Loading...
Item E17BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Louis La Torre Social Services Director Meeting Date: 11/19/03-11/20/03 Division: Communily Services Bulk Item: Yes X No _ Department: Social Services/Nutrition AGENDA ITEM WORDING: Approval of Nutrition Services Incentive Program (NSIP) (formerly USDA) Rate Agreement Contract #US- 451 between the Alliance for Aging and the Monroe County Nutrition Program. ITEM BACKGROUND: The NSIP Rate Agreement reimburses the Monroe County Nutrition Program for meals provided to older adult clients over 60 years old in the county who receive meals at the Congregate Nutrition Sites or home -delivered meals. PREVIOUS REVELANT BOCC ACTION: USDA Rate Agreement Contract #US-351 approved on 10/16/02. CONTRACT/AGREEMENT CHANGES: Changes amount of reimbursement from $32,866.02 to $37,559.00 subject to availability of funds. This represents an increase of $4,693.00. Unit rate of reimbursement increases from $.53 per unit (meal) to $.5699. STAFF RECOMMENDATIONS: Approval TOTAL COST: $37,559.00 BUDGETED: Yes X No COST TO COUNTY: Reimbursed SOURCE OF FUNDS USDA Agriculture) REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year APPROVED BY: County Atty _�#VOMB/Purchasing ✓ Risk Management _ // DIVISION DIRECTOR APPROVAL: DOCUMENTATION: DISPOSITION: Revised 2/27101 Included X To Follow Not Required AGENDA ITEM MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract #NSII' (formerly USDAZContract #US-451 Contract with:Alliance for Aging, Inc. Effective Date: 10/1/03 Expiration Date: 1/31/05 Contract Purpose/Description:Reimburses the Monroe County Nutrition Program for Meals Contract Manager:Louis LaTorre (Name) for BOCC meeting on 4572 (Ext.) Social Services/Nutrition Prograazn (Department) Deadline: CONTRACT COSTS Total Dollar Value of Contract: $37.559.00 Current Year Portion: $32,866.02 Budgeted? Yes® No ❑ Account Codes: 125-61531-03-33162OH- (•rant: $ 125-61532-03-33162OH- County Match: $-0- - - - ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg. i CONTRACT REVIEW Changes D e Needed r Division Director / 0�027Yes❑ No Risk Management 1.4/ A 3 Yes[] NoEr �,L��— O.M.B./Purchasing / e/i 7,0 ;Yes[:] No❑,-- County Attorney / /,//,,3Yes[:] No[� Comments: OMB Form Revised 9/11/95 MCP #2 Date Out is12- ff/ I DI October 1, 2003 Contract Number US-451 NUTRITION SERVICES INCENTIVE PROGRAM 2003-2004 CONTRACT THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the "Alliance", and Monroe County Board of Commissioners, hereinafter referred to as the "recipient'. This contract is subject to all provisions contained in the MASTER AGREEMENT executed between the Alliance and the recipient, Agreement No. PA-329, and its successor, incorporated herein by reference. 1. Recipient Agrees: A. Services to be Provided: To plan, develop, and accomplish the services delineated, or otherwise cause the planning, development, and accomplishment of such services and activities, under the conditions specked and in the manner prescribed in Attachment I of this agreement. B. Requirements of Section 287, Florida Statutes: These requirements are herein incorporated by reference. C. Final Request for Payment: The Recipient must submit the final request for payment to the Alliance no more than 30 days after the contract ends or is terminated; if the Recipient fails to do so, all right to payment is forfeited, and the Alliance will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the Recipient, and necessary adjustments thereto, have been approved by the Alliance. D. Additional Reporting Requirements: 1. If the Alliance has sanctioned the recipient, while the sanctions are in effect the recipient shall provide to the Alliance, on a monthly basis, the recipient's financial statements that reflect the current, un-audited revenues and expenditures and the recipient's cash position as well as any other documentation that may be requested by the Alliance. 2. If the recipient is required to prepare a corrective action plan, supporting documentation as requested by the Alliance shall be provided. II. The Alliance Agrees: A. Contract Amount: To pay for services according to the conditions of Attachment I in an amount not to exceed $37,559.00, subject to the availability of funds. October 1, 2003 Contract Number US-451 B. Obligation to Pay: The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature and passed through the Department of Elder Affairs. C. Source of Funds: The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations and consist of the following: Program Title Year Funding CFDA# Fund Amounts Source Nutrition Services 2003- 2004 OAA 10.570 $37,559.00 Incentive Program TOTAL FUNDS CONTAINED IN THIS CONTRACT: $37,559.00 Ill. Recipient and Alliance Mutually Agree: A. Effective Date: 1. This contract shall begin on October 1. 2003. 2. Delivery of services shall end on September 30, 2004. This contract shall end on January 31, 2005. See Attachment I, Section III.E. B. Termination, Suspension, and/or Enforcement: The causes and remedies for termination or suspension of this contract shall follow the same procedures as outlined in Section 111.13. and Section III.C. of the Master Agreement. C. Recipient Responsibility: Notwithstanding the pass through language contained in Section I.S.1. of the Master Agreement, the recipient maintains responsibility for the performance of all sub -recipients in accordance with all applicable federal and state laws. D. Notice, Contact, and Payee Information: 1. The name, address, and telephone number of the contract manager for the Alliance for this contract is: Steven Weisberg, M. S. 9500 South Dadeland Boulevard, Suite 400 Miami, FL 33156 (305) 670-6500 2 October 1, 2003 Contract Number US-451 2. The name, address, and telephone number of the representative of the recipient responsible for administration of the program under this contact is: Louis LaTorre GATO Building —1100 Simonton Street Key West, FL 33040 (305) 292-4573 3. 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. 4. The name (recipient name as shown on page 1 of this contract) and mailing address of the official payee to whom the payment shall be made: Monroe County Board of Commissioners GATO Building —1100 Simonton Street Key West, FL 33040 (305) 292-4573 E. Renegotiation or Modification: 1. Modifications or changes to the funding in this contract and corresponding services related to the increase or decrease, may be made in the form of a written Notice of Award Increase/Decrease signed by the Alliance's President and Director of Administration. The Board President or its Designee of the recipient shall sign the Notice of Award Increase/Decrease and return it to the Alliance within fourteen (14) days or sooner if requested by the Alliance. By signing Notice of Award Increase/Decrease, the Board President or its Designee of the recipient acknowledges the receipt of and agreement with the terms contained in the Notice. 2. Upon Receipt of a Notice of Award Increase/Decrease, the recipient shall update affected information in budget summaries, deliverable schedules, unit rate information contained in the unit cost methodology, or any other applicable financial information contained in the service provider application or required in this contract. This shall be done within ten working days of receipt of such notice. 3 October 1, 2003 Contract Number US-451 IN WITNESS THEREOF, the parties hereto have caused this 7-gage contract to be executed by their undersigned officials as duly authorized. RECIPIENT: MONROE COUNTY BOARD OF COMMISSIONERS BOARD PRESIDENT OR AUTHORIZED DESIGNEE SIGNED BY: NAME: TITLE: DATE: ALLIANCE FOR AGING, INC. SIGNED BY: NAME: Steven Weisberg, M. S. TITLE: President / CEO DATE: FEDERAL ID NUMBER: 59-6000749 RECIPIENT FISCAL YEAR END DATE: 09/30 MONROE COUNTY ATTORNEY PPROVEO A��- SANE .HUTTON SSISTNTC UNT ATTORNEY EY�Date 4 October 1, 2003 Contract Number US-451 ATTACHMENT NUTRITION SERVICES INCENTIVE PROGRAM 1. STATEMENT OF PURPOSE The Nutrition Services Incentive Program (NSIP) is authorized by Section 311 of the Older Americans Act of 2000, as amended. The NSIP is the new name for the former United States Department of Agriculture (USDA) cash or commodity program known as the Nutrition Program for the Elderly. NSIP provides reimbursement for the purchase of United States produced agricultural and other food commodities for use in nutrition projects operating under approved Older Americans Act Title III contracts. II. SERVICES TO BE PROVIDED A. Services: Upon receipt of a prior authorization for services from Alliance staff, to provide the following services: The purchase of United States produced agricultural and other food commodities for use in nutrition projects operating under approved Title III contracts for nutrition services with the Recipient. Prior authorization for these services will be provided by the Alliance. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's service provider application update for federal fiscal year 2004 and the Department of Elder Affairs Home and Community -Based Services Handbook. In the event the handbook is revised, such revision will automatically be incorporated into the contract and the recipient will . be given a copy of the revisions. III. METHOD OF PAYMENT A. This is a fixed rate contract. The Alliance shall make payment to the recipient for provision of services up to a maximum number of units of service and at the prospective rate stated below: Service to be Provided Units of Unit Rate Maximum Service Units Eligible Congregate and Home Delivered Meals 1 unit = 1 meal 0.5699 65,904 The prospective rate is based on the estimated OAA grant award. W October 1, 2003 Contract Number US-451 B. All requests for reimbursement shall be in accordance with policy regarding reimbursable meals and Client Information Registration and Tracking System (CIRTS) policy regarding data entry for reimbursable meals. All requests for reimbursement shall include: 1. The request for reimbursement shall be submitted on DOEA Form 117, Request for Reimbursement, USDA Cash -In -Lieu of Commodities. 2. DOEA Form 118, PSA/Recipient Monthly Meals Report must be submitted with the request for reimbursement. 3. A CIRTS report must be submitted with DOEA Forms 117 and 118 as supporting documentation for the total number of meals reported. The CIRTS report must match the number of meals reported on DOEA Form 118. 4. Duplication or replication of the DOEA forms 117 and 118 via data processing equipment is permissible but replication must include all data elements in the same format as included on the departmental forms. 5. The due date for the request for reimbursement and report(s) shall be no later than the 20th day of the month following the month being reported. C. Invoices will be in sufficient detail for a proper pre -audit and post -audit thereof. The recipient shall maintain documentation to support payment requests which shall be available to the Comptroller, the Department of Elder Affairs or the Alliance, upon request. D. Additional Reporting Conditions: 1. This contract is for services provided during the 2004 Federal Fiscal Year beginning October 1, 2003 through September 30, 2004, however, the contract is in effect through January 31, 2005. The additional four months (October 1, 2004 through January 31, 2005) are to allow rates to be adjusted for the twelve-month 'service period. Retroactive rates will be based on the final OAA grant award divided by the total eligible meals reported in Florida. This contract shall automatically terminate after the final rate for the federal fiscal year has been established and the Department of Elder Affairs authorizes the release of final payments. October 1, 2003 Contract Number US-451 2. In the event that the final reimbursement rate is greater or less than the rate in Attachment I, Section III.A., then this contract shall be appropriately adjusted and the final rate shall be effective for the entire contract period upon notice from the department's contract manager. E. Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and approval by the Alliance of complete and accurate financial and programmatic reports due from the recipient and any adjustments thereto, including any disallowance not resolved as outlined in Section I.T. of the Master Agreement. IV. SPECIAL PROVISIONS A. State Laws and Regulation: 1. The recipient agrees to comply with applicable parts of Florida Statutes, Rule 58A-1, Florida administrative code and the Department of Elder Affairs Home and Community -Based Services Handbook. 2. The Alliance and recipient agree to provide services and implement the provisions of this contract in accordance with Federal, State, and Local laws, rules, regulations, and policies that pertain to the Nutrition Services Incentive Program cash payments and Older Americans Act. 7 -,- - BOARD OF COUNTY COMMISSIONERS Loui s Liatorre AGENDA ITEM SUMMARY Social Services Direct Meeting Date: 10/16-10/17/02 Division: Community Services Bulk Item: Yes X No Department: Social Services/Nutrition AGENDA ITEM WORDING: Approval of USDA Rate Agreement Contract #US-351 between the Alliance for Aging and the Monroe County Nutrition Program. ITEM BACKGROUND: The USDA Rate Agreement reimburses the Monroe County Nutrition Program for meals provided to senior clients over 60 years old in the county who receive meals at the Congregate Nutrition Sites or home -delivered meals. PREVIOUS REVELANT BOCC ACTION: USDA Rate Agreement, US-251 approved on 12/18/01 and Amendment #1 to US-251 approved on July 17, 2002. CONTRACT/AGREEMENT CHANGES: Previous 2002 Contract amount was $29,750, as amended. Amount of new contract award is indicated as To Be Announced (TBA), since the reimbursement depends on the number of units (meals) projected to be completed by the Nutrition Program for 2003. This has not yet been determined as the Older American's Act (OAA) contract will not be fmalized until December 2002. Until then, pursuant to the Alliance for Aging, the total meal count and allowable reimbursement amount will be based on the current projection for the 2001-2002 contract period, of $29,750. STAFF RECOMMENDATIONS: Approval TOTAL COST: TBA (current year $29,750) BUDGETED: Yes X No COST TO COUNTY: Reimbursed REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year APPROVED BY: County Atty OMB/Purchasing Risk Man �ment_X_ DIVISION DIRECTOR APPROVAL: J. Malloch DOCUMENTATION: Included X " To Follow Not Required DISPOSITION: AGENDA ITEM # Revised 2/27/01 • . , MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract #USDA Rate Agreement #US-351 Contract with:Alliance for Aging Inc. Effective Date: 10/1/02 Expiration Date: 1/31/04 Contract Purpose/Description:Reimburses the Monroe County Nutrition Program for Meals Served for Congregate and Home -Delivered Program Clients (age 60 and over).. Social Services/Nutrition Program Contract Manager:Louis LaTorre 4572 (Name) (Ext.) (Department) for BOCC meeting on Deadline: CONTRACT COSTS Total Dollar Value of Contract: $TBA, current Current Year Portion: $ 29 750 Budgeted? Yes® No ❑ Account Codes: 125-61531-331-620-OH-GS0201 Grant: $ 125-61532-331-620-011-GS0202 County Match: $-0- - - - ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, Date in Division Director (d 1 b2 Risk Management )b O.M.B./Purchasing 1 0' / / 0 Z CONTRACT REVIEW Changes Needed fRer Yes[] NoET-*" Yes❑ No[2" Yes❑ NoC County Attorney 9/23/02 Yes❑ No® Comments: OMB Form Revised 9/11/95 MCP #2 �)&' 'Ck-R k (A,&A � Date Out 1 o///b2 r Contract Number US-251 UNITED STATES DEPARTMENT OF AGRICULTURE CONTRACT 2001-2002 THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the "Alliance", and Monroe County Board of Commissioners, hereinafter referred to as the "recipient". This contract is subject to all provisions contained in the MASTER AGREEMENT executed between the Alliance and the recipient, Agreement No. PA-229 and its successor, incorporated herein by reference. The parties agree: Recipient Agrees: A. Services to be Provided: To plan, develop, and accomplish the services delineated, or otherwise cause the planning, development, and accomplishment of such services and activities, under the conditions specified and in the manner prescribed in Attachment I of this contract. B. Requirements of Section 287.058, Florida Statutes: These requirements are herein incorporated by reference. C. Final Request for Payment The recipient must submit the final request for payment to the Alliance no more than 30 days after the contract ends or is terminated; if the recipient fails to do so, all right to payment is forfeited, and the Alliance will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this contract may be withheld until all reports due from the recipient, and necessary adjustments thereto, have been approved by the Alliance. 11. The Alliance Agrees: Contract Amount To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $27,756.00, subject to the availability of funds. The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature and passed through the Department of Elder Affairs. The Costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in state grants and aids appropriations and consist of the following: 1 Contract Number US-251 Program Title Year Funding Source CFDA# Fund Amounts Nutrition Program for the Elderly (NPE) 2001-2002 USDA 10.570 $27,756.00 TOTAL FUNDS CONTAINED IN THIS CONTRACT: $27,756.00 III. Recipient and Alliance Mutually Agree: A. Effective Date: 1. This contract shall begin on October 1, 2001. 2. Delivery of services shall end on September 30, 2002. This contract shall end on January 31,2003. See Attachment I, Section III.C. B. Termination, Suspension and/or Enforcement The causes and remedies for termination or suspension of this contract shall follow the same procedures as outlined in Section 111. B. And Section 111. C. of the Master Agreement. C. Notice, Contact, and Payee Information: 1. The name, address, and telephone number of the contract manager for the Alliance for this contract is: Steven Weisberg 9500 South Dadeland Boulevard, Suite 400 Miami, Florida 33156 (305) 670-6500 2. The name, address, and telephone number of the representative of the recipient responsible for administration of the program under this contract is: Louis LaTorre Gato Building - 1 100 Simonton Street Key West, Florida 33040 (305) 292-4573 r Contract Number US-251 3. 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. 4. The name (recipient name as shown on page 1 of this contract) and mailing address of the official payee to whom the payment shall be made: Monroe County Board of Commissioners Gato Building - 1100 Simonton Street Key West, Florida 33040 IN WITNESS THEREOF, the parties hereto have caused this 5 page contract to be executed by their undersigned officials as duly authorized. PROVIDER: MONROE COUNTY BOARD OF COMMISSIONERS BOARD PRESIDENT OR AUTHORIZED DESIGNEE SIGNED BY: NAME: �f4aY1es TITLE: DATE: /9 zoo 1 REC BER: YEAR END DATE: ALLIANCE FORAGING, INC SIGNED , l BY: -� V� NAME: . TITLE: PRESIDEN T/6'---'J DATE: It I 1- 2 j o 59-6000749 09/30 APPROVED AS TO FORM T AND�ANN5eUk. FFI EWf ,/ BY S////HUTTON neTF //l.7i1'df Contract Number US-251 ATTACHMENT I UNITED STATES DEPARTMENT OF AGRICULTURE i. STATEMENT OF PURPOSE The United States Department of Agriculture program provides reimbursement for the purchase of United States produced agricultural and other food commodities for use in nutrition projects operating under approved Older Americans Act Title II I contracts. II. SERVICES TO BE PROVIDED A. Services: Upon receipt of a prior authorization for services from Alliance staff, to provide the following services: The purchase of United States produced agricultural and other food commodities for use in nutrition projects operating under approved Title Ill contracts for nutrition services with the recipient. Prior authorization for these services will be provided by the Alliance or its designee. B. Manner of Service Provision: The services will be provided in a manner consistent with the Department of Elder Affairs Client Services Manual dated 12/98. In the event the manual is revised, the contract will incorporate any such revision and the recipient will be given a copy of the revision. III. METHOD OF PAYMENT - FIXED RATE A. The Alliance shall make payment to the recipient for provision of services up to a maximum number of units of service and at the rate stated below: Service to be Provided Units of Services Unit Rate Maximum Units Eligible Congregate and Home Delivered Meals 1 unit = 1 meal 0.53 52,370 The prospective rate is based on the estimated USDA grant award. B. All requests for reimbursement shall be in accordance with USDA policy regarding reimbursable meals and Client Information Registration and Tracking System (CIRTS) policy regarding data entry for USDA reimbursable meals. All requests for reimbursement shall include: 1. The request for reimbursement shall be submitted on DOEA Form 117, Request for Reimbursement, USDA Cash -In -Lieu of Commodities. 2. DOEA Form 118, PSA/Recipient Monthly Meals Report must be submitted with the request for reimbursement. 4 Contract Number US-251 3. A CIRTS report must be submitted with DOEA Forms 117 and 118 as supporting documentation for the total number of meals reported. The CIRTS report must match the number of meals reported on DOEA Form 118. 4. Duplication or replication of the DOEA forms 117 and 118 via data processing equipment is permissible but replication must include all data elements in the same format as included on the departmental forms. 5. The due date for the request for reimbursement and report(s) shall be no later than the 10th day of the month following the month being reported. C. This contract is for services provided during the 2002 Federal Fiscal year beginning October 1, 2001 through September 30, 2002. The additional four months (October 1, 2002 through January 31, 2003) are to allow rates to be adjusted for the twelve month service period. Retrospective rates will be based on the final USDA grant award divided by the total USDA eligible meals reported in Florida. This contract shall automatically terminate after the final rate for the federal fiscal year has been established and the release of final payments are authorized by the department. D. In the event that the final reimbursement rate is greater or less than the rate in Section III, A., then this contract shall be appropriately adjusted and the final rate shall be effective for the entire contract period upon notice from the contract manager. E. Any payment due by the Alliance under the terms of this rate agreement may be withheld pending the receipt and approval by the Alliance of all financial and programmatic reports due from the recipient and any adjustments thereto. IV. SPECIAL PROVISIONS A. State Laws and Regulations 1. The recipient agrees to comply with applicable parts of the Florida Statutes, Rule 58A-1, Florida Administrative Code and the Department of Elder Affairs Client Services Manual dated 12/98. 2. The Alliance and recipient agree to provide the services and implement the provisions of this rate agreement in accordance with the Federal, State and Local laws, rules, regulations and policies that pertain to USDA cash payments and Older Americans'Act program. 5 Warm, Cimnty Z errs office Or-*,,_.+1 AMENDMENT 001 Contract US-251 Page 1 THIS AMENDMENT, entered into between the Alliance for Aging, Inc., hereinafter referred to as the "Alliance" and the Monroe County Board of Commissioners, hereinafter referred to as the "recipient", amends Contract US-251. The purpose of this amendment is to make an adjustment in the number of meals to be served through September 30, 2002 and to adjust the corresponding reimbursement amount to which the recipient shall be entitled. Section II is hereby amended to read: ll. The Alliance Agrees: Contract Amount To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $29,750.00, subject to the availability of funds. The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the provider pursuant to this contract are in the state grants and aids appropriations and consist of the following: Program Title Year Funding Source CFDA# Fund Amounts Nutrition Program 2001-2002 USDA 10.570 $29,750.00 for the Elderly TOTAL FUNDS CONTAINED IN THIS CONTRACT: $29,750.00 2. ATTACHMENT I, Section 111, Paragraph A is amended to read: A. The Alliance shall make payment to the provider for provision of services up to a maximum number of units of service and. at the rate -stated below: Service to be Provided Units of Services Unit Rate Maximum Units Eligible Congregate and Home Delivered 1 unit = 1 meal 0.53 56,132 Meals AMENDMENT 001 Contract US-251 Page 2 3. This amendment shall be effective the date on which it has been signed by both parties. All provisions in the contract and any attachments thereto in conflict with this amendment are. hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract and the Master Agreement. This amendment and all its attachments are hereby made a part of the contract. IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their undersigned officials as duly authorized. MONROE COUNTY BOARD OF COMMISSIONERS =' SIGNED BY: NAME: 04a r e S nhrl„ 1 /!/! r616 TITLE: /Nma.n ALLIANCE FORAGING, INC. SIGNED BY: NAME: STEVEN WEISBERG, M.S. TITLE: PRESIDENT/CEO DATE: i - DATE: AN AL SUFFICI ANN H TON FEDERAL ID NUV9Y_ / 59-6000749 PROVIDE' aEJ��r4R ENDING DATE: 09/30 IITY C=RK :% L :.