjCCI to O%IB Circular A-13 3 and or Section 2 15.97, F.S.
NOJ E: 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 IuLlSt Comply with Section 2 15,97(7), F.S- and Rule 691-.006(2), FAC [state financial assistance]
and Section 400 O%IB Circular A-133 [federal awards].
PART III: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR s,t*..kTE 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 regu
lations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES ;MUST FOLLOW:
2 CFR Part 225 Cost Principles for State. Local and Indian Tribal Governments(Formerly OMB Circular AL-87)*
OMB Circular N-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 0 RGALN i z..k,r IONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122 ---Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-1 10-Administrative Requirements)
Requirements)
01013 Circular A-133 -AuditReqUirernentS
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws. rules and regulations
EDUC,kTIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST
FOLLOW:
CFR Part 220 Cost Principles for Educational Institutions ON11 B (Formerly Circular A-2 I - Cost Principles)*
CI-R Part 215 Administrative Requirement,; (Fornierk,ON113 Circular A-I 10 - Adininistrame Requirements)
O%IB Circular A-133 -- Audit Requirements
Reference()aide I'Or State Expenditures
()tlicr tlScai requirements set forth III program laves. rules and regulations
',some tederal protArams Illa" He C\k2rnpled froin :olllpllance %%ith Hie Cost Principle,-, Circulars i> noted III the UMB (--.Ircular
1,3 (,'oMpharlCe Supplement. API-ICIIJA I
or,\rv, EiNANci.\i-, vssisTANCE. ,0w 'I"I'I'llice and cAho are Io be a
k Ir State \l!Crldl tilt Cs
Vthcr 11 t I I c:Illelll> Ct tOrIll In ril"',rcilll �,m , I u1c, 'Ind
Contract Number K I'I- 1472
('F,R,rIFIC.,k'TION' IZE(;ARDI.N(; DATA iN"rEGRITYCOMPLIANCE FOR AGREEMENTS, GRANTS,
L()AN'S AND COOPER,,k'1'1\'E .,k(;REF:NIEN"TS
'I he undersigned. an ,I uth orl zed represcntative of the Contractor named in the contract or agreement to MIMI this form is
,in attachment. hcrcbv certifies that:
I The Contractor and any Subcontractors of services Linder this contract have financial management systems Capable of
providing certain information, including: ( I) acCUrate, current, and complete disclosure of the financial results of each
grant-'funded project or, program in accordance with the prescribed reporting requirernentS. (2) the Source and
application of" tLuids for all agreement Supported activities, and (3) the comparison of outlays with budgeted 11110LIIItS
for each award. I"he Inability to process information in accordance �Oh 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, subcontractor(s), or any Outside entity Oil 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 technologly, the
undersigned warrants that these products are capable of processing year-date dependent data accurately. All versions
of these products offered by the Contractor (represented by the undersigned) and purchased by the State will be
verified for accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and Internal Subroutines that
impede the hardware or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software programs to the same level of functionality as warranted herein,
at no charge to the State, and without interruption to the ongoing business of the state, time being of the essence.
(4) The Contractor and any subcontractor(s) of services under this contract warrant their policies and procedures include a
disaster plan to provioic, for service dclivci-v 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 subagreernents, subgrants.
and other agreements and that all subcontractors 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
(,),%113 Circulars A-102 and 2 CTR part 2 15 ( 'Orrrierlv 0\113 Circular A-I 10).
-)N 'T. S(-J-f-E 2-257, KEY WFS-E I .'T 3 0
1-,J-Y BOC(: - I 100 Sl%l()N V( .40
Name ar r c.�6 t~ 014 t r a c 1�,)r
t,'N I Y A DN I I NI S I RA I
---- ------------------
ILmiture I Itle Dme
R()\I,-\\ ITSI
ro7tG
�011'd
Contract N1.1111her Kll- 1472
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SC-SPENSION, INTILIGIBILITYAND
VOLT"NTARY EXCILL'SION' FOR LOWER TIER COVERED TRANSA(."HONS
I he prospective contractor Certifies. [IN sIurllnu this certification. neither It nor its principals is presetltl\
kicharred. SLISPCIWed. PrOPOSed for deharinent, declared ineligible. or %011.lntarlly CXCILided frOill Participation Ill
this transaction by any federal department Orat-lencV.
2) ",Ilcrc_,1l4Q_)Prospecti\e contractor is unable to certify to any of the Statements In this certification. SLICII
Shalt attach an explanation to this certification.
Sit'inatUre Date
—ROMAN GASTESI-COUNTY ADMINISTRATOR MONROE COUNTY BOCC
Title Agency/Organization
(Certification signature should be same as Contract signature)
Instructions for Certification
z
I. The terms "covered transaction," "debarred," "Suspended," "ineligible," "IoNver tier covered transaction,"
"person," "primary covered transaction," and "Voluntarily excluded," as used herein, have the meanings set out
in tile sections of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by 2
CFR 376.10-376.995). You may contact the Contract Manager for assistance in obtaining a copy of those
regulations.
2. This certification Is a material representation of facts Upon which reliance was placed when the pat-ties 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 "IlCtl Submitted or has become erroneous by reason of changed
circumstances. 'File Contractor may decide the method and frequency by which it determines the eligibility of
its principals. Each participant to a lower tier covered transaction may, but is not required to. check the
Excluded Parties List System (EPLS).
4. The Contractor will include a "Certification Re(-Yardint, Debarment, Suspension, Ineligibility and Voluntary
Lxclusion - Lower Tier Co,.ered Transaction"" in all its lower tier covered transactions and in all -solicitations
for lok\er tier covered transactions.
5. The Contractor agrees that it shall not knowingly enter into any lower tier covered transaction �4 ith a person
\\ho is Licbarred. suspended. determined inell(phle or WlUrltaril4 excluded from pall IC Ip3t l0n. LHlICSS OtherNk Ise
�mthorlzed by the federal go�ernnlerlt.
6 If tile Contractor enters Into a lo\ecr tier covered trall�a01011 �� Jtll Zi J)el-SoIl M10 1, WI)CIIded.
deh,irred. or wltllltarlly excluded from participation II this transaction. II addition to other remedie
s
.i%iidahle to tile [�Aleral government. the Department fflily [)Lll_:�(IC d Mlahle f-VIUCLIle,. III,:ILIdIII_1'
'111d or
I lie Contractor nitid lei upon a certification ol a prospecii\e 1),wicilmnt In a lost er tier Co%cred 11%ill"actioll that
it is not dcharred, Iti,11CIIJed. HICIII_Ilble. Or WILlhLink c\cIuJcd from the eo\ered tjnles,, it know,
that file .:ertIt'iCItIoIl is tTI,0110Ms.
C'ontr.tct \'umbcr KI1- 147'
:1TT:1C1i11ENT V1
kSS1'I2.kN('ES--NO.N: -(`O`r"'. 'I'IZL'("I'I N PROGRAMS
1''l,llal(c rq','rtInC I.,urd.tiII l�)r tlllti cA)llcctl,Iti 4,f Int,TTII at!kIII Is t:,,t III I It�:C'1 tO A%C tltttlutel� rer respon,�k�. includill�,, tillte t01"I
N%le%AIM-1 111;,tructlolls, 'L"1rCIIIIII-1 eXttitln< dutll s0urC s. the dltu nwCdCd 111d c0Illpletltl11' ;I31d rC%11%%1111,3 fllC:
Collection t.lt }ntormation. `'send conitllcnts the burden estimate or :any other Lisped t)f this LOII CtlUt1 of 111col-Il1 at,C)rl,j
includini-, tur rcducing this burden, to the Ot'fice c tMana-enlent and Budget. Nper%%ork Rcduetion Project W348-u011 1),I
Wa,hiniton. DC. 20503
PLEASE DO NOT RETURN YOT'R COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND
IT TO HIE ADDRESS PROVIDED BY THE SPOtiSORING 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 ar ill be notified.
1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (includim! funds
sufficient to pay the non federal Share aflaroject cost) to ensure proper planning, management, and completion of the project
described in this application.
2. Will give the awarding a<gency.. the Comptroller General of the United State,, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award: and will establish
a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
S. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPNI's Standards for a
Merit System of Personnel Administration(5 C.F.R. 900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination. These include but are riot limited to: (a) Title VI of the Civil
Rights Act of 1964 (P,I... 88-352) which prohibits discrimination on the basis of race, color or national origin: (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686). which prohibits discrimination on the
basis of sex: (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C, 79.1). which prohibits discrimination ors
the basis of handicaps: (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), Mitch prohibits
discrimination on the basis of age: (e) the Drug abuse Office and Treatment Act of 1972 (P.L. 92-255). as amended, relating to
nondiscrimination on the basis of drug abuse: (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L 91-616). as amended. relating to nondiscrimination can the basis ofalcohol abuse or alcoholism.
tv�) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee 3). as amended, relatin-Y to
confidentiality of alcohol and drug abuse patient records: (h) Title Vill of the Civil Rights ,-act of 1968 (4_' U.S.C. 3601 et
seq.). as (amended. relating to nondiscrimination in the sale, rental or financing of housing: (i) any other nondiscrimination
1}rovisions 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.
l�ill comply. or has already complied, ,aith the requirements of Titles If and Ill of the uniform Relocation .lssisttance and Real
Prorerte lcquisitwri Policies :Act of 10-0 W,I- 91-646) Avhich pro,,ide f<rr fair and equitable treatment of'per,4-,n.s chs,placed or
,A h,"e propert+, i, acquircd as a resalt rat te&ral or tcderall% assisted programs. These reclutretnents apply to all interests in real
propert% aclltaired [or pro�iect purposes regardless rf federal participation in purchases.
1tiill conirl',. ;.r till thee ill'0vi'kltls of 111e Ilatc:Il .let i? l.' tiC'. L�t1l-I ;rl,� ;Incl �3_'1- ,� ;J. F1I1i�11 IttIIIt rile
ItICN Ot'ti'nip R.�,ec's 1.,110'k! prinktpal cirplo%Brt'nt .1�wti'.itic.l 111C iLand�!d Ill AA It0ic 'Ir to i%111 AA lull tcdc rag tun44,.
Ill ,`dllt`-1`. ;In .it�t71��:.1k'lc;. '.~till Ihc' ltr,,)Ai>la`S?,vla;lll,-I3acti'tl .act C',,'t it1
C Ind Is f ti 4"..ti ,alld t1"e HMI(-, ,trid saf to �talldard, \��t t lU f ti,C w). ,�'.I;lrctiit
t.lbc�r't'lnd,tld, h"I lcdc'rall% ;IN'I�Ied C',''n`IT-II tI0Il
Ill ",'111p1A. It wpll4:,Ible, '.gall ilood inN,IIFAIICC purCil,110 re ClulrCII1CIlt, 01 SCc'11011 1()2ta) �,rt the I lood fr,,tc,(hill .AC:t ,0
`-I
[m)tract NunnI)crK||- 1472
xhich o4uirc+ recipients in u spccix| flood hazard area to participate in /he pmLrnnl nnd m poohx�e Ou^J
insumnc(2K the wx| cua of'insuo6I ecnnumchon and auquishiunis ".)|0.O0Ourmore.
'^{| Will colllpI% vithmvimnmmo| smnJznjsvhich mu)nm bcposcri6cdpuuaon, ,othe W|u«in�] (u) iogxxhono[ n mmmu� `in |
quu|i/) con|m zmm u a| /rusnJ�r |h� � dooa| Envi m mm| Po|ic! Act ut !»hv (PL9|'|90> nnJEumh\rorJo /LV> | (5||.
(b) nmi6czuon nfvm|abng b6|ihmpunuunt to E0 | |7]O: (c) protection ofxm|xnJspursuant to EO | |4qo. (d) c`u|uohuo "t'
OuoJ hazards in Uoodp|oins in ouurdunu vi,h £0 11988: (c} uSsuono of project cnosistmc! ni/h ',he appmud Su|e
management pngomJe`cloped under the Coastal Zvnc }1unogcmcnt6ctuf |47) (\o [S[ |4j| c| conhanm�! of
federal actions toStuz (Clear Air) |mp|emcnmhon Plans undcrSccdun {76(c) u�the Ocur Air &c{ o� |Y�5� is umcndcd (4-'
[�5.C. 7401 c| ag. protection Of' Underground Sources of'drinking xoter Linder the Safe Cvinkin-, Water Act of |97l, os
amended. (Pl, 93'�;23 and (h> protection of ndungend spccim Linder the Endungcred Species Act of 11)7l as amended. (PI,
93-2O5)�
12, Will comply xi/h the Wild arid Scenic K|,cs Act of 1968 (N [SI. 17 21 u( scgJ /r|med oa pnxechn(, componcnm nr
potential components obhc national wild and scenic rivers sy*em.
|l Will uuia the uwundinaagency in assuhn� comp|iunce with Section l08o[the National Historic Preservation Act nf )066 as
amended (|6 U,5.C. 470). ED | |5q3 (identification and protection o(hiaohcproporties). and the 1ohaeo|o-icu| ond Historic
Preservation Actof |A74 (|6 U,8.C, 464u-\ et seq.).
14. Will comply with Pl. 93'348 regarding the protection of human subjccs involved in research, development. arid rc|uud
activities supported by this award ofossisunce,
15, Will comply with the Laboratory &ninnu| Wc|furc Act of 1966 (PL, 89-544. as amended, 7 U�S,C. 21 3)1 ctscqj pertaining to
the care. hund|in�� and treatment »ofann blooded uoimuo held hnresearch, �aohin�� ormhcra�ivk�s Supported 6y this award
of assistance,
16. Will comply with the Lead-Based Paint Poisoning Prevention A# (42 U.S.C. 4801 et aoql which prohibits the use of lead-
based paint in construction or rehabilitation of res idence structures.
/ 7, Will cause mhc performed the required financial and compliance audits in accordance with the Bino|c Audit Au Amendments of
l996 and OMB Circular No. A-\3]. Audits of States, Local Governments, and Non-Profit Organizations.
18. Will comply with all applicable requirements of all other federal |uws, executive nnjcrs, regulations and policies "overrun,, this
program.
`
��
\L111111C1- I' ll- 14 7
HOME CARE FOR THE ELDERLY PROGRAM
13 U'D 'ET SUNINIARY
The Alliance simil imi -e 1-mymerit to the pr-o%Ider I'Or pr*o%islon of serti ices tip k) a 11MXi11,U111 IILIII`IbCr Of U111tS of Ser\Ice
and at the 1-atc(s) stated helow-,
--7
Service Maximuni
Maximuni
Unit Units of
Service to be Provided
Rate Service Dollars
Case Management $50.48 251 $12,694
E. rotal 512,694
\(1111her K11- 1472
ATTACIINIEN'T VIII
HOME CARE FOR THE ELDERLY
INVOICE REPORTSCIIEDULE
Report Number Based On Submit to State on this Date
I July Advance* July 1
2 ALI'-ILISt Advance* July I
3 July Expenditure Report AUgUst 25
4 August Expenditure Report September 25
5 September Expenditure Report October 25
6 October Expenditure Report November 25
7 November Expenditure Report December 25
8 December Expenditure Report January 25
9 January Expenditure Report February 25
10 February Expenditure Report March 25
1 l March Expenditure Report April 25
12 April Expenditure Report May 25
13 May Expenditure Report June 25
14 June Expenditure Report July 25
- Final Expenditure august 15
1 )
16 Closeout Report August 31
Legend: Advance based on projected cash need.
o
A'I"FACIVNIEN-l' IX
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY
co —v 7 E vP P A'r F N
----------
.....................
PSA x
CERTIF CATfC'4 t hereby cerl.rfy to tk�si best of my K,,owiedge that this request or rekird ccriforms with 1fle terms and tr,e trunooses of the above contract
Prepared by Date Approved by ....... Cate
PART A BUDGET SUMMARY CCE Ad.,r.tr, CCE Servoes TOTAL
1 Approved Contract Amount S -------
2 Previous Funds Received for Contract Period S
3 Contract Balance $................
4 Previous Funds Requested and Not Received for Contract Period S
5 CONTRACT BALANCE S--- 5
PART B CONTRACT FUNDS REQUEST
I Antic fated Cash Need(1 st-2nd rnontlls)
2 Net Expenditures For Month S------------ S—
,DCEA Form 1(35C,Pad 8,Line 4)
3 TOTAL S
PART NET FUNDS REQUESTED
I Less Advance Applied -------
2 TOTAL FUNDS REQUESTED(Part B Lme 3,minus Part C Line I
:1,CEA FORM 'i'6C
Co11tI'tICt \U1111)C1- l k{- 1
ATTAC'll1[ENT t
RECEIPT AND EXPENDITURE REPORT
HOME CARE FOR THE ELDERLY
J
C ,r E Ad.... ... .. .G 4T 4 A C
t>.EP<>RT 9
9
C:E"RTIE"I<;;�A'C't t,JN r.—t fy rre t 0hll f MAt I'll, S C:(7 rr7)ylxj ten Jnd CO r t ,tr+rs"ll —A[a,;
Ysrgregirf 2lrkA fo, Cr1rr ooses set tC rrih xn (tYe c t�rY lr2f 4'::t.
.Ap—j r'Y .... .... t).:xta ....._.....
.PART A BUDGETED INCOrv;tE/ RECEIPT'S 1 A{',)).7roved 2 A(:t al ReWOWtS :3 Tot.11 RecelptS 4 P accent(If
E31�C)e�t F'c,,r Ch,fi F2 En>crrt -ar fe3 C)att3 A-,j-r�ud E3uc7(
i �it23tk3'PunrAS $C).(90 $0 t7(J &:4?.C)lJ tt C71 V:O r.
?. Prca<)ra rx3 Inromre $0(N) $0-CA) $0 00 rtn V110
l"C41l CC,3Sn%1atGr) $(3.00 $O 00 SC)00 tx G71 VlU!
3
4. SUBTOTAL CASH RECEIPTS
(i. TOTAL.RECEIPTS $0.00 $0.00 $0.00 401Vi01
PART 6 EXPENDITURES 1 .Approved 2. E.pe od.ture3S :I F_xpe3r}dlture3s 4. p rc,ent of
Bud..et For'This Report `+"",to Owe A 7:nrea eaef Bude rat
1 ActYn lniStrative Sc-111CHS $().00 $0 00 $0.C7 C7 0DIV101
2.Seurvlce Sx.r CJcontrc3cie'(s) $0.00 $0 00 $0.00 rt01V10,
3 Adult ProtICt-0 Services $0.00 $0.00 $0-c)0 #C?IV/01
4. 'TOTAL EXPENDITURES $0,00 $0.00 9$0 00 401V/01
PART C OTHER REVENUE* AND EXPENDITURES ll. klterest: III, Advance Recouped
I. Program loco...e(PI) 1. Earned on GR Advanc:e$___ „ $ _..__........_.....���
I CCE: PI Collected YTO 2. Return of GR Advan(.e $,_,__.,__,_..__.
(Includes fees collected) :3. Other Earned $. _......
ART D CO-PAYME_N"1'S CURRENT NtONTH YEAR-TO-DATE
i. Total of Co-payrrlents assessed $._�..._. —�_...........,_ $--_.. ��__.__...._..
2. Total of Co-pavrrle3nta collected $........_._._ _...__.....,..._ $...........___ .......,,..._..,
(P='or T,aCkrng Purp0.5eS 0131Y)
u u
h(�
11 tr�lct N'Li I III)Cr K,I i- 14
k FL\("I I'N I F''11'
Department of Elder Affairs Programs & Services Handbook, provided on CD.
Also, available at the Department's Intranet Site Under, "Publications".
Wow Number KIP 1472
NFIACIINIEVY 13
STATE OF FL(MURA DEPARTMENT OF ELDER AFFAIRS
RT h READ I"E %rTV "ED AST RI C FH)N% FOR I tKI SVR%n%E IN I ORNI%TION %%H VCH \N ILL.I IVI P 1 M (omPrETE THIS FORM.
I WdescribeIdescribeto go,grionc area sen od by the program tin lin"nd Me mpe o C wnue provided: Tr 4y-,t-fi2e.,
_LO)Z N roec '441V50"Or
2. 11(:)PL:I...\flC)N ()FARFASERVFD. Smm" 4data:
3. I.-\i,--,CURRENTLY EMPLOYED, Fffecme date:
--77 Fan ale Di,abled
rot,il Kwk ffi,pamc 11(7)1��Lr
_ ..mod C) C,
I CLIENTS CURRENTLY ENR(-)LIED OR REGISTERED. FRAtwe date:
T
i "" ,
i FT11:;- F)i,alrfled )%,:r 41)
L- 00
—00 S J.-
i, ADVISORY OR GOVERNING BOARD. IFAPPLICABLE.
Imaj Blacl, Other
ITAWTII: USE A SEPARATE SHEET OF PAPER FOR ANVEXPLANATIONS REQUIRING 1-10RE SPACE.
6. IsanAssurance of Compliance on 60 with DOER? If NA or NO,explain. N,A NO
El EF
T Compare the staff composition to the population. Is staff representative of the population?
If N/A or NO, explain. N,A YES NO
El
H. Compare thee bent composition to the population. Are race and sex characteristics representative of the
population'? ITN'Aor NO, explain. N;A YES NO
0, ,Ve eligibility requirements for services applied to clients and applicants without regard to race,color,
national origin, sex. age, religion or disability'? It'N/,,-X or NO,explain. N A VI'S NO
El 14 EI
10, ,are all benefits. services and facilities available to applicants and participants In all eq Lial ly effective
manner regardless of race. m. co[or ago nanomd ongirr. mhgkn or disability ' If N A or NO. explain. N A YE No
L0
1 1. i'or m-patient tierce Ices. are room asygnmems nude ',-it our regard to race. who, national orivin
A or e\plam, X I-S NO
A
-----
----------- ------------------
41 51)
Contrict Number K I 1- 147')
Is the to non4'.1m-,1i,h peakmg 11 N N or 'N'(). N A Yl-S NO
El 17
13, :Are cmployces, applicants and particil),-Int,, int'Ormed of their protection auamst di,,crimination? It' i'ES.
hog %? Vcrhal ❑ written F7 Poster 7 It'N A )I- 'NO, explain. N A )'ES NO
El
14. Give the number and current status o C any discrimination complaints regarding services or employment tiled
civainst the program:tacillty. N A NUMBER
❑ C>
15. Is the program,facility physically accessible to mobility, hearing, and sight-impaired individuals? It'N A or
NO, explain. N,A 'iT NO
PART III:THE FOLLONVINGQUESTIONS APPLY TO PROGRAMS AND FACILITIES NVIT" 150RNIOREENIPLONrEES.
16. Has a self-evaluation been conducted to identify any barriers to serving disabled iridvviduals, and to make
any necessary modifications? If NO, explain. %'T7 NO
W h
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO, explain. Y5S NO
18, Has a person been designated to coordinate Section 504 compliance activities? If NO, explain. YE,5 NO
F-1
19. Do recruitment and notification materials advise applicants, employees and participants of tiond isc ri initiation
on the basis ot'disability? If NO. explain.
Ik' NO F-1
10. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If
NO, explain* NO
PART 1\,: FOR PROCR VNIS OR f WILIJ IFS\\ITN ;0 OR MORE E\IPLON EES kNI) FEDER\L CONTRAC IS OF S;0.000,00 OR MORE.
2 1. Do %ou have a ��ritten affirmative action plan? IfN(). explain. i S NO
ALLIANCE USE ONLY
In i-ollnlllmice: 'i I'S
of(,'orrek�me A,�iion '�cn[
)Ifi�e --- ----
4
Co11tr41Ct N LlIIIbCI' K 1 1- 71
............ _
flit-�ttc t__� Ue f�c,�ic,v R:�ponse keccivwd
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. I)cscribe the ucooraplric service area such as a district, county, city or other locality. if the prourarn Cacility
serves a specitic target population such as adolescents, describe the target population. Also, detine the type of
scram ice provided.
Y Enter the percent of the population served by race and sex. The population served includes persons in tine
geographical area fear which services are prodded such as a city, county or other re`ional area. Population
statistics earl he obtairhed from local chambers of commerce, libraries, or any publication from the 1980 Census
containichg Florida population statistics. Include tine source Of your population statistics. ("Other" races include
ysian Pacific Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-tirne staff and their percent by race, sex and disability. Include the effective date
of your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and
list their percent by race, sex and disability. Include the date that eru-ollment was counted.
S. Fnter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing, board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the proorram will be conducted
in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part
of the contract language t«r DOEA recipients and their sub-grantees, 45 CFR 80.4 (a).
7. Is the race. sex, and national origin of the staff reflective of the general population? For example, if 10"4, of the
population is Hispanic, is there a comparable percentage of Hispanic staff'?
S. Wbere there is a significant variation between the race, sex or ethnic composition of the clients and their
vailability in the population, the progranu'facility has the responsibility to determine the reasons for such
variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities
may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45
C'FR 80.3 (b) (6).
0. Do ehuibility requirements unlawfully exclude persons in protected groups from the provision of services Or
crnployrnent'? L%idence of such may be indicated in staff and client representation ((questions 3 and 4) and also
tllrouuli on-site record analysis of persons %vlio applied but were decried services or employment. 45 CFR `"y0.:3
(a) and 4-7 (:TR SO.I (b) ('),
t). Participrrms or clients must be provided scrt ices ;uclh is medical. nursing and dental care. laboratory scr%ices.
physical <utd rcere�atir��trrl therapies, e(>unselinIz and social ';er',lCes %cithout re.-ard to rttcc, ,ex. color, vaticlml
of"1 ln, relr"fo61, ;igc or c.tti4lblht%. (. our c"o, titles. �1ppolnmlCnt 'clledulint! aild accumcv of record kcCj)int.Z nrtttit
�� :rl7piicd (tiufrrrrttl�, ,t,td tiiout to rice. >cx. '_olor. national oritsin, rc:li,uioit, i,uc or disability.
1 tmc". d itIM-1 1_('�k'111" I"cceptwil ,,r 4rw. !'c>t110or11i I11si Col11cr 11'icilItic5 illu at :1Im) lie e2gt1,rll1 :1%<lllrtl3le t(� lYll
3 (1)r
(; tiQ
Contract NLIndicr it!K 1.172
1% in-patient scr%iccs, residents must tic assigned to worm wards. etc., whNut regard a, nice. color. imnoW
ob"n or disalWity. Also. residents mu,,t not he a?cd "nether the, are %viHing, to >hare acconiniodations \�ith
put3oty of a different race. color. national origin, or din±dQ% 45 CFR 803 (a),
Ile pi-ogram, Kcilay ami all scr%ices must be accessible to participants and applicants, InClUdil C1 I se p -,,;11
"to nmy not speak English. In geographic areas "Tere a njinit-warit poMlakn of non-FrioN spwknnz
people lip C. prograill accessibility irlay include, the employment of bihIll-11.1al staff. In other- areas, it IS -SUt'ftCiC1lt
a) have a policy or plan for service, such as a current list of names and telephone 111.1111herS Of bilingual
inIvAuds who "ill ask in the proti ision of services.45 CFR 803 (a).
13. Prograins, facilities must Make infon-nation regarding the nondiscriminatory proviskirls of Title \1 available to
their participants, beneficiaries or any other interested parties. This should include information on their n(flit to
file a complaint ot'discrimination with either the Florida Department of Elder Afthis or the U.S. Department of
HHS. The information may be supplied verbally or in writing to every individual, or May be Supplied through
the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80,6 (d).
14. Report number Of discrimination complaints filed against the progranilhiciTy. Indicate the basis, e.g. race,
color, creed, sex, age, national origin, cksabilky, retaliation, the issues involved, e.g., services or employment,
placement, ternination, 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 progranvfacility must be physically accessible to disabled individuals. physical accessibility includes
approaches, ramps arid adequate widths to entrances. The lobby,
designated parking areas, curb cuts or level
admissions offices should be accessible.
public telephone, restroom facilities, water fountains, information arid a Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving Imes should be observed for accessibility. Elevators should be observed for door width, and Braille or
raised numbers. Switches and controls for tight, heat, ventilation, tire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self-evaluation to identify any accessibility barriers. Self-evaluation is a f(-.)tir step process:
a. With the assistance of a disabled individual organization, evaluate current practices and policies which do
not comply with Section 504.
1). Modify policies and practices that do not meet Section 504 requirements.
c. fake remedial steps to eliminate any discrimination that has been identified.
d. Maintain sCl f-eValUation on file. (TNs checklist may be used to satisfy this requirement if these four steps
hake been followed.), 45 CFR S4,6,
17, Pro,rrariis or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
wRvN0aW due process standards and provide for the prompt and cognmWe resolution of complaints alleging,
any action prohibited by Section 50145 CFR 817 (h).
1 s- ProLrarns or thalittes dou cmpkq 15 or More persons nnist designate at least one person to covAnone eTwN to
till Scction 50-4 45 (TR `4,- (a).
"rall" �aclht�",1 1"ItIM111114 'k:i), mu"t lie !;:ko:n to the pulill': t)l the tllo�
011 1hc 1M,1^ 0 c{3�at7lli( '. I Ws includm rvt:ruitincnt nmtCmal.
ritten conlmunicat!on, 45 t. F R ` 4,17
44 50
('() It r,I Ct N u I I I I)ej- 1,[I- 1-4 7 1
"o, Progranis t'acilitics th,'It employ 15 x nkne penons mu pro%ide appropriate auxilimy juk to pasums "Oil
imp aNd senno, mamml or Skills %Olcrc rtcccs arr AuxiliLirw Lulls Inay include, 1)"'It are not 1IInItk:d
k), interpreters t"or hc.iri ng, impaired i ith%UK I s, taped or Bm il I e inatenn Is. or any a Iterimt i%e resources that ':an
be used to R",le cqLlaily eft'ccth e soi We, 45 CET S402 (A
21. Programs WAVS with 50 or more cinployees and 550,000?1 in t0deral contracts must dc%clop, implement
and nmiltain a "Hun of irritativeaction conVIOnce program in accoakince with ExecuSe Order 11241 41
CTR 60 and Kle \1 of Me CAI Ilghts Act of 1964. as amended.
DOEAFwn IM-KRn;ndAyuwW)
45 51)
('011traCt NUIllbCr K11- 1472
A 1"1'A('11MEN'1' ('
REFERRAL PRO'YOCOL NIONROE
ISSUC: ScI-CCMIIU, t'Or A� :tl%Litioll under the Commmilt% ('dirc COr the L:I(Icrl% I lome Care the
Eider!~-
Policy: Rcterrals %�III he lased on '1%allabtllty of fu!lds' III accordance \c Ith prioritizat toll requirellicilts,
PLII-PO,';e: To ensure t1uidmg 1s Spent expeditiously and consumers are referred itito programs for appropriate scr%ices.
Procedure for N1011roe COLIIItN':
1. Roles and Responsibilities
A. Alliance for Aging \gltig and Disability Resource Center
• Reconciles overall prograrn and Lead Agency specific spending levels on a monthly basis to ensure the
Lead Agency is operating within the funding allocation.
• Reviews the number of cases released for activation based on projected funding available.
• Screens consumers to link with appropriate resources arid prioritize for DOEA-funded programs arid
services.
• Recommends potential cases for activation based upon projected funding available by Lead Agency.
• Selects consumers from the waiting list based on their prioritization score.
• Refers consumers from the waiting list to the Lead Agency in Monroe County for activation, based on
availability of funds.
• Monitors compliance with service standards and outcome measures.
• Reviews care plans and tiles per the File Review Policies and Procedures.
0 Reviews data in CIR'rs.
B. Case ),laria-ernent Aoencv
• Requests and accepts referrals frorn the Aging and Disability Resource Center, to serve an optimal
caseload and to avoid surpluses or deficits in accordance with the AAA CCE HCE Surplus;Deticit
Analysis Pollcv.
• Refers Inquiries t rorn consumers interested in services to the ADRC for Information and Referral to
community resources. Screening, Triage. and Lon-Jcrm Care Options ('01.111SChni-T. as appropriate.
• The Intake are OWSOUrced to the Lead ,Agency. Screening and Intake may
also be coinplctc(l by the ADIZ('.
• CoIllpletes cornprellensl\C JSSCS,,�IllelltS 011 11CW C011SLIMCl', alld anIlUal reassessment oil e\IstI111-1
,:0115Llniers aiid cic%clop5 care plans alid rc le%� " mare pl'llls
• \Litiiori/es scr% ice dcll%(:r% Lwd enters c14ita IWO ( IRJ-S-
101- SM-MC1. F(' ell-'IN11tv. Bills III ( 114 I'S 11s
• Vomtors care plalrs iii 4in eff'Ort to keel) cwts lo% ii ��hlic the ll"dl\ klu'lls III the ck>111111 Lill it%
Contract `Jutaalicr KI 1- 1.47'
�,,I1. M�tlasl� clllc:nt t,�f�tl1e :ti;�e�scd Priciritized C`orrstlraler List (_.1PC"L).
V Ref'ernds to the ADRU �lre routed to the Inforinatiola <and Referral Specialists or Intake limit staffdepClIdIn;-,on the
type of'reterrtal. CIieIIts are provided iriforraltiltioil on Coll I Mull Itv resoa trees and prograraas zlvailable including, pri%ate pay
option,. Persons are directed to those rescnirces most capable of mcet'm! the n v need the% hae expressed to ADRC
Cases presenting strong identifiers that indicate the consumer might, benefit fironi publicly funded lone terra care sere ice:s
are screened, entered into CIRTS, triaged and provided options cowiselin,:. In Monroe County, tllc functions of
Screening and Intake are outsourced to the Lead Agency. Screenin z and Intake may also be completed by the ADRC.
D(.)EA prioritization requirements %trill be adhered to by both entities, as follows:
I. APS 1Ii4,,h Risk Referrals (See section B) .
?. Imminent Risk cases will be prioritized for activation after APS Iligh Risk Referrals have been served. If budgetary,
constraints prevent opening new cases, clients will be placed on the APCL,. ADRC staff will contact the client Mara a
monthly basis to determine if there has been a change in the client's situation.
3. All other CARES referrals will be screened and prioritized in accordance with D(7EA requirements.
4. Aging out consumers will be referred by DCF for prioritization and/or activation in the corresponding aged program
managed by the Alliance, as appropriate(See section IV).
S. Consumers applying for the Community Care for the Elderly (CCE) and/or Nome Care for the Elderly (HCC)
nrograms %Vill be contacted and screened using the statewide form developed assessment by the Department of Elder
Affairs for this purpose (Form 701 S). If a consumer is being served through a DOEA-funded agency which enters their
annual assessment into CIRTS, the Priority Score generated by that assessment will determine their ranking on the APCL..
6. Consumers referred for inclusion under the Statewide Medicaid Managed Care I..ong Term Care Program APCL� will
be contacted and screened following the same procedure as the one described under Section 5.
7. Individuals who appear as potentially eligible for other types of public assistance will be referred to the Economic Self-
Sufficiency [.snit at the Department of Children arid Families.
S. All other referrals will be wanlisted and prioritized, during which time other community resources will be researched,
including private pay fee for services providers. Consumers oil the waiting lists will be reassessed according to the 2013
Department of E'Ider ,Affairs Programs and Services Handbook, or any revisions made thereafter.
I3. 1IIP.�1�1 forms will he sent to the corastrrner aS appropriate.
Ill. ()penirr x New Cases
\. ('C'Ei: I{CLi Clients
i . I lie 1~fiscal Departnlemt ,d Ill Illonitor Lczld :1t!eticc �I)c ltrc ,17enciin�.r (eels �n tr In<nit4al� I�rasis to ensure each Lead
�uelac� ��her:nin�z �.w Pt11111 its l endim�r �ruth�7rit In 'ldditioll. the fisc;.1l dcprutlalent t�ill ,u1.111ze ; lrplus deficit
���C Eie�fl5. 'read �iN e the 1,l7tor11awlt on ',% ,1;1 The Lti2,l i to atitiltit In th1.:Ir dclerllll!1<!tW11 rOt y, tOt 'IAJl�<'lhlllty I lie I_c'rtcl
17 s c>
Colltl-,ICt NLIMhCI' KH- 1-472
request lcfermls directly 1'ronl the ADRC. The Fiscal Department will he notified of the nunli)er of ncw c&,;cs
heinu reteri-cd to the I.-cad A�--'etic\- ilor "Ictl%atlwl
receipt ot, tile rcq last for retcrmls from the I-cad the ADRC I[IMk-C I-I'llit Super'l,;0r 'XIII 171,111 the
I)rlonti/cd Ri,,)k Report to Idellt,t'% the cOt"Llillers Oil the AR1, to he opened.
In re,)pollse to the request fOr referrals, tile :U)RC Intake Unit Super%isor %g III refer wait listed clictits to the Lead
Aaencv Or activation. t accordance with prioritization -CL[UI C1CIItS. Vile Intake Unit I Update the. wait 1 t crroIIIiIQIt
usln,-, the appropriate code to terminate t'rom the APCL. Upon receipt of referral, the Lead \gency will enter the Al-11-IL
enr()IIjIleIlt, aljd subsequent enrollments to reflect client status.
I enter the APPL enrollment, will
4. Upon receipt of list released from the waiting list, the Lead -Nocricy wl
ontact clients to offer program enrollment, and will proceed with activation. The Lead Agency will enter Subsequent
enrollments into CIRTS to reflect client Status.
5. In accordance with the DOEA Pro-ram & Services handbook, consumers who were screened using Form 70 IS and
received a priority
score or rank of 3, 4 or 5 with a C[RTS Enrollment Screen program status code set to-APCL-and subsequently assessed
using 701 B and receive a new priority score or rank of* I or 2 must be returned to the APCL to allow for prioritization of
Other consumers on the APCL with priority score or
ranks of 3, 4 or 5.
The ADRC will oversee the enrollment process to ensure referrals have timely outcomes in CIRTS,
B, Statewide Medicaid Managed Care Long I'errn Care Prog-rarn Clients
1. The Department of Elder Affairs will run the APCL (Assessed Priority Consumer List) report to review clients wait
listed for the smimcii..'rcP . DOEA will provide the ADRC with a list of individuals authorized for release from the
Al"CL.
2. For clients active in CCE or I ICE and authorized for release from the ?Medicaid Waiver waiting list, the ADRC will be
responsible for the application process. For CCE active clients the NDRC will notify the Lead Agency in order to waive
the co-pay.
\PS Referrals
1. ..\PS Low and Intermediate Risk, referrals will be screened and prioritized by the ADRC for services as per the
%lemoralIdUrIl OfUnderstanding. Low and Intennediate Risk- referrals are also offered information and
rcterral to additional C0IllIllLIrIIty I-CSoUrccs. includin', pri\titc pay as cipproprlltc.
APS Ilidah Risk Referrals are not "valth"te& lice are Ill-Iniccliately referred for scr ice from DCI-` In Monroe COUIlty
to tile I,cicl AR rcferrals \G Ill he f'Or-wardcd directiv the Lcad \gencv. APS cascs are to be screed t'or :l
rat.,I calettciar claw. lt',iddinonal t Inc i ltl;tlficd. the case ]H tIlffthe C&sc with the
Vii"i,cc it, O)t'llil ;he e tcttsiott ilecdcd.
Contract umber K H- 14
3. t,:roll receipt of,the APS I ll,-,Ii RIA Lk:,Id Amlcv will services to ItIlill the -;-"' hour
t1iXidited b', StlitUtC- be done within 72 hours of the referril. 5cr\ices rc(jLII;-ed
under ti"e care; 1)1,111 will rr tiaitt in placc 1,or a
111aXi Ilit I!I 1 0 1 dtivs, unless all exte I Is I o I I has a", !)Cc n �,ra I It ed.
I I TS addition, service C CS
-1. The Lead Amlcv hill enter enroIIIIICrIt Wider their provider 111.1111hCr Ill CIR - Ill �iddit'011, S " e C0d I
be entered by service date for al I services provided. It'a service(s) IS riot provided as reCjUII-Cd under the care plan, an
NDP code will need to be entered ill CARTS and the case notes Wider tile Client File Should document the reason for non-
&B ery OC Such Ser-%'ICC(,)),
IV. Aging, Out Consumers:
out" consumers will be referred by DCF to the ADRC for enrollment into the corresponding aged
program managed by the Alliance.
B. C011SUrners active in the CCDA and FICDA programs that are turning 60 and are eligible for CCE and or IICE will be
opened in the corresponding aged program managed by the Alliance if funding is available. If funding is available, these
consumers will be made active. If funding is not available, they will be waitlisted for these programs but will be given
priority for activation once funding is available.
C�
Note: These ADRC policies and procedures are subject to change. Any niodifications will be done through a
contract amendment.
Contract \umher K I 1- 14
I I ENT D
Department's CORIPLIter Use Policy and its Social Media Policy, provided on CD.
Page 5 |
ATTACHMENT
Alliance for Aging, Inc.
� Business Associate Agreement
aThisBuonessA by the AUiancefor Aging, Inc
("Covered Entity") and ('Busine s As octe'). a not-for-profit Florida
corporation. .
1.0 Background.
1.1 Covered Entity has entered into one or more contracts oragreements with Business Associate
that involves the use of Protected Health Information (PH|).
1�2 Covered Entity, recognizes the requirements of the Health Insurance Portability and
Accountability Act of 1998 (H|PAA) and has indicated its intent to comply in the County's Policies and Procedures.
1�3 HIPAA regulations establish specific conditions on when and how covered entities may share
information with contractors who perform functions for the Covered Entity.
1.4 H|PAA requires the Covered Entity and the Business Associate to enter into a contract or
agreement containing specific requirements to protect the confidentiality and security ofpatients' PH|, as set forth
in, but not limited to the Code of Federal Regulations (C.F.R.), specifically 45 C.F.R. §§ 1G4,6O2(e). 184.504(e).
164,308(b). and 184,314(a-b)(2010) (ae may apply) and contained in this agreement.
1.5 The Health Information Technology for Economic and Clinical Health Act(2009), the American
Recovery and Reinvestment Act (2009) and Part | — Improved Privacy Provisions and Security provisions located
at42 United States Code (U.S.C.) §§ 17Q31 and 17Q34 (2O1O) require business associates cf covered entities tV
_ comply with the HIPAA Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 1G4-3O8. 1G4310. 164,312.
( and 164,316 (2009) and such sections shall apply to a business associate of a covered entity in the same manner
that such sections apply 0o 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 read, wri(e, mmdify, or communicate
dotz/informaUon or otherwise use any system resource.
2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to
manage the selection, dpve|mpment, imp|ementedun, and maintenance ofsecurity measures to protect electronic
Protected Health Information (ePH|) and to manage the conduct ofthe covered entity's workforce in relation to the
protection of that information.
23 ARRA. The American Recovery and Reinvestment Act (2009)
2.4 Authentication, The corroboration that a person is the one claimed.
25 Availability, The property that data or information is accessible and useable upon demand by an
authorized person.
2 8 Breach The unauthonzed acgu/s/Uon, access. use. o/ disclosure of PHI which compromises the
oecun�yor privacy of such information.
2 7 Compromises the Security Posing a significant risk of0nanoiai reputatmoai oruthe/ harm to
momdua|a
2 8 Confidenda|ity. The propartytl�,e{ data or information /s no, made available orU/no{osed to
unao<honzeU persons orprocesses.
� |
Page 52
2,9 Electronic Protected Health Infonnation.(ePH|) Health information as specified in45CFR
§18O1O3(1)(i) or (1 )(U) hmitedtotheinhormadonoreatedorrece/vedbyBuainessAsaooiatefromoronbehe|fof
` Covered Entity.
210 H|TECH. The Health Information Technology for Economic and Clinical Health Act (2009)
2]1 Information System, An interconnected set of information resources under the same direct
management control that shares common functionality. A system normally includes hardware, softwana.
informahon, data, applications, communications, and people.
212 !ntegrity. The property that data or information have not been altered or destroyed in an
unauthorized manner,
213 Malicious software. Softwane, for example, a virus, designed to damage o/ disrupts a system.
2.14 Parti Part I — Improved Privacy Provisions and Security provisions located at 42 United States
Code (U,S.CjGG17&31 and 17A34 (2O1O).
2.15 Password. Confidential authentication information composed ofo string ofcharacters,
2.16 Physical Safeguards, The physical measures, policies, and procedures tm protect acovered
entity's electronic information systems and related buildings and equipment, from natural and environmental
hazards, and unauthorized intrusion.
2,17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR
Part 108 and Part 1G4. subparts A and E.
_ 2.18 Protected Health Information. (PH|) Health information as defined in45CFR §160.103. |imited
( \ to the information created or received by Business Associate from or on behalf of Covered Entity.
2.19 Required By Law. Has the same meaning as the term "required by law" in 45 CFR § 1G41O3.
2.20 Secretary. The Secretary ofthe Department ofHealth and Human Services or his or her
designee.
221 Security incident. The attempted or successful unauthorized access, use, disclosure,
modification, or destruction of information or interference with system operations in an information system,
222 Security or Security measures. All of the adminiotrmtive, phyaico|, and technical safeguards in
an info/mehonayetem.
223 Security Rule. The Security Standards for the protection of Electronic Protected Health
Information et45CFR part 1G4. subpart C. and amendments thereto.
2 24 Technical Safeguards, The technology and the policy and procedures for its use that protect
electronic protected health information and control 000emn to it.
225 Unsecured PHI. Protected health information that is not secured through the use of technology or
methodology specified by the Secretary 'n guidance issued under 42USC section 17Q32(h)(2),
2,26 Ni other terms used. but not otherwise defined, in this Agreement shall have the same meaning
,is 1,hose terms /n the Privacy Ru|o,
30 Obligations and Activities of Business Associate.
] � Buameys Associate agrees to not use or disclose PHI other as oerm4ted or requ/,ed by th/s
agreemento/ as Required byLaw
Page �5]
32 Business Associate agrees kz:
(a) Implement policies and procedures to prevent, detect, contain and correct Security
\ violations m accordance with45 CFR § 1G4,3OG�
(b) Prevent use or disc�osure of the PHI other than as provided for by this Agreement or as
required by |aw,
(u) Reasonably and appropriately protect the oonhdenda|ih/, integn|y, and availability ofthe
ePH| that the Business Associate cnaahas, reoeives, meintame, 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
hzdh in45CFR §§ 184,308. 164.310. 164.312. and 164.316.
33 Business Associate agrees to mitigak*, to the extent practicable, any harmful effect that is known
to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this
Agreement,
14 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI
not provided for by this Agreement of which it becomes aware. This includes any requests for inspection, copying
or amendment of such information and including any security incident involving PHI.
3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security
breach pertaining to:
(a) Identification of any individual whose unsecured PHI has been, or is reasonably believed
by the Business Associate to have been, accessed, acquired, or disclosed during such security breach,- and
(b) All information required for the Notice to the Secretary of HHS of Breach of Unsecured
Protected Health Information.
36 Business Associate agrees to ensure that any agent, including aubconiractor, to whom it
provides PHI received from, or created or received by Business Associate on behalf of Covered Entity, agrees to
the same restrictions and conditions that apply through this Agreement to Business Associate with respect tosuch
information.
3.7 |f Business Associate has PHI in Designated Record Set:
(a) Business Associate agrees io provide access, at the request of Covered Entity during
regular business hourm, to PHI in a Designated Record Set, to Covered Entity or, on directed by Covered Entity, to
an individual in order to meet the requirements under 45CFR §164524; and
(b) Business Associate agrees to make any amendment(s) to PHI in a Designated Record
Set that the Covered Entity directs or agrees to pursuant to 45 CFR § 164.526 at the request of Covered Entity or
an Individual within 10 business days of receiving the request,
3.8 Business Associate agrees to make internal pracLicea, books, and rmoords, including policies and
procedures and PHI, relating to the use and disclosure o/ PHI received from, or created or received by Business
Associate on behalf of Covered Enti|y, available to the Covered Entity or to the Secretary upon request of either
for purposes ofdetermining Covered Entity's compliance with the Privacy Rule,
39 Business Associate agrees to document such disclosures of PHI and information related to such
disclosures aswnu}d be required for Covered Ent/|yto respond to request by an individual for an accounting of
4/sc(osu,es of PHI /n accordancow/th 45 CFR § 164 528
J 1O Bua/neas Associate agreestu provide ioCovored Ent/tyoran /rd/v/dua| upon request.
/ntlormat/onooldected /o permit Covered Ent�,y10 respond to request by an !nd/v/dua| for anoccount/ng of
d/ac/oauresof PHI /n accordance vv/(h45 CFR § 164528andARRA § 13404
��
Page 54
3 11 Business Associate specifically agrees to use security rneaSUres that reasonably and
appropriately protect the confidennahLy, integrity, and availability of PHI in electronic or any other form, that /t
-�� creates, receives, maintains, or transmits on behalf ofthe Covered Entity.
' ' '
\ _ 3.12 Business Associate agrees to mpierinent security measures to secure passwords used to access
ePH| that it accesses, mamtmma, or transmits as part ofth/s Agreement from malicious software and other man-
made and natural vu|nerabiUUes to assure theovaUebi|ity. integrib/, and confidentiality ufsuch information.
3,13 Business Associate agrees to implement security measures to safeguard ePHI that it accesses,
maintains, or transmits ae part nf this agreement from malicious softuane and other man-made and natural
vulnerabilities to assure the avaUabUity, integhLy, and confidentiality ofsuch information.
3,14 Business Associate agrees kz comply with:
(a) ARRA § 13404 (Application of Knowledge Elements Associated with Contraots)�
(b) ARRA § 134O5 (Restrictions on Certain Disclosures and Sales ofHealth Information); and
(c) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Core Operations).
4.0 Permitted Uses and Disclosures by Business Associate. Except as otherwise limited inthis
Agreement or any related agreement, Business Associate may use urdisclose PHI to perform fundions, activides,
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 cf the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except asotherwise 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.
62 Except as otherwise limited in this agreement or any related agreement, Business Associate may
disclose PHI for the proper management and administration of the Business Associate, provided that disclosures
are Required By Law, or Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and used or further disclosed only as Required By Law or
for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information has been breached.
53 Business Associate may use PHI to provide data aggregation services toCovered Entity as
permitted by45 CFR §184.504(e)(2)(i)(B). only when specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law toappropriate Federal and State
authorities, consistent with 4GCFR §1G4.5O2(/)(1)�
60 Obligations of Covered Entity.
61 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices
of Covered Entity in accordance with 45CFR § 104520. to the extent that such limitation may affect Business
Associate s use ordiaciosun* cf PHI, by providing a copy of the most current Notice of Privacy Practices (NPP) to
Business Associate asAttachment X| {o this Agreement, Future Notices and/or modifications to the NPPshall be
poatedonCovered Entity's vveba/teat ,v\,v,.y ad ,
O 2 Covered Entity shall notify Business Associate of any restncUon to the use or disclosure of PHI
�hat Covered Entity has agreed to in arcordanoevv/th 45CFR8 164 522, to the extent that such restriction may
a�ect BuamessAeaoc/ates use ordisc|osure of PHI
r O Permissible Requests by Covered Entity. Except for data aggrag�non o, nnanagemen� anU
od:nmetrahve activities of BusmessAssociate Covered Ent/tyahaU not request Business Associate to use or
dadose PHI m any manner |Aat wnu|d not he perm`as/b/e under1he Privacy Ru/e if done by Covered Entity.
-�4
Poge55
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 asfollows,
(a) These Business Associate Agreement pnovismns, with the exception of the e}ectrooic
aecuntyprovision* and the provisions mandated byARRA. H|TECH and Port | shall be effective upon the later of
April 14, 2003, or the effective date of the earliest contract entered into between Business Associate and Covered
Entity that involves the use nfPK
(b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or
the effective date of the earliest contract entered into between Business Associate and Covered Entity that
involves the use ofPHI; and
(o) Provisions hereof mandated byARR4. H|TECH and/or Port | shall be effective the later of
February 17, 2010 or the effective date of the earliest contract entered into between covered entity and business
associate that involves the use of PHI orePHi
8�2 Termination for Cause. Upon Covered Entity's knowledge of material breach by Business
Associate, Covered Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end the violation and
terminate this agreement if Business Associate does not cure the breach or end the violation within the time
specified by Covered Entity;
(b) Immediately terminate this agreement if Business Associate has breached a material term
cf this Agreement and cure is not possible; or
(o) If nor iyha�eib|e Covered Entity mhoshallnepu�the violation to the
. .
Secretary.
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section, upon termination
of this ogreemant, for any reason, Business Associate shall return all PHI and ePH| received from Covered Entity,
or created or received by Business Associate on behalf of Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or
agents of Business Associate. Business Associate shall retain no copies o/the PHI and ePH|.
(b) |n the event that Business Associate or Covered Entity determines that returning the PHI
or ePH| is infeaoib|e, notification of the conditions that make return of PHI or ePH| infeasible mho|| be provided to
the other party, Business Associate shall extend the protections of this Agreement to such retained PHI and ePHI
and limit further uses and disclosures of such retained PHI and ePH|, fora minimum of six years and so long as
Business Associate maintains such PHI and ePH|, but no less than six (G) years after the termination of this
agreement,
00 Regulatory References. A reference in this agreement toa section in the Privacy Rule or
Security Rule means the section then in effect or as may be amended in the future.
lOO Amendment. The Parties agree io take Such action ao /s necessary t* amend this agreement
from time to time as /s necessary for Covered Entity to comply with the requirements of the Privacy Rule. 'the
Security Rule and the Heaith Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-181
1 | O Survival. Any term, condition covenant or obligation w,nichrequ/res performance byexher4ar!y
�erem aubseouent to the iermmahon of this agreement shaU remein enforceable agens� such party subsaqueo� �o
suoh �ermmaUon,
l20 Interpretation. Any ambiguity mth/s agreement sha|| be reoo|ved kzpmrm/CCovered Entity to
comr,)iy with the Privacy Rule and SecuntyRule.
��
Page �h
130 Incorporation byreference. Any future new naquiremen|(s), ohangesorde|abon(s) enacted m
/-� federal |amwhiuh create new or different obligations wxUn respect to H|PAA privacy and/or aecun1y, shall be
\ automat/oaUy incorporated by reference to th/s Busmess Assoo�ate Agreement on the respective effective date(s).
140 Notices, All notices and communications nequired, necessary ordesired to be given pursuant to
this agreement, including change ofaddress for purposes ofsuch notices and corn muniort|ons. shall be in
writing and delivered personally to the other party or sent by express 24-hour guaranteed courier or delivery
service, or by certified me] of the United States Postal Semioe, postage prepaid and return receipt requested,
addressed to the other party as follows (or to such other place as any party may by notice to the others specify):
To Covered Entity: Alliance for Aging, Inc.
Attenbon� Max Rothman
780 NVV 107Avenue
K4iami, Florida 33172
To Business Associate:
Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery
thereof is refuaed, delivery will be deemed to have occurred on the date such delivery was attempted.
15�O Governing Law, The laws of the State of Florida, without giving effect to principles of conflict of
|aws, govern all matters arising under this agreement.
16.0 Saverabi|ity, If any provision in this agreement is unenforceable to any extent, the remainder of
this agreement, or application of that provision to any persons or circumstances other than those as to which it is
.held unenforceable, willwillnot be affected by that unenforoeabi|ity and will be enforceable to the fullest extent
(
- permitted by law.
17�O Successors. Any successor to Business Associate (whether by direct or indirect or by purchame,
merger, ooneohdubon, or otherwise) is required to assume Business Associate's obligations under this agreement
and agree to perform them in the same manner and to the same extent that Business Associate would have been
required koif that succession had not taken place. This assumption by the successor of the Business Associate's
obligations shall bebywritten agreement satisfactory toCovered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement of the parties relating to the
subject matter of this agreement and supersedes all other oral or written agreements or policies relating thereto,
except tha\ this agreement does not limit the amendment of this agreement in accordance with aoodon 10,0 of this
agreement.
Covered Entity
Date:�
�y� \_ \
(signak rie � --
Business Associate
a' Oaba�
By:
y�n.` «\�r
.h
Page
F 1'.k CI I J I F' N'F F
Verification ot' Employment Status Certification
AS a condition ofcontractini-T with the Alliance t�)r ,-\(,Ing. Inc.,
Oft(oe- Li-rM-V hereby referred to as contractor, certifies the
use of the; U.S. Departiberit of loincland Security's E-%-erit'v system to %erify the employment
eligibility of all IIC%v 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 perfonning, work- or providing services pursuant to this Agreement utilize the E-verify
Z,
system to verify the employment eligibility of all new employees hired by the subcontractor during the
contract term.
Signature date
(Sarne as contract signature)
A1)
S —�� TL-Isl�
Title
M-0
Company Name
7 ,
Page tiS
\I I \('I M LIN F G
BACKGROUND SCREENING
AFFAIR� Affidavit of Compliance - Employer
f A T IF OF-L'J,41 DA
AUTHOR Ire! This tuirin i.requatred uil"twilly of Al ely'rPluYers to Comply owith 016 ittestall(Al
e t n c"I t s F;el f o r it t i I r i t�e ct I c4 il 4 3 5,06 13), F 140 r I Ll a Statutes.
ho unit " "&1` 110.10 S PI-N) I I' s i''I,,,I It,I I it'1?
fiA f'o, 1:0 Ili! C W.1 7 ry
tAl e i'.I I I v I..,I -,tt t.; l.N 1,r l I,
Pw,Imrl, fll-,Aol,� 'wid ;ry iM-wl It
111(0 —.1"o e
f,l w",dol I Ill-f,rlrl 114
11,;o trrr f Ic"I'l I'lf"—111,10 :lth I cIwnl drip, 4,r, to 1h,-,Iwnt
killd',pri""l%ji
It(sed F I ii I;.,:us. I itt. tr,j of Irl"J IMM, t u,m-11 1whil N, III&l,Jgtj .J:Id -A✓e rr;,Aj 4 4It I tj+det I r,j I
ar lVil"'; ;114 4'll ,.Ili'I I fln'l,i IA —.0
ATTESTAT101:
As trie duly aUthiriv?d
9ucatad at
ot ie'
lo hereby affirm under-efal-y of perjury
op,f, 1i f.
mimed i!milnyer it; in ',:jmp mn.7,t Mth lb!! .)f C.Ntrptcr 415 and -t—ion
4,0 L,402,Florida statute-_jeq�,J:tag level 4 backp_,t)--lod:creenimq.
:,i qiavure of Repre-i.entat Date
-ATE IJ F F LIJ R 11)A,C'J'-rt TY 1)F:
,,,-)rn*,o inr a^irrred) and s�-bscribed be-,Dre r-le tees _day oaf -71!L� 0'j
'Li rr P o Re-or—pt-ifativej who Srt-,onaily 4rmvn
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ATTACHMENT H
'RUTINUED CO .NIPANIES I.IS'I*S
I lie undersl'-med, all mithori/ed reprc,elatative Of the Contractor mulled III the contract or ns_,reenlcnt to %%hich
tlll,, fOrrn Is an attachment, hereby certifies that-.
I ) I lie Contractor understands that pursuant to s, 287,135 F,S_ any company at the time of hidding, or
SLIhIllitting, a proposal for I ne k contract or renewal of an existing.! contract, that is on the
Companies with Activities III Sudan List- or the —Scrutinized Companies with Activities in the Iran I)ctroteLIIII
Sector List (collectively. '*the Lists") is ineligible for. and may not bid on. submit a proposal for, or enter into
or renew a contract pursuant to which funding is provided by the Department of Elder affairs (Department)
for _,00ds or services of I million or more.
(2) The Contractor understands that, pursuant to s. 287.135 F.S., any company that submits a false certification
investigations the finding IS Subject to civil penalties, attorriev's fees and costs and any costs for investigations that led to t iding of
false certification.
(3) The Contractor understands that the contract to which this form is an attachment may be temunated by the
A�,-VN 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.
(eZ26
Signature Date
z:1
(Same as contract signature)
PWN.
Company Name
F. �-- � fit/
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