06/21/2021 Agreement m" _st ', Kevin Madok, CPA
Clerk of the Circuit Court&Comptroller— Monroe County, Florida
DATE: June 23,2021
TO: Pam Radloff, Director
Finance Department
FROM: Sally M. Abrams, D.C.
SUBJECT: June 21, 2021 BOCC Meeting—For the Record
Attached, for your handling, is item DI, Ratification of Alzheimer's Disease Initiative
Program (ADI) Contract KZ-2197 between the Alliance for Aging, Inc., and Monroe County
Board of County Commissioners/Monroe County Social Services In-Home Services for the
contract year 2021-2022 (07/01/2021-06/30/2022) in the amount of$57,549.12.
cc: County Attorney
Finance
File
KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070
305-294-4641 305-289-6027 305-852-7145 305-852-7145
ALZHEIMER'S DISEASE INITIATIVE CONTRACT
2021-2022 Fiscal Year
THIS CONTRACT is entered into between the Alliance for Aging Inc.,hereinafter referred to as the"Alliance"and Monroe County
Board of County Commissioners,Social ServiceslIn-Home Services,hereinafter referred to as the"Contractor," and collectively
referred to as the "parties."
Attachments 1,II,111,VI,VIl, VIII,IX, X,A,B,C, E, and G are incorporated herein and made a part of this Contract.
WHEREAS,the Alliance has been designated as the Area Agency on Aging for Planning and Service Area 1 I encompassing Miami-
Dade and Monroe Counties; and
WHEREAS, the Florida Department of Elder Affairs (the "Department") has entered into a Contract with the Alliance to fund
Alzheimer Disease Initiative Contractors in Miami-Dade and Monroe Counties;and
NOW THEREFORE, in consideration of the services to be performed and payments to be made,together with the mutual covenants
and conditions set forth in this Contract,the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments and exhibits,which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department of Elder
Affairs handbooks,manuals ordesk books,as an integral part ofthe contract,except to the extent that the contract explicitly
provides to the contrary, In the event of conflict in language among any of the documents referenced above,the specific
provisions and requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s) or
other general materials not specific to this contract document and identified attachments and shall be governed in accordance
with the applicable laws.statutes,and other conditions set for in this Contract.
Incorporation of Reference Memoranda:
In accordance with Chapter 287 F.S.,amended,and Department of Financial Services' Chief Financial Officer
Memoranda,the following memoranda are hereby incorporated by reference:
(1)CFO Memo No.02: Release date, October 3, 2012;
(2)CFO Memo No. 06: Release date,June 27,2012,
(3)CFO Merno No. 01: Release date,July 26,2012; and
(4)CFO Memo No. 04: Release date,June 30,2006
3. Term of Contract
3.1 Effective Date:
This contract shall begin at twelve(12:00)A.M.,Eastern Standard Time on July 1,2021 or on the date the contract has been
signed by both parties, whichever is later. The contract will end on June 30,2022,or such earlier date as the contract is
terminated pursuant to Section 51 herein, except that the parties shall continue to perform those limited contract close-out
activities set forth in this contract.
3.2. Delivery of services shall end at 11:59 P.M., Eastern Standard Time on June 30,2022, or such earlier time as the contract
is terminated pursuant to paragraph 10 herein. Under no circumstances will the Alliance reimburse the provider for services
provided after June 30,2022 or any earlier termination date. No changes to funding allocations will be made after June 30,
2022. Only limited contract close-out activities are to be performed after June 30, 2022 consisting of reporting, invoicing
and payment as stipulated in ATTACHMENT VIII.
4. Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions o1"this contract in an amount not to
exceed $57,549.12 subject to the availability of funds. Any costs or services paid for under any other contract or from any
other source are not eligible for payment under this contract.
4.1 Obligation to Pay
The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the
Legislature to the Department and funding received by the Alliance under its contract with the Department.
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4.2 Source of Funds
The costs of set-vices paid under any other contract or trotin any other source are not eligible for reimbursement Linder this
contract. The funds awarded to the Contractor pursuant to this contract are in the state grants and aids appropriations and
consists of the following:
Program Title Year Funding Source CSFA# Fund Amounts
Alzheimer Disease 2021- General Revenue 65.002 $57,549.12
Initiative 2022
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $57,549.12
5. Renewals
The contract may be renewed on a yearly basis for no more than four additional years. Such renewals shall be contingent upon
satisfactory performance evaluations as determined by the Alliance and the availability of funds. Any renewal of a contract
shall be subject to mutual agreement,confirmed in writing,and Subject to the same terms and conditions set forth in the initial
contract, with the exception of establishing unit rates which is described further in this section.The renewal price,or method for
determining a renewal price,is set forth in the bid,
proposal,or reply. Requests to renegotiate the original contractual established
rates are provided for in the Alliance's approved Reimbursement Rate Review Policy,which is incorporated by reference.
The parties shall re-evaluate the contract's reimbursement rates on an annual basis pursuant to DOEA's Notice of Policy
Clarification: Service Cost Reports Notice 4092815-1-PC-SCBS dated September 28th, 2015 and the approved Alliance's
Reimbursement Rate Review Policy.
In the event that contracts cannot be executed prior to the July 1st start date, the Alliance may, at its discretion, extend this
Agreement upon written notice for up to 120 days to ensure continuity of service. Services provided under this extension will be
paid for out of the succeeding agreement amount.
6. Compliance with State Law
6.1 This contract is executed and entered into in the State of Florida, and shall be construed,perforined,and enforced in all respects in
accordance with the Florida law,including Florida provisions for conflict of laws.
6.2 The Contractor shall comply with requirements of s. 287.058, F.S, as amended.
6.2.1 The Contractor shall provide units of deliverables, including various client services, and in sonic 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 section 215.971, Fla. Stat.(I)and(2). Expenditures must be
in compliance with laws, rules, regulations, including, but not limited to the Florida Reference Guide for State
Expenditures issued by the Florida Department of Financial Services("DFS").
6.2.2 The contractor shall perform all tasks contained in Attachment 1.
6.2.3 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre-audit and post-audit.
6.2.4 If itemized payment for travel expenses is permitted in this contract,the Contractor shall submit bills for any travel
expenses in accordance with s. 112.061,F.S_or at such lower rates as may be provided in this contract.
6.2.5 The Contractor shall allow public access to all documents, papers, letters, or other public records as defined in
Subsection 119.01](12), F.S., made or received by the Contractor in Conjunction with this contract except for those
records which are made confidential or exempt by law. The Contractor's refusal to comply with this provision will
constitute an immediate breach of contract for which the Alliance may unilaterally terminate the contract.
6.3 If clients are to be transported under this contract,the Contractor shall comply with the provisions of Chapter 427, F.S.,and
Rule 41-2, F.A. C.
6.4 The Contractor may not subcontract with any individuals or entities on the discriminatory vendor list because they may not
transact business with any public entity, in accordance with the provisions of s.287.134,F.S.
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6.5 The Contractor 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.
6.6 The Alliance and/or Department may terminate the Contract if the Contractor is found to have submitted a false certification
as provided under 287.135(5),F.S., has been placed on the Scrutinized Companies with Activities in Iran Petroleum Sector
List, the Scrutinized Companies with activities in Sudan List, or the Scrutinized Companies with Activities in the Iran
Petroleum Energy Sector List (Lists), or the scrutinized companies that Boycott Israel list, or if the Contractor has been
engaged in business operations in Cuba or Syria or is engaged in a boycott of Israel.Further,the Contractor is subject to civil
penalties,attorney's fees and costs and any costs for investigations that led to the finding of false certification.
7. Background Screening
TI The Contractor shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met regarding
background screening for all persons who meet the definition of a direct service provider and who are not exempt from the
Department's Level 2 background screening pursuant to s.430.0402(2)-(3),F.S.The Contractor must also comply with any
applicable rules promulgated by the Department and the Agency for Health Care Administration regarding implementation
of s. 430.0402 and Chapter 435, F.S. To demonstrate compliance with this provision, Contractor shall submit to the
Department,the Background Screening Affidavit of Compliance (Screening Form) upon thirty (30) days of execution of
this contract. Should the Alliance have a completed Screening Form on file for the Contractor,a new Screening Form will
be required every twelve(12)months.
7.2 Further information concerning the procedures for background screening is found at
Iltq t'( 'w1 i(1�x(Ii f 1�'.�_�._i ti doi,A
8. Grievance and Complaint Procedures
8.1 Grievance Procedure
The Contractor shall comply with and ensure sub-Contractor compliance with the Minimum Guideline for Recipient
Grievance Procedures, Appendix D, Department of Elder Affairs Programs and Services Handbook,to address complaints
regarding the termination,suspension or reduction of services,as required for receipt of funds.
8.2 Complaint Procedures:
The Contractor shall develop and implement complaint procedures and ensure that sub-Contractors develop and implement
complaint procedures to process and resolve client dissatisfaction with services. Complaint procedures shall address the
quality and timeliness of services,Contractor and direct service worker complaints,or any other advice related to complaints
other than termination, suspension or reduction in services that require the grievance process as described in Appendix D,
Department of Elder Affairs Programs and Services Handbook. The complaint procedures shall include notification to all
clients of the complaint procedure and include tracking the date, nature of the complaint and the determination of the
complaint on a complaint log.
9. Public Records and Retention:
9.1 If,under this contract the Contractor is providing services and is acting on behalf of the Alliance and the Department as provided under
section 119.011(2), Florida Statutes, the Contractor, subject to the terms of section 287.058(1)(c), Florida Statutes, and any other
applicable legal and equitable remedies, agrees to all provisions of Chapter 119,Fla.Stat.,and any other applicable law,and shall:
9.1.1 Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order
to perform the services.
M. 2 Upon request from the Alliance or the Department,the Contractor will provide a copy of the request for records or
allow the records to be inspected or copies within a reasonable time at a cost that does not exceed the cost provided
in Chapter H 9, Florida Statutes,or as otherwise provided by law.
9.1.3 Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements
are not disclosed except as authorized by law.
9.L4 Upon completion of the contract the Contractor will either transfer,at no cost to the Alliance,all public records in
possession of the Contractor or will keep and maintain public records required by the Alliance or the Department.
If the Contractor transfers all public records to the Alliance upon completion of the contract, Contractor shall
destroy any duplicate public records that are exempt, or confidential and exempt,from public records disclosure
requirements.If the Contractor keeps and maintains public records upon completion of the contract,the Contractor
shall meet all applicable requirements for retaining public records. All records stored electronically must be
provided to the Alliance in a format that is compatible with the information technology systems of the Alliance.
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9.2 The Alliance may unilaterally cancel this contract notwithstanding any other provisions of this Contract,for refusal by the
Contractor to comply with Section 9 of this Contract by not allowing public access to all documents, papers, letters, or
other material made or received by the Contractor in conjunction with the contract, unless the records are exempt, or
confidential and exempt,from Section 24(a)of Article I of the State Constitution and Section 1 19.07(1), F,S.
IF THE,CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119,FLORIDA
STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS
CONTRACT,CONTACT TIIE CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Florida Department of Elder Affairs
4040 Esplanade Way
Tallahassee,Florida 32309
850-414-2342
doeapublierecords@elderaffairs.org
10. Audits,Inspections,Investigations:
10.1 The Contractor shall establish and maintain books,records,and documents(including electronic storage media)sufficient
to reflect all assets, obligations, unobligated balances, income, interest, and expenditures of funds provided by the
Alliance under this contract.Contractor(s)shall adequately safeguard all such assets and assure they are used solely for
the purposes authorized under any contract or agreement which incorporates this Contract. Whenever appropriate,
financial information should be related to performance and unit cost data.
10.2 The Contractor shall retain all client records, financial records, supporting documents, statistical records, and any other
documents(including electronic storage media)pertinent to this contract for a period of six(6)years after completion of
the contract or longer when required by law. In the event an audit is required by this contract,records shall be retained for
a minimum period of six(6)years after the audit report is issued or until resolution of any audit findings or litigation based
on the terms of this contract,at no additional cost to the Alliance.
10.3 Upon demand,at no additional cost to the Alliance,the Contractor shall facilitate the duplication and transfer of any records
or documents during the required retention period.
10.4 The Contractor shall assure that the records described in Paragraph 10 will be subject at all reasonable times to inspection,
review,copying,or audit by federal,state,or other personnel duly authorized by the Alliance.
10.5 At all reasonable times for as long as records are maintained,persons duly authorized by the Alliance and the Department,
pursuant to 45 CFR part 75,will be allowed full access to and the right to examine any of the Contractor's contracts and
related records and documents pertinent to this specific contract,regardless of the form in which kept.
10.6 The Contractor shall provide a financial and compliance audit to the Alliance as specified in this contract and in
ATTACHMENT III and ensure that all related third-party transactions are disclosed to the auditor.
10.7 The Contractor agrees to comply with the Department's Inspector General in any investigation,audit,inspection,review,
or hearing performed pursuant to section 20.055(5), Fla.Stat. By execution of this Contract the Contractor understands
and will comply with this subsection.
11. Nondiscrimination-Civil Rights Compliance
11.1 The Contractor shall execute assurances in ATTACHMENT II that it will not discriminate against any person in the
provision of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, marital status or sex in compliance with state and federal law and regulations. The Contractor further
assures that all Contractors,sub-Contractors,sub-grantees,or others with whom it arranges to provide services or benefits
in connection with any of its programs and activities are not discriminating against clients or employees because of age,
race,religion,color,disability, national origin,marital status or sex.
11.2 During the term of this contract, the Contractor shall complete and retain on file a timely, complete and accurate Civil
Rights Compliance Checklist(ATTACHMENT B).
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11.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving services
or benefits through this contract. These procedures will include notifying clients,employees,and participants of the right
to file a complaint with the appropriate federal or state entity.
11.4 These assurances are a condition of continued receipt of or benefit from financial assistance, and are binding upon the
Contractor, its successors, transferees, and assignees for the period during which such assistance is provided. The
Contractor further assures that all sub-Contractors,vendors,or others with whom it arranges to provide services or benefits
to participants or employees in conriection with any of its programs and activities are not discriminating against those
participants or employees in violation of the above statutes,regulations,guidelines,and standards. In the event of failure
to comply,the Contractor understands that the Alliance may,at its discretion,seek a court order requiring compliance with
the terms of this assurance or seek other appropriate judicial or administrative relief, including but not limited to,
termination of and denial of further assistance.
12. Monitoring by the Alliance far A&iag
12.1 The Contractor shall permit persons duly authorized by the Alliance to inspect and copy any records,papers, documents, facilities,
goods and services of the Contractor which are relevant to this contract, and to interview any clients, employees and
subcontractor employees of the Contractor to assure the Alliance of the satisfactory performance of the terms and
conditions of this contract. Following such review, the Alliance will provide a written report of its findings to the
Contractor,and where appropriate,the Contractor shall develop a Corrective Action Plan(CAP).The Contractor hereby
agrees to correct all deficiencies identified in the CAP in a timely manner as determined by the Contract Manager.Failure
to comply with the CAP shall subject Contractor to enforcement actions as described in this Contract.
12.2 The Alliance will perform administrative, fiscal, and programmatic monitoring of the provider to ensure contractual
compliance,fiscal accountability,programmatic performance,and compliance with applicable state and federal laws and
regulations. The contractor will supply progress reports, including data reporting requirements as specified by the
Alliance or the Department to be used for monitoring progress or performance of the contractual services. Examples of
review criteria are surplus/deficit reports, independent audits, internal controls, reimbursement requests, subcontractor
monitoring, targeting, program eligibility, outcome measures, service provision to clients, data integrity, client
satisfaction,and client file reviews.
12.3 Service Cost Reports—The Contractor shall submit Service Cost Reports to the Alliance annually,but no later than ninety
(90) calendar days after the contract year ends. The Service Cost Reports shall reflect actual costs of providing each
service by program for the preceding contract year. If the Contractor desires to renegotiate its reimbursement rates,the
Contractor shall make a request in writing to the Alliance in accordance with the Alliance's approved Reimbursement Rate
Review Policy,which is incorporated by reference.
13. Provision of Services
The Contractor shall provide services in the manner described in in ATTACHMENT I of this contract and in the Service Provider
Application(SPA). In the event of a conflict between the Service Provider Application and this contract,the contract language
prevails.
14. Coordinated Monitoring with Other Agencies
If the Contractor receives funding from one or more other State of Florida human service agencies,in addition to the Department
of Elder Affairs,then a joint monitoring visit including such other agencies may be scheduled.For the purposes of this contract,
and pursuant to s. 287.0575,F.S. as amended, Florida's human service agencies shall include the Department of Children and
Families, the Department of Health, the Agency for Persons with Disabilities, the Department of Veterans Affairs, and the
Department of Elder Affairs. Upon notification and the subsequent scheduling of such a visit by the designated agency's lead
administrative coordinator,the Contractor shall comply and cooperate with all monitors,inspectors,and/or investigators,
15. Indemnification
The Contractor shall indemnify,save,defend,and hold harmless the Department,the Alliance and its officers,agents and employees from
any and all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the execution this
Contract,or performance of the services provided for herein.It is understood and agreed that the Contractor is not required to indemnify the
Department or the Alliance for claims,demands,actions,or causes of action arising solely out of the Department's or Alliance's negligence.
15.1 Except to the extent permitted by s.768.28,F.S.,or other Florida law,Paragraph 16 is not applicable to contracts executed
between the Alliance and state agencies or subdivisions defined in s. 768.28(2),F.S.
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16. Insurance and Bondinz
16.1 Contractor must provide continuous adequate liability insurance and worker's compensation insurance coverage, during
the existence of this contract,and during any renewal(s)or extension(s)of it.The Alliance shall be included as an additional
insured on the provider's liability insurance policy or policies and a copy of the Certificate of Insurance shall be provided
annually or when any changes occur.The Contractor accepts full responsibility for identifying and determining the type(s)
and extent of liability insurance necessary to provide reasonable financial protections for the Contractor and the clients to
be served under this contract. Upon execution of this Contract,the Contractor shall furnish the Alliance written verification
supporting both the determination and existence of such insurance coverage. The limits of coverage under each policy
maintained by the Contractor do not limit the Contractor's liability and obligations under this contract. The Contractor
shall ensure that the Alliance has the most current written verification of insurance coverage throughout the term of this
contract.Such coverage may be provided by a self-insurance program established and operating under the laws of the State
of Florida.The Department and the Alliance reserve the right to require additional insurance as specified by this contract.
16.2 Throughout the term of this contract, the Contractor must maintain an insurance bond from a responsible commercial
insurance company covering all officers, directors, employees, and agents of the Contractor, authorized to handle funds
received or disbursed under this contract, in an amount commensurate with the funds handled, the degree of risk as
determined by the insurance company and consistent with good business practices.
17. Confidentiality of Information
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any purpose
prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent
or when authorized by law.
18. Health Insurance Portability and Accountability Act
Where applicable,the Contractor shall comply with the Health Insurance Portability and Accountability Act(42 USC 1320d.),
as well as all regulations promulgated thereunder(45 CFR 160, 162,and 164).
19. Incident Reporting
19,1 The Contractor shall notify the Alliance immediately but no later than forty-eight (48) hours from the Contractor's
awareness or discovery of conditions that may materially affect the Contractor or Subcontractor's ability to perform the
services required to be performed under this contract. Such notice shall be made orally to the Contract Manager (by
telephone)with an email to immediately follow.
19.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect,or exploitation of a child,
aged person,or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number(1-800-96ABUSE).
As required by Chapters 39 and 415,F.S,,this provision is binding upon both the Contractor and its employees.
20. Bankruptcy Notification
During the term of this contract, the Contractor shall immediately notify the Alliance if the Contractor, its assignees, sub-
Contractors or affiliates file a claim for bankruptcy.Within ten(10)days after notification,the Contractor must also provide the
following information to the Alliance: (1)the date of filing of the bankruptcy petition; (2)the case number; (3)the court name
and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division); and, (4) the name,
address,and telephone number of the bankruptcy attorney.
21. Sponsorship and Publicity
21.1 As required by section 286.25, Fla. Stat., if the Contractor is a non-governmental organization which sponsors a program financed
wholly or in part by state funds,including any funds obtained through this contract,it shall,in publicizing,advertising,or describing
the sponsorship of the program,state:"Sponsored by[CONTRACTOR NAME],The Alliance for Aging,Inc.,and the State of Florida,
Department of Elder Affairs."If the sponsorship reference is in written material,the words"Alliance for Aging, Inc."and"State of
Florida,Department of Elder Affairs"shall appear in at least the same size letters or type as the name of the organization.
21.2 The Contractor shall not use the words"Alliance for Aging,Inc."or"The State of Florida,Department of Elder Affairs"to indicate
sponsorship of a program otherwise financed,unless specific authorization has been obtained by the Alliance prior to use.
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22. Assij!nments
22.1 The Contractor shall not assign the rights and responsibilities under any contract without the prior written approval of the Alliance,
which shall not be unreasonably withheld.Any sublicense,assignment,or transfer otherwise occurring without prior written approval
of the Alliance will constitute a material breach of the contract or agreement.
22.2 This contract shall remain binding upon the successors in interest of the Contractor and the Alliance.
23.
23.1, The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract,whether
actually furnished by the Contractor or its subcontractors. Any subcontracts shall be evidenced by a written document
and subject to any conditions of approval the Alliance deems necessary. The Contractor further agrees that the Alliance
will not be liable to the subcontractor in any way or for any reason. The Contractor, at its expense, shall defend the
Alliance against any such claims.
23.2 The Contractor shall promptly pay any subcontractors upon receipt of payment from the Alliance or other state agency.
Failure to make payments to any subcontractor in accordance with section 287.0585,Fla. Stat.,unless otherwise stated
in this contract between the Contractor and subcontractor,will result in a penalty as provided by statute.
23.3 The Contractor shall programmatically monitor,at least once per year,each of its subcontractors,Subrecipients,Vendors,
and/or Consultants. The Contractor shall perform programmatic monitoring to ensure contractual compliance, and
programmatic performance and compliance with applicable state and federal laws and regulations. The Contractor shall
monitor to ensure that time schedules are met;the budget and scope of work are accomplished within the specified time
periods, and other performance goals. The Contractor shall also perform fiscal and administrative monitoring for all
subcontractors to ensure fiscal accountability.
23.4 The Contractor shall have a procurement policy that assures maximum free and open competition. Such procurement
policy must conform,as applicable,with Federal and State contracting and procurement regulations,as set forth in Title
2 Code of Federal Regulations(CFR)Part 200,Ch.287.057,Fla. Stat.,U.S.Office of Management and Budget(OMB)
Circular 110, Florida Department of Management Services (DMS) Rule 60A-1, F.A.C,, and with the Department's
Program and Services Handbook.
23.5 The Contractor shall dedicate the staff necessary to meet the obligations of this contract and ensure that subcontractors
dedicate adequate staff,accordingly.The provider shall ensure that staff responsible for performing any duties or functions
within this contract has the qualifications as specified in the Department's Programs and Services Handbook.
24. Service Cost Reports and Unit Cost MethodoloLyv eports•
The Contractor shall submit Service Cost Reports to the Alliance annually, but no later than ninety (90)calendar days after the
contractor Fiscal Year ends. The Service Cost Reports shall reflect actual costs of providing each service by program for the
preceding contract year. Costs associated with services provided under this contract shall only include allowable direct and
indirect costs as defined by applicable state law. If the Contractor desires to renegotiate its reimbursement rates,the Contractor
shall make a request in writing to the Alliance,with the inclusion of a Unit Cost Methodology,in accordance with the Alliance's
approved Reimbursement Rate Review Policy,which is incorporated by reference.
25. Funding Obligations:
25.1 The Alliance for Aging, Inc. acknowledges its obligation to pay the Contractor for the performance of the Contractor's
duties and responsibilities set forth in this Contract.
25.2 The Alliance shall not be liable to the Contractor for costs incurred or performance rendered unless such costs and
performances are strictly in accordance with the terms of this contract, including but not limited to terms governing the
Contractor's promised performance and unit rates and/or reimbursement capitations specified.
25.3 The Alliance shall not be liable to the Contractor for any expenditures which are not allowable costs as defined in 2 CFR Part 200 and
45 CFR Part 92,as amended,or which expenditures have not been made in accordance with all applicable state and federal rules.
25.4 The Alliance shall not be liable to the Contractor for expenditures made in violation of regulations promulgated under the
Older Americans Act,Department rules, Florida Statutes,or this contract.
Page 7 of 53
26. Independent Capacity of Contractor
It is the intent and understanding of the Parties that the Contractor,or any of its Subcontractors,are independent Contractor's
and are not employees of the Alliance and shall not hold themselves out as employees or agents of the Alliance without specific
authorization from the Alliance.It is the further intent and understanding of the Parties that the Alliance does not control the
employment practices of the Contractor and will not be liable for any wage and hour,employment discrimination,or other labor
and employment claims against the Contractor or its Subcontractors.All deductions for social security,withholding taxes,
income taxes,contributions to unemployment compensation funds and all necessary insurance for the Contractor are the sole
responsibility of the Contractor.
27. Payment
27.1 Payments shall be made to the Contractor as services are rendered and invoiced by the Contractor. The Alliance will have
final approval of the invoice for payment and will approve the invoice for payment only if the Contractor has met all terms
and conditions of the contract, unless the bid specifications, purchase order, or this contract specify otherwise. The
approved invoice will be submitted to the Alliance's fiscal department for budgetary approval and processing per
ATTACHMENT Vill,
27.2 The Contractor shall maintain documentation to support payment requests which shall be available to the Department of
Financial Services, the Department, or the Alliance upon request. Invoices must be submitted in sufficient detail for a
proper pre audit and post audit thereof.The Contractor shall comply with all state and federal laws governing payments to
be made under this contract including,but not limited to the following: sections 216.181(16)(a)&(b),215.422,Fla.Stat.,Rule
691-40.120,F.A.C.regarding advances;and the Invoice Requirements of the Reference Guide for State Expenditures from
the Department of Financial Services at
L%ps,i;)o,wyT yflQridacfq ggM ivisiori,,'aa/nxa�i�,.ials/docunierits/Ref,,-reiieeGi.i(i.eforS.ateF n If
The Contractor shall maintain detailed documentation to support each item on the itemized invoice or payment request for
cost reimbursed expenses,fixed rate or deliverables,for this contract,including paid sub-contractor invoices,and will be
produced upon request by the Alliance.The Contractor shall only request reimbursement for allowable expenses as defined
in the laws and guiding circulars cited in this Contract section 6, in the Reference Guide for State Expenditures,and any
other laws or regulations,as applicable.
27.3 The Contractor and subcontractors shall provide units of deliverables,including reports, findings,and drafts as specified
in this contract to be received and accepted by the Alliance prior to payment.
28. Return of Funds
The Contractor shall return to the Alliance any overpayments due to unearned funds or funds disallowed and any interest
attributable to such funds pursuant to the terms and conditions of any contract or agreement incorporating this Contract by
reference that were disbursed to the Contractor by the Alliance. In the event that the Contractor or its independent auditor
discovers that an overpayment has been made,the Contractor shall repay said overpayment immediately without prior notification
from the Alliance.In the event that the Alliance first discovers an overpayment has been made,the Contract Manager will notify
the Contractor in writing of such findings.Should repayment not be made forthwith,the Contractor shall be charged at the lawful
rate of interest on the outstanding balance pursuant to s.55.03,F.S.,after Alliance's notification or Contractor discovery.
29, Data IntearltV and Safeivardin_Information.
The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using in the
performance of this contract. An appropriate level of security includes approving and tracking all Contractor employees that
request system or information access and ensuring that user access has been removed from all terminated employees. The
Contractor,among other requirements,must anticipate and prepare for the loss of information processing capabilities. All data
and software must be routinely backed up to insure recovery from losses or outages of computer systems. The security over the
back-up data is to be as stringent as the protection required of the primary systems. The Contractor shall insure all sub-Contractors
maintain written procedures for computer system backup and recovery. The Contractor shall,prior to execution of this agreement,
complete the Data Integrity Certification as part of ATTACHMENT II.
30. Computer Use and Social Media Policy
The Department of Elder Affairs has implemented a new Social Media Policy, in addition to its Computer Use Policy,which
applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel affiliated with third
parties, such as, but not limited to, Area Agencies on Aging and vendors. Any entity that uses the Department's computer
resource systems must comply with the Department's policy regarding social media. Social Media includes,but is not limited to
blogs, podcasts, discussion forums, Wikis,RSS feeds,video sharing, social networks like MySpace,Facebook and Twitter, as
well as content sharing networks such as Fliekr and YouTube.
Page 8 of 53
This policy is available on the Department's website at:
-http_,//�I d c raf fai rs.stqL� -s/Socki ug
0 11,Us/&O_eA/_dOc _1%6�201 Ledia%20
A�L_.usfl 3201 Oti)df
31. Conflict of Interest
The Contractor shall establish safeguards to prohibit employees,board members, management and subcontractors from using
their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or
personal gain.
No employee,officer,or agent of the Contractor or subcontractor shall participate in selection,or in the award of an agreement
supported by state or federal funds if a conflict of interest, real or apparent, would be involved. Such a conflict would arise
when: (a) the employee, officer, or agent; (b) any member of his/her immediate family; (c) his or her partner; or (d) an
organization which employs,or is about to employ,any of the above,has a financial or other interest in the firm selected for
award, The Contractor or subcontractor's officers, employees or agents will neither solicit nor accept gratuities, favors or
anything of monetary value from Contractors,potential Contractors,or parties to subcontracts.
Pursuant to Chapter 4, Section 2 of the Department of Elder Affairs Program and Services Handbook, no Contractor may
employ,in any capacity,any member of its governing board or any family member of a person on the board.
The Contractors* 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 Contractors' employees and subcontractors must make the same disclosures described above to the Contractors'
Board of Directors.Compliance with this provision will be monitored.
32. Public Entity Crime
Pursuant to s.287.133,F.S.,a person or affiliate who has been placed on the convicted vendor list following a conviction for a
public entity crime may not submit a bid,proposal,or reply on a contract to provide any goods or services to a public entity;may
not submit a bid,proposal,or reply on a contract with a public entity for the construction or repair of a public building or public
work; may not submit bids,proposals, or replies on leases of real property to a public entity; may not be awarded or perform
work as a Contractor,supplier,sub-Contractor,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.287.0 17,F.S.,for Category Two for a period of 36 months
following the date of being placed on the convicted vendor list. If the Contractor or any of its officers or directors is convicted
of a public entity crime during the period of this agreement,the Contractor shall notify the Alliance immediately,Non-compliance
with this statute shall constitute a breach of this agreement.
33.Purchasing
:
33.1 The Contractor may purchase articles which are the subject of or are required to carry out any contract or agreement from
Prison Rehabilitative Industries and Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, Fla. Stat., in
the same manner and under the procedures set forth in subsections 946,515(2) and(4), Fla. Stat. For purposes of this
contract,the Contractor shall be deemed to be substituted for the Alliance insofar as dealings with PRIDE. This clause
is not applicable to subcontractors unless otherwise required by law. An abbreviated list of products/services available
from PRIDE may be obtained by contacting PRIDE, 800-643-8459.
33.2 The Contractor may procure any recycled products or materials, which are the subject of or are required to carry this
contract in accordance with the provisions of section 403.7065,Fla. Stat.
33.3 The Contractor may purchase articles that are the subject of,or required to carry out,any contract or agreement from a
nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, Fla, Stat., in
the same manner and under the same procedures set forth in section 413.036(1)and(2),Fla. Stat..For purposes of this
contract,the Contractor shall be deemed to be substituted for the Alliance insofar as dealings with such qualified nonprofit
agency are concerned.Additional information about the designated nonprofit agency and the products it offers is available
at http://www.respectofflorida.org.This clause is not applicable to subcontractors unless otherwise required by law.
34. PatentS,COQVE.jghts,Rovalties
34.1 If this contract is awarded state funding and if any discovery,invention or copyrightable material is developed,produced
or for which ownership was purchased in the course of or as a result of work or services performed under this contract the
Contractor shall refer the discovery, invention or material to the Alliance to be referred to the Department. Any and all
Page 9 of 53
patent rights or copyrights accruing under this contract are hereby reserved to the State of Florida in accordance with
Chapter 286,F.S.Pursuant to s.287.0571 (5)(k),as amended,the only exceptions to this provision shall be those that are
clearly expressed and reasonably valued in this contract.
34.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property,notwithstanding any agreement made pursuant to this section 33.
34.2 If this contract is awarded solely federal funding,the terms and conditions are governed by 2 CFR Part 200,315.
35. Emergency Preparedness and Continuity of Operations
The Contractor shall,within thirty(30)calendar days of the execution of this contract,submit to the Contract Manager verification
of an emergency preparedness plan. In the event of an emergency, the Contractor shall notify the Alliance of emergency
provisions.
In the event a situation results in a cessation of services by a sub-Contractor, the Contractor shall retain responsibility for
performance under this contract and must follow procedures to ensure continuity of operations without interruption.
36. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
ont�.n 1000 Qvn_gna_! t_'onfract Condfitions,t df
In the event of any conflict between the PUR 1000 Form and any terms or conditions of any contract or agreement terms or
conditions the contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the
PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000 Form
shall take precedence.
37. Use of State Funds to Purchase or,Improve!Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or political
subdivision granting to the state a security interest in the property at least to the amount of state funds provided for at least 5 years
from the date of purchase or the completion of the improvements or as further required by law.
38. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager,who shall reduce the decision to
writing and serve a copy on the Contractor.
39. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to which sovereign
immunity may be applicable.
40. Venue
If any dispute arises out of this contract,the venue of such legal recourse will be Miami-Dade County,Florida.
41. Entire Contract
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or representations shall be
valid or binding upon the Alliance or the Contractor unless expressly contained herein or by a written amendment to this contract
signed by both Parties.
42. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control, provided the
party experiencing the force majeure condition provides immediate written notification to the other party and takes all reasonable
efforts to cure the condition.
43. Severabilily Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable; the other
provisions are severable to that void provision and shall remain in full force and effect.
44. Condition Precedent to Contract: Appropriations
The Parties agree that the Alliance's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature to the Department and a corresponding allocation under contract from the Department to the
Alliance.
Page 10 of 53
45. Addition/Deletion
The Parties agree that the Alliance reserves the right to add or to delete any of the services required under this contract when
deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties shall
negotiate compensation for any additional services added.
46. 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.
47. Conitaliance
The Contractor shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable current
state statutes, laws, rules and regulations, policies of the Department, and the terms of this Contract. The Parties agree that
failure of the Contractor to abide by these laws,rules,regulations,policies,and terms of this Contract shall be deemed an event
of default of the Contractor and subject the Contractor to disciplinary action including corrective action,unannounced special
monitoring, temporary assumption of the operation of one or more contractual services, placement of the Contractor on
probationary status, imposing a moratorium on Contractor action, imposing financial penalties for nonperformance or
noncompliance,or other administrative action to immediate, unilateral cancellation at the discretion of the Alliance.
If the Alliance finds that the Contractor fails to abide by all applicable current federal and state statutes, laws, rules and
regulations, as well as conditions of this Contract, the Alliance shall provide the Contractor a Notice of Violation which shall
include a concise statement of the specific violations of the Contractor and the facts relied upon to establish the violation.
Upon receipt of the Notice of Violation, the Contractor shall have twenty-one(21)days to respond to the Notice of Violation.
The Contractor's response must include a statement of any disputed issues of material fact and a concise statement of the specific
facts the Contractor contends warrant reversal or deviation from the Alliance's proposed action, including an explanation of
how the alleged facts relate to the specific rules,statutes,or contractual term.
Failure of the Contractor to respond to the Notice of Violation within twenty-one (21) days shall be deemed a waiver of the
rights outlined above and the Alliance will proceed against the Contractor by default.
The Alliance,upon receiving a timely filed response to a Notice of Violation, will forward the response and all accompanying
documentation to the Contract Manager to review and consider. The Contract Manager shall, within 30 days after the receipt
of the Contractor's response,file an order which lays out the final determination of disciplinary action by the Alliance.
48. Final Invoice
The Contractor shall submit the final invoice for payment to the Alliance as specified in this contract. If the Contractor fails to submit final
request for payment as specified in this contract,then all rights to payment may be forfeited and the Alliance may not honor any requests
submitted. Any payment due under the terms of this contract may be withheld until all reports due from the Contractor and necessary
adjustments thereto have been approved by the Alliance.
49. Modifications
Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly
signed by both parties.
50. Susuension of Work:
The Alliance may in its sole discretion suspend any or all activities under this contract when in the Department of Elder Affairs
and the Alliance determination that it is in the best interests of State to do so. The Alliance shall provide the Contractor written
notice outlining the particulars of suspension. Examples of the reason for suspension include, but are not Limited to, budgetary
constraints, declaration of emergency, or other such circumstances. After receiving a suspension notice, the 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(2)
terminate the Contract or purchase order. Suspension of work shall not entitle the Contractor to any additional compensation.
51_ Termination
51.1 Termination for Convenience.This contract may be terminated by either party without cause upon no less than thirty(30)
calendar days' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice
shall be delivered by U.S. Postal Service with verification of delivery or any expedited delivery service that provides
verification of delivery or by hand delivery to the Contract Manager or the representative of the Contractor responsible
Page 11 of 53
for administration of the contract. The Contractor shall not furnish any product after it receives the notice of termination,
except as necessary to complete the continued portion of the contract, if any. The Contractor shall not be entitled to
recover any cancellation charges or lost profits. See notes on email regarding this paragraph.
51.2 Termination for Cause.The Alliance may terminate this Contract if the Contractor fails to (1)deliver the product within
the time specified in the contract or any extension, (2)maintain adequate progress,thus endangering performance of the
contract,(3)honor any term of the,(4)abide by any statutory requirement,regulatory requirement,licensing requirement,
or Department policy or(5) in the event funds for payment become unavailable for this Contract. The Alliance will be
the final authority as to the availability and adequacy of funds. In the event of termination of this contract,the Provider
will be compensated for any work satisfactorily completed prior to the date of termination. Rule 60A- 1.006(3),F.A.C.,
governs the procedure and consequences of default. The contractor shall continue work on any work not terminated.
Except for defaults of subcontractors at any tier,the Contractor shall not be liable for any excess costs if the failure to
perform the Contract arises from events completely beyond the control, and without the fault or negligence, of the
Contractor. If the failure to perform is caused by the default of a subcontractor at any tier,and if the cause of the default
is completely beyond the control of both the Contractor and the subcontractor, and without the fault or negligence of
either,the Contractor shall not be liable for any excess costs for failure to perform, unless the subcontracted products or
services were obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule.
If,after termination, it is determined that the Contractor was not in default, or that the default was excusable, the rights
and obligations of the Parties shall be the same as if the termination had been issued for the convenience of the Alliance.
The rights and remedies of the Alliance in this clause are in addition to any other rights and remedies provided by law or
under the Contract.
51.3 Upon expiration or termination of this Contract,the Contractor and subcontractors shall transfer all public records in its
possession to the Alliance and destroy any duplicate public records that are exempt or confidential and exempt from
public records, disclosure requirements at no cost to the Alliance. All electronically stored records shall be provided to
the Alliance in a format that is compatible with the Alliance's information technology system(s).
52. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the Contractor,subject to the assignment
provisions in Section 22 above.
53. Electronic Records and Signature
53.1 The Alliance 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 Uniform Electronic Transaction Act,s.668.50,Fla. Stat.All electronic records must be fully auditable;are subject to
Florida's Public Records Law, Ch. 119, and Fla. Stat.; must comply with Section 29, Data Integrity and Safeguarding
Information;must maintain all confidentiality,as applicable;and must be retained and maintained by the Contractor to the
same extent as non-electronic records are retained and maintained as required by this Contract.
53.2 The Alliance's authorization pursuant to this section does not authorize electronic transactions between the Contractor and
the Alliance. The Contractor is authorized to conduct electronic transactions with the Alliance only upon further written
consent by the Alliance.
53.3 Upon request by the Alliance, the Contractor shall provide the Alliance or DOEA with non-electronic (paper) copies of
records. Non-electronic (paper) copies provided to the Alliance of any document that was originally in electronic form
with an electronic signature must indicate the person and the person's capacity who electronically signed the document on
any non-electronic copy of the document.
54. Special Provisions
The Contractor agrees to the following provisions:
54.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Contractor or any sub-Contractors and referred to a governmental
or investigatory agency must be sent to the Alliance. If the Contractor has reason to believe that the allegations will be
referred to the State Attorney, a law enforcement agency, the United States Attorney's office, or other governmental
agency,the Contractor shall notify the contract manager.A copy of all documents,reports,notes,or other written material
concerning the investigation,whether in the possession of the Contractor or Sub-Contractors,must be sent to the Alliance's
contract manager with a summary of the investigation and allegations.
Wage 12 of 53
54.2 Volunteers:
The Contractor shall ensure the use of trained volunteers in providing direct services delivered to older Individuals and
individuals with disabilities needing such services. If possible,the Contractor shall work in coordination with organizations
that have experience in providing training,. placement, and stipends for volunteers or participants (such as organizations
carrying Out Federal set-vice programs administered by the Corporation for National and Community Service), in
community service settings.
54.3 Enforcement:
The Contractor agrees to the following provisions:
54.3.1 The Alliance may,without taking any intermediate measures available to it against the Contractor, rescind the contract, if
the Alliance finds that:
54.3.2 An intentional or negligent act of the Contractor has materially affected the health, welfare, or safety of clients served
pursuant to this contract,or substantially and negatively affected the operation of scr\ices covered under this contract:
54.3.3 The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual funds have been
misappropriated;
54.3.4 The Contractor has committed multiple or repeated violations of legal and regulatory standards-regardless of-whether such
laws or regulations are enforced by the Alliance,or the Contractor has committed or repeated violations of the Alliance or
the Department standards:
543.5 The Contractor has failed to continue the provision or expansion of'services after the declaration of a state oferriergericy:
and/or
54.3.6 The Contractor has failed to adhere to the terms of this contract.
54.3.7 In the alternative, the Alliance may, at its sole discretion, take immediate measures against the Contractor, including:
corrective action, unannounced special monitoring. temporary assumption of the operation of one or more contractual
services, placement of the Contractor on probationary status, imposing a moratorium on Contractor action, imposing
financial penalties for nonperlorniance,or other administrative action.
54.4 In making any determination under this provision the Alliance may rely upon the findings of another state or federal agencN, or
rri
other regulatory body. Any claims for damages for breach of this contract are exempt from administrative proceedings arid shall be
brought before the appropriate entity in the venue of Miami-Dade County.
54.5 Use ol'Service Dollars:
The Contractor will optimize the use of contract funds by serving the maximum possible number of individuals with the services
allowed by this contract.The Contractor will spend all funds provided by this contract to provide such services,
54.6 Surplus/Deficit Report:
The Contractor will submit a consolidated surplus/deficit report in a format provided by the Alliance to the Alliance's Contract Manager
in conjunction with the required monthly billing submission.This report is for this contract between the Contractor and the Alliance.
The report will include the following:
54.6.1 The Contractor's detailed plan on how the surplus or deficit spending exceeding the 1%threshold will be resolved:
54.6.2 Number ofelients currently on the APCL.that receive a priority ranking score of four(4)or five(5):
54.6.3 Number of clients currently on the APCL designated as Imminent Risk,
54.6.4 Number of clients served and Aging and Disability Resource Center("ADRC")client contacts,
In accordance with its surplus/deficit management policies,in order to maximize available funding and minimize the time
that potential clients must wait for services,the Alliance in its sole discretion can reduce funding awards if the Contractor
is not spending according to monthly plans and is projected to incur a surplus at the end of the year.
54.7 Training:The Contractor will attend all required trainings and meetings schedule by the Alliance.
55. Contract Manager
The Alliance may substitute any Alliance employee to serve as the Contract Manager.
Page 13 of 53
56. Official Payee and Representatives:
The name,address,and telephone number of the representative for the Alliance for this contract is:
Max B.Rothman,JD,LL.M.President and CEO
760 NW 107th Ave, Suite 214
Miami,Florida 33172
(305) 670-6500,Ext. 224
The name,address,and telephone number of the representative of the Contractor responsible for administration of the program under
this contract is:
The Contractor name, as shown on page I of this Monroe Countv Board of County Commissioners,Social
a. contract, and mailing address of the official payee to Services/In-Home Services
whom the payment shall be made is: 1100 Simonton Street,2-257
Key West,FL 33040
Sheryl Graham,Senior Director
b The name of the contact person and street address where Monroe County Board of County Commissioners,Social
financial and administrative records are maintained is: Services/In-Home Services
1100 Simonton Street,2-257
Key West,FL 33040
The name, address, and telephone number of the Sheryl Graham,Senior Director
C.
representative of the Contractor responsible for Monroe County Board of County Commissioners,Social
administration of the program under this contract is: Services/In-Home Services1100 Simonton Street,2-257
Key West,FL 33040
The section and location within the AAA where Requests Vice President for Finance
d. for Payment and Receipt and Expenditure forms are to be Alliance for Aging,Inc.
mailed is: 760 NW 107th Avenue, Suite214
Miami, Florida 33172-3155
Contract Monitor
e The name, address, and telephone number of the
Alliance for Aging,Inc.
Contract Manager for the AAA for this contract is: 760 NW 107th Avenue, Suite 214
Miami, Florida 33172-3'155
In the event different representatives are designated by either party after execution of this contract,notice of the name and address of
the new representative will be rendered in writing to the other party and said notification attached to originals of this contract.
57. All Terms and Conditions Included
This contract and its Attachments and any exhibits referenced in said attachments,together with any documents incorporated by
reference, contain all the terms and conditions agreed upon by the Parties. There are no provisions, terms, conditions, or
obligations other than those contained herein, and this contract shall supersede all previous communications, representations or
agreements,either written or verbal between the Parties.
By signing this contract,the Parties agree that they have read and agree to the entire contract.
Page 14 of 53
IN WITNESS THEREOF,the Parties hereto have caused contract,to be executed by their undersigned officials as duly authorized.
Monroe County Board of County ALLIANCE FOR AGING,INC.
Commissioners,Social Services/In-
Rome Services
SIGNED BY: SIGNED BY: kh,D.Rohim-n h n I ,jazz 1 ECT
NAME: Roman Gastesi NAME: MAX B.ROTHMAN,JD,LL.M.
TITLE: Monroe County Administrator TITLE: PRESIDENT AND CEO
DATE: June 14, 2021 DATE: Jun 15,2021
NROE COUNTY ATTOnNEY(-"N
�A r, HOV�Z E S�j FORM
�•e!
PE d J. ea
ASS1,51- UNTY ATTORNEY
Date 6/14/21
Signed By: (Seal):
Name & Title- Michelle Coldiron, Mayor
Date:
Page 15 of 53
INDEX TO ATTACHMENTS
Attachment I SERVICE PROVISIONS ALZHEIMER'S DISEASE INITIATIVE
Attachment 11 CERTIFICATIONS AND ASSURANCES
Attachment III FINANCIAL AND COMPLIANCE AUDIT
Attachment VI ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII BUDGET SUMMARY
Attachment VIII INVOICE 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)—
Attachment E BUSINESS ASSOCIATE AGREEMENT
Attachment G BACKGROUND SCREENING AFFADAVIT OF COMPLIANCE
Page 16 of 53
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I.SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Alzheimer's Disease(AD)
Alzheimer's Disease Initiative(ADI)
Activities of Daily Living(ADL)
Assessed Priority Consurner List(APCL)
Adult Protective Services (APS)
Client Information and Registration Tracking System (CIRTS)
Community Care for Disabled Adults(CCDA)
Corrective Action Plan(CAP)
Department of Elder Affairs—(DOEA)or Department
Department of Elder Affairs Program and Services Handbook(DOEA HANDBOOK)
Home Care For Disabled Adults(HCDA)
Instrumental Activities of Daily Living(IADL)
Memory Disorder Clinic(MDC)
Planning and Service Area(PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the Department of Children and
Families Set-vices Community Care for Disabled Adults(CCDA)or Home Care for Disabled Adults(HCDA)services to the
Department's community-based services.
Area Plan: A plan developed by the Alliance Outlining a comprehensive and coordinated service delivery system in the
respective planning and service area, in accordance with the Section 306 of the Older Americans Act(42 U.S.C.3026)and
Department instructions.The Area Plan includes performance measures and unit rates per service offered per county.
Area Plan Update: A revision to the Area Plan wherein the Alliance enters ADI specific data into the CIRTS. An Update
may also include other revisions to the Area Plan as instructed by the Department.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement. DOEA Form 701B is used by case managers to conduct the
functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1) and (2), F.S., to provide
diagnostic and referral services,conduct basic and service-related multidisciplinary research,and develop training materials
and educational opportunities for lay and professional caregivers of individuals with AD.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
The primary purpose of the ADI program is to provide a continuum of services addressing the special needs of
individuals with AD,their families and caregivers.
1.2.2.Alzheimer's Disease Initiative Mission Statement
The AD] program ensures that persons afflicted with AD and other forms of dementia are given essential services to
help them age in place in an elder-friendly environment with security,dignity,and purpose. The program also provides
support to family members and caregivers of persons afflicted with AD,
1.2.3 Authority
The relevant authority governing ADI program are:
Page 17 of 53
a. Rule 58D-1, Florida Administrative Code
b. Sections 430.501 through 430.504,F.S.
c. The Catalog of State Financial Assistance(CSFA)Numbers are 65004 and 65002
1.2.4 Scope of Service and Eligible Individuals
The Contractor is responsible for the programmatic, fiscal, and operational management of the ADI program per this
contract. The program services shall be provided in a manner consistent with the Area Plan, as updated and the current
DOEA Handbook, which are incorporated by reference. The Contractor agrees to be bound by all subsequent
amendments and revisions to the DOEA Handbook, and the Contractor agrees to accept all such amendments and
revisions.
1.3 Clients to be Served
1.3.1 General Eligibility
The ADI Program addresses the special needs of individuals with AD or other related disorders and their caregivers.
1.3.2 Individual Eligibility
Clients eligible to receive services under this contract must:
a. Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be suspected of having AD or a
related disorder;and
b. Not be enrolled in a Medicaid capitated long-term care program.
1.3.3 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk of
placement in an institution.
SECTION II. MANNER OF SERVICE PROVISION
2.0 CONDITIONS
All services under this contract will be provided in a manner consistent with the conditions set forth in the current Florida
Department of Elder Affairs Programs and Services Handbook.
Client access to services, assessment and eligibility determination must conform to the protocols listed in ATTACHMENT
C.
2.1 SERVICE TASKS
To achieve the goals of the ADI program,the Contractor shall perform or ensure the performance of its Sub-Contractors,
the following tasks:
2.1.1 Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a client is
based on meeting the requirements described in this ATTACHMENT I, Section 1.3.
11.2 Assessment and Prioritization of Service Delivery for New Clients
The Contractor shall ensure the following criteria are used to prioritize new clients for service delivery. It is not the
intent of the Department to remove existing clients from any services in order to serve new clients being assessed and
prioritized for service delivery.
Priority Criteria for Service Delivery
a. Individuals in nursing homes under Medicaid who could be transferred to the community;
b. Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community;
c. Individuals in nursing horses that are closing and can be discharged to the community;
d. Individuals whose mental or physical health condition has deteriorated to the degree self-care is not possible,
there is no capable caregiver,and institutional placement will occur within 72 hours;and
e. For the purpose of transitioning individuals receiving CCDA and HCDA services through the Department of
Children and Families' Adult Services to community-based services provided through DOER when services
are not currently available,area agency on aging staff and lead agency case managers will ensure that"Aging
Out" individuals are prioritized for services only after APS High Risk and Imminent Risk individuals.
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2.13 Priority Criteria for Service Delivery for Other Assessed Individuals
The assessment and provision of services should always consider the most cost-effective means of service delivery.
Functional impairment will be determined through the Department's functional assessment form administered to
each applicant.The frailest individuals not prioritized as described in this attachment,Paragraph 2.1.2. will receive
services to the extent funding is available.
2.1.4 Delivery of Set-vices to Eligible Clients:
The Contractor shall ensure the provision of a continuum of services addressing the diverse needs of individuals
with AD and their caregivers. The Contractor shall ensure services are performed in accordance with the current
Department of Elder Affairs Programs and Services Handbook, Services categories include:
a. Caregiver Training/Support;
b. Case Aide;
c. Case Management;
d. Counseling(Gerontological);
e. Counseling(Mental Health/Screening);
f. Education/Training;
g. Respite(Facility-Based);
h. Respite(In-Home);and
i. Specialized Adult Day Care
J. Specialized Medical Equipment,Services, and Supplies.
Caregivers benefit from receiving training, respite and related support services to assist Chem in caring for the ADI
client.
2.2 SERVICE TIMES AND LOCATION
Service Times:
The Contractor shall ensure the provision of the services listed in this contract is available at times appropriate to meet client
service needs at a minimum, during normal business hours.Normal business hours are defined as Monday through Friday,
8:00am to 5:00pm.
Change in Locations:
The Contractor shall notify the alliance in writing a minimum of one week prior to making changes in location that will affect
the Alliance's ability to contact the Contractor by telephone,facsimile,or email.
2.3 Service Units
Services will be reported in units as described in the DOER Handbook.
2.4 REPORTS
2.4.1 The Contractor shall submit Service Cost Reports to the Alliance annually no later than ninety (90)calendar days
after the Contractor Fiscal Year end. The Service Cost Reports shall reflect actual costs of providing each service
by program for the preceding contract year. If the Contractor desires to renegotiate its reimbursement rates, the
Contractor shall make a request in writing to the Alliance in accordance with the Alliance's approved
Reimbursement Rate Review Policy,which is incorporated by reference.
2.4.2 Client Information and Registration Tracking System (CIRTS)Reports
The Contractor shall ensure timely input of ADI specific data into CIRTS. To ensure CIRTS data accuracy, the
Contractor shall adhere to the Alliance's CIRTS Data Integrity Policy and use CIRTS-generated reports which
include the following:
a. Client Reports;
b. Monitoring Reports;
c. Service Reports,
d. Miscellaneous Reports;
e. Fiscal Reports; and
f. Outcome Measures Reports.
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2.4.3 The Contractor shall provide the Alliance with an expenditure plan by July 15 or two weeks after this contract has
been signed; a monthly update is due on the l 5thst day of each following month. The expenditure plan and updates
must follow the format provided by the Alliance.
2.4.4 The Contractor shall respond to surplus/deficit inquiries and will provide ad-hoc reports as requested by the
Alliance.
2.4.5 The Contractor shall submit Program Highlights referencing specific events that occurred in the contract year
covered in this contract by 1.5"'day of the third month following the contract end date. The Contractor shall provide
a new success story, quote,testimonial, or human-interest vignette. The highlights shall be written for a general
audience,with no acronyms or technical terms. For al I agencies or organizations that are referenced in the highlight,
the Contractor shall provide a brief description of their mission or role. The active tense shall be consistently used
in the highlight narrative, in order to identify the specific individual or entity that performed the activity described
in the highlight. The Contractor shall review and edit Program Highlights for clarity, readability, relevance,
specificity,human interest,and grammar,prior to submitting them to the Alliance.
2.5 ELECTRONIC RECORDS AND DOCUMENTATION
The Contractor will ensure the collection and maintenance of client and service information on a monthly basis from the
Client Information and Registration"Tracking System (CIRTS). Maintenance includes valid exports and backups of all data
and systems according to Alliance and Department standards.
2.5.1 Timely Data Entry
The Contractor must enter all required ADI data per the Department's CIRTS Policy Guidelines for consumers and
services in the CIRTS database. The data must be entered into CIRTS before the Contractor submits its request for
payment and expenditure reports to the Alliance as per ATTACHMENT VIII.
2.5.2 Data Accuracy
The Contractor will run monthly CIRTS reports and verify client and service data in CIRTS is accurate. This report
must be submitted to the Alliance with the monthly request for payment and expenditure report and must be
reviewed by the Alliance before the Contractor's request for payment and expenditure reports can be approved by
the Alliance.
2.5.3 Failure to Maintain CIRTS Database
Failure to ensure the collection and maintenance of the CIRTS data may result in the Alliance taking disciplinary
action as described in Section 47 including delaying or withholding payment until the problem is corrected.
2.5.4 Computer System Backup and Recovery
Each Contractor, among other requirements, must anticipate and prepare for the loss of information processing
capabilities. The routine backing up of data and software is required to recover from losses or outages of the
computer system. Data and software essential to the continued operation of Contractor functions must be backed
up. The security controls over the backup resources shall be as stringent as the protection required of the primary
resources.A copy of the backed up data shall be stored in a secure, offsite location. The Contractor shall maintain
written policies and procedures for computer backup and recovery. These policies and procedures shall be made
available to the Alliance upon request.
2.6 PERFORMANCE SPECIF ICATIONS
2.6.1 Outcomes
a. The Contractor shall timely submit to the Alliance all reports described in ATTACHMENT 1, SECTION
2.4:REPORTS;
b. The Contractor shall timely submit to the Alliance all information described in ATTACHMENT I,
SECTION 2.5:ELECTRONIC RECORDS AND DOCUMENTATION,
c. The Contractor shall ensure services in this contract are in accordance with the current DOER Programs
and Services Handbook.
d. Establish procedures for handling complaints concerning adverse actions such as termination,suspension,
or reduction in services,as per Section of of the Contract.
e. Conduct client satisfaction surveys to evaluate and improve service delivery.
f. Monitor and evaluate subcontractors and vendors for programmatic and fiscal compliance.
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2.6.2 'The performance of the Contractor in providing the services described in this contract shall be measured by the
current strategies for the following criteria:
a. Percent of elders assessed with high or moderate risk environments who improved their environment score;
b. Percent of new service recipients with high-risk nutrition scores whose nutritional status improved;
c. Percent of new service recipients whose ADL assessment score has been maintained or improved;
d. Percent of new service recipients whose IADL,assessment score has been maintained or improved;
e. Percent of family and family-assisted caregivers who self-report they are likely to provide care;
f. Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention(as determined by the caregiver and the assessor);
The Contractor's performance will be documented in the Alliance's annual monitoring report.
2.7 Contractor's Financial Obligations
Cost Sharing and Co-payments
The Contractor in conjunction with the Alliance shall establish an annual co-payment goal (amount to be collected from
clients). Using the method prescribed in the current Department of Elder Affairs Program and Services Handbook, the
Contractor 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 Contractor is required to meet at least 90 percent of the goal.
2.8 Alliance for Aging Responsibilities
2.8.1 Program Guidance and Technical.assistance
The Alliance will provide to the Contractor guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Contractor.
2.8.2 Contract Monitoring
The Alliance will review and evaluate the performance ofthe Contractor under the terms ofthis contract.Monitoring
shall be conducted annually through direct contact with the Contractor through telephone, in writing, or an onsite
visit. The Alliance's determination of acceptable performance shall be conclusive. The Contractor agrees to
cooperate with the Alliance in monitoring the progress of completion of the service tasks and deliverables. The
Alliance may use,but is not limited to,one or more of the following methods for monitoring:
a. Desk reviews and analytical reviews;
b. Scheduled,unscheduled and follow-up on-site visits;
c. Client visits;
d. Review of independent auditor's reports;
e. Review of third-party documents and/or evaluation;
f. Review of progress reports;
g. Review of customer satisfaction surveys;
h. Agreed-upon procedures review by an external auditor or consultant;
i. Limited-scope reviews; and
j. Other procedures as deemed necessary.
SECTION HI. METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement for administration costs, as well as fixed
rate and cost reimbursement for services. Payment may be authorized for all allowable expenditures to complete the tasks
identified in the deliverables, in accordance with all applicable state and federal statutes and regulations, and are based on
audited historical costs in instances where an independent audit is required. All Contractor requests for payment and
expenditure reports submitted to support requests for payment shall be on Alliance forms 106 and 105, included as
ATTACHMENTS IX, and X. Duplication or replication of both forms via data processing equipment is permissible,
provided all data elements are in the same format as included on department forms.
3.1.1 Contractor invoices shall be submitted in accordance with ATTACHMENT VIII, except that invoices cannot be submitted
beyond the date for final invoicing,as stated in this contract.Invoices submitted late will not be honored.Exceptions to this
rule are at the discretion of the Alliance,on a case by case basis; such exceptions must be requested prior to the expiration
of the invoicing deadline. In making a determination of the exception the Alliance will consider whether the disruption to
the billing cycle was beyond the control of the Contractor,the frequency with which such exceptions are requested by the
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Contractor, 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 Contractors may request a monthly advance for service costs for each of the first two months of the contract
period,based on anticipated cash needs. Detailed documentation justifying cash needs for advances must be Submitted with
the signed contract, approved by the Alliance, and maintained in the contract manager's file. All payment requests for the
third through the twelfth months shall be based on the submission of monthly actual expenditure reports beginning with the
first month of the contract. The schedule for submission of advance requests is ATTACHMENT VIII to this contract.
Reconciliation and recouping of advances made under this contract are to be completed by October. All advance payments
are subject to the availability of funds.
3.3 Advance funds may be temporarily invested by the Contractor in an FDIC insured interest hearing account. All interest
carried on contract fund advances must be returned to the Alliance within thirty (JO) days of the end of the first quarter of
the contract period.
3.4 Final Request for Payment:
3.4.1 The Contractor must submit the final request for payment as stipulated in ATTACHEMENT VIII; if the Contractor
fails to do so, all right to payment is forfeited, and the Alliance will not honor any requests submitted after the
aforesaid tirne period.
3 If the contract is terminated prior to the contract end date, then the Contractor must submit the final request for
payment to the Alliance no more than 30 days after the contract is terminated,but no later than 15 days beyond the
original contract end date. If the Contractor fails to do so,all right to payment is forfeited,and the Alliance will not
honor any requests submitted after the aforesaid time period.
3.5 Documentation for Payment
The Contractor will maintain documentation to support payment requests that shall be available to the Alliance or authorized
individuals, such as the Department of Financial Services, upon request.
.3.5,1 The Contractor must require Subcontractors to enter all required data per the Department's CIRTS Policy Guidelines
for clients and set-vices in the CIRTS database. The data must be entered into the CIRTS before the sub-Contractors
submit their request for payment and expenditure reports to the Contractor. The Contractor shall establish time
frames to assure compliance with due dates for the requests for payment and expenditure reports to the Alliance.
3.5 2 The Contractor must require subcontractors to run monthly CIRTS reports and verify client and service data in the
CIRTS is accurate. This report must be submitted to the Contractor with the monthly request for payment and
expenditure report and must be reviewed by the Contractor before the subcontractors' request for payment and
expenditure reports can be approved by the Contractor.
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ATTACHMENT II
CERTIFICATIONS AND ASSURANCES
The Alliance will not award this contract unless Contractor completes the CERTIFICATIONS AND ASSURANCES contained in
this Attachment. In performance of this contract,Contractor provides the following certifications and assurances:
A. Debarment and Suspension Certification(29 CFR Part 95 and 2 CFR Part 200)
B. Certification Regarding Lobbying(29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination& Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes,section 287.133,F.S.
E. Association of Communitv Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pub. L.
11. 1-117)
F. Certification Regarding Scrutinized Companies Lists,section 287.135,F.S.
G. Certification Regarding Data Integrity Compliance for Agreements. Grants,Loans And Cooperative
Agreements
H. Verification of Employment Status Certification
I. Records and Documentation
J. Certification Regarding Inspection of Public Records
A. CERTIFICATION REGARDING DEBARMENT,SUSPENSION, AND OTHER RESPONSIBILITY MATTERS -
PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies to the best of its knowledge and belief,that it and its principals:
1. Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered
transactions by a Federal department or agency;
2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them
for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain,or performing a public
(Federal, State,or local)transaction or contract under a public transaction;violation of Federal or State antitrust statutes or
commission of embezzlement,theft,forgery,bribery,falsification or destruction of records, making false statements,or
receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity(Federal, State or local)with
commission of any of the offenses enumerated in paragraph A.2. of this certification;and/or
4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State,
or local)terminated for cause of default.
B. CERTIFICATION REGARDING: LOBBYING -Certification for Contracts,Grants, Loans,and Cooperative
Agreements.
The undersigned Contractor certifies,to the best of its knowledge and belief,that:
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No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,to any person for influencing
or attempting to influence an officer or employee of Congress, or an employee of a]Member of Congress in connection with the
awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan, the entering into of any
cooperative agreement,and the extension,continuation,renewal,amendment or modification of any Federal contract,grant,
loan or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency,a Member of Congress,an officer or employees of Congress,or employee of a
Member of Congress in connection with a Federal contract,grant,loan,or cooperative agreement,the undersigned shall also
complete and submit Standard Form- LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers
(including subcontracts,sub-grants and contracts under grants, loans and cooperative agreements)and that all sub-recipients
and contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered
into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any
person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
C. NON-DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART 80). As
a condition of the Contract,Contractor assures that it will comply fully with the nondiscrimination and equal opportunity
provisions of the following laws:
I. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220),which prohibits discrimination against all
individuals in the United States on the basis of race,color, religion, sex national origin,age,disability, political affiliation,
or belief,and against beneficiaries on the basis of either citizenshiplstatus as a lawfully admitted immigrant authorized to
work in the United States or participation in any WIA Title I-financially assisted program or activity;
2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the
Regulation of the Department of Ilealh and Human Services(45 CFR Part 80),to the end that, in accordance with Title VI
of that Act and the Regulation, no person in the United States shall,on the ground of race,color,or national origin,be
excluded from participation in, be denied tl le benefits of or be otherwise subjected to discrimination under any program or
activity for which the Applicant receives Federal financial assistance from the Alliance.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-1 12)as amended, and all requirements imposed by or pursuant to
the Regulation of the Department of Health and Human Services (45 CFR Part 84),to the end that,in accordance with
Section 504 of that Act,and the Regulation,no otherwise qualified handicapped individual in the United States shall,
solely by reason of his handicap, be excluded from participation in, be denied the benefits of,or be subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from the
Alliance.
4. The Age Discrimination Act of 1975 (Pub. L.94-135),as amended,and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services(45 CFR Part 91),to the end that,in accordance with the Act
and the Regulation,no person in the United States shall,on the basis of age,be denied the benefits of,be excluded from
participation in,or be subjected to discrimination under any program or activity for which the Applicant receives Federal
financial assistance from the Alliance.
5. Title IX of the Educational Amendments of 1972(Pub.L.92-318).as amended,and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 86),to the end that, in
accordance with Title IX and the Regulation,no person in the United States shall, on the basis of sex,be excluded from
participation in,be denied the benefits of,or be otherwise subjected to discrimination under any education program or
activity for which the Applicant receives Federal financial assistance from the Alliance.
6. The American with Disabilities Act of 1990(Pub. L. 101-336), prohibits discrimination in all employment practices,
including,job application procedures,hiring,firing,advancement, compensation,training,and other terms,conditions, and
privileges of employment.It applies to recruitment,advertising,tenure,layoff,leave,fringe benefits, and all other
employment-related activities,and;
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Contractor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above.
This assurance applies to Contractor's operation of the W'IA Title I- financially assisted program or activity,and to all
agreements Contractor makes to carry out the W'IA Title 1- financially assisted program or activity. Contractor understands that
the Alliance, Department,and the United States have the right to seekjudicial enforcement of the assurance.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
Contractor hereby certifies that neither it,nor any person or affiliate of Contractor, has been convicted of a Public Entity Crime
as defined in section 287.133, F.S., nor placed on the convicted vendor list.
Contractor understands and agrees that it is required to inform DOEA immediately upon any change of circumstances regarding
this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE (Pub. L. 111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions pertaining to
ACORN and its subsidiaries per the Consolidated Appropriations Act, 20 10, Division E,Section 511 (Pub.L. 1 11-1 17).The
Continuing Appropriations Act,2011. Sections 101 and 103(Pub.L. 1 11-242),provides that appropriations made under Pub.
L. 111-117 are available under the conditions provided by Pub. L. 11 1-117.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers
(including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements)and that all sub recipients
and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS CERTIFICATION,SECTION 287.135,F.S.
In accordance with section 287.135,F.S.,Contractor hereby certifies that it is not participating in a boycott of Israel.
If this Contract is in the amount of$1 million or more, in accordance with the requirements of'section 287.135,F.S.,Contractor
hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or
Syria.
Contractor understands that pursuant to section 287.135,F.S.,the submission of a false certification may result in the Alliance
and/or Department terminating this contract and the submission of a false certification may subject the Contractor to civil
penalties,attorney's fees,and/or costs,including costs for investigations that led to the funding of false certification..
If Contractor is unable to certify to any of the statements in this certification, Contractor shall attach an explanation to this
Contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,GRANTS,LOANS
AND COOPERATIVE AGREEMENTS
l. The Contractor and any Subcontractors of services under this contract have financial management systems capable of
providing certain information, including: (1)accurate,current,and complete disclosure of the financial results of each
grant-funded project or prograrn in accordance with the prescribed reporting requirements; (2)the source and application of
funds for all agreement supported activities;and(3)the comparison of outlays with budgeted amounts for each award.The
inability to process information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
2. Management Information Systems used by the Contractor,Subcontractors,or any outside entity on which the Contractor is
dependent for data that is to be reported,transmitted or calculated, have been assessed and verified to be capable of
processing data accurately,including year-date dependent data.For those systems identified to be non-compliant,
Contractors will take immediate action to assure data integrity.
1. If this contract includes the provision of hardware,software,firmware, microcode or imbedded chip technology,the
undersigned warrants that these products are capable of processing year-date dependent data accurately. All versions of
these products offered by the Contractor(represented by the undersigned)and purchased by the state will be verified for
accuracy and integrity of data prior to transfer.
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2. 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.
3. The Contractor and any Subcontractors of services under this contract warrant thew policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data
integrity compliance issues.
H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Alliance, Contractor certifies the use of the U.S. Department of Homeland Security's E-
verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform
employment duties pursuant to this contract and that any subcontracts include an express requirement that Subcontractors
performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment
eligibility of all new employees hired by the Subcontractor during the entire contract term.
1. RECORDS AND DOCUMENTATION
The Contractor shall make available to the Alliance and the Department staff and/or any party designated by the Alliance and
the Department any and all contract related records and documentation.The Contractor shall ensure the collection and
maintenance of all program related information and documentation on any such system designated by the Alliance and the
Department. Maintenance includes accurate and current data,and valid exports and backups of all data and systems according
to Department standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of section 9 of this contract,and 119.0701(3)and (4)F.S.,and any other applicable law, if a
civil action is commenced as contemplated by Section 119.0701(4). F.S.,and the Alliance and/or Department if Elder
Affairs is named in the civil action, Contractor agrees to indemnify and hold harmless the Alliance and/or Department for
any costs incurred by the Alliance and/or Department,and any attorneys'fees assessed or awarded against the Alliance
and/or Department from a Public Records Request made pursuant to Chapter It 9, F.S., concerning this contract or services
performed thereunder.
2. Section 119.0](3), F.S.,states if public funds are expended by an agency in payment of dues or membership contributions
for any person,corporation, foundation,trust,association,group,or other organization,all the financial, business,and
membership records of such an entity which pertain to the public agency(Florida Department of Elder Affairs)are
public records. Section 119.07, F.S,states that every person who has custody of such a public record shall permit the record
to be inspected and copied by any person desiring to do so, under reasonable circumstances.
The Contractor shall require that the language of this certification be included in all sub agreements,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 OMB Circulars A-
102 and 2 CFR Part 200 (formerly OMB Circular A-110).
By sign' below,Contractor certifies the representations outlined in parts A through I above are true and correct.
(Signa ure and Title of Authorized Representative)
, N1IOE COUAOVEONTY ATTonNEY
CFORMI
ontractor Da / ��c
PE0 O.I.
1 A ASS1 UNTY ATTORNEY
(Street Address) Date 6/14/21
A(Ci te,Zip code)
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FINANCIAL AND COMPLIANCE AUDIT ATTACHMENT III
The administration of resources awarded by the Alliance for Aging,Inc.to the Contractor may be subject to audits and/or monitoring
by the Alliance or the Florida Department of Elder Affairs, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S.. (see
"ALTDITS"below),monitoring procedures may include,but not be limited to,on-site visits by the Department of Elder Affairs and
Alliance staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this
agreement, the Contractor agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the
Alliance or the Department of Elder Affairs. In the event the Alliance for Aging, Inc. determines that a limited scope audit of the
Contractor is appropriate,the Contractor agrees to comply with any additional instructions provided by the Alliance for Aging, Inc,
to the Contractor regarding such audit. The Contractor further agrees to comply and cooperate with any inspections, reviews,
investigations, or audits deemed necessary by the Chief Financial Officer(CFO)or Auditor General.
AUDITS
PART 1: FEDERALLY FUNDED
This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in OMB Circular A-133,
as revised.
In the event that the Contractor expends$750,000 or more in federal awards during its fiscal year, the Contractor must have a single
Z, 9
or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. EXHIBIT I 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 Contractor shall consider all sources of federal awards,including federal
resources received from the Alliance or the Department of Elder Affairs. The determination of amounts of federal awards expended
should be in accordance with the guidelines established by OMB Circular A-13", as revised. An audit of the Contractor conducted
by the Auditor General in accordance with the provisions of OMB Circular A-]33,as revised,will meet the requirements of this part.
In connection with the audit requirements addressed in Part 1, paragraph 1, the Contractor shall fulfill the requirements relative to
aUditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
If the Contractor expends less than$750,000 in federal awards in its fiscal year,an audit conducted in accordance with the provisions
of OMB Circular A-133,as revised, is not required. In the event that the Contractor expends less than$750,000 in federal awards in
its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133,as revised,the cost of
the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from Conti-actor resources obtained from
other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to agreements with the Alliance for Aging,Inc.shall be based on the agreement's requirements,including any rules,
regulations,or statutes referenced in the agreement. The financial statements shall disclose whether or not the matching requirement
was met for each applicable agreement. All questioned costs and liabilities due to the Alliance for Aging.Inc.shall be fully disclosed
in the audit report with reference to the Alliance for Aging,Inc.agreement involved. Ifriototherwise disclosed as required by Section
3 10(b)(2)of OMB Circular A-133,as revised,the schedule ofexpenditures of federal awards shall identify expenditures by agreement
number for each agreement with the Alliance for Aging. Inc. in effect during the audit period. Financial reporting packages required
under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the
Contractor's fiscal year end.
Page 27 of 53
PART II: STATE FUNDED
This part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2),Florida Statutes.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of$750,000 in any fiscal year
of'such Contractor (for fiscal years ending September 30, 2004 or thereafter), the Contractor must have a State single or project-
specific audit for such fiscal year in accordance with Section 215.97,Florida Statutes;applicable rules of the Department of Financial
Services; and Chapters 10.550(local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance for Aging, Inc. by this
agreement. In determining the state financial assistance expended in its fiscal year,the Contractor shall consider all sources of state
financial assistance, including state financial assistance received from the Alliance for Aging, Inc., other state agencies, and other
non-state entities. State financial assistance does not include federal direct or pass-through awards and resources received by a non-
state entity for federal program matching requirements.
In connection with the audit requirements addressed in Part 1I, paragraph 1;the Contractor shall ensure that the audit complies with
the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by
Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations),Rules of the Auditor General.
If the Contractor expends less than$750,000 in state financial assistance in its fiscal year(for fiscal years ending September 30,2004
or thereafter),an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not required. In the event
that the Contractor expends less than$750,000 in state financial assistance in its fiscal year and elects to have an audit conducted in
accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the non-state entity's
resources(i.e.,the cost of such an audit must be paid from the Contractor resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to agreements with the Alliance for Aging, Inc. shall be based on the agreement's requirements, including any
applicable rules,regulations,or statutes. The financial statements shall disclose whether or not the matching requirement was met for
each applicable agreement. All questioned costs and liabilities due to the Alliance for Aging, Inc.shall be filly disclosed in the audit
report with reference to the Alliance for Aging, Inc. agreement involved. If not otherwise disclosed as required by Rule 69I-5.003,
Fla.Admin.Code,the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each
agreement with the Alliance for Aging, Inc. in effect during the audit period. Financial reporting packages required under this part
must be submitted within 45 days after delivery of the audit report,but no later than 12 months after the Contractor's fiscal year end
for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of
the audit report, but no later than 9 months after the Contractor's fiscal year end. Notwithstanding the applicability of this portion,
the Alliance and the Department of Elder Affairs retain all right and obligation to monitor and oversee the performance of this
agreement as outlined throughout this document and pursuant to law.
PART Ill: REPORT"SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of
this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the
Contractor directly;to each of the following:
The Alliance for Aging,Inc.at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107"Ave.Suite 214
Miami,FL.33172-3155
The Federal Audit Clearinghouse designated in OMB Circular A-1.33,as revised(the number of copies required by Sections .320(d)
(1)and(2),OMB Circular A-133,as revised,should be submitted to the Federal Audit Clearinghouse),at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10°i Street
Jeffersonville,IN 47132
Other federal agencies and pass-through entities in accordance with Sections.320(e)and(f),OMB Circular A-133,as revised.
Page 28 of 53
Pursuant to Sections .320(f),OMB Circular A-133,as revised,the Contractor shall submit a copy of the reporting package described
in Section .320(c),OMB Circular A-133,as revised,and any management letter issued by the auditor,to the Alliance for Aging,Inc.
at each of the following addresses:
Alliance for Aging,Inc.
Attn: Fiscal Monitor
760 NW 107"'Ave. Suite 214
Miami,FL.33172-31550
Additionally, copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or on behalf of the
Contractor directly to each of the following:
The Alliance for Aging, Inc.at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107"Ave.Suite 214
Miami, FL.33172-3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building,Room 574
111 West Madison Street
Tallahassee,Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Alliance for Aging, hic. pursuant to this
agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes, and Chapters 10,550 (local
governmental entities)or 10.650 (nonprofit and for-profit organizations),Rules of the Auditor General, as applicable.
Contractors,when submitting financial reporting packages to the Alliance for Aging, Inc. for audits done in accordance with OMB
Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the
Auditor General,should indicate the date that the reporting package was delivered to the Contractor in correspondence accompanying
the reporting package,
PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years
from the date the audit report is issued,and shall allow the Alliance for Aging,Inc.or its designee,the CFO or Auditor General Access
to such records upon request. The Contractor shall ensure that audit working papers are made available to the Alliance for Aging,
Inc.,or its designee,the Department or its designee,CFO,or Auditor General upon request for a period of six years from the date the
audit report is issued,unless extended in writing by the Alliance for Aging, Inc.
Page 29 of 53
ATTACHMENT 1II
EXHIBIT—1
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE
FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec,215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative Program General Revenue 65.002 $ 57.549.12
TOTAL AWARD $57,549.12
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
State Financial Assistance
Section 215.97 F.S.
Chapter 691-5 Fla.Administrative Code
Page 30 of 53
ATTACHMENT111
EXHIBIT-2
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133, as
revised, and/or Section 215,97, Fla. Stat. Contractors who are determined to be recipients or sub-recipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part 11
of Exhibit I is met. Contractors who have been determined to be vendors are not subject to the audit requirements of OMB Circular
A-]33,as revised,and/or Section 215.97,Fla. Stat. Regardless of whether the audit requirements are rnet,Contractors who have been
determined to be recipients or sub-recipients of federal awards and/or state financial assistance must comply with applicable
programmatic and fiscal compliance requirements.
In accordance with Sec.210 of OMB Circular A-I33 and/or Rule 691-5.006,FAC,Contractor has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A-133 and/or Section 215.97,F.S.
X Recipient/sub-recipient subject to OMB Circular A-133 and/or Section 215.97, F.S.
Exempt organization not subject to 2 CFR Part§200 and/or Section 215.97, F.S. For Federal awards,for-profit organizations
are exempt;for state financial assistance projects, public universities, community colleges,district school boards,branches
of state(Florida)government,and charter schools are exempt. Exempt organizations must comply with all compliance
requirements set forth within the contract or award document.
NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and or state financial assistance and has been
approved by the Department to subcontract,they must comply with Section 215.97(7), F.S.,and Rule 691-.006(2), FAC[state
financial assistance]and Section— .400 OMB Circular A-133 [federal awards].
PART 11: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive federal awards
or state matching funds on federal awards and who are determined to be a sub-recipient must comply with the following fiscal laws,
rules and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State,Local and Indian Tribal Governments(Formerly OMB Circular A-87)*
OMB Circular A-102—Administrative Requirements
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122—Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-1 10—Administrative Requirements)
Requirements)
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT)MUST FOLLOW:
2 CFR Pail 220 Cost Principles for Educational Institutions OMB(Formerly Circular A-21 —Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-I 10—Administrative Requirements)
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some federal Programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular
Page 31 of 53
............
A-133 Compliance Supplement,Appendix 1.
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient/sub-recipient must comply with the followingfiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691-5,Fla.Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
THE REST OF THIS PAGE WAS LEFT BLANK INTENTIONALLY
Page 32 of 53
ATTACHMENT VI
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response,including time for reviewing
instructions,searching existing data sources,gathering and maintaining the data needed and completing and reviewing the collection
of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043),
Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program.If you have questions,please contact
the awarding agency. Further,certain federal awarding agencies may require applicants to certify to additional
assurances. If such is the case,you will be notified.
1. Has the legal authority to apply for federal assistance,and the institutional, managerial,and financial capability(including
finds sufficient to pay the non-federal share of project cost)to ensure proper planning, management,and completion of the
project described in this application.
2. Will give the awarding agency,the Comptroller General of the United States,and if appropriate,the State,through any authorized
representative,access to and the right to examine all records,books,papers,or documents related to the award;and will establish
a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance
of personal or organizational conflict of interest,or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of tile 19 statutes or regulations specified in Appendix A ofOPM's Standards for a
Merit System of Personnel Administration(5 C.F.R.900,Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination.These include but are not limited to: (a)Title VI of the Civil
Rights Act of 1964(P.L. 88-352)which prohibits discrimination on the basis of race,color or national origin;(b)Title IX of the
Education Amendments of 1972,as amended(20 U.S.C. 1681-1683, and 1685-1686),which prohibits discrimination on the
basis of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C. 794),which prohibits discrimination on
the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 1972 (P.L.92-255),as amended, relating to
nondiscrimination on the basis of drug abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970(RL.91-616),as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
(g) _ 523 and 527 of the Public Health Service Act of 1912(42 U.S.C. 290 dd-3 and 290 ee 3), as amended,relating to
confidentiality of alcohol and drug abuse patient records; (h) Title Vill of the Civil Rights Act of 1968 (42 U.S.C. 3601 et
seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination
provisions in the specific statute(s)under which application for federal assistance is being made; and (j)the requirements of any
other nondiscrimination statute(s)which may apply to the application.
7. Will comply,or has already complied, with the requirements of"Titles II and III of the uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970(P.L. 91-646)which provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328), which limit the
political activities of employees whose principal employment activities are funded in whole or in part with federal funds.
9. Will comply,as applicable, with the provisions of the Davis-Bacon Act(40 U.S.C. 276a to 276a-7), the Copeland Act (40
U.S.C.276c and 18 U.S.C. 874)and the Contract Work Hours and Safety Standards Act(40 U.S.C. 327-333),regarding
labor standards for federally assisted construction sub-agreements.
Page 33 of 53
10. Will comply, if applicable,with flood insurance purchase requirements of Section 102(a)of the Flood Disaster Protection Act of
1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and acquisition is$10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a)institution of environmental
quality control measures under the National Environmental Policy Act of 1969(P.L. 91-190)and Executive Order(EO) 11514;
(b)notification of violating facilities pursuant to EO 1 1738; (c)protection of wetlands pursuant to EO 11990; (d) evaluation of
flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Lone Management Act of 1972 (16 U.S.C. 1451 et seq.);(f)conformity
of federal actions to State(Clear Air)Implementation Plans under Section 176(c)of the Clear Air Act of 1955,as amended (42
U.S.C. 7401 et seq.); (g)protection of underground sources of drinking water under the Safe Drinking Water Act of 1974,
as amended,(P.L. 93-523);and (h) protection of endangered species under the Endangered Species Act of 1973, as amended,
(P.L. 93-205),
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components or
potential components ofthe national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470),EO 11593 (identification and protection of historic properties),and the Archaeological and Historic
Preservation Act of 1974(16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L.93-348 regarding the protection of human subjects involved in research,development.and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.)pertaining
to the care, handling, and treatment of warm-blooded animals held for research, teaching, or other activities supported by this
award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C. 4801 et seq.), which prohibits the use of lead-
based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments
of 1996 and OMB Circular No. A-]33, Audits of States, Local Governments,and Non-Profit Organizations.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE,
du"Jo_�� t ® J
APPLICANT ORGANIZATION DATE SUBMITTED
Monroe County Board of County Commissioners, Social ( l
ServiceS�n-Home Services u
NROE COUNTY ATTORNEY
APROVE S FORM
PED b J.MERA8,,8T UNTY ATTORNEY
Dat, 6/14/21
Page 34 of 53
ATTACHMENT V11
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
The Alliance shall make payment to the Contractor for provision of services Lip to a maximum number of units of service and at the
rate(s)stated below:
Maximum
Service Unit Units of Maximum
Service to be Provided Rate Service Dollars
Case Managemnet 60.73 19 1,150.98
Case Aide 15.00 3 50.67'
Caregiver Training Ind - 0.00
Respite Facility 10.96 3,759 41,193.51
Respite In-Home 24-22 — 462 11,185.63
Specialized Medical
Equipment Cost Reimb. - 2,000.00
Shopping Assistance 30.90 34 1,043.78
Telephone Reassurance 27.37 34 924.54
Total 57,549.12
Page 35 of 53
...................
ATTACHMENT VilI
ALZHEIMER'S DISEASE INITIATIVE
INVOICE REPORT SCHEDULE
Report Number Based On Submit to Alliance on
this Date
I July Advance* July 1
2 August Advance* July 1
3 July Expenditure Report August 10
4 August Expenditure Report September 10
5 September Expenditure Report+ 1/10 advance reconciliation October 10
6 October Expenditure Report+ 1/10 advance reconciliation November 10
7 November Expenditure Report+ 1/10 advance reconciliation December 10
8 December Expenditure Report+ 1/10 advance reconciliation January 10
9 January Expenditure Report+ 1/10 advance reconciliation February 10
10 February Expenditure Report F 1/10 advance reconciliation March 10
11 March Expenditure Report+ 1/10 advance reconciliation April 10
12 April Expenditure Report+ 1/10 advance reconciliation May 10
13 May Expenditure Report+ 1/10 advance reconciliation June 10
14 June Expenditure Report-+- 1/10 advance reconciliation July 10
15 Final Expenditure and closeout July 31
Legend: Advance based on projected cash need.
Note 1: All advance payments made to the Contractor shall be returned to the Alliance as follows:
One-tenth of the advance payment received shall be reported as an advance recoupment on each Request
for Payment, starting with report #5. The adjustment shall be recorded in Part C, Line 1 of the report
(Attachment IX).
Note 2: Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the Alliance,payment is to accompany the report.
Page 36 of 53
ATTACHMENT IX
REQUEST FOR PAYMENT
Form 106
ADI
Provider Name,Address,Phone# Type Of Report
Contract#:
Provider Advance
Address
Contract Perod
Telephone Reimbursement Report Period
REPORT#:
CERTIFICATION:I hereby certify that this request or refund conforms with the terms of the above contract.
Prepared By: Date Approved By: Date:
BUDW tiUMMARY ADI TOTAL
Approved Contract Amount 0.00
0.00
Previous Month YTD Billed 0.00 000
Prior Month Ending Contract Balance 0.00 0-00
Current Month Amount Billed 000 0.00
Less CurrentMonthAdvPayback 0.00 0.00
Contracted Funds Requested for Month 0.00 0-00
CO-PAYMENTS CURRENT MONTH CONTRACTYTD Prior Mo.YTD
1.Numberofpersons assessed Co-payments
Z Num bar of persons trem inated for non-payment _
3.Number of persons waived from termin.for non-payment
A.Number of persons waived from assess ment
5.Num ber of persons exam pt from co-pay u
6.Total amount ofco-pay assessed $ -
7.Total Amount of Co-pay collected S _
8.Total amouhntofco-payexpended $ _
PSA#11 ADI Forms,Revised December 2020
Page 37 of 53
Attachment X
RECEIPTS&UNIT COST REPORT
Form 105
ADI
PROVIDER NAME.ADDRESS PHONE# FUNDIN OURCE THIS REPORT PERIOD:
0 ADI contract#: 0
Contract Period 0
0
Report Period 0
REPORT#: 0
CERTIFICATION: I certifyto the best of my knowledge and beliefthatthis reportis complete and correctand all outlays herein are for purposes seiforth in
the contract Further,I cerrfythai the attached monthly and YTD seance units/unduplicated clients'reporl is correct.
Prepared by: Date: Approved by: Date:
INCOME/RECEIPTS A. Approved Budget B. Actual Total Billing C. Total Billing D. I ofApprovec
for this report Year to Date Budget PriorMo.Recei tsYTD
State Funds $ - $ - $ - I #DIV/01
Prooram Income $
Cash Match $
SUBTOTAL: Cash Receipts $ y. $
Local In-Kind match $0.00 $ #DIV/0'
TOTAL RECEIPTS $0.00 $ $ #DIV/0!
Billable Unit Cost Rep A Unduplicated Clients Served
(A) (B) (C) (D) (E) (F) (G) (A) (B)
SeNces Contract Billable Unit Rate Amount Earned Y-T-D Y-T-D Current Month Y-T-D
Amount Units This Period Billable Billable Undup Clients Undup Clients
Units Cost Sened Sered
Prior YTO units Prior YTD$
$ $
$ $
$ $
$ $
$ $
$ $
Total Is $ $
PSA#11 ADI Farrre.Revised October 2019
Page 38 of 53
ATTACHMENT A
Title; Department of Elder Affairs Programs&Services Handbook
Department of Elder Affairs Programs& Services Handbook
11"I Y ww Ma (see Contractors/Program Documents)or
"f�.�_�_���ta; k {�> nok, ' 1(notices of instructions)
Page 39 of 53
ATTACHMENT F
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH NVILL HELP YOU COMPLETE THIS
FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided: e- P F(041101or
�g 2. POPULATION OF AREA SERVED. Source of data: �" ,�' '� '� P
Total# '%White '%Black %Hispanic "/o Other %Female
3. S AFF CURRENTLY EMPLOYED. Effective date:
"'total# %White V.Black %Hispanic %�her %�e Ic %Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total 4 %,qluie %Black %Hispanic %Other %Female %Disabled %Over 40
Q 0 (OCD
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total %White %Black %Hispanic %Other %Female %Disabled
0 d
PART 11: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOER? If N/A or NO,explain. N/A YES NO
❑ X ❑
7. Compare the staff composition to the population. Is staff representative of the population?
If N/A or NO, explain. N/A YES NO
❑ X ❑
8. Compare the client composition to the population. Are race and sex characteristics representative
of the population? If N/A or NO,explain. N/A YES NO
9. Are eligibility requirements for services applied to clients and applicants without regard to race,
color,
national origin,sex,age,religion or disability? If N/A or NO,explain. N/A YE NO
❑ ❑
10. Are all benefits,services and facilities available to applicants and participants in an equally effective
manner regardless of race, sex, color, age, national origin, religion or disability? If N/A or NO,
explain. N/A YES NO
❑ ❑
11. For in-patient services, are room assignments made without regard to race,color,national origin
or disability? If N/A or NO,explain. N/A YES NO
❑ g ❑
Page 40 of 53
12. Is the program/facility accessible to non-English speaking clients? If N/A or NO,explain. N/A ES NO
❑ ❑
13. Are employees, applicants and participants informed of their protection against discrimination? If
YES,how? Verbal fK Written®Poster 16 If N/A or NO,explain. N/A YES NO
❑ ❑
14. Give the number and current status of any discrimination complaints regarding services or
employment filed against the program/facility. N/A NUM 4 ER
15. Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? If
N/A or NO,explain. N/A YES NO
❑ X ❑
PART III:TILE F OLLOIVIN(>QUESTIONS APPI-N TO PROGRAYIS AND FACILFTIES WITH 15 OR MORE EMPLOYEES.
16. Has a self-evaluation been conducted to identify any barriers to serving disabled individuals, and to
make any necessary modifications? If NO,explain. YES NO
17. Is there an established grievance procedure that incorporates due process in the resolution of
complaints? If NO,explain. YES NO
X ❑
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain. YES NO
D
19. Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination on the basis of disability? If NO,explain. YES NO
PSI
20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired
individuals? If NO,explain. S NO
PART IV: FOR PROGRAMS OR FACILITIES 1v1TH 511 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF S50,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO,explain. YES NO
Reviewed By7
In Compliance: YES ❑ NO* ❑
Program Office *Notice of Corrective Action Sent
Date Telephone Response Due ! /
On-Site ❑ Desk Review ❑ Response Received l !_
Page 41 of 53
Revised August 2010_Page 2 of 2
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county,city or other locality. If the program/facility serves
a specific target population such as adolescents, describe the target population. Also, define the type of service
provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city,county or other regional area. Population statistics
can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing
Florida population statistics. Include the source of your population statistics. (`'Other"races include Asian/Pacific
Islanders and American Indian/Alaskan Datives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled,registered or currently served by the program or facility,and list
their percent by race,sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOER recipients and their sub-grantees,45 CFR 80.4(a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
population is Hispanic, is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race,sex or ethnic composition ofthe clients and their availability
in the population,the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Same legitimate disparities may exist when
programs are sanctioned to serve target populations such as elderly or disabled persons,45 CFR 80.3 (b)(6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on-site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a)
and 45 CFR 80.1 (b)(2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies,counseling and social services without regard to race,sex,color,national origin,
religion,age or disability. Courtesy titles,appointment scheduling and accuracy of record keeping must be applied
uniformly and without regard to race, sex, color. national origin, religion, age or disability. Entrances, waiting
rooms,reception areas,restrooms and other facilities must also be equally available to all clients,45 CFR 80.3(b).
1.1. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race,color,national origin,or disability,45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants,including those persons who
may not speak English. In geographic areas where a significant population of non-English speaking people live,
program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy
or plan for service,such as a current list of names and telephone numbers of bilingual individuals who will assist in
the provision of services,45 CFR 80.3 (a).
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13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries or any other interested parties. This should include information on their right to file a
complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS.
The information may be supplied verbally or in writing to every individual, or may be supplied through the use of
an equal opportunity policy poster displayed in a public area of the facility,45 CFR 80.6(d).
14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color,
creed,sex,age,national origin,disability, retaliation;the issues involved,e.g.,services or employment,placement,
termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and
address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status,
e.g.,settled, no reasonable cause found, failure to conciliate,failure to cooperate, tinder review, etc.
15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas,curb cuts or level approaches,ramps and adequate widths to entrances. The lobby, public
telephone, restroorn facilities, water fountains, information and admissions offices should be accessible. Door
widths and traffic areas of administrative offices,cafeterias,restrooms,recreation areas,counters and serving lines
should be observed for accessibility. Elevators should be observed for door width,and Braille or raised numbers.
Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an
appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-
evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
a. With the assistance of a disabled individual/organization, evaluate Current practices and policies which do not
comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have
been followed.),45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate
due process standards and provide for the prompt and equitable resolution of complaints alleging any action
prohibited by Section 504.45 CFR 84.7(b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7(a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads,and other appropriate written communication,45 CFR 84.8(a).
20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired
sensory, manual or speaking skills where necessary. Auxiliary aids may include,but are not limited to, interpreters
for hearing impaired individuals,taped or Braille materials,or any alternative resources that can be used to provide
equally effective services, 45 CFR 84.52 (d).
21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and
maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60
and Title VI of the Civil Rights Act of 1964,as amended.
DOEA Form 101-B,Revised August 2010
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ATTACHMENT C
REFERRAL PROTOCOL
Issue: Screening,Triage,and Referral for Activation under the Alzheimer's Disease Initiative(ADI)Program.
Policy: Referrals will be made based on availability of funds, in accordance with prioritization requirements.
Purpose: To ensure funding is spent expeditiously and consumers are given a choice of case management agencies,to
the extent possible.
Procedure:
1. Roles and Responsibilities
A. Alliance for Aging/Aging and Disability Resource Center
• Reconciles overall program and AD[ Agency specific spending levels on a monthly basis to ensure the ADI
Agency is operating within the funding allocations.
• Screens consumers to link with appropriate resources and prioritize for DOEA-funded programs and services.
• Releases cases for activation based upon Adi Agency Requests.
• Releases cases from the waiting list based on their prioritization score.
• Monitors compliance with service standards and outcome measures.
• Reviews files per the File Review Policies and Procedures.
• Reviews data in CIRTS.
B. ADI Agency
• Requests and Aging accepts referrals from the Agi and Disability Resource Center, to serve an optimal caseload and
P t�
to avoid surpluses or deficits in accordance with the Alliance Surplus/Deficit Analysis policy.
• Refers inquiries from consumers interested in services to the ADRC for Information and Referral to community
resources., Screening,Triage,and Long-Term Care Options Counseling,as appropriate.
• Completes comprehensive assessments on new consumers and annual reassessment on existing Consumers and
develops care plans and reviews care plans semi-annually.
• Authorizes service delivery and enters data into CIRTS.
• Bills in CIRTS as appropriate.
• Monitors care plans in an effort to keep costs down while sustaining the individuals in the community.
11. Management of the Assessed Prioritized Consumer List(APCL).
A. As clients are referred to the ADRC,clients are provided information on community resources and programs available
including private pay options. Persons are directed to those resources most capable of meeting the need they have
expressed to ADRC staff, Cases presenting strong identifiers that indicate the consumer might benefit from publicly
funded long-term care services are screened,entered into CIRTS,triaged and provided options counseling.
1. Consumers applying for the Alzheimer's Disease Initiative(ADI)program will be contacted by Intake Unit staff
and screened using the statewide assessment form developed by the Department of Elder Affairs for this purpose
(Form 701 S). The 701 S will determine their ranking on the appropriate waiting list(s) APCL status, .
2. The ADRC will reassess consumers oil the waiting lists according to the 2018 Department of Elder Affairs
Programs and Services Handbook,or any revisions made thereafter.
B. HIPAA forms will be sent to the consumer as appropriate.
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111. Opening New Cases
A. ADI Clients
I. The Alliance Fiscal Department will monitor ADI Agency specific spending levels on a monthly basis to ensure
each ADI Agency is operating within its-spending authority. In addition,the Alliance will analyze surplus/deficit
projections, and share the information with the ADI Agency to assist in their determination of slot availability.
The ADI Agency will request referrals directly from the ADRC. The Fiscal Department will be notified of the
number of new cases being referred to the ADI Agency for activation.
2. Upon receipt of tile request for referrals from the ADI Agency, the ADRC Intake Unit Supervisor will run the
Prioritized Risk Report to identify the consumers on the APCL to be opened.
3. In response to the request for referrals,the ADRC Intake Unit Supervisor will refer wait listed clients to the ADI
Agency for activation, in accordance with prioritization requirements. The Intake Unit will update the wait list
enrollment using the appropriate code to terminate from the APCL.,for release to the ADI Agency(TAEIJ
4, L'-pon receipt of the list of clients released from the waiting list,the ADI Agency will enter the APPL enrollment,
contact clients to offer program enrollment, and proceed with the process for activation. The ADI Agency will
enter subsequent enrollments into CIRTS to reflect client status.
5. The Alliance will oversee the enrollment process to ensure referrals have timely Outcomes in CIRTS.
6. Choice(for Miami-Dade County only): In the event that unallocated funds become available at the Alliance to
allow for new client enrollments into ADI,the ADRC will contact consumers from the waiting list to offer choice
of ADI Agency. If the client is no longer interested in receiving services,the appropriate wait list enrollment(s)
will be closed and the next client on the list will be contacted.
a. Intake Unit Specialists will contact the client to obtain choice of Provider.The client referral will then be sent
to the AD] Agency selected by the client.
b. If after two attempts by phone the Intake Unit staff is unable to reach the consumer,the client will be assigned
for release to an agency on a rotation basis.
c. Upon receipt of referral, the ADI Agency will enter the APPL enrollment, and subsequent enrollments to
reflect client status. Contract amendments will follow in accordance with the number of clients referred for
activation.
B. Statewide Medicaid Managed Care Long Term Care Program Clients
I. The Department of Elder Affairs will run the statewide APCL(Assessed Priority Consumer List)report to review
clients wait listed for the SMMCLTCP program. DOEA will provide the ADRC with a list of individuals
authorized for release from the APCL.
2. For clients identified as active in ADI and authorized for release from the SMMCLTCP waiting list,the ADRC
will be responsible for the SMMCLTCP application process. For ADI active clients, the ADRC will notify the
ADI Agency in order to waive the ADI co-pay.
IV. Clients Changing ADI Agencies
A. Frequency of Changes
I. Consumers may change ADI Agencies on a monthly basis if they so choose.
2. Consumers will need to request a change of ADI Agency by the first(I't)of the month in order for the change to
be in effect by the 161"of that same month.
3. If the request is made after the first of the month,the change will take effect by the 16"of the following month.
B. Process for Changes
1. Requests to change case management agency must come from the client or their personal representative to the
ADRC/Elder Helpline. Requests made by a case management agency will not be honored.
2. When requesting a change, the consumer will be asked by the ADRC staff person to share his/her reasons for
doing so; if they spoke with their case management agency about their concerns;and if they would like to speak
with someone else at that agency.
3. If the consumer chooses to call the agency, nothing will be done until the consumer calls the ADRC back
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requesting a change.
4. If the consumer does not want to speak with the ADI Agency and wants to change, the ADRC will initiate the
transfer process.A verbal choice will be accepted and documented in the REFER database.
5. The ADRC/Intake Unit will send a Transfer Form to the selected ADI Agency and to the current ADI Agency.
Both ADI Agencies will work closely with the ADRC to ensure the transfer process is completed by the 15'of
the month,as long as the transfer request was received at the ADRC by the first of that same month.
6. The ADRC Intake Unit will change the owner provider record in CIRTS to the new ADI Agency.
7. The current ADI Agency will terminate enrollment in CIRTS as of the 1511, of the month when the transfer is to
take place. The new ADI Agency will activate enrollment in CIRTS as of the 16"of the month when the transfer
is to take place,
S. Each ADI Agency will notify its respective vendors of the termination and/or activation of services for the
transferred client as appropriate.
9. Services will start on the 16"'of the month when the change becomes effective.
Note: These ADRC policies and procedures are subject to change. Any modifications will be done through a contract
amendment.
Page 46 of 53
ATTACHMENT E
Alliance for Aging,Inc.
Business Associate Agreement
This Agreement, made as by and between Alliance for Aging, Inc. ("Covered Entity"), a Florida corporation, and Monroe
County Board of County Commissioners,Social Services/In-home Services.(Business Associate).
WHEREAS, the Alliance for Aging, Inc. is a Covered Entity as defined in the Privacy Rule adopted pursuant to the Health
Insurance Portability and Accountability Act of 1996(HIPAA Privacy Rules).
WHEREAS, the Business Associate has been retained by the Covered Entity to perform a function, activity, or service on
behalf of Covered Entity that requires the Business Associate have access to Protected Health Information(PHI).
WI IEREAS,Covered Entity desires to receive satisfactory assurances from the Business Associate that it will comply with the
obligations required of business associates by the Privacy Rule,the Security Rule Health Information Technology for Economic
and Clinical.Health Act(HITECH),the Final Rules and any rules or guidance issued by the Secretary from time to time with
respect to such security,privacy, use and disclosure requirements.
WHEREAS, the parties wish to set forth their understandings with regard to the use and disclosure of Pill by the Business
Associate in performance of its obligations.
NOW,'THEREFORE, in consideration of the foregoing,the parties hereby agree as follows:
Section 1. Definitions.
(a) Breach shall mean the acquisition, access, use or disclosure of protected health information in a manner not permitted
under the HIPAA Privacy Rule which compromises the security or privacy of the protected health information. For
purposes of this definition, "compromises the security or privacy of the protected health information" means poses a
significant risk of financial,reputational,or other harm to the individual.
(b) HITECH shall mean Title XIII of the American Recovery and Reinvestment Act of 2009 (ARRA), called the Health
Information Technology for Economic and Clinical Health (HITECH) Act, codifies and expands on many of the
requirements promulgated by the Department of Health & Human Services (DHHS) pursuant to the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) to protect the privacy and security of protected health information
(PHI).
(c) Individual means the person who is the subject of protected health information 45 CFR 160.103 and shall include a person
who qualifies as a personal representative in accordance with 45 CFR 164.502(g).
(d) Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and
part 164,subparts A and E.
(e) Protected Health Information or"PHI"shall have the same meaning as the term"protected health information"in 45 CFR
164.501, limited to the information created or received by Business Associate from or on behalf of Covered Entity.
(f) Required by L,aw shall have the same meaning as the term"required by law"in 45 CFR 164.103.
(g) Secretary shall mean the Secretary of the Department of Health and Human Services or his designee.
(h) Security Incident means the attempted or successful unauthorized access, use, disclosure, modification or destruction of
electronic PHI relating to the Covered Entity.
(i) Security Rule shall mean the Health Insurance Reform: Security Standards at 45 CFR Parts 160, 162 and 164.
0) Underlying Agreement shall mean the services agreement executed by the Covered Entity and Business Associate, if any.
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(k) Unsecured Pill means PHI that is not rendered unusable,unreadable or indecipherable to unauthorized individuals through
the use of technology or methodology specified by the Secretary in the guidance issued under Section 13402 of Public
Law 111-5 on the HHS website(45 CFR 164A02).
Section 2. Obligations and Activities of Business Associate
(a) Business Associate agrees to not use or disclose PHI other than as permitted or required by this Agreement or as Required
by Law.
(b) Business Associate agrees to use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to
electronic PHI,to prevent use or disclosure of PHI other than provided for by this Agreement.
(c) Business Associate agrees to mitigate,to the extent practicable,any harmful effect that is known to Business Associate as
a result of a use or disclosure of PHI by Business Associate in violation of this Agreement.
(d) Business Associate agrees to comply with the Security Rules, as required by HITECH, in a manner consistent with the
Rule and regulations that may be adopted by relevant federal agencies, to keep all electronic PHI in a secure manner, as
required under federal law.
(e) Business Associate agrees to report to Covered Entity any use or disclosure of PHI not provided for by this Agreement of
which it becomes aware, including breaches of unsecured PHI as required at 45 CFR 164.410, and any Security Incident
of which it becomes aware.See"Reporting"contained in this Agreement.
(1) Business Associate agrees, in accordance with 45 CFR 164.502(e)(1)(ii)and 164.308(b)(2), if applicable,to require that
any Subcontractors that create, receive, maintain or transmit PHI on behalf of the Business Associate agree to the same
restrictions,conditions,and requirements that apply to the Business Associate with respect to such information.
(g) Business Associate agrees to make available, in the time and manner designated by Covered Entity,PHI in a Designated
Record Set,to Covered Entity or,as directed by Covered Entity,to an Individual,as necessary to satisfy Covered Entity's
requirements under 45 CFR 164.524,
(h) Business Associate agrees to comply with an individual's request to restrict the disclosure of their personal PHI in a manner
consistent with 45 C.F.R. 164.522,except where Such use,disclosure or request is required or permitted under applicable
law.
(i) Business Associate agrees that when requesting,using or disclosing PI-II in accordance with 45 C.F.R.502(b)(1)that such
request,use or disclosure shall be to the minimum extent necessary,including the use of a"limited data set"as defined in
45 C.F.R. 164.5 14(e)(2)to accomplish the intended purpose of such request,use or disclosure as interpreted under related
guidance issued by the Secretary from time to time.
(j) 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, and in the time and manner
designated by Covered Entity or take other measures as necessary to satisfy covered entity's obligations under 45 C.F.R.
164.526.
(k) Business Associate agrees to make internal practices,books,and records including policies and procedures relating to the
use and disclosure of PI-11 received from, or created or received by Business Associate on behalf of, Covered Entity
available to the Covered Entity,or at the request of the Covered Entity to the Secretary,in a time and manner designated
by Covered Entity for purposes of the Secretary determining Covered Entity's compliance with the HIPAA Rules.
(1) Business Associate agrees to document such disclosures of PHI and information related to such disclosures as would be
required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance
with 45 CFR 164.528.
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(m) Business Associate agrees to provide to Covered Entity or an Individual,in time and manner designated by Covered Entity,
information collected in accordance with this agreement,to permit Covered Entity to respond to a request by an Individual
for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.
(n) Business Associate hereby acknowledges and agrees that Covered Entity has notified Business Associate that it is required
to comply with the confidentiality,disclosure,breach notification,compliance,and re-disclosure requirements of HITECH,
Privacy Rule and the Security Rule to the extent such requirements may be applicable.
(o) Business Associate acknowledges that if it becomes aware of a"pattern of activity or practice"by Covered Entity,or any
other Business Associate,that breaches a Business Associate Agreement, but fails to cure that breach, Business Associate
shall immediately terminate the relevant agreement, or report the non-compliance to the United States Department of
Health and Human Services' Office of Civil Rights.
(p) Business Associate acknowledges that it is subject to compliance audits by the United States Department of Health and
Human Services' Office of Civil Rights.
(q) Business Associate shall comply with any and all regulatory requirements which may arise in the future to comply fully
with the Privacy Rules, the Security Rule, ARRA,and HITECH, including, but not limited to, restrictions on disclosures
to health plans,clarified minimum necessary standards,expanded accounting requirements applicable to electronic health
records,revised prohibitions on sales of PHI,and updated marketing and fundraising restrictions. Business Associate shall
require that any agent, including a subcontractor,shall also comply with the requirements set forth herein.
(r) Business Associate acknowledges that,pursuant to HITECH, Business Associate, its employees and contractors, and any
third party (and their employees, contractors, and further third parties) who may have access to or possession of the
Covered Entity's PHI, are subject to regulatory oversight of the various federal and/or state agencies as a Business
Associate,and may be subject to both civil and criminal penalties which may arise from violations of this Agreement,the
Privacy Rules, the Security Rule, HITECH, and any rules or guidance issued by the Secretary- from time to time with
respect to such use and disclosure requirements.
(s) Business Associate agrees to provide the Covered Entity with notice of a Breach of Unsecured PHI pursuant to the
requirements of 45 CFR 164.402. See"Reporting"contained in this Agreement.
(t) To the extent that Business Associate is to carry out one or more of Covered Entity's obligation(s)under Subpart E of 45
C.F.R. Part 154,Business Associate agrees to comply with the requirements of Subpart E that apply to the Covered Entity
in the performance of such obligation(s).
(u) Business Associate agrees to comply with the "Prohibition on Sale of Electronic Health Records or Protected Health
Information,"as provided in section 13405(d)of Subtitle D(Privacy)of ARRA,and the"Conditions on Certain Contacts
as Part of Health Care Operations,"as provided in section 13406 of Subtitle D(Privacy)of ARRA and related guidance
issued by the Secretary from time to time.
Section 3 Permitted Uses and Disclosures by Business Associate
(a) Except as otherwise limited in this Agreement,Business Associate may use and/or disclose PHI only in a manner that is
necessary to perform functions, activities, or services for, or on behalf of, Covered Entity as specified in the Underlying
Agreement, provided that such use or disclosure would not violate Subpart E of 45 C.F.R. Part 164 if done by Covered
Entity.
(b) Business Associate may use or disclose PHI as required by law.
(c) Business Associate agrees to make uses and disclosures and requests for PHI consistent with Covered Entity's minimum
necessary policies and procedures.
(d) Except as otherwise limited in this 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.
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(e) Except as otherwise limited in this 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(s) 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.
Section 4. Re op rtino
As described below, Business Associate shall report to the Covered Entity in writing (a) any use or disclosure of PHI not
permitted under 45 CFR section 164, Subpart E, this Agreement, or by law, (b) any Security Incident of which it becomes
aware and(c)any Breach of Unsecured PHI in accordance with HITECH,including 42 U.S.C.A. section 17932.
(a) Reporting Security Incidents or Improper Uses or Disclosures. Business Associate shall make the report to the Covered
Entity within 3 business days after Business Associate learns of such unauthorized use or disclosure or Security Incident.
Business Associate's report shall: (1) identify the nature of the unauthorized use or disclosure or Security Incident
including the date of the Security Incident or unauthorized use or disclosure and date of discovery; (2) identify the PHI
affected; (3) identify who made or caused the unauthorized use and/or received the unauthorized disclosure and/or
participated in the Security Incident, if known; (4) identify what Business Associate has done or shall do to mitigate any
deleterious effect of the Breach, unauthorized use or disclosure or Security Incident; (5) identify what corrective action
Business Associate has taken or shall take to prevent future similar unauthorized use or disclosure or Security Incident;
and (6) provide such other information, including a written report, as reasonably requested by the Covered Entity. Any
Security incident or unauthorized use or disclosure of PHI that is a Breach of Unsecured PHI shall be reported as required
under subsection(b)below_
(b) Notification of a Breach. Pursuant to HITECH,including 42 U.S.C.A.section 17932..and regulations under 45 CFR Parts
160 and 164, as amended, Business Associate shall provide written notice to the Covered Entity of any Breach of
Unsecured PHI within 3 business days after Business Associate discovers the Breach. Business Associate shall conduct
the risk assessment to determine whether a Breach occurred. Business Associate's report to the Covered Entity shall
identify or describe:(I)the affected Individual(s)whose Unsecured PHI has been or is reasonably believed to have been
accessed, acquired or disclosed; (2) the incident, including the date of the Breach and the date of the discovery of the
Breach, if known; (3)who made or caused the Breach/unauthorized use and/or received the unauthorized disclosure; (4')
the types of Unsecured PHI involved in the Breach; (5)any specific steps the Individual(s)should take to protect him or
herself from potential harm related to the Breach; (6) what the Business Associate is doing to investigate the Breach, to
mitigate losses and to protect against further Breaches;(7)contact procedures for how the Individuals)can obtain further
information from Business Associate; and(8)such other information, including the risk assessment analysis prepared by
Business Associate,as reasonably requested by the Covered Entity.
Section 5. Obligations of Covered Entity
(a) Covered Entity shall provide Business Associate with the notice of privacy practices that Covered Entity produces in
accordance with 45 CFR 164.520,as well as any changes to such notice,to the extent that such changes or limitations may
affect Business Associate's use or disclosure of PHI.
(b) Covered Entity shall provide Business Associate with any changes in,or revocation of,permission by Individual to use or
disclose PHI, if such changes affect Business Associate's permitted or required uses and disclosures under this Agreement.
(c) Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has
agreed to or is required to abide by in accordance with 45 CFR 164.522 to the extent that such restriction may affect
Business Associate's use or disclosure of PHI under this Agreement.
(d) With respect to any Breach, the Covered Entity shall notify each individual whose Unsecured PHI has been, or is
reasonably believed by the Covered Entity to have been accessed, acquired, used or disclosed as a result of such breach,
except when law enforcement requires a delay pursuant to 45 CFR 164.412:
1. Without unreasonable delay and in no case later than 60 days after discovery of a breach.
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2. By notice in plain language including and to the extent possible: a brief description of what happened, including the
date of the Breach and the date of the discovery of the Breach, if known; a description of the types of Unsecured PHI
that were involved in the breach;any steps Individual(s)should take to protect themselves from potential harm resulting
from the breach; a brief description of what the Covered Entity involved is doing to investigate the Breach, mitigate
the harm to Individual(s), and to protect against any further Breaches, and, contact procedures for Individual(s)to ask
questions or learn additional information which shall include a toll-free telephone number,an e-mail address,web site
or postal address.
�. Use a method of notification that meets the requirements of 45 CFR 164.404(d).
4. Provide notice to the media when required under 45 CFR 164.405 and to the Secretary pursuant to 45 CFR 164AW
Section 6.Permissible Requests by Covered Entity
Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under
the Privacy& Security Rule if done by Covered Entity.
Section 7. Tenn and Termination
(a) Term. The Term of this Agreement shall be effective as of and shall terminate when all of the PHI
provided by Covered Entity to Business Associate or created or received y An Associate on behalf of Covered Entity,
is destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy PHI, protections are extended to such
information,in accordance with the termination provisions in this Section.
(b)Termination for Cause.Upon Covered Entity's knowledge of a material breach by Business Associate,Covered Entity shall
either (1) provide an opportunity for Business Associate to cure the breach and then terminate the Underlying Agreement if
Business Associate does not cure the breach within time period specified by the Covered Entity or(2)terminate the Underlying
Agreement immediately. If neither termination nor cure is feasible,Covered Entity shall report the violation to the Secretary.
(c) Effect of Termination. (I) Except as provided in paragraph (2)of this section, upon termination of this Agreement or the
Underlying Agreement for any reason, Business Associate shall return or destroy all PHI received from Covered Entity, or
created or received by Business Associate on behalf of Covered Entity. This provision shall apply to PHI that is in the
possession of subcontractors or agents of Business Associate.Business Associate and subcontractors shall retain no copies of
the PHI. (2) In the event that Business Associate determines that returning or destroying the PHI is infeasible Business
Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible.Upon mutual
agreement of the Parties,that return or destruction of PHI is infeasible, Business Associate shall extend the protections of this
Agreement to such PHI and limit further uses and disclosures Of Such PI-I1 to those purposes that make the return or destruction
infeasible,for so long as Business Associate maintains such PHI.
Section $. Miscellaneous
(a) Re,pulatory References. A reference in this Agreement to a section in the Privacy& Security Rule means the section as is
currently effect or as may be amended from time to time, and for which compliance is required.
(b) Indemnification. Business Associate shall release, defend, indemnify and hold Covered Entity harmless from and against
any claims,fees,losses,and costs,including,without limitation,reasonable attorneys' fees and costs,that Covered Entity
may sustain as a result of, or arising out of (i) a breach of this Agreement by Business Associate or its agents or
Subcontractors, including,but not limited to,anv unauthorized use,disclosure or breach of PHI,(b)Business Associate or
its subcontractor's failure to notify any and all parties required to receive notification of any Breach of Unsecured PHI or
(c)any negligence or wrongful acts or omissions by Business Associate or its agents or Subcontractors,including without
limitation,failure to perform Business Associate's obligations under this Agreement,the Privacy Rule or the Security Rule
or any other applicable law or rule.
(G) Remedies. The parties acknowledge that breach of this Agreement may cause irreparable harm for which there is no
adequate remedy at law. In the event of a breach, or if Covered Entity has actual notice of an intended breach, Covered
Entity shall be entitled to a remedy of specific performance and/or injunction refraining Business Associate from violating
or further violating this Agreement. The parties agree the election of the Covered Entity to seek injunctive relief and or
specific performance of this Agreement does not foreclose or have any effect on any right the Covered Entity may have to
recover damages.
Page 51 of 53
(d) Amendment.The parties agree to take such action as is necessary to amend this Agreement and the Underlying Agreement
if necessary from time to time as is necessary to comply with the requirements of the Privacy and Security Rules, the
Health Insurance Portability and Accountability Act,ARRA the HITECH Act,the HIPAA rules and any other applicable
laws. Regardless of written amendment to this Agreement or the Underlying Agreement,the parties agree to comply with
all applicable laws
(e) Survival. The respective rights and obligations of Business Associate under this Agreement shall survive the termination
of this Agreement and/or Underlying Agreements, as shall the rights of access and inspection of Business Associate by
Covered Entity.
W Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to
comply with the Privacy and Security Rules,HIPAA,ARRA,the HITECH Act,the HIPAA Rules and any other applicable
law.
(g) Governing Law; Conflict. This agreement shall be enforced and construed in accordance with the laws of the State of
Florida. Jurisdiction of any litigation with respect to this Agreement shall be in Florida,with venue in a court of competent
jurisdiction located in Pinellas County. In the event of a conflict between the terms of this Agreement and the terms of
any of the Underlying Agreements,the terms of this Agreement shall control.
(h) Notices. Any notice given under this Agreement must be in writing and delivered via first class mail, via reputable
overnight courier service,or in person to the parties'respective addresses as first written above or to such other address as
the parties may from time to time designate in writing.
(1) Assigns. Neither this Agreement nor any of the rights,benefits,duties,or obligations provided herein may be assigned by
any party to this Agreement without the prior written consent of the other party.
(j) Third Party Beneficiaries. Nothing in this Agreement shall be deemed to create any rights or remedies in any third party.
Business Associate: Monroe County Board of County Commissioners,Social Services/In-Home Services:
By: Date: June 14,2021
(signature)
Printed Name: Roman Gastesi NROE COUNTY ATTOnNEY
A nOVE ` FORMA
Title: Monroe County Administrator `ti
PED O J. EWN:ASSISTA UNTY ATTORNEY
Date 6/14/21
Covered Entity:Alliance for Aging,Inc.:
I R,-hwff 1i
G.�� n< <v��n 11 ),. v 6T7 Jun 15,2021
By: _ Date:
Printed Name: (signature) Max B. Rothman
Title: Pres.&CEO
Signed By: (Seal):
Name & Title: Michelle Coldiron, Mayor
Date:
Page 52 of 5
ATTACHMENT G
BACKGROUND SCREENING
Affidavit of Compliance - Employer
AUTHOR]"TY: This form is required annually of all employers to Comply with the
requirements set forth in seofion 435-05(3),Florida Statutes-
The to 'empbier' means any person oF entity required by lava to conduct hackgraund szreening,
ineu&ng but rKit limed to,Area Agencies on Aging/Aging Kann Disability)Pasoufce Canters,Lead Agencies,
and Serve Prooders treat contract directly or indire,,-N mth the Department of Ekf4--r Affairs(DOER)„and
arry other person or entiti which hires employees or has vounteers in service MI'D meet the deRnition
of a direct service prowider-see§§435-G2,430.M2,Fla-Stat-
A direct service provider is 'a person 1.3 years of age or 6,der who,pursuant to a prograrn to oode
ser izess to the elderly,has direct,face-to-face contact Muh a Ghent while pro-06ing services to the client
and has access to the dienCs living area,funds, personaz property,or personal identification information
as defined ins.Bi-,-565,The term anclu des coordinatois,managers,and supervisors of residential facvljdes,
and Mlunteers' §43ao4o2(i)(b'1,Fla stat-
&the duty authorized representative of Not, 0101 4-,y Sncz.,j- &p.&)tczs
EMP)OV'_'y riurrre (
P�A
located at noo !!ikft4mNs- *re&& V-44 LZCS+ , IrLl
Sire,-t Addr,-ss rity 'State ZeP code
do hereby affirm under peraity of perjury
Plarne of Re Qr"fativ e
that the above named employer is in compliarce with the pre"risions of Chapter 43S and section
430-0402 Statutes,regardrig laval 2 background screenipg.
,W: - (V?_1W2_1
Tignat'L,re--ol-re'pi-esentai--ivs Date
STATE OF FLORIDA,COUN7�OF Of)VAM:e-,
Sworn to{or affirmed) and subscribed before me thi%2!_i day of 20.ZL,by
0 1p.f-u I (Name of Representative)who is personally known
( d_
.10 me or proW ce prof ofidentific-ation.prc,
LIZ YONGUE
P Not public
(9
ru No public UnderwriterS
,EftdT '=b_-mttrZi,Z0J7 Fs.
Fv�Ws�,abj e f` tn i r L V. LTV
7' C
11� ROE COUNTY ATTOMEYp
AklkovE FORM
j
e' ,, �Z
P-4 ED ff_FM�ASS( WUNTY ATTORNEY
Page 53 of 53 Date__
Provider signed
Final Audit Report 2021-06-15
Created: 2021-06-15
By: Stan Mcneese(mcneeses@allianceforaging.org)
Status: Signed
Transaction ID: CBJCHBCAABAAjMrGRrobWw7R1DGyAtl7Vp-DFlbzrNgq
"2021 -2022 ADI Contract Monroe County - Provider signed" Hist
o ry
Document created by Stan Mcneese (mcneeses@allianceforaging.org)
2021-06-15-12:22:26 PM GMT-IP address:52.201.156.234
Document emailed to Max B. Rothman (rothmanm@allianceforaging.org)for signature
2021-06-15-12:25:16 PM GMT
15 Email viewed by Max B. Rothman (rothmanm@allianceforaging.org)
2021-06-15-12:52:46 PM GMT-IP address:76.109.240.37
Document e-signed by Max B. Rothman (rothmanm@allianceforaging.org)
Signature Date:2021-06-15-12:53:52 PM GMT-Time Source:server-IP address:76.109.240.37
nE Agreement completed.
2021-06-15-12:53:52 PM GMT
Adobe Sign