07/20/2022 Agreement n� Kevin M�adok, CPA
b .k* Clerk of the Circuit Court& Comptroller_ Monroe County, Florida
DATE: August 26, 2022
TO: Sheryl Graham, Director
Social Seances
ATTN: Kim Wilkes Wean, Sr. Aduiiiiistrator
Fiscal& Program Compliance
Lourdes Francis, Aduiiiiistrator
FROM: Pamela G. Hancock, D.C.
SUBJECT: July 20' BOCC Meetnig
Attached is a copy of the following, fully executed item, for your records:
C14 Alzheituer's Disease Initiative Program Contract K7--2297 between the Alliance for
Aging, Inc. and Monroe County Board of County Commissioners, Social Seances/In-Home
Seances for the Contract Year 2022-2023 (July 1, 2022 to Dime 30, 2023) 111 the amount of
$91,807.73.
Should you have any questions please feel free to contact me at (305) 292-3550.
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 305-852-715
ALUIUMER'S DISEASE INITIATIVE CONIRACT
2022-2023 Fiscal Year
THIS (A)NTRACT is ememd Wo bamen Me AHWme Rv AgAg Inc., hereinarter referred to as the "Afliance" and Nimiroe
County Board of C011MY Cwtumisshmn, SoAd SnYWONNome Swvhns, hereMaRer Wined W as the "PawideC and
cohativdy iWer,rd to as the "pam in."
Attachments 1, K, 1K V1, 'VII, VId, IX. X, A, 13.C, E, andD are WorImmted Win W mwW as pm of IN cmmwt,
WHEREW Ow Ulm has been designmed as die Area Agowy an Agig kv PWnning ad SaKe Ama I I owomposikig NW&
Dade and MAmrue Clunks: and
WHEREAY dic 19mWa Dqmmmnl orEWer Affairs (to "MpMnnvW) Ims emewd hHu a CoMmul "Th Me AM= M !bid
Aizheinici Discasu hritWivv Pmviders in and Monroe Comifies;and
NOWTHERE'FORE, 41 of1he sendues to be 1wrAmned and payinents io he mad,nagedwr%vhh the nimuml covoiams
wid condidors so hewn h in 11 WOW We Pudes agrov as Wom
1, "(wroacat
Hie purpose ofthis Contract uM ter in accordarice with me tums widcoridUms spacted WhN cmumet AduWAg
,111 annhinents and eshibils. Which Consdutic flie Contrac"t doculnellL
hucelk-11"Itildi (if—Dock"fl—CE(S—WRU-11t ke-Culbalat
d lie, contract wM inconwrtite anachnierut promm%j stale Mmosl gmW agcenwnK mWo Fkpatonoul of FkQr AiDds
handbooks,nianuals urdusk twoks. as an Wgrd Imirt orthe Wrtmel,except to the extern that the contract expPiNly govWs
w Me convaq. In me evou urconnint v Impmg anw,Mq of the AwwwriN m9mud nbrwe. Me qw6fic pawishm and
rapihmems orme counsel docunwn,Q)shall pre"dl twer inamWent providons in the fmvpm1s)or o4v gareW inmaints
not specific to dik c mtracl ducumemand identified anchnnom and AW1 be gownwd&nuonanne vet Ah be qpwNc hmN swwy,
and whLir condilions -;o k"-ia fljjs Contmcq
,I Tom 0 Co ° ,
3,V UJI,e�Ctivv Date�
Ibis conum CAI hegin at twelve (1200 A M . Nslarn Swmkud Time on July 1,2022 or cm, iN date the coivrad has,
rhe conhact %6H end on JunnvNh 2021 ormich earHadaw as die conimet,
N taminmed puimaint lo ScoWn 51 her6n. except &M dw pades W umdime W perAnn low Hind W moine, dose-
out activities StA forth in his corfltnacr,
11 rkket, oNa urea s UN nd w 11:59 11,M., Frzsfern StwidatA The m"Nne 3%2021 cw soch WE time as We curitivict
is terniinwed puisuata lave paragp-al-,)h M heiein. I hiderno circuinslarim W Te ARmce r6rnburse 1he provider for services
provided aficr.June 30,2023 or mW ardier Invi bal ion date'.
2023,
Mid P"MUU M MQUIal0d iii, A I I A(11 V1 FN]' \,r 111
I CIntract APlog 0,"Ou"i
A NO agim W puy 14 cuinmcwd services amoMing W he laws and conditions orlhk convac, M an ainouni marvel 110,
e.�xc wed$91,8t)7.73s,tol,wject tau lhenvadandiyoftundi Aun,coMs or services paid For mWerany o0wer coflilrac or fi-orn any other
source are not efigible for paynicitt undur(11k,conlrao,
4A (WgM hewn feu Pq
The Alfiance's,po-fon-muice aW oWjWon W pay under this contmo is coniNgent, upon an ainnual approglation by the
LyWmwv W be Def,amment and %ding received by the 1111ince under its cmama v01 the Dqmnmenl.
The contract nray he reviewed on at yearly bads Kv no unmv Own three addRi0nial years. Such rcirowats shall! be contingent
upon s""Ifistactory pedbmame ewWmAns as doen"ined by dic Alharce and floe availabifity of funds. Any renemah of as
coninmut shMI be sullect to nimal agneenim conRimed in wrid"g,W suWect to the sa-ine ttrrns and condifions,set 1"orth in the
Withl cmaran, Wh hu owepikir if,whikhring unh rmes Qkh k descdbed firt,ther in this secdon. The renewal price, or
Mod kv dearvAnkig a mmwM pKin h so for 0 Ow Lid pwfumd,or reWy. Requests W wnywNw Me orWAM concrumaI
INge I tad 57
eslmblishcd raivs am pmd&d Nr in the Alliance's appro�ved Rerniburwinent Raw Revic)A Policy, 'Adlich is incotfmrawd lr")),
MOMUC,
Me paribs shd rvevaWe Me c=vaWs rein'ibursement rates on an wa-iml hnis pursuant to DOEA's Nofice of Policy
ClaiMcnikno ovice CW Regm Notle HN2815AT&SCHIS daWd Seliteimber 28th, 2015 and the approved ARGaance's
Reinibm-sement Raw Fkevicw Poficy
tiro the eveiii dult Cofltracts Cunnol he executed pdcw to the July W start date, the Alhance way, art its (fiSC1'0iM1' exioid this
AgiTerim qpn written nofice for up to 120 days to ensurc conW4 ofmix1v Savices provided under 0his emension, svHI
he paid tbr out of the stwendbg agincomm!anium
6A, He l9ovivier shall mm empkj an unmalwWad dim IS AHWwe AWI consider the cnipWymm ornmuthudzed alkns
a vkAwAn of Te ImmyMbn W Nwhuhty Act (8 U A Er, U24 a) and the hvirvjatiori Reform and CowrolI Act of
1906(8 US.C. I Wly Smh vWWWn divill be cwsa Rw unikowA canceNationof MA ammict by to AllAce,
62 Ifthe ProNider is noniprfh poviderand Ws to lnwnnl Revenue rvic 111 Wxet tgnk mWo Q a bg,
as Wrrn 99(hw Foram 99()-N,N and has As Mx exenio sWum rvvoked fbrRuhng tun conip"whh the filing
tvquhvn manes of:hc 200h lknskmi ProWelion Ad or rtwanjy orlicr rcason,the Provider inustnotify ihe Alhince in wri6ag,
m1hin MkW(301&Ws ofreceiving the IRS nmwe orrevown,
03, [he Providei slmH mnWY whh Tide 2 UFR Pan 175 mga&hW TAM&hg hKonwis.
0* Unless eNentjm undo 2 CFR Part 170,1 10(b), the PTovide'r "d-wiH cojnply with the reporting! recli[dreiniciins of the
I ransparency Act as eNprcss"l in 2 C'FR 170'
6J. It cwtoy %vkh Pivshlv= WomaNe order 12989 and State of Wida 1-jecutive OdurThimber 11-1161
Provider agt%"es to titilize the I is. mpximew or ilomorintj securitys lVeril'), System roverif"y the e1111,110yolent of aWI
new enWkjms hied by PmvWor OwNg We conirmi Wnth PmvWu dull iticlude in related sad'scolitracts a requironlent
that std-�Cfoirhacku"s and"'oll- Vendors perlon"ing )V(ffjs ()[ jja,m)V'iLfing" SL."I vjt:'(!S 111.11-Suz"It ko 0,11k, SU'fle Conlract n0h/o the
VeNty symeni to Verify einployn-jent of'0 nny emphyms h0d by the subconvam,and/or venoJor during the U)"Wad
terrrru Providers, jtiee6ng the terms mhl cond0uns of Me FNedly Qman wo dam al W be 4 emuplihowe with Mis
pmNkiom
7, Lon"fiance Nvith Stale Lm"
L_
7A 'II loin umitract t!"; e\ccuted iind erueivd imn 0 al c Wimo W Fkrkta, and WU hv "vnmrud, pcifoniiekL and LriloivefJ ni aH vcsp"ts R11
accordance wOih 11kc,1051 Nw hwludhw F"Wa pwWmh krwdho of,knx„w.
12 Uk RoOder shall comoy nth Seohn 2 NOT FS and requixeimmis iWs, 287A% VS.as amended.
721 no WOW WH "HAm aH Wsks conudned in mad-nneni I
722 ne WAK AW1 Rmfle uArs tWWWW, hOuAW vninus chen, ser0cov and in vome inmat"ces n-iny
helude repony Hndhgv and dins as specified in Thus Coinma. W&A It Coiamo Wmgcr mma wmhe mid
=cqA in wrkkg prNT to payrneM in amndamv %Th Y 215171(1)and (2)AIL AM. EMmiditures nwat be in
(,,oniphance with havvs, rinles., regukifions, &cWdWg, Ima not lindwd to die WWI Relhmnc GnWe Rw Awe
xpenclitur-es issued by the Florida Department of Flinwicial ServiWes VVIT').
5 23 the PmOdor shall coulpy with the cNerie and Aml &w by Which such Criteria nium be niel for Coiripleficin tpf
this conlimcl as specified in UncHent L,Sodion HI Method of Payment,
72A De Proddu sAH mlmh lulls Car bes cw whar comgmsmion NY scrAces or e"eives In Wdmz &WA Kw a
proper pre-audit and post-aucfit.
711 4 iteriAnd pqmm W traycI experises is pawated &Mk uontr= the Provider shall subutit bilk fc)i any wavel
expenses, in accc�rdartce MM Y I U16 k ES1, or at such lower nao as may he pmvWcd W this cmitiram
T15 Me PmOda AmH Abw pAlic zxcess tar all docunients, Ilapers. Luers, or other pubhc reconis as dcl-moJ in s,
I NMI A 121 FS, made or rucled by the Provida hi cotwwdun wAh this contuAct exceo Wr thow: rmoK
which,are madc confidenuhl or exempt;by W"Te PmWet'stefusal to comply wAll this provision will consfitute
an bmtedAte bwxh Wimmaci IN,Weh Me Uhne may uniNtemily Wriminme the connect,
intge 2 or 57
T3 11 c I k.,uts are I o be transpomed under His con wact, the Prod da OmH mmNy with,the prov is ions of'Chaptct,427, FS- and
Ulu 4 1-2. K k C'.
7.4 Subicomraclors who axe on the Di[scrAdmory-Aundor list may not Immact bushms;KM any l oalty, in accomonce
whh the pm ovishm of s,287A 3? FT
7.5 rhe t,rovicier simu umpv with to prowkwis or w 1,1,062. F S- and s 2 1 6 :147, F.S, which pioldb4 fhe expenditme ull
contract Funds for the pmpme"hb4bg the QgMeumn)WIchl N-m-rch or as siate a,,,,ency,
T6 I he A Ifiance and/or I.Deparinicia niay wm AmIc to CmWau I dw PmOkr is round to have sahnihowd n Use wificatim
as provaded under 28T 13,5 Y FS. has Ill plaCCd=the S01t0il iYCd COinparks with A,ct k'n ics in Iran, Petroleum Sector.
I Am.die Sena inded widi activities in Sudan B An, Of the smul cmu priles Mul Boyncou krael hm (v 1 I'llhe
Pmvkkr has hem engaged in business qwmkms in Cuba(w Spia of is engaged in a ixivou or Go,
N, LN"Mck womd S"unfig
U Provider Shall annuv Um the require merus of s. 430.0402 andl Chapter 435 1 S- as wucndck,L aru , nict tegarding
hdgromd wnening for all persons who mcci The definition cWa direct sow le provider and who arc not cxempt fi-mil the
Ikpamnetat Imml 2 badq"mnd scremilig pursumn to s. 430VIC12(2143), F,S Ifie Provider must also comply with any
applicabie rules promulmm1by dw DeImmom mW Me Agmxy Rm I NAh Cive AdmithwalmOwn wgudhg imp4muntmAt
ol' s. 430,0402 and Chaptei 435, FS '!).) denionsirate Compliance %vith this Provision, Provider shall subri,fli to the
Depamnem, the Background scrwliuy, Affidavk ofCoinpNance (Screenitqq Forni) urpmorrm lfih'tY 43t))tkays of'CXCM[i0f1 Of
Ihis contract. Should dw Adhance have a umWUed Amming Fwm on Hle Rw Me Provider. a oew Scrcvning 1"onrt willl be
required everY twelve(d2)1111(inflis.
8,2 Furflier information Cloncernog aw PVud1"VS Ar backgnmund semening is round at
"o, dm(%
lant 1�roccqures
RA CrIvance F%cedure
'Me PmO&r A01 comply whh und anuire milTonwaour comptAnce withi the Nfinflmum (itaklehne for Reel
Ubmwe 11medwes, AppendN D, Depulmen! of IlOder Anhks Pmgmms and Services I landIrcwk, to address complaints
mganUng the temBadon suq;mNiwn or reduction orservien, as requilined IN rucett or am,
y.2 C01111flItilit PF-OMIMVS:
Ile liar Wer 4mh dewlp mmA Q10mon comphihn pnwuWms wid oism Mal m14Amwaumm dewhj and hnphnunt
complith, pincedums to process and wsoNe clkim dANNbcdon whh scrNem Amplaha pnwmhwn Aull addem the
quaMy and drrichussorserNes, PmvWa and Am savle worker comphtim.urany other ahle mWed tommIlaints
ower Umn tennhw6m sugmuhn cw reductimi in wrvkvs that requiro tKo gdevence pmem as docMwd in Appaidix D,
Department ot"FIder Arms wgimms mW SoNles I Widbook. IN consplahm procedwesshalt kiclude ffi.AnniCdtion zcm all
clients of the cornplabi procadumv md HAS tmckirig Me dw, nwmm of Me umWbiril md Ow dewmAwkin or Te
comphirit on a cotmNaint Q,
10, Pubhe RennAs and Rmemum.
s d 19,01 tl2). Suown Ow VnnWa. wQQ w Me wms uF s. 2MT051 Inc, Horidu Moumn,and any,odwr;WpGmNh kpil
ngjw,;1oalH Immk ions WIml fit Pla, Stu namimq whrWNK"eQw mmidwlk
ITLI Keep and mninwin publi mcords Am otxlirimMy and mcwado wn& be requked by Ow puNic agency in mder
io perforrill the serviccs.
10JI Upm rquem Clav A All ume or We lQuomaul. tie Pmvi&r%vill p"wide a copy, of the requum for recods or
Alow the records to be inspected or cc pks w1hin as rmmiable time m a crest At&ws not emed To cum l pruvidid
in(ThqAer 119, RUAN smums,m as m1know provwed by hw.
10T3 Enswr Am prd1c mmWs thm my eump o"onAdew Al and exempt fi:�ucri,public rcirords d tsclostux,requ iti-enients
are not discloscd except as authorized by lam" .
INge 3 of 57
10,k4 Upm cornphion of his cmqat- Me JWwWa W unn0r, at no cost to Me AUWwq all publil rmar& in
possessim"t of the Provider or will kcq)and mnintapn public records required by the Alliance or the Dcparuuon, 11'
the ProvWer lmnskrs affl pubhc records to dw Alflarisx upon contplenon offlic coruttact, Provider shall dcshroy any
dhrokwe pbk ramds AM rav matnK or uarifiden6al und exumN, Rom pubht"vowds diclomnv mquhvinerds.
4 dw PmvWa kups W nw%hs pul% wowds upn amuplutimn of the conUmcl, the PwOda OW mem &I
appficablv requircnients Rw mWining public $neCuq"(],,_ AN records skorcd elcuronically must he provided to the
Alfi;ince rn a fim-inal flwt is uMcartwptatr9rle whh the inAwimmiun ledundogy syswnis or the motme.
112 ne A%wc nmy urviWerally caricel this conumci notwilsmmMy any other pruOsiwis of Wh ContracL W relIvad by
Me PmAder to comply,%vkh Section 9 q--0 flik; Coinract by not nUmving puWk nmns W WI dowinw,paInt, Imem or
other material Inade or received by the Provider in Conjunction %vith to corivaq unlfss the rvcor& are exenilA. oi,
confidendal and exenyL Imn Sevion 24p)orAnkle 10 Ow Swe Consthision and SwWn 119MA I Y F,S-
IF T HE PROVIDER "AS QUE411ONS RE CARDING TH HE: APPLICATION OF C11APTER I II FLORIDA
S'FATUTES, TO TFIE PRONIHERIS DUTY Y10 PROVIDE PUBLIC REC'ORDS RELATING TO THIS
CYNTRACY CUNTAET THE CVSU)I)IA,N OF'PUBLIC REC"ORDS AW
Public Records Coordinator
Florida, Department of Elder Affairs
4N0EWWnWeMQ,
"Fallahasm, Flor%32309
1l5541443412
ILL."�112 L
113 tyun twaimthn or ohis entumco %tether Ar convenknee or for cause ,as doladc',c] in this conlract, the Provider and
WIL at no am to Ke AHW= vwNWIll public records ni thvir [wsscsskm to the AMaurice and dcstToy
any duplicaw ptiblic mwds that am ewn, or con%&M W exa"L Sta pUbfic records disclosore reqinrewions.
All records sm-ed electrortically sh'all be provicled to the Adiwwe in as Kam Anat is conitialible with 010 infonllalkml
technology systenis of1he Allkince,
I L I Ile PmvWur AWI owNhIn and nmhmh WU rmmd% mW duumerrm(AdudOg vrIecinirric rnedia)sufficicnr
to rV, llecl all assets, abugationn urnubligawd baNnm% inconw. biorest, mid cNperiditures of Ittn&,; 1novided by the
Alliance under this conn-am Pravideifo shalli adequately safeguord call such aws mid asmuv 1hoy me used soluly 11or the
purposes aLHh0YiZVd War my c(nin-act or agreortent whidi &CWpomies IMS C4nJrWL Whenc"r appoptan WWI
information should be relmedl to perfin-juvince arid unit cost daia
I L2 Ile Pawkier shall mWA Al cherit records, fimancial reCOYCIS, dOCLIMCWN. StatridCal NCOIXIS, and d1ly (rdlel
inedia)portincril W thi'scontract foraperiod(,4'si-x (6)years a rice cU np I ,tiara of
Ike corthawl or lutyn m1a rNuirW lay Wm 5 Ow event an W K mquh-W by dais cmkml- mcumb W be mniacd
fora n1irlifflujil pawd USX Y)"as aPer the ault report is Wed or until rewWdon ufny amid Whig"w gptupttr On
Wed an Me taws orms cmant M no Wd&mW cum W Ow AHW=c
11 3 Qwn demaml,W rm WNW cmt to le AMmwq dw Pni&du Omll faciihilalt,flic,duplicat ion and tninsfer(jf"Jjry records
ot duculnews dnritlp,the vvquired icwnfion pericid!
I I A 1w Pmviclur shall ussam that Q records descHbcd in Pumgmph 10 W he saubject at all reasonatfle knies to insl')ection,
reviivw, cqayrvqg,of ClUdit by RdemL MuN, ear other pumoruwl dWy authmind by Me !QlH mace.
5 At all reasorrable 0ows, f6rus long as records am nuAnW&cQ persmi�,duty awhorized by die(WhInce and the Depwiment,
pursuani to 45 ("FR part 71 v011 bv alimmal 11H ames"o nd be HWH W eumine any of Provider's contracts .md
rdaWd imods and Imam=pwhwm w 1his specillic cw ntnact.tvgkadless ofthe llornri in whch kept,
I L6 'Me PraNkler W pruvWc as IbneW md complimue aull U) the AUWwe as specil"red in thk, coon—act and in
ATTACIMIENT IN wined viumv Tan all wNted Tidimay rrumadhns wr dkelowd to leam1itor.
I L7 I he Provider agrees to comply i0h the DWwtwrit's Inspector Ganeml in any WesUg0on, audit, Inspection,review,
I 2 Ky execution ofthis Conmixt Te Provider undenilands and Wjjj CotylpiYror hearhig , , . .
wAh &N sAmokm. NovkWWWwragrees that h shall inclAde in rekned subconwacts a jre�quircrrrruni,tbat mlu"Moor�
hge 4 of 57
pubmih, amd or pa0dirig selwkes pwauma to IN conunct agree to cooperate w0h Ow hupemn Gemml in any
hiveY Qualml, awht- impalkn mdew,or hearing prisuant W w 211055(51 RS,
12. N—ond iscriln ilia(ion A,-'bd U-4-ixhLs'Lmmmh mula,
III Ile Pnwidcl- shall execuu; amwances hi ATTACHMENT It dmi 4 KH not disabihate agar rim any person hi dv�
provkiw, kWsevvices or henerils under this co"vao or in vinji1opywris because oflge, race, refigion, cok)r, disabilky,
natiowd on-in, niarhi swus sw wx in compharice vvith smote and Ildeml law and regulatrolis. I he [Irrivider furdler
asstuts IhW all Provwat uwjwwrzaors„s"b-"grai I tees, 01,othas Willi whovir it arranges to per service,,or Iwriefns
in conneohn "TV my of A pmgmms mW akvihn are nm d1suhhoing waist clients our empo"n bumlac(if age,
MCe.Nkgi011,COI(ir-, diStibility,naliortal otight,rnaritall sratus or se%
122 During 1he lenn of Ak emM=L Ow Pro6da MmH umplew md V0,1611 mi filu ct tinleiy. compltte and acculate OvH
RiWMs Colnphance Checkfim,amrcircd to d6s,cunlvaa
123 The PmvWer slall extaW proadlarm pwvmni to federal Imv to QWN uniqlatkas olkiNahAnlim AwAvNg sWces
or benc 0 1 s f1miaugh I is cmuma, I frese pimeeWs M 0 in c Wde not i Qh ig 0 Wy el n ploymy W put cipm WAve do a
to fide a con'tplaim wilh the appropriate lceVerraV or State endly,
114 nuose awwwas am a condidaii of condnued rmeyt nror hvnevi noolarrandal assisme, and two fAnding upon the
Pl`0VidCl%n,S SUCUSSMS, and assignees Im-the period dwring uddch such assistunce is provkkd. 'rhe Provkhr
Ainher asswes hot Al vendurs, m odwis wWi whmn 4 amiaps to pnwWc semices or batuAN lo
pmAcomas or wnphyen A connection wkh any of Is pmgmMS MM aoNi[jes jone riot discriniinating, against those
pardcip�Mllts 01 ernployees in vio"tatiorr offliv reguladolls,gj6dcflnvs,arid slandards, In the cvcnt offoiltire
to conirdy,flic Provider that thee Alliance inay,ai hs disovi,imu mxka court orah.,r'rcquirirtg coillpfimme whIl
the terrvis of lins assurasice or week anther approl'HiflIC jddrCikil oi adininisirative rehet" irchr(fin", but not fin'llited fo,
Wrinination ofand denial offiloher assisutnee.
13. VmHorhig by tluew AlIhme jr A
13,1 Hit!I"I'm tukt rshsu pennh pemonsdut wAnthed hy the AM=to Spat as cl, HM vxor ,,paperu, facifikii.,.; goods
and set-Wes tlfthe %Kler Wch are relevant to Ods ca"Uncr,annul to inwrvww all ownK MqAIMS MW mommmoor
ernoymm or we PrmAkr w ut"ury Me A Mawe or tho sudsRuiry per-fiarnance of the terrns and conditions of this
cm= Fdhmhg suh mvAy the AUKruce W lwovWc as %when report iW S findhigs w the %vicler and where
appinqW, the lira vivier shvdi dewhV a (Unve0vc Akwi Man (CAP; The Provider hereby ugmes W cormcl all
dekiencres idendfio] 6 Uw CAP 0 a Hmely mmmor as dwamiumMy die Contract NInflage1% 1'ailklre to Comply With flie
CAP MmIl QY0 NPO&r W cuNrcernew actions as dusedhod in this Comet,
13,2 "I"he Afliaucv will perforlIll IiSCM, zurd pinymmmoak nionknirig of th pvvicla to en mrre cwttramwfl
emnMimwo I&A acwulvaWh,pitgmumindc perAnuunwe.and cumpHmuse with uMfliublesmic,and 11dervil tows and
regnbAns. The Providw wM sur;oy pirogtws mpm hicluAng rhan rq)wdng requirvnialls as speckrial by the Allince
Or the Departruent to bu used lam nronitoring pmpas or puMnuance of the conuacuml servicc% Fxtunples of review,
criteria arse sturflus/deficil reports, indqvndent awhy. imernm cotu"s. rehowwMem rawom, mth"namor
lnotriiorirlg„ turgmirlg, pregrwin OWTH4, owalme nvmum& scrKe yovision W d&M datu ANgtity, client
sad%cihn,mnd ellul Me reviews,
133 RmilaVaSt think Craft hdedv,Woluo Repons (RMSI) - IS Provichr AmN mhrnh Rorwpmhve IhA Cost
Methodoktgy(I'U1CM)W the AffInce annually, hut no ImerOmn nhey(WO calenclan-days n1ler the Provkkr Idscrd Year-
can s Costs
immeratud w1h savkn prcivihd muter Ohs cowl-act shahl vmt include allovuble dKo and [riddrect sm as deMud by
upokable smu law. If to Pnnkkr desks ran renegobale S rehinhursernent rates, the Provider sdiali makv a rarLlltcsl pil
WITifing w Ov lfiance, %vith, the inclusion of a prospective Unit Cost N40hodology, in mcmhnu with Me AM and
upproved R6nihursenicrn HAW Rubw Polly widdis hempamwd by m0mrice,
14, Provisioliof Services
The PmyWer Au purvide services in Me nimora dnu6bW in A ATTACI MENT I c5thk contract and in tire Servoce Provider
Applicitlioli (SPA) In the event and conl1c; howun to Service PunhJur Appikkon and Its condrad, the contract Imigunge
prevails.
Isqa rdinalal Nlou kowfi,LMy�i0i OffiCi Agencies
loge 5 Uf 57
I fthe Plovidei receives MmMW Enron crane,or;rnnwoKuStMe cif FhQda hunian say we agencis, in addition to the Dqwworteni
or HWa Aflhim that a Ykt mmiturbig vidt incWtUng such other mgcncles nia)"bc sclledulc,& For the pUrp0SCs of this conlracl,
and purstrant to & 2117A57t IQ as antencled, F'lortda's liturian, service agencks shuH include tile Departiment.of Children and
Faillihes, the Departolmo of Hold; Me Agony kv Pumms %Yhh DisahHbes. the Deprhnml a Volume AHWm. md Me
Departanant of 101der ANY& Upon nwification as to obolwnt scheduling of such as visit by the designated agency's dlead
whWWWAve cwWwr.the Provider(dtill Con1my Wo Co"Mme with all lnolfltois. inspectors,and/t.u'uivemigaitirs,
10, 111deninification
Flic I'm%J& shal V indconiife,%Vwe.LICIC11d, tind 1101d hA1'Hd0SS IIC DVIIHN11WHI,I[W, 'Xtha]uLC and jis klffitCCra. rL,-MLIS Ord C-1111110yCO ft(mi 011)
and calf chim,demundT aedma.cnwes of au kin of"I mwver nahre of chwvcWn Ming nui or or hy remon of I he exmudon thk C Am rmo
or performance tit'ific sorw ices ptm,itted f6r],letein. his Wanond and ilmod I hm i be IW Oda,k nor NquNd h)indenmiQ Te I kpaiinwnt
tu rhe AHAK*hor drdini-demudn r-r 6mis.vir cnuws rot Mmi n&Kg wk,wH M dw DqwMcOs m AM=m4 wp4mu.
17.t Provkler niust Pavide concinuous adequate habQ insurance and worker's compensation insurance coverage,durhip,tile
exis,tarce of this corrim aW dwing any rvnewaj)or extension(s)ref or. Fhe All iarweshal I be urcluded as arrr addifion"d
insured orl the provider's HabRity insurance policy or policies andi a cc y ON Cadkoe ofInsuraricc Shall be:provided
"Unnially or when,any Changes occor, The Provider accelirs, flill reqmisTly Cox WoWyly mW delambibrig Te jp(s)
and extent offiability insuranze neceswry io provide rewonabre firrancial protections for the ProvWerand tile chants tc)
hosc,rved under flli,;connraet. Upon execution,ofthds Contract,We Pro0da AN Funikh the UNce mQuen veriPention
suprkmhng hWh the detamhathm mid exWome nfmwh himn-mice Covera"'e. The Hlifils of oovoir,,qm'r untler,each poli",
nurkwhindAl the Pmvida do mu HmA Ow Pinovixial HAHRy and obhpiklis Lm&r this cm&KL Me PwAds OUH
el'SLAr'C 1hat the Alliance has flio mosil current %whwin veinnion or Naurance coveragc throughont 11tc, terill of fl-ris
cwWaL Such awemge awy be pirtnUed by H self-inmwance progman estabhshed and oporafing under the laws ol'the
swe or FkWdm W lkiialltlawn and rhea Alkanclo rowrve the right to reqr0re addkional illsunancu as specified by Mi's
corrtrad,
IT2 1%mghma the lenn or Ilds cm= be Pmvida Hmm miihimili an insurance, bcmd flom c wspolrdWe oonuuercilll
insurance coinpany cmeQ all of6con, throciory ernpWyew, arid agents of the Pnwidmr, im1horryed to luardlo flunds
racived or dishurani UnW Ilds CMUMCL W an arnawl coturnerimimle Wi he W& Willel the dqwe onhk as
dewrl-nined by the inmirmwe emnimny wid cmimmit whh good bilshns practices,
18, (Imlid rut U YjjAnQTW.Q0L1,
W—P—m0der MWI rnm use or Asclinc any inhannruhn correQrnhig a reciprort ofseirvrc�.S under this Conlrael for-any Purpose
pixIdAred by moo or Ademl NW OF TgLdhtWns except whh the wriHen consort of as per m"i 10gally authodzed to give duu cimsent
or whc,11 a"Iriorized by lmv,
9. LLealth I 11sul alm Po,(a WrLtLand Accwlnt:ahilh.- .
Wherc applicable,the Pnwhda simil comply whh drat, HwAll Insmancc Portability and Accountabilily Act,i,42 LISC 13200, as
oicIr ,is"M regulaticlils PmMulpred Botudu Q0 CFR 16% 161 mid I M)l,
24
211 Ile P"mhkr W wHQ di AlKwu irurrimbWeV N" no Wa dlan fortyh&No Kim hum the Pmd&&s awareness
or disc every of Candisms mar nmy inaterilly anicl No PmAdu or- Subcontractcu's ability to perfoTill the services
requked to be jjCjn formed under Us cwaracL Suh notice W be We omlly U) he Contmet Manager(by telephone)
wuh an eniail to inimediately follo%v
212 Tur Pruvider shall hnnielately report knowledg,"'e or- reasollable suspiJon ofabLlse, negko, m-expARM On or a Q Id,
aged llerson, or disabled aba to are Widd Abuse Whe on the suawkie tolkhve tdoMune nnrnher (V-800-
96ABUSEY As rapdrvd by Chapiets 39 wid W. FS. thk pmOdoti is bhidhg upon hods be Pmdcfer subcorrnmam-s
and its empWyms.
2L Lb i i I
Dwhgdie to dliscontimcL Me ProvkladulH himeaMely MAQ the Anoxcifle Miwidw; hs nss4neav sub-Cuanneurs
or affiliates file a chitin Ar ban%Ncy. Within ten (10) days aRmnimidWon, Me PmvWu mug ak"mwhale the Hlowmig
inAii-rinwimi to the AHWww 0) Me dade ormy oNhe hankruNcy IMAM (2) the case ntmiber: (3) We coun nnnu aml the
WvWon M whWh Ow Qdw mms lled(ag.Nomhem DWAU orFhddv Tallaha%ee DPvkioiri)-,and,(4)the natne,address,and
lelephone nuniber offlie bankrupicy iluorney
15ge 6 of 57
22.
211 As requinad Q Y 2MA& Fk SW HAe MmUer k n mmymmurwniM wpwhahm Miich slumsors a pirogram dnmrrccd vdwllg o�
in pmi hy sww RnOw hicKtirig my Rinds WON 14migh Mis smimm. 4 AWL I QW, advealking. or desaNny Me.
qwnw"hp of Me pwgrnrn. sWS "Qmmmd hy IPR()VH)VR NAML], Th,, Alham!Q for Agrug, paau., and thc Slatc off`kirida,
Deparmem a EW ARW" If Me qwismNp m1mme 1 4 Wien maWAI be vnwds"NUAmee hur AQW, W" and"Slare of
11m ida, 0ep,amincm of gluier Affair,5",Shall pliciti, in ni out me Nwne one imvm o")q us vc mumnime 30howin.
2 2 nP Hie Pmv dcr shall no uric Me wor&Whwc Ar AgQ WT w"Vw We "F!nrlda, DepariRnent o'E,1do-Affairs" do findicaw,
spvqlsorship M a proms in odwrwise finjoced, aml»,,sw specific nuMoNatkoin has how;Qahwd by the,Alba iwe ha by rasa:.
23. AL�,&nments
211 IS ProviClaskk mg nmqn Sw nphis and nalonsahNio undawg mmnu"W"I MepiorivrOWn ojTnnAl ofle ANOnce.Arii�
q1t fliv Qonood cil,agi-cQuicill
:232 111scontractshall remuin PmAWWWALlhimc.
24. 5ulmanitmMs-
211 1 he Prtwider hwvMundWe Rw aH wmi pubnwd and Mr aH econmadW pmdmed pufsund W his contracL whWher
actua,Hy Fra-vished by time WOW allN wbeemmom, Amy milhumirms shall be,evidenced by ai wrkten docrunent and
milliecl to any condilimm ofamraul dw HAnne dmnN necesuryWe ProvkWr hinher qgmes I%the AHAwe W tricii.
he Who to Me Wwori;motw W any way or Or any rvasom rhe Novklen, al its expurise,shoran defend the Adlince again d
MV Such dw=
242 Me PnmhNr dvall pmm,V lmy any mWatntimoms uMn recoM of l-4.Nment fix.nin the ph ance or Wherstalo, agency,
Failure to niake pulturcruts to uny suixon hWar hi accin-dance s. 2 7 01.585, Faro SU"'IL, unles. otherw rose SUIhed in this
ecmime! between the Ifavider mid suhconWuc"q "wW rum& in a pewhy as pnwWed b.y stawk!
213 Ile Pmvidur OwN pnTminnnalkaHy moilor, at least Once Per ytNir, each of its, SU11011111-,100]'S, SUbrecipients, VCndors,
wrilhw ChinmEms Ile hv&br hall porInn rimgmtrimmic numidorhT to onmr convacaml uAmplianco, anti
pnVaimnwk paWitance mW cornfWarice whh aptYlkable state and Iet.leral laws and regtikflions, The Provider shall
nioNwir W amwe Mw We whWuhs mv nwt: die budget and scope(A"work are accorNAWd whidn Me S1,w6fied 61,11Q
paW&, mW other potwmane guak 'Me Provider Aral] also P0116rin fiscal nrid adinintsurative, intrmiu.)r4ig Vor nfl
subcono-aclors,to ensure
24A Ile der vW9r shaEl have a 171veureivean poky ihat assums rinaxiinum Rea and open cmripshhun. Sch procuenuon,poQy
in um umd6n,as up,plImble.whh Fideral and%aw cutimcibrig Md Pmenwrilml i assei forth, in '11fle 2 C!odc
offeder-A Reguiaiiimm RTR) IS"201 UK 2MO51 I'la, Siat- U.S.Office map Nian.'agemeat and rindget (C)MB)Circulat,
1 10, Florida, 6ep=&nt or Management SerNes (DMS)Ruk 60A-W RAE, and wUh, the Department's Program and
Services, d landhool,'-
215 11w PmvWm sAH dMIMe to MMfummaq R, mom A oblWations imp 0ik cao,)wraO anti Qnsurc, 0)1,1 subcontiveWs
dakme adejoe sW" rwea,ra9lrmgly, The pmvW" Qfll Qnsurk 1hat Staff responsible lbi, perfinurifil", iany duldc of
functions within this contract has the qualiflicadons as WNW in the Depaitment's Prog rani s and �,wrvices Fla ndbix)k.
21 Undue„NLediodoli)iv lle&orfs',
Ac PmvWcr Aall!suNnnh Rormpective LOH Cam IdelWologARUM to Ow Allhance annualy,but no fmcr 1%n0ty(90)
calendar days afier dw Provideir [J.Stajj Year oWn Ile RUCNI shall reflect acwrd corns of providing,each so-vice by jwqgrani
for throe precedtng connuct yen. [Foos ansocited wqh savivus pvnhled under this contmcl shall only indude ulloNvalle direct
and indireacoms asde&ed byappkahk ame Nw, UMoPmvWcrdeOvswrmwgmhwhsmMbmwmwumwtOwPmvWck,
NuH rnAc a request in %Wng to tlw AHQnq wth Mv WSW of a Pampative (Jiflt Cost Medlodojogy. in accor(hvice wh]i
the AHWxes qylamved Reiintibursenient Raw SO= Policy, which is hicorpoirated by reference,,
26, Eunki du dmd�i om,
211 ncAhlhuxeforAg ging, hm,acknowledges its=Qon tam my to PtrovWur Rw to j-.w.rFornijance of Provider's duties
and responsillihfies set forth in this Conn,act,
INge 7 cW 57
2&2 IS Alhisice NWH not be Thk to Me Provider hm crests immiod or poTcpirnrance 1-01dCrCd U111CSS such toasts and
performallico are, Strictly in accora,luccx0h the lenns oftlis contract„ inchidinglout not lAnhod to lemis goveniOgthe
Pm~s promised puforrowne aml unh rates anWor r6raburserneot capiurOons specifivd,
2&3 Ile AHmme W nm he We R, to WoOda W any expoWhao"NO aw mi alhm AN ows as dawd & 2 CFR nm NO mr(l
45(A It Pao Was amendNk or Mria eVerrImn We wn Imm mMe W nwmWwo wil all appHoldc maw mml Ideml rugs.
2&4 Dw AHMme = nor he liable to the ProOder bw c"aid1twes rrinde in violbrion of mguWiwB procriulgaied mdu My
Older Arnerkaim Am, Deparwicn(rMcw. Flod(Li Statutes.or this Contract.
h is Me intou and umQmWnd&g Arow Partios that Iprur Provider, or ,my of raw Stibconnactors, are indelmn3cra Provider's and
31V MCI Um",va tW Me AHAnce mW MNM am hW3 MonwIles out as ernphyces or agerum of the /UlWnce Khoul spedhc
mahlorizaiii,xi 1'roill Oir Alkance, H, is the 14Mer himi and uWagandig of Me Parties Iful; be AHNnce rear s mm aintrol die
ciliployment practices of the Provider aild will not he liable for any wage anvi hour, ernplo)niew cfiscwdninafion, kri wheii labor
aud cuiployincim clahns uphist the Novider or Rs Subcordracitus.AH dedu0iom ho-wural scciiri(y,w4filiolding laxei.incoine
taxo,conlriboHons to memploymnH conipensWK Bids and aH ncccssary insurmice fin'tho Ilrovjdvraire than soh2 responsibilily
of die, Provider
28, PAlrmnit
2&1 lkynimms shill he made in the Nuilder as servies arc rdtdcrcd and invoiced b)/ the PrOV410% ThC Alliance will have
&M approval of be hwha I&pgrinon wicl "ThWgme the invoke I&paynum oMy W Ke PmOkr has area A tennis
and cmWibrns of die ==L unless Me bW s"cifimilmy purchmse okm or Mk coomut Wedfy othuwNe. 'Me
approved invoice will he subixthted to dre Alliances Awal dqaorvient (6r budgiclary approval and proccs0ng per
ATTACHNum viH.
282 Ile PnmWer sluild maktal dw:ummauthm to m*pwi paynnern wqw0s wNch Aull he avdWbk In be Departnuont of
Financiat serviccs, the Dcpaihnew (n- die Alhairce, upwi request, Invoices Innst be subnfllu.^d in SUFfiCiOn deMil fi)r as
propa pv mAd mid pm awk vernunw Pmvwu man winpl, wwo state and Ideml hws gmendn Ipaymentsto
be made under thins cmirae; indudinglir;nut Ihniked to the IbHowing:saimns 216,t8h,16no&Grip„ Fla, awua-a and
11w lmoice Requiremetfls(il"the Reference (Akle NT State hqarcl4urm hvm to DqwUnient of Financial Services at!
t'.".o 0'wid:fvj�' coill dt"L'Jo�j' Y-LurEVlk 00"HIM"Hk k'xl
The Prc'6dei Amon the imnized itmoke or'ptyurwwwgresi Sw
Cost Ili x ed ranted or('lej j+uer'111)]es' fi)i lhisconhwcL wfll Oc
PM&WW Upm requiest by the 11 H once, 'Me PMVWU CIA truly request ivhnhumomm tart olkwAYle cMwnses ms defined
in the laws and guiding cireWan eked in this Curamc!scoian 6. in To Refereocc,Guide fcw Statc L'Lxpenditures' and any
other laws or regubtr nts. as applicAL
2&3 Uw PmO&r and nbcontmoors shall provide units ortlihmrah4s, hichOhl rqxim findhigs,and drans as specinmi in
Ohs counnic;to he med"d and weepecl Q to A&=pior to payinan,
2% Remni t1, 1.;, M!s
Ile ProAK shall rlatim to Me AHWice aq muzpayrnmrs du to urromsed hmitls or• nxi-rds dk&Wwvd and any 40crol
ivuribumtdc to gmh ffurds pursumn to be jams and ccrndidons ofany coritrm:t or incorporwing lhis Contract by
mlivne AM wemchNnsed to the [hovi der days the AlHonce. In the event Mat the Prnw0ror its iWeperidera wKWordismwers
Mar an mertiqrronil has been made, die PmWkr AM I mpy said ovurpwayrnmit hlal'wdiately williout prior rrofifica6on fron"i,the
UK= In the evew Own, Me AM= MV (AccamN aii overpqrnent has Iwen triade, she. Comma khrutiga wHI rohy Q
ProKer W vaking of such Andirigs. Should repaymeM nM he mak RWMWWL the Ptovider shall be Charged at die lawful rate,
iWinterm on te ouManding balance pursuant to s. 51A31 F& ether AHNirceN w1koWn m Provi&r 1wovv,
30, Q a t�al dame t g�j r j fe Ly Li U(jLi&Un WwwA0
—
The NoOhr %H ennwe an appmprime IN ordmu scaMy An he hihmmithn le PmAda is c6kahg on ming & tare
pahmmuc of Via confMcL An appnqriMc level of semirit hicludes appuving and tracking, all Vrovider eninployco that
request sy,,itern or inhm-timinn accem and unswkg Hurt umer access hays bun mmond froni all lenninatedeniployces. The
aver Vicipaw and prepure UK Woof Whraim4n Alldtna
and soRware must be roaWndy ba&ed up to instIN rec"Overy froni lose, or Otitages (if eornpUtCrsysteins, The security over the
kick-rap data is to bo as miligmt m dw par imeo ion ralu Ned of p inlary syswius. The N cwider shaI 1 insure rapt/sub-Contrackns
INge H of 57
rm0niiaul a,Vritwn procedm-es for coniputer try steam backup and recovery. Fite Provider shall,pKir to executmi'i of this agrecanenil,
mmpMe dw Cerfficaficat Regarding Data. ImegiTy Conipluice for o%.greeiveWs, 6varils, Loans,and Coopiasatrve Agrecurents
prkv to die exeMonWHAS ConVael, as[W or/v FFACHMEN'r if,
3 L Social Moliti aarru M1..r ,eMd -"1'aaaaae U Sr u
:MM®M Inappropriate use of&ocial wedia and pemmml cdl pMmcs may posc risks to DOEA's confldendal and proprietaTy
h4ornraiion and way jo)paii Wuh Qgm UNWAKV By Synirig this CWUrt 0. lywidev agives lo We
Mowing social rnmPh and pier soniM W phone use ralu0mvents,
W Social Media Defiae(L flne wirn Social Media and Q posmml mHuln includ", W N nW UmMd w,
su,wiM iretworkfiq! websites, Nogs, pndcams, dismisMon himirns, RSS fi!ed�, videt) �Jrviiiiqj,, SMS
h4conges WhIst Messages, wxt mosage% On I social nelwarls Hko InswW= 711W Wpdar Googh; I lanpmfs,
Whai,,App, Siignai, FaMmA, Pirdorv, W Minor; and cuirimm Auk, ne"arks such as FHckr and YouTuhe, IT&
ineWdes the wansmsion orsock! merlin ihmqh my COWU Or Online IrMISI'llissicin via any el��xtrordc, in ernes, invanct,
tw orhel wvireless colonoinica6olin.
313 ikpiflivoliini (o any Me! or PricidetAl DOEA or WWw Mall husMem I his conlracl applies to airy UX)EA or olher
sune buskess conducwd mi my afdw PmOkeq Subconmoi&q o"heir ernployees' social niediaaccounts or through
pM'SOYMI COULIhAl COMITHIlliCalt011.
3 1 l Application to DOEA and PmYWNN EquipirienlKnItis conlract applies itgardess of Wha dw social mela is
accused mhgDOEA'slTibcHhlnmWcpWmaA can equommem befongingro llrovhler, respvetjve
enjiWyeew EqQnmt hckht bw is nca thriked to, pomnM corripmos"Mikir phow& po=W d*Md mAmw
siolart watches„ or,sullarl CrVdcts,
313 Florida Governinent in tire Sunishkim, FMrMa Public Records Law, and [1111AA. Pjrftj&r- ackjonvliudges lhat I'lloy
of mlier "I"rie Whms unnMod by weial WK or dinmgh pemortal cellular ommnmication is sullecl tos
Me Surf MicLaw,Horida'sPl,ibfic RcccnWaiw(CliaAter 1 !9,Florida Stahnies),and thellealth
h1suratice Porlabililly and Accuunrahihty,Ncl(IMMAYCOmphance whMse lawsand WheraMlicalAe lawswe Ru-ther
doaHed in the conunct.
MA PmhMHW or RnmWild hohns.
Anysocj,rl ruc(fia posis which Mule ph=, vi6.,,(:)s,or riatnes ol"efieiu , volrinteers, staff, cir other Arfiliaiies of DC'WA
In"j), oWy be posted Miell auahorizvd by law ;tird when -aiiiy iv,Mvd I HPAA mahodnAms and wry other cotmniN m
araatMrorrurwrtdrurrw required pursumn, hr I'McrMam wate Nw are on hile with the Provider's records.
31,7 Assisil DOEA wkh (Immunimitions. Unri may he aded pei-imkalono msim W dimbuthy camirn DOEA
curnmunilaHans hirmigh dwir sm:Wl meta owkN. Any smM reoiems AmMm Nand I a8emme M dw uwW Mai
rvquircuierrs hurcita and Wic othel of ihis contract,
1, Conflict.of :KA—
Fhe Provider shah est,,iil&Nh Mgmah wiTntill eqW,mv ho;wd tuna:Wwtv nmugument and subconurcWrs 1140111 Wing 1110hr
pvNwn pm a pimpme do ummhwn or pmwims me qMamwe or pammid (ti, ofailmay in personad
gain,
No eni oriricen nr agcni or the Pru%ddur or subcontravisir Own Poik"Me in Somitsh CW Do Me awaW owl"an agivernNrt
5upponed by swite or federal funds if a u-nillict of inlumst, rmhw amwer, =W be M&W Swh a cmnh Md whe
Wv 40 We empkWee, Wke; w, agm, (b) any murnho, of hibler immi fmnily; (c) his or hcr partner; or (d) an
cqrganizahon which emlikys, or is Mat to o"ploy mW of rhe Wwc, hm as Hirianchl or other hHemst in tho rhin se%NJ IS
award. The Provider or stibcontractor's off1mry arnplo)rmm or ageriN MH neiler solicit nor accept g,rafuities, finvors or mWMhg
of mcnivary vAw num PmvkU& potmHO MOM or ImMus in subconiraos.
Pursuant io Chapter? Section 2 ofidw Mpulment of FWAMW Pirogntm mid Services Handhocpf,,no Providcr rintry cniploy,
in any capacky.uny rrimnlha ohN gmmmig bmd or any h,',irnHy raaerrahe.r ofa po-sori on dic boM
The Providers' board moribers and management nnuo diclow to the Alfiance any ire hitionsiflp which may be, or rimy be
perceived to he, a conflicl of interest wilin thfily (30) calrWir days of an hdividuat's original apt,x6nInio-it or ptacement in
that position, air if'the jjj&Vj(jjj"fl is ,er,Vrijjg as an inicurnheni. widin thibly (30) caleri,dur days orlz commencenwrit of Ms
14ge 9 of 57
con MWL I be Rv0dem'employces and subcoMractorsmust make the ume&u5num docribed above tea the Pi oviders' Board
of D ii-ectors. Compkance, with this provisic)n ^�W tic lnonhored-
31 L'iLbfic jifirlCrinNe
Pumunim to s.287J30 rs, as pmon orairlifiate lVillo,has hCal Placed on [lie convictc'd veridiw list followijir!,as convicroll for a
phhc early We nwy not submit a bW^qwMAw mp" on as conw, to li zu,goods aw services to as puMic eniky,
"my Ma SOMA a No pmpmm"W reply on a coMnwt wUh a pAhe ady fair the conmruction or repaid or!"a pubhic building,or
puiiflic work; imay not satibinit bids. proposals or ropfics Oil icases o ro"d property to a pubhc ewity: r1ray not tau: awarded Or
puRrn"Ywt as as Pi-ovWer, (wenmMarn ads a amwae"Odr a,puNk arty:and nnq nm ommul-
busiuivss vvilh any pubHc eniHy in excess ortho Wreshold arnomm pnwWed in v 28711l7, V,S- for Category]wo lbra p"hd oil'
36 inontli-is foHoNvuq,,, he dme orheig plued on die convicled vendor hm Wde PmOder nr any or is,Ahcem or dhvcuws is,
L,MlVieled ofa publiC enfity Crinw, during flue peiicud Offlusal,"reeMUL Ow Provider WhWil mdN Me Ablince hmielmedl Non-
ommpHance with IN,, statuic shzfll consthwe as WHO, oNhk sigmernew.
"wwuulsUmm,
3*1 The Pruvider May Iairchase arlicks Weh are the suynct orow two requinad tocoy ow a"CMWW eau aweemmu 6un
Prison kehahihGwOve industriesaml,Divcrsified WaRkadw(PRIIAV bderitifled underCluipter 94k,Fla. Stat. Q die
nwe mama awl ander We pmcmWrey set RWh in sT 9=515(t mid (41 Ft. Sm, hw pimpmes of his cmum die
Providershiffl be deerled to he suhst:ided Nir Ow AMance WmOhras dealhigs whiki IWO, This elhime is not applicabP
W Subcontractors niflcss otherwise i-quiiad by W. An Weviated w orproduWa0un awAlk W" PWDE nuty
be obtained by contacting PRIDE, 800-643-8459,
312 Am Piv0da nmy pwcmv my mqycQd pm&icis or nrawrmalls,"Vikh are the QQ ofor am mqiAmd to awry Ak cuumoct
in accordance swith the pi()0a,Jojis ofsectioin 403,7065" Fla Slat,
3 JiUly �)J,j
14.3 rch",tse articles Am am dw MIQ of" or required 10 carry own, any colntraO or fi-oln a
fcn-dw 1131kid m l'or the Severely I kklwayiped Kai Is quid-Rd PIUMMIN LOChIMM 4 11 Flm SML, W die
sarse nwinner und under the same piwedwes set US in s, 413536(1)and (26 Hm Sm. Fm puMoso onhis wrimet,
Te ProAder W he deeind to he mbsbuwd W Ilk Aidiance Wonr as Whirigs vvNh such quidified nmpn4h agowy
am conmrrimL Adithlikirml inkunuRkm about Me daymad mmlisindh aguiny and Me prodiwrs At oflAs k nud6W at
This clause is not applicable to subcomraws unks olhenvke requRd by law.
35, ILiftaa_ fliu RaxaLtls!s
351 IfTfs conlram is awarded maw Wirigmid Imq dikumv, WhAn orcopyrylildAe inyoQid is deyekqied,produced
(q folj' oW"ei.,Sjjip wqis purchased in Be emnse mr,as as mso or wott =adus pubmwd ander 05 cows mct
be inventionormalerird lodic PUlAnce lobe rethired tole lkpaturim tulysacred wall
paww rights or copydgWs acerming under Wk commui am hereby resenned to Ow We of F&Hda 0 aiccurdwwe mAdi
Chapter 286, F`,S Purstwim los. 2HU671 (5Rky asainvirdel the only exceoions to 001 provisimi,shall he those dial ure
clearly expvessed arid ircascmably vaililed in illis Colairacl,
311 ir die Rimary palmse of wk coiant k Me cmMion of iradlenual popony die Stale or Fhvwa shad windin an
uneiccuiril,.)ered 10 USC SLICII property,nMwWaMa;WhW wq agrcemNu mak pnsaitirr; W dWeelln 33,
352 If Hik c(nitnizi is awarded soQ Idden] fund4g, the wme W cwdidwN am gmairied by 2 CFR rNn 2MY315.
The Provider shufll, wIMM 11-dry (NO calendar Sys or Be execirtum of mis,coniumm subw to Me All[ame CwWwt Mmiager
vedli or an emergency Im,mcinns pWm hn Q ewm (Ian mnergen, Be PmOkr WH nW1Q trite Ailhince or'
eillergency provisions.
In the event a situadori results in a cess,,nion or scrNWes by a sAXIMmom. the Pm-odder WH miulh resymAhkity Ar
perflirmunce under dtis comnel and Entisl follow pvcedums U)answe conViniAl,Wpawkwis Whoul WarrMlion,
K, PUR IND Rw=
lie did R MOD Fwvi W lvemby incoVoralml by rebmwe nd auk% v
-v V Am"[w,041ndo wU D � j if,'Inua,d_
Page 10 of 57
In Hie event wA'ajvy confrict behveen the PUR 1000 Forni mW an ternis or condiiions of an_5 n� cmmac I or agreement terins or
conditic,nts the, cw:.orOracl shvill i'lke Precedence over dw PUR IND Fons I Imynen if1he confljoing temis or condirians in the,
PUR I NO Fcarr; aiv mquied by aqy secdon of the Flodb SMMW% the tuans or conditions contemned in the IT R 1000 Qrrn
,.drafl lake pirccederwe.
38. Use of StMe Funds to Purchase or Inn irove flea 11"PEC
IT2PILL
i al
Any state funds provided f(.m-Me purchase of Or iniprOverTICMI's U) MW propmy are confirlgeW tq'wn the Provider or poh'[ical
subd N isicin gymiting to Me We a wcurfLy Wwmm in Me proNmy ar IMM to dw amomh of SWe Spar& pmdkd Rw W lam 5
ye,ais frorn flie date ofpmehase or Ov cmriplathon of he Sprovaivunui or as Whor ruqukod by biw
39a 1)�is'EgLRE2LjjL,)Li
Any dispue corwai%W puMmmwe of Me cwAmu W! be deckkd by Me Comract Manager.who sAH revMue Me deddan to
and Serve a Copy oil]the fllrovider
40,
Nothing contained in this agriverimit is hxvnded to serve as a w0ver of soverdgn hmmunhy tW any emity to whkh sovovyi-i
inununity Jim)) be apq1hc'ahL
4L Venue
H"Hily diSpilte aHSCS fArfl,Of1hiS C00ract,to vonve ormwh [egn-1 reamne%dl be MW&WR(Auq, Morkh.
41 Coutrad
This Contract contains ad Ow to and cmWihmn agmed upo 11he Paoros� No oral aggrcerneill's or Sholl be
Vafid or bijilding, 111"wit the Ildlince or Mu RovkIvr unlles exprossly comaked hwvk tv by as ivrWvn tunendmuni to US auntract
signed by" t"'Lloth Parties,
41 EnSWOUn
Me Pubus W not be WAW Rw mV dQv or Whws A polmnwwclime W chvinnstances heyond their Conta ol. provided kho
pmy eValnuhng Me We mqMmv cWhion par ovkbs innimediaw wkwn mAl'inkm amk oku party mO On M hvisWde
effol'-IS to Cure,111C ccm�'Iidon'
41
!"he Panks agev that War couri of ewnpotetu kwisledum A= any temp m coWRW0ww& vWd ar unenhommWo Mv Wher
provisioris are severable to ihit void provisitm and slued] votioini in R01 forceand cfl'ca
41 Lo ifflt.LotL Pr(wedent to,(.:Lmtr H,a(di 0 in,S
rhe Parties agree 11W be dap hnx& perfunnuma nd oQwhon to py umkr this cmAran A cwhgerr; upon an unruml
au prophom by thelegklmure to the Ikpanrnmu and as cmuVonding aHoudVon under contriet hurn the Deptrtment to the
Alhance.
X AddRiodDeWti
T7®r Parties agyec that the 101hrice rosoxes dw rIM to add wo dcWw any or me MI'ViCTS 1V(,jU6Vd uturler this contract whon
deerned to be in the We of Florida's best interest and reduced to a vaitten mnendinent Signed by bodi Parties, Re llarfiew Sh'111I
riegoti"'ue Compens"Ifion 661.airy aiddidonal serviocs added,
47 Waiver
The delay or fadure by Q ANAme to exercise or enfuircc mW WN Qrs under Ods,cotarso wHNM coristitute or he darned
a Avaiver olf the lfiances HWit diewaRer to enbrce low dgMsmor will my sht&or partial excrcise ofany such right preclude
any imher or further exercke thervof or the exenise of any wher QU,
48. Lonj)Iiance'nw %ddor AW We by aH andiCaNk CWTC19 W01 SIMUMV hwv rOes and regulalkis m W m aRQuahk mwmu state
swwws, W tuhs and mp&kms, policies of F)epartairent,and the tervus of this Corvtract.Ttw Parties,agree Ihat Car hire of
the Provider to abide by We laws, miles. reguhtSms, poikk& and larnN of this Contract sluril be deenied ar, event of"defauh,
or Me PmOdcr mid vikVo he PmvWu W AnVAmy aoWn AdWWg corrective action. iinannounced specisfl inonitoring.
ternporary assurnpOon of Me operritim W'one or moru contractual suwiceq pheemeni of the Wvidw-on prohmionan; swatmi,
imposing a inormodunr on Mvvicla a0k; hinposhng financiaJ perialthes Am nonperInTIMICC cw noncompEnce, or oMer
adrilh-listrative action 01 AnmUmv ukhrteml canceHkon at the discretion of 1he/OlAnce.
Page 11 of57
WK A H Awe MAN dul the ProvWWW tau abide y and sudesuduten laws.rules and reguNtions,
as wel I as condidunh or I h6 Conwom 11w A HiNtirice shall provide the flovikier a T4oHceoFVKWKn which sharl NOW a uWsv
Mcment or We specille 6dalions ofthe ProVidd'11nd the fiaChrChCd LiflUll to citabfish ilie violafion.
Upon rucett of the Nmke of ViNAMW the ProvWurshaH have twenly-one(21)days to respond Wthe Not ice ofV it Platt on, The,
Provido"s response must include a statetrienl of my dhpWed desires of maWdW Ext and a concise-staternern of tiie specific racts
the Provider cowends wauam reversal or WhAm Am the AUhrwtfs popmd actkin, including an explanation (Whow the
alloged thus rehibe to he sWeMc r&4 suiminy tw cwwadual tenti
Failure ofthe Provider to resporad to ihe NoW=Wkakm Whin 1weny-otiv(2 l)i:hiY,,,,,sha11 be devnied a kvaivei-of [Ile rights
outhured above and the A111aauwe wM pmmedziguitrst the provider by del-alull,
11-be Alliance, upon iecciviDg a iiint.dy filed reslittlisv. w a Notice ofvitflai[km, vVill we w4mme MW all WUMWW"&jg
documentathn 0 dw Cmrhard Mam, to ro icw and consider-, the(,cirnract Manager 511afl I, Wiflifit 30 days a fier 11-le receipt of
flie Provider's response, Hie an order Wert lqs oW the HnW doeminiatiott of discipfinany action by die Afluvncc,.
W War h1voke
rho Provida"AlaH oibmit ikc fimai 6ivoivo WpMmwM UsS AM=w 4p&Akd 4"Warmam Inhe Nmkkr Woo mW W reqnst
fi r pAyinvill ns�jlccified in IN,, uolilmct. ItIC11 a11 1'rVhws to pa° prlcnw Emly lie forfekod and lheAlkancc wows m4 himior runt requcm stihinklol,
Any tmy n1o'd &W Unda to WMB"IN omanto inn he wRhheW uWU A Npais due Wn 1he NoWla aW tier ouD ,cry gum sate kmlo
haw hem appnNed h) the Alkwo
5W Modifications
WIfintimm of po0d= ofMis ccavrao shaH voily he Wi when dwy We twen rebwed to %Whg mul Idy
signed hy both, parfles.
51,
The/Whince inq, in its We discmikin suspond a"or A auNdiks un&r lids coulrad when in Ific Department of'[,Acr Affairs
anchor the Alfiancc &ternScs that A is in Mo bust interests, of SWW to do so IS AlUnce shafl provide the I't-ovider vvrilto'r
nmke owbing be pankuham or ,smpnisW Exan-irdes t4tho reason pier siqwnsion Unclud, but are not hmited to, Imidpewry
corwrafilts, declaration or other W Sciorinance, ARer recKing a mispembn nwic, dw Provider �dinfl
compy iOh Me noke ad W11 nm aaqx an pmbmsc orders, Within Inanely, duys or ,airy ronocr perrod agreed to by the
Provider, the Afliajice shall Athn(0 We a mmnplin sat work, at:which thric ac0vity shag resurne, or(2)
terininate 01c.Cornracr or J)UrCIUISLr Ortkl- SUSIwmAn awod shall not enthhe the 1havitki to any Wiftmal ctrrnpenswion
511 10minalion for L'onvenSm. I his conrincl may Jx kwunhtawd by vkhwr pony WWI cmNe upm rw Ins Man dirty O)
Wendar days' naLice in %widng to the War rim, urn ms a sooner time is tnutually agreed npon, in wrikg. Said noke
OaH he delivered by US. Mrsmi Stawke x0th volkadmi of ddivoy or any eMmOred dehvery service that pmdcles
verificaiion of"delivery car,by hand delivery are Me Coraraci Nlanager or the represernarive orke Fhavida wsponsibG Or
WinknVAn of the cmVracl- The Mnvkbr WN nor fumkh ml PWdtW"Ra it J`UCeiVCS1hC 1106CC of except
as nmessary to amWkw dic cmdnwd pmbn of the coumd, 4 a" Me Pmd&ir shall iwt Inc endded to recover any
curicellation changes or Ios; proMs. Ac motes on emWI regmAidig this pmvparih.
52.2 Terminaiion, for WAse. lie IdAnce may lernihime this Coamd Wait PmvWtr A&M(0 dAker the product wAhK the
finic sgiociried in thic contact or any exturNAm (Q rtmintain a&Wmw pregims, thus 11010111EAMC Ofthe.
contruen(3)honor any toin Wh,(UabWe by my stathmmy requirenrem,NgLdal0l'y hcensing reqUireffierit,
or EXTmMma pa cy or (5) in the event Rm& Rw payment bmaine un"Alable Ar MN ClmraWf1w AHWxe W be
dw AnW midwriq as to Hie avaikabiThy mid adequac,v of-fundc In the event of WmAmdon of ON amwwL the Pmvieler
tvifl be tcanpcnsared f'or am work satislacrorily completed prior to the date of tennhurtimi nx PmWer W11 amhwe
work on my wort ima MnOW Wept For del"Im of mhcorhmoors rat any 6er, dw Provider shah not, he liable for
any excess vos s ifthe failure in perform the Conant altos Fronunws cmuodely beyond the cornrcd,and wnhout dw
Wt or negligene,orthe provm woe ram m paronn is causaf by the dehuh of as m1cmumcWT W any kq and it'
Me emse of We With is cornplerelyhcymd le awd ofhol Me ProvNer and the subcamrackir,W widuna the Sull
or neg1jence of chheq the Provkhr shall not be HaWe t'orany excess costs, for failure to perfornl„utdioss the
prolm wnerOms were WnWu Ruin other sources in Aliffichu dum nx Me WOW to nwet Me mqWmd detimly
selmdW, IG It N damukud Mm Me PwAW was not it dtfauk rear`that Me&Fhk wm cuumbdu dre
rights and oWjliorts or am Panks, W be Me ware as if Me lamirmlion had been issued rear the com,crionce ofrh,e
Afliance,'Flic rights and reniedies ofthe Altiance in irns clause are in addhimi U)any o4her rights and renne(fies provided
Page 12 of 57
by law t)I undro the Onorrad
513 14mn exondkn or unnhat ion or twin corarruct me PrmWr and mlemiummm OwN V=05 aH PAUcivwrds A Is
pwsWwAo Hw AUNwe wW demny any dupficaw public records Olal nae exempt or corlfiderltiad and ewlnjlu from
PUbhC records, dischmure req&-urneWs M no em"o he AHWwo AH ehMunkdt stomd rewak Awil NawwWa"o
New AHMme A as Rum Mat is wunpatibN whh the 10hances in1f,mmHon wKw1ogy s"Wrijo,
51 Sweesgol's
TV convact WH remin bOdOg tWon Ow stuctmoms & imewo of diher he Allhince w1he PnwWer. QW H,We wmgwlwm
provisjors ardor, ve,
51 Evewo"K 1 eco nature
54A 'Flu Alhamce authorizes, hift does mead reqArn Ow PmvWu Wrewe wW raah COU00 raods Owd kv me cluormnic
Agnaun-us to conduct ImmacHans imcesoty w cmy md me tems orow l2mmmt A Provider Creates and retains
c,V(�CfttjojC 1,rt°(°u)t.&' urramduso;eleca rordc Sigolffill"CS W COnClild tranudWs sIT comply whth the requVrements conmined in,
dw NOT= Ekumnk Wnsudan Act w 66821 Ow SWL AH cleawKe wwds rawl hu Rd,audialk; mv sW"al to
Florida's Public Rewds Law, Ch, V 10. und Fla, SU : nuist cotnpdy with, Section 20, Dala hrtlgrity and Safepuirding
h1f6ttuation,must trinhud" all omOdmthlity,as appkahk:anti wumt he rewined and mAw'diwd by lire Provider do the
some extent as n(woolectronic trCCOrcharc re wined and mahimined as required by this Ouram
512 Ile AHAnceN auhnHudicin pumunt Ni IS sed ion does not mthar-in chumAc hmnuelms between Me Prmiky atittl
the Alliance The Provider is aulho6zed to conduct Ckeclrotdc transaclions with the Allianu (Jflly L.11)011 Furthervvii1ten
consent by fficAlhionce
513 Ljon requol by dw AHWwq Mu Pwvidcr shaH provkle, the AOra nce wkh non-ekmronic(pa�,'Jcr)Copies vrfrccon'K Non-
Oluctrovic (paper) Copies proyWed lu die AHWnce of my dournou lit was, origin"'Illy jin eketronic i'ornl Ivith ?aura
cle0ronic sigrtah.wc mw�a, firdicate the tau rsoo anal me penwes Capuny who edeclronicaly sigrived the thwwwrut an my
lloll-&c�ronie Copy dot the docronent
Hie Provider a�rccs lo,flie IbHokykny"provisiow;:
55,d Investigation of Criinfiud Allegatimm
Ajry rej-,w)o dmi, impties crhikwl intew on we pmrt orme PmOdur or my sub-Contractors and reforrcd dtl a yq'overnnwrrt"'d
our illvestigalory agency Inust fie scro lo to ATiumn ir we Provide, Am reamn, lu behove that the alkgaikons wHI he
wkumHn Ow SWA Adwmq, as Mw cuRmwerrient agency, Me UnMd SWWs Attorney's of'fice, ur other governinental
iq,,.ency, dw Provider still mAy Ow smima nmiapu A candy cud ll &wwmins, repods, notes, or oher m inen uralerial
concendng the hii vest igza ion,wheflicr in the jrosscss4ai orlhe Prodder or Sub-Conlracwrs,must be,sent to the Owes
Contract Inamager With as t;unuuary and tyre inve-,.rOgahon and aflegations
i 5,21 Volunteers:
nw %Wer shN cmwv he uw or trained volunwers in pR)Adhg Wo semkos ddWered to okkr hWWI&ak and
hW 0 W uk "I h Am N W ws need Ong sucdu sery key V juski N c,dw P n M der sh a I d ~A ork h-j coord itial ion With.or,�)anizat icm
that have expeHence in rmuvidhg imining. pkwernus and st"ends, Or vulwitcers or por�icipants (such as
Crarl')'iii1&1 001 fedeml smNke par creams adnWrOmered by dw Clirpombm W NaflonM and ('ol-ninuirlity Service), in
COWPII]Mnily scrvk"'e selflrrigls.
513 1511omemaK.
Hiie Alliance may. wv khow AM,my njCajsjjtC� to 0 agalnsu111e Provido. rcs(-,ind Ow convau. H'i4e Alliance
Findi dw
55 11 An kurkiid tw w0yunwo oWle hmidct has nime�Madly aljcmud 111C he"rhk \'wLdfalc'o safe[y cif thews serve pur."'hillt
to this ConVaci,m and tleg"'Alk olly UnUM UW JWMAfl OfSCY-ViC"COVCrOd tin&r 116s,Q(,"Inov&
'5-1,3 2 Jhc Pm' 6dcr hwks filmancial SlatAk) Sull"Icieni To nwel commomil oNjAm" or Mw cmuriwmd hw& We hmn
55,,1,3 11w nuilIQ or wNawd YOUGms a0gal wid up"My 4=Wmk rqmUm urwha wu
hms or rogk&"aiunsarc Lnfotced hw dic AHiWUT.or the Provi(kj has Comnimed or rel')COWd A1011hMIS or'llk!Alkm'icc ar die
Page 13 of 57
Y'aop arravar.^war su�woarksaa;h
31:14 "lMlaiwnwauOlw,sN MCI arr"wa�rtaararc°rlruapauwwoMawr uitl^,�ae�uw,u,ww.Gt�unggaalrc�rew<tiiiaa�wtrwpww�p�wl:°�ual"a°Mw~wVericyMWlswr°
S.3 5 File rsrauwru.lew lw t°Aed arw arallaere as,We auswlaas cwl'ahisconlrwact.
In the aaheranaauvo Me 'ylluance uasuw. at ttw.ralr.M°eturaaa,the h'uwauec90re weelsuar,^"y him wlue l"auaa der awaaalu.rcling cawup`ea.raowe ,w6mb
uularuaahwuuaueua sNchd a wraslwp9arr'iwwyr.,aclrarwera p a:,ww.aaaalrwauawa uwl'wlwe uwlweaaMiaawu arGuarae raw mom euulaiumud mvW pal;ueemew uril"tk l"ruwr Nu1cr
on prwwlwauaquauaar;, stuatars oraalsea.waprlys a uarrao-utawrturn on Providor rue.tirrua, amlaed,rawr, GNaawalcial petaasrlauesn Gswa wrr ewhor
'Awaawaalwaallve aac kpn,
i5A lua rar i{.ilia+ aatly a.arwalc°a- rluls partrw uwnn QC MlaMCO nlau rely u"urr We. gtaaaluw,p "&aawu'walaea sim"wa° N"w°alw.M apnq, or
MWr mpdaanq lawaely wtray rpa ms furs°al,alar,ys Guru°hmaae:hr of lk at'nat wo m awerarlww lraaraa a aelwurnousaswe prr�'awweahngs w"d sl"wA N:
W.ly H l>c•,q'Ar Ow aaMwlaalal irua:e My faa We voware^W rsMl-lltaele Curraaay
I faaw lwro auolvr v011 upliour,Q my eal'eeuaudr°auet funds fry vei•r ing wlwe urar"Awruuruaaa Iwww ilrle uuuuiw h ar'erl nawllw ralu Ms ww ralr tlw. w"Wo salpwwww�eaul
try flu s corl nict p liv,N nluaea•wcull qrc°arul°all MWN MMlelM by rlllS e.awaaarsao tww frrwrr i O ,ar6 sre,u°w CL�S,
55 lw Rqu w—
I lie lea°srvaalara wwilN ,rol,wrwali as a.uruu.,rslid,utur¢l lurlalap,%cWelieit aepom in�l f prrrwal provided by dwcr 'ylhauaace aw,tlae Manager
uea ecawapaua e lswaw awraalu Glue•aealuhed raaawaaMRyr a a NillAgsuahauvaav+,ioau,714 wregaml W Rw pNslrr e•.carvl act fro wa°u at rlhw Pr a iulast`iml tl e Alpianacc:, IS
uqom ewH lulra k Ow Irrplaarvlrry
rl l p Nuu:Prow ir,Nee's aletalileal pwW groat p'waaww tlrr° suurphl ss akn"deficit spcaba Ii g exceed kw illi�, d`,j, l Ua ,gold waaN lwe w',rwtlN.d
5'i,6 q is"ualrI cr 4 c I e v i,j Is cuirci^ rly on rltc AIICI.. wpruwr rccerw e ra gwrkwa w t y ran k j ng se, pic,ail lirtaa°44)tin 9iee',
ss.Ga.a Ysuuawtwa°r�wrP alluslwta u�awrire^,aatly w+aaa rl°ac°,"till"V_'H.:w9srroiyrw,wN,u:wN gas laaatvaisresat l�gsG�,
*+ti,l'A hA wawlwea°eaP'elknis semcd and w"4 roralt araudDlsaabillty contacts„
lk'r eaK,a°a7a'tlt9aat;e wa�r'Nlw 8t'a tiaaapllr.a;,i�wleTMl&Q:".III INbaklwaa��tlli3�w'lIl l:�d:P�N�"Vl�r,lq"w 4tw'Chw"la,�Vllg»"1'tiaalaYJ0.. nflV�;NIUw91FlAr fill&"Yk�lfl'�;�NIYGI Ifi71wa1U1wH�4 G���"lMaa"lire"
that pw'wlt^eatfM ellerYfla a wsl wait Wr sa�wvrewz Tv AIlWac,c in A We clka:r•uaaitaaa on eacWee BtarradAg aawaaa°wls Ahe I"auw"tirider-
l.s carat slwerWing aur„°am°eih j to trwuarnht IwVams and is}al u'al cted to incur:a slwrlaltas at the end of shoe year.
55,7 Trtalatwraan ..flag° lsrrmwii`lea w ll amend all, required walwuia°wgs and Tneerrings,,e•Vuoalade by the Alluaariccc
The ABlrrwwacer ruway,s uflustihatue any Miaawace e.waalapuyce To serve as the C'e nlra ce I"v onuger°,
T Officntl 11� va,a aaata liar uaG °s rrr�tl�viis,
The male, address,and lelewplacusae r uua bet, ofthe representative lair•the Alliance for this contract is,
Max l Iler hnia n, JD, 1.1 .MM . Pr�esl Jw�swul and l' V':9l'
'�C�h91"t I I00h A e. ylrllCe 214
lvllaaaaaaa FkwaWan 3072
(305)670 6500 Ext.2:24
Hic name, address, and to Ophone inmi her oF IA represen tat rvc of Te MTO&r mWwusiblo for adjvnn strwiwl of the progrrull
under Mis conumo 0
..............
11'he Provider naine. as shown on pqgo I orthis c"onivact, Nvlonnw Auray Ruud of Comy Commimionem.
and mading addre" of We ofAdd payee lo whoin the SAW SeMckht-Hurne Sunkes
(aayraacmtShall be made is: I 100 Samontuii Street,2-257
JSey \Ya sL±_L_330 40
Shelyt 6rallmn, Solior Oh-ector
I ho name ol'i lie,contact Person and snvei address wherc Monrou Uunty Boam of My Comm i"Knen
l-Iwallcjal and 0111unisinnfivc records are 1111aintdinod is� SocUal Services,
t 100 Sa,nonlon Strceil. 2-257
Kev WesA, 171, 33040,
the na n, ip, addrefss. an lcRcphonc nqixmeir arid" Ow - SIWY�yl GrahLIM, SCHi0 NFCCtor
C. represciitatWvc o Ow Pmd&r munbMbK A Mon[w(WComy Bomd orcownycow macm,
SU6w Semicedho Home semkcs
of dic proglain uncler this Contract isa I hffl Siinc)nton Strect,2-257
K�ev West, FL 33040
VA thesWent Q Finwcv
Fhe sec6on nnd loc;Ukm %Adn the AAA where Requems
td aw hqnient and Rcccipt and Fxpenditure fori-Tis are to he Alllancc for Aging, Inc,
7
mailud is 60 NM/ 1070 Avvime, SuB214
NIAN Rod& 33172-1155
-------------------------
I 14unhor,
T Ile nmric,wf*ov and Lelephone imniburuf0w Qnww Mhancc lor Agong Inc,
NCiriaggcr kw the A,AA for this contrztct is: 760 NW 107d'i Avemw, SCOW 2 g4
MM FWH&33 053 B5
-----—-----------— -—---------------------------
4 we nem different wv dw4uawd 1q, chhur par, alien execMinn or wis cornma nwice 4 he nmne mm]
awkez orthe ntw rqwncnmNe wW he minkred K wdkg ki,Ow oher pug mid gid notif0miun anachad lo oryinak(Athis
CO&W
58, AU I cy-eras and Contfiflons Included
Ilk mnmd and its Attachmenis andany cxhib4s referoiced b;sah!auachmerm togoher NO any chwinnenN Acoquovied by
1,061cncc, corfla6ii all Me terms and condiHmb agived upwi by lie PwAm Them am no pmOwlmm taw condlimm tW
Oblywom Oma qw flwsc conlajoed horvin,and this contract shall supersede ah previous conmin,unicaIions, represelwflions or
agmernew Sher witten or vabW bammi to Pant es
INge 15 of 57
By signing this conkscs,t1w Parties t dwy have read and agove to the
IN W"ESS THEREOF,the Panics beivio have mud convact,to be execafied by their undersigned m officials as duly authwimat
BoardMoorot Cooney f County
Provklere Cownwhislowers,Social ® e ALUANCE FOR AGING,INC.
Services
SIGNED BY: SIGNED BY hdauV.1I1Mh—,(J.129,202.2uI 9E!Dr)
@ ro Q.vid RimNA B.R °RHMAN,Jet,LL.M.
1I f w.. ....,......._.,. _,...,_........... . . .mm........,. e PRESIDENTANDCEO
b „
m „
r u� 3
% V adok, Ctak
James D. t lees D.
:.` Molenaar utinIIN
"� UWd
DeputyAs 1er
r
ROE Coutm ATToRmYs OFFICE
a«
Page 16 of 57
INDEX TO ATTACHMENTS
Attachutent I S E Rk"I C If" PROVISIONS ALZHEIMER"S DISEASE INITIATIVE
AttachmeW H CERTIFICATIONS AND ASSLIRANCIKS
Attachinent III FINANCIAL AND COMPUANCEAUDIT
Aflachinent VI ASSURANCTS NON CON ST RU C'TION PROCRAMS
Attacluncul VII B UDC,ET SU M M A RY
Attachinent Vill INVOICIE REPORT SCHEDULE
Attachinvul IX REQUES'l" FOR PAYNIENTFORM
Attachment X RECElp,r AND EXPENDUTURE RETORT
AftachinvW A t)0EA HANDBOOK
A(lachument B CI AIL, R 16 1 FFS COM 13 LLA NCE IIECKLIST
Attachment BUSINESS ASSOCIATES rant" RETNIE'NT
Attachment 1) BACK(I-o'ROUND SCREENINC AF'F'All')AVII'Ole'(,.'ONtilli,�IAN(,'E
RFIFE.RRAL PROTOC(H,AGING AND DISABILIFTY RESOURCU]CENTER(ADRQ
P,age 1*7 of'57
ATTACHMENT I
ALZI-1EIMER'S DISEASE INITIATIVE PROGRAM
SEC"FlON I.SERVICES1`0 13F PR(WIDED
A. DEFINUMNS OF TERMS AND ACRONYMS
L ACRONYMS,
Alzlicimer's Disease(AD)
AWWWs Disease hfidmive(ADT)
WNW of Dwily Uvhg(ADt)
Amu Agwwy on AghT(AAA)
Asscsscd Priority (,onsunicr List (ATICL�
Aduh llrotecrivQ Services(Al-IS)
Uietfl hifornimk)u and ReowntaNn Tinking ymoan(aARNS)
Community(,,'atv for Disabled Aduks(( CDA)i
Correctivc, Action Plan(CAP)
DmwMW Cwv & Cwv KkWNv OXVI)
lkparuwo ofE[der ARIB --(DCMIA)or nqmnnnem
lkpwWwo of kWor ARMs Pmgmm W SaWs HmWNmk ROFA 11ANDHOOK)
I lorite Care Ftrr Dkabled Adults O W'DA)
hNnime,wal Aclivifivsof'DaAy Living (JADL)
klentory Disordell,("Hlk(MI), )
PMnWng and Savice Arn (INA
I PROGRAM SPEC"IC TERMS
Depadmnul at EW Arhdrs tiundbunk: An WWI docurnent off)01`"A 'I'l I DOVA I WWWA imW&s pmpan
pMWIN prou&m% and 5wWamN anAnbk M aVndn wlkh am reefloasluovAkrs iW DORA Nuded progn"nv An
awnW uphira is pwided through as Nofice o f Instruction MUM
leunctimeal Assessinciw A comprehensive, sys rnatic, and rnmWWmwQwiW raiew of an perAds abiMy totwilaill
imlepefidom and & die Imm remloWe IN&g nawlemern. DOHA Fhrrn 701 H k uwd by mw inanpnN w emAuct be
kirtcdonal assessnictit,
WWmwy DkWer CHnk: Rewmrh miand pwWwns ewated pumuma lo v;cx6mrs ,130 502,(I) and (2), F.S. w prrovide
diagpiostic arid r&,rrul se vica,ecmduct hwk mrdscrWeiQued muddWahwq wearck wW dWopwhrAg mweilil.",
and educadoiwI opp(muniks Rw kW mid pDlh"Aml camgWer"W WNWN "it AM
Proviso: Lwq�uagc used; in a W to quahly of mstdo We wy in whWh a s"Wit appqwWdon k to
be expend(N],
Progrnm Ill ghlWhIs: Smxen sude, qw9cq lestimonials, or hwrmwWWwM Qwltcs that are used ni the Department's
Sunimmy of'Prognanis nd SuNion(SOPS) to Ackide inkminatkm thm he"s t0l dw mory (it'how pror�Mills alld scivices
hey&lu.. farniks"nd caregivwx
Spolalked Day Care: Lkenwd Specialized Alzheimer's Services Aduh Day Care Centers, licensed in aecordance with
Sectinn 42%911 KQ AM am corisirlemd modets because they provide specialized AWteiiner's services for AD clients.
provides an up-lo-daw Whg oNH Spdalked AlMeirtwrs Samles Aduh Dly Cw-e Wrim
SpedWbed Ablidure0m Serykes:Spedalked Whehmees scrAces,athred in day care centers,include,bw are wx kinited
to,those fistcd lick)Ax:
Ai® Provid4ig educathn and rralIg on the specialized needs of pasorns %wifli Alzheimer's disease or related niemory
wwrxkm to cwqNas.
b. PrwMisigspeduldedeclivilkshat pmmWq maintain,orenliancellic ADJ cheurs physixaL colmitiv,social,spkitriml,
or eirlotiorial health,
e. Providinp,,thagwrnin Wvht-A, lwalth, satety, and wcurity Wrventions chnical eare,arRI supporl servicv l(w the
ADI client wid caregiver.
Page 18 of 57
It. GENERAL 01,,SCRIPTION
t. (An.w swwrnolt
Thc pmpwe of Me ADI 6 to adtkess die spechl needs orodwom"-qua AR IN&NmHK mW enryWas
1 Alzbehner's Disease Initiative Mis0on Shatc1flerd
Vie AM pragmm mj% pasms oMkwd Kh AD mud oker kinns ofdcuIentia lo live as independervb, ns ptaskle uvula
support w 1`arriilw,,,mernbers and caregivers.
3. Authority
blue rellevaril audamij goveming AM pmgmn me:
,I. RUh.,5,4D-1, Horida Admunktrafive (Zode
I), Sections 430_50 I through 430,504, 1 .S.
c 'Fl ic C atalog ol'Smw Fhmdrd A%khrim(CS VA) Num has am 65MA and 65M)2
4. SaMe of SmvWe and Ehg= MciNkluals,
The Illovidc�r ds responsR-Ac for 0rc 11"Lal,and a)perafimal MnImpono"ol'thc ADI piograni per thk cuiorakA,
1111Q I"WO'gla fill servicvs MY be my0ded in a mAh the Ann Phn as qAwW amd ka mmm IXTA
I hirdbwk %dYch am YmMuted bymbumv 'Me PmvWa ngus W be hound by A subseqmwt mnaWnwnts kmd
reviduris in the teX3p,A I hundinich, and the Providei-agrces to accept A m ch atriendnients and re use
C' CHenbilnheSemed
N. General ElWibHhy
'Chu ADI Progmm addremes IS speck!needs or HdNiduals mTh AD or mherivimed thsortlers and d0w caregmu".
1 Client Eligibility
Llionts eligNe to racerve services under Ohs conhwel numV
x 1k I H yeam of ago or older and hmv a sawunk orAD or a rekwd dkorder o0e mNN0dAKNw1ng AD o"udWcd
dkorW or
11), If enrolled fin Spleciahzed Akhehncrl Servkcs Aduk Day Can he a pWkipruit who has as docrin-ict0cd diagnosis of
Alzhehees diseme or a dumnsinvialed disorder(ADRD) from as licensed physichin lRensed physician assishmi. 01
a lRenscd advanced regkturd rawse pradhianer and
v. Not he enrolled hi any Medicaid carp datcdi long-Mail CIAN Program.
3. TaMeWd (Ornups
Priorky for ser0ces prow4ded un&r this connuct diall be gimi W tow 0WHo pvrsons aswswdi to twall risk ofplatcejneW
in an insiiil,uIion.
SECTK)N IL MANNER OF SERVICF PROVISION
A. Sery lac,yasks
paipmm Q %vidurMuM pufbrm ormswe Ito is Ire, fiAlowaig
wdls:
1. Client Eligibility Determinalion
Ile Pmv%AM I ensurc that applicant dwa k"Awled Ki ddamhe chUh, [AWRAH, to become a choo Is bmed on
nwakg the mQuoents described hi Svclion 1,C2,
1, Assessnireni and PrhaHthatimi of SarKe DOWay K New Chornts
flIe Providershalf enwm to NNmhg chtedo are used to priorillize new chents al thesequelace beknv fi.n.semice dehVery.
It is nor the intent of Ole to ivniuve existhjg clims Toni survices io save new chews bAng assessed and
pimkized Rw say We del Neq.
Page 19 ol'57
a, huninieril Risk inclrdduals IndividuWs it the corznnunhy wh(me nierval ur physical Waif; condhion has detwinnood
to the degree dim scUmv N nm pwsdWe, W is no caphk careg%o and nunhg home placornmt ns ISO w1thin a
monfli or very likely wnhin three(3)trionihs,
b. SoNke phoily ror irdivihah nm hwW&d aNw, regmTess or mun, m"ww, NON be dewn-nKud WuWi Me
Depaftinent's finictional assessment atfirtinistered to each applicant, to the extent fmiding is available, The Providea
AW mumv Am prAwhy is Viven to apoicaras at the higher Wels of Will and Sk of nw-sing hmnu phcmiml.
3. "Task Writs
The lbovk1er shall not perlor-ni any msks rckued to the prQ,ct other than ihose dcscribed in flik,contract wNj thow Me exracss
Written con cant(.)I'the
U. StWng Requimments
1. SUFfing LuMs
' s myu ymbis oHMs w=i ru'dMe pmvwa slump msju is own adininixvratbe W " l mtf
shall ouure Tat skamtractom ded4me actequaw swRacandhQ,
1 Professional Quolificii(ions
lit PmOdu sWU oisure AM dw staff respxWWe Rw perfumiNg arly CWHeS Or fiL,1110i0flIs wilhin this contact h avea IS
qualiNcodons as spechfied K Ow cnvm DOHA I Wndhxit
Sery ice Thoes
ne pnnkkr shau misum Hw anwomy: orthe services Wed W Ods conimci at thmes aptnuMime W—Med CHMO Semite
needs including,at as minimuni,during rimmal hushims he or as othenSe specified in proviso or ffie Subcontractor's
itpprovv,e]service providerqiplicafion,NorniuMn5we hmn are defined as h4ondy;Mnmgh FhdM%&U0 aim in 100 Rni.
W Wc
J Use of Subco"Wactors
If Ods conimc; WwOwnes We use of a sukwinwixic x did earl when to F'rovider shall not.deliay the ot'ltg
gj-ceircnt with the SkibNnanmn W inq chTunistance occur,dul nuty mstih in it delay Rw as pMod M r,kj (6D) days or
inote or initiation or the subconnact or Ow paMmane of the Wcontramor. Me PmvWa WH nutf-the Allhnctfs
Commu Mwiija of mich doWy lie, Proviidet sfmH not pamh n to perhmmn serWes rebted h)Sk cuninwi
wittioat Wing as Wing Wannvnmr agremnent exected. lie Lkparnnent %vill not be responsibdc m, liable R-tr any
ohl ig,,itions or clahns restilfing fi-ornsuch ilction,
m. coys arsunatuacts
'Me Provider shH mArnh as uly of all wbcon"uB W the AHWwo Gmanict Manager wjildn 1hirly (30) days or die,
Silt)Wintlld hCing CX=UWd,
lh, N11ordloring the Per forintance of Subcontractors
,11 lie Provider Shatl nioninar M Imm onc pa Wit Itm, mch or is subconnTekno, subn0pients, vcndoi-s. and/or
consuhatits pivid firoin funds provided wider, &A emmum -me Provider Shafl perfix,rn fiscaL and
pmgiAimnark nwidwAg to usure cmWwW cwtiqlAnca Ascal accounwhility pmgmmamic pabnwna, wit
ewnpEinwe whh apoWaNe maw and fad at lawsand regulations.The Provkhr WH mon1wi to ensuix that Ow budget
is imen die scope W'work is acannViished %vikin We gwcWkd Hnw poldwamd riKer perMi-nnanu goak MmaHn Wis
cormma mv aWyed
c. of opics of Subcontractor Monitoring Reports
Hic, Provider shMl forward a aVy WAH milbummmor McnWing Repons to the ANQue Wmet Mnmgu ;%*hJn
thily(30)days of the mpam held g ksmd to the Subunntracwrs, Subrecipients, Vundors mid!or Consailtants,
Defiverabl"
the
completicni ofthe tasks specified in this contract.
MePmvMaMiaHewnwtepvdMmofnemuhwwmofservkusuddmsing the dt vane needs ofindbibiWsiOthADunct
Wr camoven. The Provider shall ensure liciformance and rep ording or we Ukiwing services hi accordance whh be
annu DOEA Handbook, which is incorpoi-Med by rehavace. and Suctkin MAmrwis con=L DocumemKori of ser0ce
f1ge 20 of"57
dchvej mint Ardude a repM cotukthng of dw Uhwhng: nwnbwnWcHvnVs scrvcd, nkjrrzbcr of service toi3Os pirovided by
servicc'and ratc JIVIr gNvice Und wit UnkulMNS owl eqiol the lotall irlvoicQ arlounk '111v conlinumn of services provided
under His conhAcl hickde those idoidkd by We PoNmity wndce aw gar we s:
Respite and 01her Services
(I)Caregiver
(2)Nse A We.
(3)Case hdanugernent.
(4)UtmNeling(Govrook,00,
(5)('ounseling(NIentall i Jeah h/Scrovu lng).
(7) 1 ionic D6vo-ed Nicals
(8) 1 ROusing Improverren
(9) klawilM Aid
10) Resphe(FludUpHosed),
I I I Resphe(hpNoine),
12) Rmspite(hyFacRity,SpeebUzed ADhahmet's ser0cus)
13)SpechIked tvledicd R:apluuipuaa enr 'sc vices.and Supphes: aind
14)llranMponwion,
2. Senkes and LWIB of Savkw
0W I'mVider O w H unsure MW Ow pnwkhn ukerOms dmuAwHn Mis cwnracl iS Al =11CIUMCC With Q C"ITWV DfNiA
I WndNmk and to service tasks described in Section ILA. The tin4get SwumaD (ARachim; XID lists to sembes dmt
un he puRwrnaL he reimhunnumt, and two The nickod uFpyvwnL and We soNke At typo U&M (Wsavko = be
Imid piirmwnt to the 13tidget Summary (Allactmiew V t),,
AdminhooWe Ropowsibilivies
1% Pm Oda sImN piv0de mannemeto wW ownQN of ADI prxign" qwradons In accordauce ;vhh be murrem 101"A
I landhook- and oversight of MM pnWw" opoalkns include the foNowing:
w IAAHA cmurulmd apvunwas whh qVimpriaw mod up%m%mMw"x aml wndmAtgrecrnenM Own upplkaNe
b, Provide technical asMsfancv to subconnichms mW voWnii Wonsum pw0&wmTqnHq uNces,
tn Nimikor and evalmme subcontruchus mW vendon for qprotwiatv pioyranunatic anc] hsczfl compfia,Kv.
d, ATprupdwe[y submi payrnmvs to suhcunvachnz
C. Fsrahkh procedures for handling recipiem complahns and emmv Wril wMecinimcums duvehT and QIentent
CCIIIIIIIIIIanil J"Irocedurus lu Imucem and mm4ve chera dissatkilacdmi with savlev C'ornpNKH pnwedtwes Oull! adIvsS
Me yNty mW lhu%% o"oNkes, provider and direo wavke xwwWr comp hints, or any wher advice re%xl to
ann"AnN cder man rems.ion. susponsaon ot reduction hl SN-ViLCs rhat requie the grivance lNucem as descHhed
in Appendix, [),Dqiwinicn oflldo-Affairs Prognung and Scrykes INnImok Demomphdit paudums dmH Akde
nwHkatiun to A chetHs of the complaint procedwe and AWde Imckiij the dMa natwe of coinonint and the
dewmAnathm of enh cwnjinl,
Ensure Compliance with,Client hffornmfion and Registration Fracking Syswna (eCH TS)regLfla6J)nS.
Monitor oulcorne nwamra in accoRfame%vith Imps seat'by We Jkpammwa.
h. (VmWo dim o0haki nnNeys to evaknoc and irnprovewirvice dehvely,
EL 14EPoRTS
Vw VmAda dmil mToiW Io a&Wkmal rowine or spechl requests Rw irdbrnmthn and reports reliked 11, Ow Adthrice in a
efirwly rnatiner, as detertnined by the Alkance Ct.nilract Manager R'lic Provider sh'IH Ustubfish repolling due dates 161,
Subcontractors thal perink i1w llrovjdt.-,r to rneo the contract retiorttng
R. Re""Speedve Loh Cum mhmodomgy(RUCM).
The Pmvkkr AaH mIrnh a lRetrcwsfierctNe Qh C'ost Medwdology (RIJCNA) to the Uhmee annimit no Inter' than "inety
(90) uakndar days aAr to PruvWur Fkcal Year end, The R4pCN4 YhWI rencei mWal cmN of Mwiding vuh wmkc,by
pn%mm Ir Te preuding Prodder Awal year. irthe Provikr deskes to IvnegoHate its reinthursernent ratesti the Provider
0A mAe as wWwst hi %khrig to the AlAnce in accmdance w4h the AFliatmCs Vpmwd Rchbusemmu to Kn1w,
flohc,y. which is incorporated by
Page 2 1 or 57
1 (e(ARTS) Reports:
the Provider shall crisure Onrely input of ADI qm6hc dwa W WWV& lb unsure c(]RI'S dwo ,,iccuracy, the Providcr
shall adhere to the Alliance's KARTS Data linegrily Policy MA uw XMINquinerated reports Wdi indride the fbHomil
a Clan Rqon
h Monitoring Rqoris�
c. SoN ice RqxW,
d MiSCCIL-MCOUS' RCl,)ONS;
c, Filscal Reporvi: kind'
i'r OUtCOMU MCIISM'Q'S KC11ONS.
3, Surphis/Ochcht ft,eport,
rhc 11rraviaicar w0l sirbil as consoh(Wed surphrkd6cAqwn in as lbrirnnt provided by the/Uldnee to the Alliances Watrau
klam,tger in corrijunchon wVitfii Ole required nrojohly hdhng submision. The wpom NvHl frickde the IbHo"Wg:
Ill Actual cvrr(racle R d uiding wifized cath niot and V I(
In Nuariber of nedve Okints conTaivd to the uvenge ritumber and cfienis tuilded lit the corill
c. kkaiddy and Y I'D nurnber ohinduplic"mcd chents served
cL Ekindled phn on hmv tiny prQued suplus Q &W) spendhT unuedhig the Suiplus allowmwe dunhoW in the
Alliance policies, incorporated here, b)Y,refererrico,i wilf be resolved,
In accor(Lance%VilhlAllhime mupluddc% inanagernent polkin. in ordet w ninxiiiiite avaihihle hunding and innihnize [lie
dine that potcluial chents mlast wall l"or service,the ANinance in 1B sQ d6mvi1m um and uce l awmk 4% Pwv%
is not within thc Mliance pohey
,t (-o-Pay (`ollverlions fteporl
lie PmvWer shall suNmk a cornoWed annual co-payinenit coHealons report w he AM= Oimmu Nbmga by hly
11,2023,us bg A Untchrimni. 5, low led in Aplicridix 11 ofthe Programs aandl S`Lmw vice s Alanqfliook.
1 Program FlighUghts
'Me provAl WH MAMU pragmn lligldyas mlOwnhig spallic everns diat occurred in the 1,',arcvions fiscal yelar by
Seirronber 150 of 1he curmra corinmel yem% Ile PruvWer AuH provilic as new sawcess sl quote, lestinionhil,or lunnan-
utlucosa vlgneite. The [tighlights s4uffl bc wAKwn liar a genall andienu. with no acronyms or technical imns. For afl!
agencies cw organ kaficais lh,,rt are icilero-teed On Ow hWIWM Te J%vhda dWl pnMe a NAf&WOon "Wir misOn
or ruW. The a0ve totse OW be cow;tstendy used in to highligiv naindw, in Wer tar kiritify Kv spedfix incividual or
el thru pallarned Ow acOO, dnailml K the highlight Be Prud&r shall review and edit Progrant llfgfilighi Nor
("h I t j[Y, reA da b i I i t Y,N tC V a 11 c Ua spe C i Ir C i ry"I i,li i I la I a i I O-c st,a u i d g i a i n ii n a r, I ir i o r i t i s i i lin r i i t i n g t I team i tut d i o A I l i n c e
E RECDRDS AND DOCUMENTWON
Me PmOkr wM ensure he collecibn mW aminmirtnm of 00a mid servile Ahmuil sm as nwrl baxis Awn Me (.1hit
IntionnWkin and RegiWon Timchig Symm WCA K rsh NUntunance indwks vand eMmus and hadups of W1 dam md
qmwm accoWing to A 1hance and Dupairtment suindards
L Rapirsk Rw Payment
The providel SLIH rrtraaarrauaapru CIOULDIWnlatiort to supporl Requests for Pqrnmu of Aall he awd[able to the YWhince, to
Depzil t:arOdrcruu1.hoHxcdagcncQs ad WNUnkranch as the FUldn Depailmcniorlinanch! ServRes(DF%upon
requeW
2, cORTS D alga mild Maintenance:
lie PravWar Aall ensum= a mmthk hut cWhsohn md makilawrice W410M and savice Adharthan 4 (TARTS or,
aunty such system dviguired#dw AHAns Wnwrwnce indudes accurate and current data.and valid,expolu and backilips
of Wl Tart W yvems au: orclOg W he AHAnce wild DrpaMvm"Mn&rds.
I DaW IMMrHymind Back up Mmmdmm
Hw Pirovicla AW anflcipale and prepare [or the km of ilit lbri nal lon processing caphHOW The awdue hukhg q of A
clida mace WMwc is requixed to recover from %ses or dart gcs or the conipwr qmeim Dan and mAkne omW W die
coatis led oper"Aion,of provider furictioris rnuM be backed up. 'Me swurily cominds over the backup rest,mveg shall be as
INTMI."to pwWC60111 raildred of the resources, It is reconiniended Mai at copy of to haded up dombe stomd
inasecure, offishe location.
Page 22 4 57
4, VofijOcs aiNd Procedures for Records and Documvilit"Ifion:
Vw WNW WN mahilain wdWn pAlcks uW pmudwes V conipwWr sysurt h=Up mW rumeq mAsWil We the
same rquVwnern of hs Subconimcims, 1buse poNciesturd procedures diall he Triade avadable to time AllYce upon mquest.
F. PERFO�RMANCT SPECITKIATIONS
1. (julcomes
x Ensum Me Rovisimi oT the servVes described in this coWract are in accordance with flue curreld DOEr"'A
t1andhook and Section ll.A—and Sec6on ]ll.[),cWthis coniracl';
Kw. Hm Provider shall tinvely submit w Me hies we aN rupas clesuibed in Sc(nfit,-m ILD of this,conliact;
h, Fhe Provider,h,,M inaintain ",d] dvscribcd in Section ILE-of ffiis cc�piflracL
I me PMVW" 01"111 unsure the prioritization and service provision oi,Chow, in accordancc widi Section ILA.2 of'fliis�,
COMW
C, T11C PRWiCkT SJ1MHKWV HIM nuumey saved mh tar he ANhwe AmuStens IT X and syMoAng Wmematicat in
accordance with Auaclunero V111 M'Hds c.rorflrau,
I Criteria
Thv po-f6rinance td be PmOder K par- vkUng the servles described in this conunut shall be tnuauuvd by to curimm SR(k,.
Sh ategies d`Cm HIC f'oflow lng'cdte�iwr
a. Pemon oFAPS rclerrzils wYho are in need urimmiclubc suNkes K puvni Wmhedwnin who am serval whhh 72 hours;
W Qvon(feklen amemul with h1h or modunw rNk who 611proved 016r envircriniolt sicorc�
C. Percent of'newv service lvcipienls "'idr high-risk nuh,mon,scxwcs whose nuwitionfl Stal LIS fi'nprtrVc(k
d. Porcut ofnew service recjpiaiws whose ,AD1 assessnient score has been rnaii-clained or inqm-caved;
C, Pora:,olt of,new sk,,rvice recipients vdtose WA,asSCSS111CV1 Score ha,been maiWained nr improved:
f Porwo or Rwwy and JWY-assiskA caregNers who sAkimpon Hwy me Ue" lu puBW um-u,
g. dyer emit whose ahih y lo prodde core k nurmairted iw impruved aki ona year urser0ce inwirvernhm (as
duimmom by Me MMWVU MW dw amnmo�
I NrcerA of mom 1511 Odom mTo rmmin M hmmmr K die cmmmurity Wad of pkg how PurshW home:
i, percentap"e of active Charts caling two or,rnore oteals pwr day,
j, After sci-vice inrervention, the porcentage of CMVWVCM %vho Selormall hoing Vol anclFidurit nbuta duhr dwily to
con6nue to pi-ovide care
3, The Provider's per-formaace of the measures in F'D.2, ahove W be nNiowed and dueunwrteed A that Adbuteds Anmml
Progmummk McudmIng Repml.
4. NmhuNng and EvsWafinu
The Allk.ince will review at evaluate Ow pabrummy uFle ltwklu mid Ow ITIMS"dlk CMVWL NM1WMhg Aall ho
conduond dwough frect emmo %AM Q PmvW" dimnh tee ephonej in writinp, and/ov on-site visit(s). fhe Alliance's
detennitradon of acceptaWe peAmmumo W he aura lmivu Ile PmOdu nrees W ccxTume with Me Wmc K
ntunitoring., be progress orumqWolon or the 5ervke Insks W dAWANY Vix AHWwc mq uw. Wn N not Jimled w,
one or more rod the foflowdrV medrods f(m wwcwiilodng�
a. Desk reviews and wrMytical review,),;
h. SdedWel tmscheduled, and l'oHow-up on-site visils4
e. Chent vlishs�
d, Reviov ofindependoil auditur's reports;
c. Redew ref mud-party dovurnoti.sand/or cvahmtimt�
E Review ofprop,ress rqorts;
g. Review swisfiaction surve),S,
h, Agreed-upon procedures,veview b an e\teinal m0itvri (ir cousuhanty
ii. Litnited-scope reviews.and
J, (Ater procedures as deemed neccsiskvy
G. Provider Wspousibifitiesa
Page 23 of 57
I� Provider Accountability
All service WAs mid ddivoutdo puanam lo this coninict wr We"and cWwWdy Te reTomihiliq (Ate PMVWCV and
we WAs mWAd ivemblo Rw wh Nk by exau6on of M K CWWWL Q Providet agree,�to be held acc(,Ruaabh,
1 CuWWWWri m,Hh Other 11mvNet% andAr Enthides
Notwiflismnding those services fbr which the PmvWr N lield nummmble-1nvolve comAWK %hh oker embiles in
perfornling, dile requhvmems or I, coranno, Me Failure of Wier cWhiew shoes wo akvhw Aw Pmwidcr Awn mi
acconnuthdity for tasks or serWes that be PmOder Is oNjwd to pmMmn pnwro W ON conkw
I-L AHiance forAginn i4tsponsibilifles
Alliance(A.0igalions:
r1wr Alliance niay,within its resources,pun-ovi&wdinkM mMpn W aoWanec W We MuOU io amlst the:Nvd&r 5 nwAng,
the requhrunew of this cmania 'Me AHWxie supp(a and assWmxn or Ah dwrcof. shad I'lof relieve the, Provider fr(R-n l'1111
ped'orniancc oll cc)110'acl rquirenitins,
A, Payment Methods Used
'rhe incow or piquem a sk contract N a cmosmon or AW NWUW mhn CML nA nwWwrnmin am Rune PWMMM,
suy"cl U; the nvaHaWHj or MWs wW PnwWa PUAMMUM Ile ANQue "Al rwy dreg lhovidm upon swiScuvy annpkqQ
of,the Tasl,,S/Dehveu ab les, as specifled En ",Secfion H.- Nlmum or Sel-Oce Pwvision, and in accordance v6lh otheir terrns and
COndifioll'S cod this ueenwrtnauct.
4 VNed N*MnU Rntv
for Hxed Fce/Unit Raw shhM rKg exceed anun"as esl,,ihhshed in Atutchinew VI 1, por unil ofservkc,
("'ost
Paynivni may he inahwKed mt for alkwaWe expandimtres which we iniwuWamw mTh Ow serOws MmWed in
Afmchmon VH. AH Cot RdmNwwnnm9 RepnN Tr Mqmwn nwm it the Rcceifn nd EMWkme Rqwrt,
beginning, with Ifie first,ntonih offliis contracl.
3. Advance 10tyrnents:
Non-pi-ol'it ProvIders linty request arnonlifly advance foi sory ice costs Arvach ofthe Arm.ovonimahsofthe coninset period.
based ("i anticipaled cash needs, For the first tnondi's advance reqw, Me Novider shall KoOdo lo the ANince
docunimnmion justi"itig Ow need Ar an Hdvmwe and dwuhing how the i"kinds wifl be disulbined. ff the Provider is
mpeming two 0) niondl,; ofadvalices, docnaientation nium, he ymilvided reflecting the cash needs or the Provider whItill,
Ow h6hif two Q) unmahs and slumdd be siqlporwd Inwgh a cmbflow anwoMs or Wwr Whmnhmi aMwoptac to
dmmmmmw be Pmv WKS financiM nced for the second rriorilb ofadvances.'Me Provider rrust also describe how the flunds
\0 H he d Wbated Wr dw Hirm nd mxond mosul irmadent Nlago N aunable,and the Deparlinent's Contnict Manager,
in his or her We d NwHon, has dewradnat dnn tau it j um ired need for an advancs, the Jkpmhvma wdl i,nwe apnea uvW
'Advance 11aI)ATICVIIS;,ffler,jj,dy Is[ of dw Contract year.
Add advance paynwrirs made W Me Novkler shuH bu Wnhawd W be AHAnce as Womm: A! least one -wh u Fthe advance
payrilent recAved slull he raponed as an advance reumpri ou an each Request fbr Ikynienl (Aft'vidnnent X 1),starli Ing whh
We NvAu mArnkMon of the th Nd inonT ao Md"ud MAN,in a"Wmce with the I nvoice Report SchC&Lde(Anachnienil
did.
K Method of,In voice Payllrent
Pay w nei i I sh all be i nad c u pon I h e Prov kk Vs pms w lat K"o f an W vo ke su h!wq u ei n to the ac c'Cl%ai i,c e a nd appr(wa I I)),1A e A I ia n cc
offfic defiverablies 411MV41,oil the invoice and payrnent has been received Um DOEA. Tlic form nnd substance or each invoke
submitted by the provider shall he ai fullows:
I IR ext u CS t IN15"recut On a i non flit fy basis, for M e wd N and Ae rOces cm a b I kh ed K thus contme n pm v W vJ In cordbmi are w hh H le
requ Wrimi as as cksc id bed 1 n I h a DOE A Prog rann and Sud co I N MWI, and at the irmes es la W is]ied i i i A I tach r n e r i I V I t
of the, contrao. Docurnentation ofseirvice defivery mum include, a rqori consisting of then fi,,wHoMqr ininiberofeHents
served, inlin,Im ofservice untis provided by suvke, md melee per service unit wit cakubnhms Wt eWmf One total guava
arnount. An)/Wnge to We twal corinma awotaa requires a fiwnla aniencinient.
Page 24 of 57
2. Ile PmvWm-shW11 consohdaw adl subconwachws'Symms Rw Payinem and 1? pmc nd i!t Lire Reports that Support Requom's for
Ppmas nd W submit tam the AtHatme using lboms apest Rw Payment (WeInimrit IXJ Remifit and INponlr"re
Reports(AttachrneM X) R)r Cbse Managonma and SNchl SOsWy SurvRes,
.1 All apasts Rr Papnmq end H he Wed an Ow sWwrikshn of momho INpundinure RxI'xa,v,begaining %vRh the first orumih
ofilic, The whn% Rw whininsimn nradvmice requeus and invokes k Invoke ScIvadid, WSmorra Vllf;
4, In t1w=1 Ot survices"qxc not hdRd during the reguLarl.hHog cyth, AW Provider in ay request payment For services no
later dia'n 00 days aftor the month in n,hWh the expemc wwWwro?exequ Im rNmas ennnot be made aRcr the conumt
Weaut dMon Reowst Wr p"mwU of servOes Wemd 90 dMi aRmAhe morlh in which Ow expmusu was KcwvW Nvill
require almrovaj or the connect manager prior to the I°Pilfirng, ofsuclu incurredexpens" I-ate service billing requests w,M
not be paid "IdeSs ril"dCaHon is submined W qpnwed by Me comrarl maxmgw'�;
5. Ile ProO der OmU rnWnWn ductunmiNimi to mq)port paynient rcqLwsh °vhich shall be ayadablc to the w\lhance. the
Qpm-nnw(and the Depaitsent of linandal Services.or Mher Wrxhed maw and Ideral prannnod uM;n ivetuem;and
6. A H paynients unda Ae wnm onbig coramet are coisth-goa upn = anmW approln-iluion by the LC64dature, arld "uIjuct
to the avadabifity offunds,
C. Payment Withholding
Any foaryinent due by the Department trodet, tfic Ivi'mis ot'lIns imifloact nlay he wilhheld pending the recerpt and,appmval by d,w
Ikpahmen, of aH firtwxAd and paWranunadc i-epons Ow Rom Ow Chswuv and my aQmhmnm dwmm, Wc1WWg my
Wkwunces
1). Final IInvoic^c Instructions
The Providei,shaHstl;rrih 11w MwHhqwM Rw Pluum to the Idliance no Imer than 30 days after the contmel pe6ed ends and
as reNrenced in Anachnnow VHL Wdie connect is icirmhuned pay%r W Te und&He(Wthe cocnact,then the ProvMcr nuist suhnnif
the final iecluest tolL PqMWV W Ow AWnwe m"mn On 30 d"s after to cornmo is tuna ninalml. Wtho lwovkkT W in No so,
all rig'ht to payntent is %khed,and the AIIAnce will not honor any requests suhnained arlle,r the aforosaid 6nw po.riool
E. eCIRTS Data Lutries For Subcontractors
the Provi(h,,r nius't requim Suhconurchws to enter all raluked dwa nw eWn6 W servRes in time WIRTS datubase per the
L)OLA Programs and Services llaridboolw and the WIN P; I Wer%UnuW -Aging ProvWu No"W users Ommod 4 Nwrn=
on ow ecum Enwqirke ;%pprication Servic").SubcmOrmomrs rnuM enfoAlvis dwa imn Me eCIRTS Whr w submiROg Own"
WLtUOMS for pIWYMCnl and CQwnditure reports to Me kyvidw Ile Pawinler AaH emabhsh dead fines, f'or cOR"I'S
data entry and to assai-V earrmapmdratrao.,aa %%'njj ujijV dates tear the wrquesK hr p"namm a"! expenckure J-epo)r'rS il.g
mWit W Ow Uhznxe.
It Prm%irf Ndmdhy eCIRTS JUpods
The PwAda must nm nwMhO uCWTS wpwu aW Wy 01M and service.Lima in Me eCMTS N necmatc TbN wpM nwst
he subnKited to the AdiAnce%vRh the nionRdy request for payment and eNpend4uro report and mum he revkwed by Te AlAnce
Wfurc time NvAlerl wqwn Aw pyrnoU mW e"Whure refinns can he;qTroved by Me)%Hiance,
W. SPECIAL,PROVISIONS
A. Provider's Finandal Obbigadans
1. hWhIng, Wei of Effort, aind LarrnarlOag Retinirell'ient;
Ile Pmvider mug pnovkc n nmwh of M kni 10 povent of time cum IN all ADIsowiem The mawh %WU be nmde 0 the
I�,,wrn ofcash avd)or in-kneediesourees. Al the end of We connect per-ind.A ADI Wk"pendM mum b"nTaly mWed,
We Minds cannot be tmed to inamb another MaLe-lbrided Iparampnan,
2. CoM Shading and CoInymenh:
nw Provider in conjutmin ojh to AHAnce sp M! nwbhh mi am unuat co-pVnriero gmil ynouni W he aMeend Dorn
cfients,p. Lising the melod pmsaRxd in AppoWN B or oic currera v)epartvnent of"Fider Affah's an(] Services
IUWMoV time pi,oviller WH pvjed the annual colmyinaUs W he wilverad Rorn each acilve clbnl W 0 We= ranges
prhr to the start ofeach hwal yon Be pWder us rcqL6red to nievi (lie estabfished foal, Co-1-mynierns collected in fire
ADI pvgrem mn be uwd as pad oFTe Val match,
Nge 25 of 57
Ma no g,lernent and use rat Sarvka DnJhrs and Cnnihilmity of Semilm,
a, Ite PnwWer k uNmewd to spnd 0 funds pmWd by Te AHWwe Or Te pwWow spcdHW 5 Os cmlmo. -Me
Provider niust manalge the service dollar in suh a mmmer so as to avoid havha as mqdw ufftiWs M Ow eW ol Be
contnict period, If idle ANKme delamines W he PmOder k not max wriding available flie A,Hklfoce. in
accordowe with its Final polkim. nlay transfer funds lo other 11roviders alld,'Of�.XijttSt StIbSOLILICin funding atlocaltions
acc card i rag Ny
b. The flovklershd unum UW cwmul survices%01 he farvided unHl die end(AAhecontlaicl peldod. In order tuenable
the Provider po becur inanage thu sunkes un&u IWs emilwo and V) maAndze tine use of aubhk nnmm", Me
AWWwo WN mWWWd to qxWkg mulluvil as idenl;ifled In Mniget Ummmy Mlsidnem W Ile Plavida is
mmmnible QW "Mnaging Me qwmikig UINWAY so Am a Conilhiliky ofservice Lan be niainlained iior t1w n1axiiTioni
nwnher of consumers. Thv lVoWer agrees lo asswne wvanIM9 Rw a"cmumMaWekit Ora nmy k QmW
4. Blidget:Sunimsry:
The A Nance Us csWhlisbed a spondbg auboity hawd on surybes and rMe dolled in Me SPA md be Halgo Smunaq,
Aunchmeni Vil and any rovisions fllei`ew appnmTVV Ic A HWwo An"harips 4 We Mal aniounts ofthe Funds kJvwified
on Me RQW Swronmy mqWm as amoul amandnwnl
13.
L Ile NuAW AaH n"ure dwa aH ORK wu%senivus pmviwled unda this unsw uc dehvmd lkwfy, cwnplucy and
mmmxnume wit reWhiod standards oQualit, Shwh goods andAn, semkxs "Al on, be delvoulto 0114 pinpun
pHlAk4mms,
I H lhe PP)ViCJo'f`RHS W "Wo Me pWWMWd p0hy mamulrds t'orservicvs, such servico vault not he reiniblirged underdiis
o',OHIF,ld. In addifiCH1, early uataracrorridwrtarauiy, gotWs (Oludhig home dhvercd lneak) SCINiCU-S MA MCCOngSLACIII
WalIaMs KH nu be reimbursed under this contract. "I'lie ProddWs siombim on Me request An poymmil Inn emMes
nminlamme of mqTnmkg dbunmrdathn nd aAmmledgumml Not Me I'mvider di all Wlefy 17ear flIC COMS aSsociak!d
Ile Uincerequires illiniediato
anid/ol.systvinic infi-aclinnis owl emn"Wrlise the IMMY sec wily WAMMy"y ONUOUN W cknk,
C. Investigatimi off"rindmil Allegaikolics
Any rqoo Owt hnpHn cOnlilmd WA on Mc pw or me Pwvwn or my Subcomraclors alld referred to a 8covernmenlaI or
Ovemwomq ngutmy mum he scarf tole Allkwo widul"OH Wwn RwwaM dw khrnwition Wdle Dqxlmnem. TOwAHiallec
has reaumi to believe tat the aiNgations %vill he ieferied to die Sue Aumney., ^a 4lw enl6icenlent rirenq, Ile United St;,nvs
AnomeyscoMc,orothergovertinicnW aganqNthe ANA=shMinatiol)die QndwGumal atOtOkpartrialt immediatek
A aVy oNH &xwnctVy rqon* noWs ca Wher sal Uen inawki concendng Te humigmiow whaher in the possaWmi of ;Q
Provider or Subcontractors, must be sent to the AHWwe m1kh wHI in turn send the rnaterial to the Department's Inspector
(lenses l w4h to stamonq of Ow innMIMU erred a&gwkns.
1% YOunWers
The PmvWer W emure the use onnoned vww"em A pawitling direr sania,"IeWmd 0 older hAvAwk W hdiv%als
with disahilitics needing sKh scrOmm H' possiblo, the WOW AaH wmt in amilklmAn Keith oTanikatkm Wm leave
expeHence in FrivSky imhh& plamment, nd mijeWs Ar vWunums oT pailiconts hud as oyankalbus cmphig out
I'Weral iervico in is'(Cred by the lor National and(Onnunflo,Service), in con,imorlily scrvicVsO6q;S.
L the of soviev Whirs asid Manage"Ient nfAssessed Priority Consinner List
Vw WOW is expected to spelid all fiedera[ oMq WOW Runt prodlded by Q Uhme Ar he pqww spedOW in Me
contract, Re Provider mmm rani W so-vice doHars, in qiw1h a inzinner go as to axoW having a mqAn of UK m Ow vW of
the contract periW, for cach poq,_mj'an1 HlMapd by Me PmvWm 'Me PmvWer unlki-smMs and Hgrecs to he reaHocmiun of
Wndking as desudhed in Aunchmens 1.Secdon ILE.3."Filds contmul
Page 6 of 57
ATTACHMENT H
C'E,RTIFICATIONS,AND ASSUI(ANCES
'nw AHWwu wW nW awmd Mis emout infless Providur cNrploes the CERAFWADONS APO)ASSURANCES contained W this
Aftawlunent. I n o l,fln S con rrawa, Provider provi des the 1W lowing certiRc Wi an sand assunmem
A,� �219 Cl�,R—Paal 95 and 2 c FIR Part 2001
B. Cerfification IkCzanlaar I.modal Part 93a.Yj1 2L.,W.L C Parr(4L31,
.--- --.—L—
C� UM-0-r—ti-111—it-8 Assqraqq L21)C FR P,,Lrt 3Z-ind 4, LIJLLI 01
ALL9_
D'. 'ertification It cetion 287.13. F.S.
E- Assudylkni or Gammunilv for Ileh"In NONSI„L&C�j!LN is ssaj
11LI 17J
V QN6 (I jig-�',E.Ltdinizcd Com.j�ninic� cc ) 2_Lj�� fli 11 N7 I 15 F S
G Cer JaOon RyglUjil 3 DaW 40 ir � Con
i )��� Wx wil—u-11ts— tic, "au
—L--
Awar
It VerTWon of
"lunLalm.01. xr1ification
L Keen- occupentalion
i grur atkni R laMh u ho C J�ecords L—L bye uxamy
A. 11 ERTI 11GATION REGA R DING D EDA RM ENE SUSPENSION, A ND OTHE K RESPONS I MILITY MATTERS -
PRIMARY
nw umlemigned PmvWu caNks M ke best ol its kr;mW1aWv and b=W R and is phwynk
I. Are not presend.y debarred, susImIdes PMMKM aw War=WNW W10)1Q,or Voluntarily excluded from covered
uansiw6ons by as FcN.Jend deparnnent or agency;
2. 1 lave imm %vidihi a 1frenyear penod [xcccdhW Nis Cuntmcl been L01101W or 40 a QUukrnwn rendered apinst Tor
AH carnmission or Baud or a Whal ofQnsc in councokm with AWKQ MWmMNg W Ww oqxiJwmKg a pa 0lic
(I ederal,Saw,or loc.ao Iranwortm or cmitram under a priNic tranookmi vKht5n or Falend or Man anAnni mmuw mi,
conimiss,icrm of embezzomns.MCI WTv"4.ado"JIfls0kotion or qlo"atruction and records, nviking, false stalenlents,tit'
ivuehdng suden Impeny�
1. Are nor presendy indicred ini otherwise or civilly 6arged by as gmvrnmor cwhy jAdNaL Smw cw locao whh
commimion of nny orwe oUbmus enumomied hi pwqnph A2AWdais cmilkalAw amkr
4 have not within it r�hrcc-%year period IvemdQ this apolatkonjropmW had one m-rnore pubhc transactions(Federal, Amm
or local)ternnnalcd 161,cause of"de[aah,
K CTKV FWATION RECA RIA NG LOBRV ING -Certificatioll rol.Colarnets,(',rants, Loans, ki nd Cooperntive
Agreemems.
'Me wWckgwd Wider cenRky to A bum(W Us hamIMp aml AW Qzn�
11p 27 of 57
No I'edera I approprimed finds have been Paid or w!H be pi I Igor on Irks f of he runknigned. W any pan norl Rr Af Wend ing
to Nfluence an oUker or ernpklyee ofCongres,or an enilfloyee ofa Member ofct�alngress ill collnwi4�llll Wi I h the
mvkirdfin, ofany curlvwL the makinguf my Falral gmun to nmkhgor any Feckral knin, the enloing huu of aT,
Cooperailve agreenlog,and the exioniom comkumhm,renewah ilmendn-voll or nwARmAmi M ml FaRmOmMAM Wwu,
loan!as Cooperative agreelner%
H wry NnL6 Nhu Km Akral qpwlprAWd UWs have huen Imid or wiH he Ina id to any pawn for Knuemoky or mmunph'a to
innuence an of1ker or erqlfoyee of any agency, a MemimnACoangrem,an Wficer or ennyees orcalsym oremployee On
Mc niber ol'C can gress in connenimi YOM a Fednal cmvmr, nn Wan,or coDpennivc agreernea the tindersigned shall dso
umplew ard mMmit Swidud Fmn -LALZI)NOmutv Form to Rqon Lobbying," In accordance wvjrh its insllruclions.
'Me Undcloymd shall requie thm Yguage of this cer0cadon be Included in the docurneras Rrr aH suixommw at &I has
(Ocludog SUNOMM01 mbgranN mul cwnwo unda gi= Wns and co"craHve agmelvouO and tot all ath-redpints
and Providers shalt cafi(t) and disdose accordingly.
I"his(xi-tification is a lrwcri�,,fl relnesenladoll,of,rael upon wvjlicfi reli,,ince mis p aced aNheni this C'ontracl vms OIRLIC 01 CHAU-Cd
imo submission of dos CeniFication is as plminIuldle Rw tmkh,or emaing Ow this Untmul hnposed IV 31 USE. 1352. Any
INT""UM "dm Dads to foe the roquRed cer0hernion shall be moleo to as Kill pwah),ol-ricn! less than S 111,000 and not nime Own
$li0tt,000 Maur.CWh,Such,fiaiihlre
NO N-DIS(,RIM1NA11ON Rk EQUAL 0PR)RTUPUTV ANSURANCE Q9 CFR PART37 AND 45 CFR PART 801 As
as conchnion oFihe Umomn Pmvklr assums Hnit A %AN comply RAY whh tine mmAschnnitimbn ad epud upponnity,
provisions of the foflovv iny ta%ks�
1. scown I sm or me Wo&lbme Inv"wwra Am of 1998(%IAI (Put L W12MY w1kh probbih d6minnhwhn aphst all
individuals in the I Inked Slam om We Innis oUnw,color,refiginy mn natkiral WgInAgn d1whTly1w1hical aMlhnhn
w9dich and against haicki,anos on On:hask 04hhei citizensh p/status as an ta"ll"L'Y"t"auth"""C'Ll t:l
ova 5 Ik Qhd Stmcs or pumiciputhla hay any 'CIA Tide 1-financially assisted pro'grtull or aC1iv4.y.'
2, rok vi of Me(OH RQhN Ad nf 1964 (Pub. L 88-3521 us ammlod.and all requimmis impmed 11 or punuont to the
Rylulmhi "We DTanmou on In= Ad mun; SerAces(45 CFR Pan 801 "1 be ad To K ammAnce w0th 114 VI
orkmAumclMe Quktkrnao pawn 4 dw thud Statesshakon the or"adornal
aclivoy fuji- vvInch the Applicaln receive�i Federal firnincifl assklance hroin 1he Alhanue
3, Section iO4 ofilhe RellalrOMMArt Act or 1973 UK I., 93-f p2)as antended,ivid aH requirernents unlx)sed by Or Imo,simn't to
Ke ReguKimbn orthe De pavan neat ol I War 5 mW 11mmuln ScivOCS 05 ('J R point
84), to the etid than in accordance wvhll
SmAm 5N of TM /WL mW aw Rqulation, no othw%se qmhWd haixilicapped hidivithud in 1ho Unked Staws shall,
soWly by reapin of hk hndfuR be exchldoJ Aurn parLihpwion K be doted the benchis of,or he sjjmed to
discrinumdon, under wV pmWom o"001 R which the Applicant receNcs Federal fimancial assistance ficull the
AMIMCr
4. The Age Diwrin"athn Av of 1975 (Pub.4.94-1351 as amended,and salt requirill,,mentN urrap osed:by car pullsillant to 11W
Rcgotation ol'thc DeIxnirnew of[lealdh and I lurnan Services(�l 5 CFR 140 911 to the end tram, in accol-dance w ith lhe Act
and the Regulation, no person in the Unded States shall, on the bmis orkge.be knied the bmdh"*bc excWcled hvi!ii
paiAcipmWn in or be sQuied hs dKerhminmion under any par`Wan mmoNity for wWd dw Applicant receives Fedenfl
finaricizd assisaance froin the AHiallcc.
5r TAN IX uF le Eduntiolud Anwrldimms of 1972 (Pub, 1.- 92-3 1 8), as amended, and all finpclso�] Ily or.
Pursuant to true 1wegula6ori of the Doparlinent of hOddi u"d I-klmHn Services 05 CFR Pun 811 to dw end Man K
accc)rdance wYith Fitt IX and the Rcgutadm no pummi M Me thihod Sots sInfll. on the basis,ofsm In. excluded hwi,
pa-tikywOn hh be doted the berrenim ok or be othenvNe suounad W t1kcrimination under ally edlucadon prograin co.
acdOy Or%OAch the AppLicant ri"civcs Fcderal financial assistaricc frorn the A Malice.
6. Tho Atnerican L)kabifitics Act of 1990(Pub. L. 10 1-3361 Qdhhs diNcHmmmion In ail oriN"um praefien.
indudhgaob apykation pawedure, hhhg, Hrhg.advancernent can m pensm ion,whing. and other wrns. condition,mui
privileges ofernployniew It applK to recnOmm alhenish,renue, layoff, leave, fringe benet'lls, and "apt uter
Nge 28 of 57
Provider also assurcs diat A Quint coniply with 29 CFR lAd 37 and al I othw"vpdkons hinplurntriOng the laws Idled above. Mis
assrumnee appHes to Providor's opoe athat of the W1 A fifle, I- financinHy usWed pwgrarn or aclivhy,and R)aH agmemems
Provideyinakes to carry out the WIA Yk lie k financially assisled pro�gluin or act i0i, Prov We r understands Omt the ;U I Ance,
QmVt nent. wrd die Unhal Sbues have the tight, up seek- judicial ankn-cerumni of the assumnce
D, CERTIFICATION RECTARDING PUBLIC ENTITY CRIMES,Sf,CTION 287.133, F S
hirovider hereby certihvs that nenher rt,nor wV perwn motfilve of%vido%has hwen conviled o f au Pubhe 104by Crinia as
definNi in suctioi 281 13110. new jdac"i an the convicted vendor UNI,
%Odn mWemalrds md agms Mat 1 h,requAwd W &Rwiv IX)FA immedialdy upon my cKle of Arcummances wgmdhg
Its mmrm
E, ASSOCIATION OF (COMMUNITV ORGANIZATIONS I&R, REFORM N00 (ACORN) 1,13NDING
RESTRICTU)NS ASSIAtANCE(Pub. 1. 114 11 J
As a condom orthe comw Pmvwa mmiros mat h wi coniply Aj %vhh the Ica crul Mndhg rovkdoragenninNg k)
ACORN and its sobskhaNvs 1wr the LimmulWaled Approphmkrns Act 20 10, Divishn H,Sectimi 511 (14b. 1. 11 1 A 17h1he
%H[radng Appmpriations /in, 2011, Secdons 101 mul 103 t Pub, 1. 111-142,InovWn Mw apughailmrs mde mWer N b.
1. 111--I 17 are avalhWc un&r the cw9khms pnwidid hy Pub, 1. 111-1 IT
'Me wwersymd shall rvquhv that fanguage orthis assunvnce be Included in the docunwrits for aril subconn,aelsat all tiers
(AwWdhg s0cw"rad%mIgmnu au mincts mWa gmmv Imms and umpostive agreernem)and that all sub ivellems
and t1vvkkrs shaHmmide Uds asgMance acwnungly
F, SCRUTINIZED COMPANITS LISIN CERTIFICATION, S[",CTION 287.135, F%S
In arcoMance N00i scetion 287A K FS. PmvWa ha eby cmUhs that k is m; pwfdpathig in a NVom of Nme,1,
4 ON 17mmmo 4 ii; Me amourvi of$I 011ion or mars &amodanco vvhh the requitrnmnu WAmbonART ON FA. PmA&r
hereby Ceritfies; 1hat it is not Ibud on chher ke Sennhiked thanpanks x0th Activities A Sudan l.k,or the Serwinked
(-'onrpanies vvithi ActivRks in Me Iran lkewohmn Energy Secwr UM and&at A dous not have busin"s qxiuHons in CANI or
Syria,
Pmvider uderstunds Heart puu suant to wctiort 281115. F,S, the suhlmhn ora fhke certification nnRy irsuh in die IsHianct,
widbr Dcp0men, tumkwhng Us contract and the mMirdsMot"A a the mrfificaik.)n nray subject the Provider to civil
penahl ',attorney's 14% nWAn-mmy hwhx1ibg um pier&vcstWMkxrs Omt led to-ohe nmdhg of h&c cKfication,
UTmvWu is umMe to certify o)any,of de sumens in trial;,certification. Provider%H anuh an exQuOun to INS CIMMMI.
K CERTIFICA.71CIN RE(iA RD ING DATA I NTEGRTTV CYMPLIANCE R)R AGREEMENT$GRANT$ LOANS
A N 1)(1)0 P'E 14 A171 V E, A(01 L F N/I F NTS
I, Tho Vrovidvr and any Sulcontracm of services under trims connact have fhanckd iwariagewent syste ns capaWe of
pvv Why cei-IMn in forInaWnh irwkWOW(0 mewate,curent and cmiacir dk0sure cW the Name iM resuhs of eadl
gmalunded p*W wTmpwn in accordunce aNhh the prescribed ivportjn!i (2)flic sourecand application Of
four s Rw all agivonm sirMvarwd autiv0s, and(3)die c(irnparlson of outhys with budgeted,ainounts for each award,The
inabilfty to process inibnearion in accordance%Adi Hmse rvquhremew cm Ad rewh in as rown ofgran"Ands 00 have not
been accounted for propedy,
2, Management InkwMion Systerns used by true %viden Subcontrucum, or any nursklk enthy on which dw Fhnvidcr is
cleperident for daw than is h)he rep orted.hmnsidned tw calculawod, have been assessedand verified Iol be(,np,,,dflQ of
proce�ssfirg datilaccvaoico. Ncludi0gyen,daw depridervt dmm 1%Owse gVerns identified to be non-cornpUnra, FYovkks
w4,dl take irTunechatcaction to assure data hitcgrk)!%
2."trials conaracr indudes the provhdon o"aMm-,uAwwo finvwmv,n0rocode or inhedded clilp technWogy, die
umlenjud wwwnts Im Mew pmdue sare capable ol"processhig year-dale dependent data aecknrat0y, AH versions rfl'
Ilvew proizium cilknod by Me Pro Oder(mpresurled by the underdgned)8nd purchmed Q Ow stm will be mHOW kir
ac,cut-acy and lnlegrity or data t-.)rior to trans(6-.
F%ge 29 of A
3. In the event of tiny decrease in functionality related to time and date related codes and internal satbrouthics that impede the
hardware or software programs from operating properly, the Provider agrees to ininiediately make required cori-ections to
t, M
restore hardware and software programs to the sarne level of functionality as warranted herein,at no charge to the state,
and without interruption to the ongoing business of the state,tuna: being of the essence,
4,, 'The Provider and R11)"SUbcontractors Of services Under this contract warrant their policies and procedures Include a disaster
plait to provide for service delivery to continue in case ofan emergency nncludim, emergencies arising from data integrjo;
compliance iswm
14, VERIFICATIONOF EMPLOYMENT STATUS CERTIFICATION
As a condition ol'contracting with the Alliance. Provider certifies[lie use of the U & Department ofl-lomeland Security's E-
verify/sysiern to verify the employment eligibility ol'all new eniployees hired by Prov:ider during the contract term to perforril
employment dulics pursuant u.)Ibis contract and thai any subcontracts include an express requirement that Subcontractors
perforining work or providing services pursuant to thi's Agreement wilize the E-verify systeln to verify the employment
eligibilily of all new employees hired by (lie Subcoutraclor dur4ig the entire contract terni.
1. RECORDS AND DOCUNIFNIT'ATION
The Provider shall make available tea tine Alliance and flic Derammetv staffand/or any party designated by the Alliance and the
Department any and a9 I contract related iccords and documentation. The Provider shall ensure the collection and atainteriance
of alI prograin related information and documentation on any such systern designated by the Alliance and the Department,
Maintenance includes amiratc and current data, and valid exports and backups oCall data turd systems according to
Departrnent standards.
J, CERIVICATION RECARDING INSPEC'FION OF PUBLIC RJECORDS
1. In addition to [lie requirernents ofseclion 9 of this contract,and 1 19fflO 1(3)and (4)F.S., and any other applicable law, ifa
civil action is coltillieliced as conlernplated by Section 1 ND70 1(4), I`X, an(] the Alliance and/or Department il't",ider
AlTairs is narned in the civil action, Provider agmes to indemnify,end hold harufless the Alliance an&or Department lorany
costs incurred by the A Ifiance and/or Department,and any atiomeys' fees assessed or awarded against the Alliance and/or
Department from a Public Records Request made purmiatil to Chapter 119, l,.S,,concerning this contract or services
pci-fornied theremider,
2, Section 119,01(3), F.S.,mates it'public fun(6 are expended by an agency in payineni of dues or membership contributions
for ally person,C011)(n-ati0i'l, 60LBRIalion, 1110.OSSOC410011, r(alp,Or other organ izat ion, all the financial, bLlSillm, and
ntembership records Of SUCIII an entity Which pertain to the public kjgeuicy(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
w be inspected and copied by any person desiring to do so, under reasonable circumstances.
'The Provider shall require that the language ofthis cel-fification be,'included in all sub &ree�amcmils, subgrants, and other
.1
agneements and that all Subcontractors shall certify compliance accordingly.
_11tis certilication is a rnaterial representation of fact upon which reliance was placed)vIien this transaction was made or entered
into. Subtilission of this certification is, it prerequisite for niaking,or entering into this transaction imposed by OM13 Circulars A-
102 and 2 Cl"R Part 200(formerly OMB Circular A. 10),
Provider certifies the representations millined in parts A through I above are trUe and correct,
(S-q-
mature and Title of Authorized Represclitw No)
ny&CAL Date v1*22-1-
...........
(Street Address)
...................
e,Zip code
Page 30 of 57
A"I'TAC11MENT III
FINANCIAL AND CON111"LIANC'EALiff)"
WThe ofrq'sources awarded by de AlIhme Rw Aghl Am taro We Provinte "my be suN g,
by Me AMarwe as the Hol1da DeImMaent M'E"Ider Affairs,is described hr this section,
MONITORING
In nddtimi to wviemi of audits anAucted in amonlance wNh OA413 Clmular A-133, m mvissh and Salbri 215AI FS . Q:
"AUDITS" belaw), monitoring procedures may ineWde, but not be finlited to,on-sne. vkh by Te Dpa"wm of Hda AHAn and
AHInce MWK hnnhud saWc aults us defincid by OM Circulmr A-133. as mWed, andhw Wher procK= By enicHng inui dds
agmmnark Ole Nvvida ugava hj comply and cuopenne with wly immWing prumdwnjmm= deerned approlwhic by he
Alliame or Me Wpm-anunt nr Eldur ARRY 4 Te cwM he Aniame nw AgA& Trio, wins at a hrated sale audh or tic
PnM&r A alTmMW dw Pro Oder numas to cotvo) ivih any ndcfifionaI ilnsnructioirs provided by the AlNmce for 1g4g, No U) Me
lbovk1er regamling such audk.'Vhc PAMAWha agmes to emmoy and cmVewe wO any hqwohm rnhowc or
awfits,deenied neceisaq by the CIdef 11uncial OtTiccr(f FO)or Auchwr(Inc;-al,
AIJIMTS
PART I� FEDERALL,V FUNDED
This 1)"ui isappkahk inte PmvWwr ka Sue w1mW govarmut ma nwImMt aNankatkv m doNled W ONIHATtahr A-133,
as rvvkvd.
It Me eveM MW 1he PwWdei expends $750JAH) m more in Iedeiad awards duiring tis fi.wA yvar, the Provide- must have. ri single or
pro,u�,yaru-specific auditconducted ill accor(kowe with 0w provisk')ns 440NIB Circular A-I 3:3,as revrsed. EXI-Iff'41 V E to this agreemen t
lrdicate.i IedcrA resoumes aswuWd Wxyh Ow Ikparsnem of Wer A WN and Me A HAnce by HAs MrwnwnL In doetminMg Hann:
federal aw�,u-ds expenuld in its W! year" Hle %vidia, shalt consider al 1 sources auk` fcderal awards, nrcio(fing E"Cderal reWtlrces'
rmeiwd Crom Me AlIh r me maim mpakwom o E f kkr Alin ff . Dw dverld.—nmhn of amowns of WoW asirds expundud shouhl bo
hi acu)rdance Nyhh die MA&MMS ntabliswd by JM413 Cimular A-133,as revked An audk of the Provkkr COOdWed by the Auditor
GcnertA in accordance %6th dw provisions r46N113 Circular A-133.as revkvd, will mea Ore reW%mains onhis pork,
In cmuncohn whh hu an regiraments Wwwd in Pad L paragmph 1,he PnwWr s1mH NIRIJ the requirenwrns relative to alldheC
responsibilaies as provitIcd in Subpaj'l (AACM413 CImular A-131 as r"Wd.
Ube ProyWer expunds Ims than$75TWO h Wool a"wds K is rimm ymr, an awo vanducied in accordance wia, ale pi,ovisions
o f OMB Circa kir A-133,as reviksed. is not rmlu led hi We even; dust the Proykiue"Ws W"Owl KITHO W tWaW awar& Wts
Awal year and eleas to have an audit conducted in accordallce vvkh dre provisions ol'ONAB CrrculAr A-133,asrevEseoE,the COSI,()ftlic
aWh nust he paW Awn mWidod rmm"es(Le., the com;of such mudh must be paW Avm Pruvidur wmmm"WNW Worn mkr
Man Wderal entities")
An muld vadmWd in accurdluncc wAh this pun WWI cover dw enture organization Cor the cm1ankoWn's fiscal year. Cornpliance
findirigs related to agreemenis wWn the AMance for Aluty An sluall be band an the agrecalicni's requirernerits, includingany rules.
rqgulmions�or SU'nulvs rvferonced in the agreclncn(. 1,11"le finaneW MatanmN Ail disclose whether or not the mawhhg rapirement
imns must Mr call apoWable agreemcm, AH ques6oned costs aild fiabililies due lu the Alliance kor Agh% Inc. 3W be Wily discklsed
in the audit repoi with rellmnee w Me Uhnco Rw AgkgJna agree llrou WoNea not o6unvise Wosed as reqWwd by Seoion
31 oa))('.?)a.aromn,Ch,cutar A-131 as revised.Ole schedrde oi"expenctian-es orhedem!awarok,shafl idendf'y expendillUrCS by
number for eacll wkh ihe Afliance rot Agim glum, Inic, in effect dwhng Te Wit perkni Rwmdrd mpmhT pachges rqdwd
under His pun must bu su bad lind Ah in the ear were 30 days aflei-rcceifut ofthe audk rep olr(w9jinonflis rafter-tho endofflues Provider's
f1wal year CUT
Page 31 of 57
11'ART Ill: STATE FUNDED
U&pail k ale if NPAW k a non-mate Wy as deW hy Scohn 21 5 97QI Fkwillu Stauaw
In the event Vim Me ProvWer expends as W amoum urmuw fimarW asskwnce equal to or in excess of S750,01H) in any f1wall year
of sucli ProWder (ping fiscal yea Wibg Sqwmber 30, 20U4 or lhereAerj Me WvWw"rust We an We AWW or;mQuopecifrc
and if for such 11scal year in acWance W;SmArn 2 OIL FWAN suaw apyawe non ow lklaammetv of Hnwchf Suvbcs;
and (liapict's 10.550(l govet nnienual emitkq cw 1 OA50 Wmpnt; aml Ml oT;inKw1nsE Rules of to Auditor Gueml,
FXI HIM F I ton this rap livernent Adicaws maw AnnAW nssktane awaWed ArmWh flic A Ifiance R)r Aging, Inc. by this In
cWtum4h,be state nnunchl asidsmuce expended W hs tiscal year.the Prvvida sMH antsidergH NO ormate Would wsioar ce,.
heluclNg stauc Sancti assistutnee received frtan the AdlInce Ar Aging Inc, Whur stWc agencies, and other noir-slate ornitics, Twe
fiwanci,,'d assistance docs not include fedenill (firect or awirds and resources received by a non-state oorty for fiedenal
prcigrafo niatchurg
In connection Wi the audh mquie"imvs addressed in Part I pamgrqAl I; We Proviclu OW ensure that the audit coniphes,with; the
reclukements of Sectism 2 KNIS h Hm-Wa Smiums, Thk includes suhnission of a StanckhTfimting fmckage mi defined by SwWo
2119,2y FkwWa Statows'.and Gi,,ipicr 1(1,550(local governineinal ctilitios)or ID t;50 Worl and Al UjanowkwL Wes
of be Audhm WcW
I I"the 11rovider expends le"dun SHAW10 0 swe AmWal nsWana in its lhad year(For Wul years endinfg Sq1ernbev 30,2004
or OwmaCia"an audh cmithoad hi mcmduame w0h the provkions of SectAn 21511 Robb SmMic, IS m4 mqWm& In the"crit
that the provider expows hens can S7YMM0 in state HnaiwAal asshsmwe hn is HwM ymr-and elects to have an atidn ccoiducledl in
accorkisjnce whh tho pnwkkms or scohon 21517. Hodda Swulaun tic cost ofilik., audit must be paid From the non-stale entity's
resmirces Q,the com of W an Wh must he pall hinn Me Provider MWHrms obtaketd amn uker ban THW entities),
An Wit cmd=Wd 11 aCCOWSM With dik parl MmIl cover die endre argmAntion Ru Me uMnization's fiscal year. Complince
findings related to agrecanients with the Alhance for Aghg, No shall be bawd tm he opumeMN mqWmmerus, IOWWg a,,
uplAkable Wes, wgulations,or sranrtus. Hio rinalreld Aatenretns shall disc lose wkhoher m not Uw matchOg reclukunerd was md fur
owh andicablo agwernow A qualicawd ows W liall Ae todw YUNsunce Q Aging. Wo AmIl he Fillyr disel hi We audit
l wHh rebmice W Ore AM[ancc for Arai, No aW=nwn;t Involw& W nor othawke discIosed as required by RLde 691-5,001
FG AdnK Wde,dlw Weduk;uWperidittnes ofskau fivonckd Wsliance shall idumiyr expoldintres by agreenient number For Vach
agreentent wifit the Alliance for /tong. Inc, in effLu during be Wit pe6M. FhmxW rqmMing Inickages retluired under this part
rimst he suhnihiled Nvithk 45 days nNa delivery of be audit mpott No no Wwr An 12 nwnlhs alter the IfoRler's fiscal year end Cot,
local goventmoaal Mtn. NonymEl or fol-profit, organdwitms am wqtihod to bu uln-thial Whia 45 djN aRcr delivery or the
a5h wporL bm no 1,alcr THUS 9 nwnihs aRa Me PmOdWs HwW you W, NoWhstanding be applicabiln.), of lams por6ojr, the
Ubiwo mid Ow Dqml a Elder AfNhN MAn alk Hom nd ublip 0ion to mWor and oversee Q porKmance of this agroemem
as oudined throo'g,11mv this docUrnent and lAn'SUM tO IN W,
PART III: RE1110RUSUBMISSION
Uphes of rep arUng puluiges KWU conduted in acconfance wk1h 0MB (Jrcuilar A p.fy, as rovised, a nd required by FIAWF t of
MN agmmmm A al I be sulorrikitel whe" requ Ned by Section .320(di„0MB Clohr A41'3-is revised.by ot-olli l I a If'ofthe f1rovido,
LfiLE,aLlty to each of the klllowhj(:
ne A UK= For Aujng, hic, a,d each ofthe K)Howfitg addresses:
AHW=c Mr Agirl In,
Atin,: F'lisvad Monitor
760 NVV IOTh Ave. Suite 214
Miam" FL 33 PIN 55
1w Federal Amb, Cdeadnghousc WOW int()MB (Jrckdar A-133,as revised(Ow munber of cophes mclubred by Sections 320(d)
I and (2h ON113 WwAar A-1 33,as revised,slititfld besuibirriacd to the Federal Audit Clea6ttghouse), m the follm0n,-,addtess:
F-ederal Alutift ClIcaringhouse
B"enar Me Census
12M EnM 1U0 SHwet
JefkrsonvHW,IN 47132
Wher fidmod agencies and pass-Mnmgh Wks hi wcmduawe wit Scohns ,320(e)and (11 0MB Ckahr Ad3j as rnkal.
Page 32 or 57
I I
Ptirs no n I In Sket ions.32o(rlt. ONIB C No&r Ad 31 as revised, the HoWder W Wrn I a copy cal Ilie reporling 1--rackagc described in
Soo ion .320Q ON/113 Orctihn,A-133, as rcvisc& mul any nwnRgerneni I e"cr ism wd byte awMm% ro A e ANA me Rv A on, I mr, at
eadi of flic,
Alliance for Aging, Inc,
Mtu Fisuil Nkmitor
7AO NIN 1071 Ave. Suite 214
Pd!am i, Flan 33172-31550
Add%nult, cordes of Hnanda, mpoodng packages required by Pont H of Mis au;_, annent shaH be suhinhial by of m behaKof the
Provido,1&qjjy to each c)fdie fioHowing:
Me A Hiaiwe Rir Along, Inc, W each of die fbiloyving ad&v%es�
A[liance fbr Aging, In,
Attn: fiscal Monitor
760 NW 107111 Ave. Suite 214
Miand, FL. 33172-3155
The What,Cieneral's Officle at thel5ollowing address:
SIale of i1orida Anditor Cenera�
CArtude Pepper HWHIng, Worn 574
I I I West Aladimn hAreet
Tallahassee, Fimida 32399-141,50
Any reports. lener, or wher irdoltnmjon rocpdred lo he mArnited U) the Aifiance t6r (Nging, irac. pursuant, to this,
agMCFnOV1 Wfl IN SLibinined Key in accordanCe With OMB ChWar A-133. Florida Stanoes, and Chaplena 101.550 (hical
govemnicinMemide0or I11A50ptonprofitand Mr-pinoM orgardeadwNt Rides of the Audhor Genre ml.ris appficahh,,
11oviden. when subrMing Finuvial mpWhig packages to 1he Alliance Ar Aging, Inc. Wr audUs dcnw in owcurdance svhh OA411
Orcular /0133 (w Cluipters 10550 (heal govannicriml Wks) or IOA50 (nonproM and for-profit org'anizations), Roles Offlic
Auditor Geno,al, should indWate Sir time 1hal die rep ordng pridage "as delkered to the Pnivider A cormsjuvichme acumnpanyurns,
the repor6rtgg package,
PART 10 RRAW) RETENTU)N
lie provwcr swill re win sofficient records domonstratNig hs complimme m4h aw terms orims agreemem wr a pedud orsix ycws
Rom the date the atmilt wport is WwA and W alltmv Ow Alliance Mr Aging, No(w its d0gnee,the CF0 or Auditor General Access
lo soe'll records upon request, Fhe Provida W uBmv Chat Wit wolNg pMwrs are rnnde avaiNble to the Ahiance fin AgjTq,,,- No.
or Its desipwa We 11opartirient or Us Wynce,CEAK or Au dkcn-Gerwral upwi reywst Am a perid of sk yums Duran We dMe the aurfit
reporl is issuccl, Luiluss extended in %WQ by dw ANAme kir Agin& W
FIge 33 of 57
ATTACIIMENT III
EXHIBIT- I
L STATE RESOURCES AWARD!,.A) To ,uw RECHI ENT PU RSUANT"TOTH ISAGRE ENI E NT(,.'0NSIST0 FTHE
1701,11MVING:
MATCIHNG RESOURCES FOR FEDERAL PROGRAMS
PRf,X;RAMI TITLE FVNIJING SOURCE CFDA —AMOUNT
-----------
111-1'11,,,,..�.�.. - - TE f T A i-----i-------------------
7' 7� AWA W $0
..................
STATE FINANCIAL ASSISTANCE SUBJECT TOAcc 21&97 FX
'fi'O'—GR A M- 1—14,V" 1 N 01 NG SOU RCT, C SFA AMOUNT
Atzheimer's, Disease fnifiafiyL�, Genciral Revk,.,Mje 65,0102 S91,807,73
—-—-------- —--—-------------
............
TOT A L AWARD S91 A0713
COMPLI A NCE R IQU I R E NIENTS A PPtICAMLE TO STATE RE"SOIJ,RC'I,,S A"W A RD ED PURSUANT TO TH'IS
AG!' !!MEET A RE AS' FO 1,H)W S:
Slate Financidl AssMance
Section 215.97 FS.
ChnWm191-5 Fb. Admin6OMM Wde
f4ge 34 o F 57'
ATTACI I NIEWT I I I
EXHIBIT-2
PART 1: AUDJJ' RF..LA1"lONSI III" DE1°EA01INATION
Providers who receive state or lederal resources ni'uay or nny ium he suNec"o Mv aWKI requimments of OMB CKWYAA33, as
redsak an&ur s. 2 1197. Fh, SWL Pmvklers "to ,are dwerniked to be redNents or mWecipients and feclenfl aNvatxlk wadAv mate
fin»anciaj wss'islancc may he suNect lo the audit recInknumns jrbe audd INvAudd wqWrerneMs so. parr h in Pam I andAr Pa 11 of
ExWhR I is nWL PmWom "to have been dommirwd to Im vmdorts Wv not Subject to the andit requiretnents ofON113 Circular A-
133,as revived,aruUmns, 21 19T Ha, Stal R egard less of wheMer the met, Provider's who have beoii deterridned
to be recipierits or sub-recipients of federal awads andlor swit; HnanciW awWame inni ommpy 10h qVhcable prugrainmatk aml
nscal coniMiance requhTnienN.
In accordance "M Sc, 2 io orow Clmukw pup 33 and/or Ride 69k5AM6, FAC, Provider livv4 belen deterniined to be:
VmWw tw exempt crAity and U,suNat W(WRI(,'nvrlar A-133 ,and/cWsr 2 15.97, F'S
bject w(")NU3 Civckriair A-p33 aiidfor s. 2 l5.97,
Exempt orgariizatio iLiL)I!sr.ibiec:t� to 2 CFR Pan §200 and airs, 21197, PT RN Fedeml awarcit fugrafk aTarKaUms are
exenipt; for state financial Mistance projec(s, puNic universkW, carnnunky coHeles, dhtdct school boards, Wanches of
Mao VW,gwernrnmU, and 6artu s600ls are exempt- Exen,Vt agardadoris must conipty w0th A comp Hance
requirenients set forth w thin the contract or award document,
No FF. I fa, Provider is doernrined lo be n rechAuni /suh-r-edyew or Nderal vimUw Maw Hnacial assistance and has, been approved
by flee Dqunatmi to subconuAct. 11my rnwl cm-nply whh s. 2 11907L FA, and RK 691006(21 FAC Islate Himneial asAsuvnce'b
and Svabn 400 OM13 Circukrr.0133 I f6deml avvank ,
PART 1h FMCALCON1111LIANCE' REQUIRFN]F,,NTS
FEDERAL, AWARDS OR STATE NIA"I'01 ING F"UNDS ON FEDF,,RAL AWARDS Prmiiders wvho rc,,ceive federfl awards or.
sLale Inatching t'Onds on fedcral awarck and who two dounnhed to he as sub-rvdphq must cwnNy with Be IWWwhg Asml W,
rules and jregu lal ionsu.
STATEI IDCAL GOVERNMENTS AND INUIAN TRIIJES MUST I%L1..,0%W,,
2 CFR Pmi n5 CWM Pdmyks W Stal, Imcal am! Indiun Tijbaf Govertaneras(Formerly OMH Circulm-X801
OMB Clmuktr A-HU— Adrn"NnwNe Raludomems
ONIR Ovekdar A-133 -- e\wfit Requireni�,,,nts
Ref6voce('4iidc l'or Stwe
(Nher 11mad requiremeras set Wirth A p-oWarn Wx Wes tmd tvplaUms
NONI ,)"ROFI'1'011(;,A,NIZA,']'I()�NS MUST FOLLOW:
I CTR Put 230 Cum Princyles Mr NmyPro(h Organizations(Forniedy OMB C4"kw A-U2 —CmA PAQW)"I
2 CFR Put A 5 AvInAbstmW Repkernews Wwrw4y CAM WuNr A-I lf) - AdminWrafive Reqtdren,writs),
Requirenumts)
0MR,("ircular A-133—Audit ReLlUn-O'nenk
Helmne Wkle for Sme EsIvnImms
(")ther, fjSCafl reqjjjjpenjernsset forth in proLgram kiiws, rules,and regukoiiotv�
EDUCATU)NAL INSTITWIONS(FVEN IF PART OF A SIVU11 OR LOCAL(;0VFR 'ME NT),N'IUST FOLLOW.
2 CFR PWI 220(Amt Pkwyks Nr EduaiWal lnmlito6ons 0MR,(Fornierly C,"irctflar A-21 --Cost Principles)*
2 CTR Put 35 Adoer MstralWe Rpnimments (Formerly OW3 Circular A-1 W— A(fininisirative
ONIF1("ircular A-133— Audit Requk-enicrits
Reflumme UuWe Ar Starer Experidiiutv;
(..)1hev fiscal reqjuirenienls so lboh in pmgnmi lawN ruts and mguladons
*Maw WaM pmWrams amy he exmnpwd hvrn comphance vvhh Ow Cava PrAciples Circulars as,noted in the OM 13 Orcukir
Page 35 or 57
A-C 33 Coimphance Aj pendix L
S"I'A,"ri",,F'INANCIALASMSTANCE. PmvWcm whommN maw HmmdM anktame mW%Aowv dmanhwd m ben m6plWAX
NCif)ieffl ffILNI CWTIQ wih dw RAmving fiscal laws, rkdcsaud rcgidalic)n ;
SmIhn 21517,11a. Mal.
Chapter 691�-5 Fla, Adinin Code,
Smw F%Oos cmnowme suppkmm
RuNmuv(hWe Ir Smw ExpnAwms
01hur Ascal requhumems,so fonh hi pmgmm hwv rWe"wd mpdmhns
THE REST OF IVIS PAGE WAS LEF'TBLANK I NTENDONALLY
Page 36 of 57
AcrTACIINIENT VI
ANSURANCE&—NON-(�ONS'I'l�t�(��*'I'ION PRO(J�AAIS
Public report i ng GATT fb r Ods col I eel i on of irifiwination isestim ate d two aver cage 45 forreviewo'g,
instwitm, sumhing cKting dWa sotwcn grahAng mW rnainmisibg Me data neukd and corripleling and rnkwhg dw colleethir
of inFormation, Send conuments ragardhig tho hurden eahmw or miy otfier mpml or this commion or mmmom jmhwrn�g�
suggeMions Nor red:ucing dis hurdem H) the unice of Management arud Budget. flap etivork Reductiorl PrQect (0348-0043),
Washington, D(: 20503,
PLEASE DO NOT RETURN IYOUR COMPLETED FORNI 11)71111 OFFICE OF KANAGEOUNT AP40 BUDGET,
SEND IT TOY11E AnI)TTESS PROVIDED IT,Y-141F,SI1ONSOF4IN(; A(;LNCV
Note, (ertain ofthtse assurances may not he appLicable to your pnject or prograin. If you have questions.please contact
the awarding agency. Further,certain federalawardhig agesivies may require applicants so certiryr to additional
assurances. If such is the case,youi will be nolifictL
1, Has the legal autholy to appdy An lkdaW ani,amme,and the insHAH&K nurintgerial,mid Hmmchl cqwbHRy Onduding
Wads surmciera to pqy the mWideral dream car lyrym coM)to cmuw pr,oper plannim,,, nianayernem and cmnp&Hon of Me
prqjecl described in his appfic,,,ifion.
'Wilf gjve theawardhig agency. The CVvjAra1QrUennm1 orthe LMhed Swiev and Wappmp0m,floc;Sw1hro"It wV amhwOul
represenla6ve,access W and dic-right W eundw all mawdt%Tv paper,onhwurnents Velar to the awar&and wrll estahhsh
a proper",ac(mrintin"". systeni niaccordance %Oh generallyaccepsal accoundug standards or agency dkemiyes.
3, VAH csta=safeguards kjwcThh muflymn firmn ushg their positkins for a purpme In,ewnOnnes or prescrus the ajqwarance
orpmswul or oTankado"al cont'her of inwres cw personal gak,
1, Will inif iatc and con-wictc die work wit in the appal wable tine lfanw anmovecipt of the 'a wi rding"agency
5, Will coniffly vvith floe hoop memmeniM Pnsonnel Act of 1970 1,,42 LJ,SY 4728-4763) relaiiing to prescribed smirdards 1`6j!
Tnerit systenis for progranis funded urider ones orthe 19 sww or mgulalions specified in Appendix AmTOPM4%ndards Or as
(wrparitSysuni of Persornw! AdrnhAsIrathm (5 CAER.9011 ShMparl E),
6, Wild cornply with aH Iderd malutes relating to nOWINOONQUE Hiese inchide 1,)irl are not litilited to: (o)111le Vi orthe C"iVil
RWhN Act of W64 (PA.. H8-352) whicli, prohlbUs discrimhuition on die bitsis of race.coloir onwdma] orion:(W TAW IX onfie
F,ducadorii AnIC11dineMS of 1971 as amended (20 U,S.C', 1681-103, and 1685-16861 which pmhThs dkc6uhm6on an Me
hads of sex;(c) Section m and RehalAknOon Ao or 073,asainendmJ(29 U,S,C.'.
the bads or hamlicapy W) Ow Age UlkahnirwHoii Act 0' 1975, as urnendNJ 02 RST, 6=61071 mlich pKids
dkei-irihnihn on the bmis oNqe: W)dw Dmg ANtse Office and 11mvirrion AO of IW2 W. 910551 as arnendS rehOW U)
nomliscriniiinalion on dw hmis ord,abusc(D Me(ImpKerniVe Akohol Abmv aml AAcoholkni Prevention, 1"reabnent and
RdmWMMKn Act of 1970(PK 91-6161 as amendal,relating to ncardisci-iminadon on Me bads owdwl Qmc or alloNAW
(g) 523 and 527 of dw IhMlic [Wahh ON& An (W 162 (42 US& 290 d?3 and 290 cc 3, as amended, relating to
conrideiaiahiy ofalcolhol mW dmg We patima reoAdiy 00 TWe m orthe Civil Rights Aci of 1968 (42 U S,C', 36011 el
seiqj, as arnended. rdwhg to mmNairnihiathm in & saft =1 or Ananchg of hmmAW 0) any odwr nondismirnhaliun
providons in the spec%MMW40 under 01ch aplicrahn Rw federal nssismnce is being rnade; and 0)the requiOwnienN orany
other nondisedmination stanaos) which,may apply lo O'le apphoidon,
7, MAH compy. or has already complied, %vid, the requitanoids of TURs H amd III W die unkmi Rzkwati,mi Assistance and Real
PnMedy Axqukitkm Pol kiks AO of 1970(KL 91146) which lwovide kw 04-and cqAtable treannent or 1wrsons Wsphwed ur
xyhose property is aupt hvd as as resuh of fedcrfl or fedendly amkwd propmrriv 11we inquiturnenm apoy to aH hue rests in real
property acqujred liar prqlect Ptn*j,)oSOS regardless offeden-M lidi-ticipation in purchases.
8, Will conip'fly, as applicable, with the pmvWmv of Me Hath Ao (5 U.S.C, 1501d508 and 732403281 Widdi SO the
paw micaj actiows o,rempknves whoNe par indpal eniployrnery activniesarc t"unded in whole or art part vvidr, (cderal funds.
9. VAH comply, as apNicable, mith he lrnwWons ofMc Davis-Bacon Ac (40 U&C, 276a M 276a-7,L floe Chpelwid Ael (40
U,S,C. 276c and 18 UST. M mW Te CwHruct Work I hurs and SOhy Skinchrds Ad (40 1,1,S,C, 327-,.333), regarding
labor su�ndards for federMly assisted cc)jinstruction
Page 37 of 57
t 0e Will comply, if'applicable, with flood insurance purchase requirements ol'Section 102(a)of the Flood Disaster Protection Act of
1973 (1:11� 93-234) which requit-es recipients in a special flood hazard area to participate in the prograni and to purchase flood
insui'ance if the total cost of insunible construction and acquisition is S10,000 cw more.
11. Will Comply w1th envirolunental standards which tnay Inc.prescribed pursuant to the following: (a) institution ofenvironalental
quality control meaSUres under the Nafional Divironniental Policy Act of 1969 (P.1—91-190)and lExecutive Order(I-D) 11514,
(b)notification of violating facilities purswant to FaO 1 1738; (c) protection ofwetlands pursnant to E0 1 l9ft, (d) evaluation of
llood, hazards in floodplains, in accordance with, EO 11988; (c) assurance of pro.ject cousistency with the approved State
nuanagenient progran'i developed under the Coastal Zone Management Act of 1972 (1:16 U.S.C. 1451 et seq);(r)con fonn ity
of' Ueral actions to,State,(Clear Air) hiiplementation Plans under Section 176(c)of"the Clear Air Act of 1955,as anicoded (42
ti.S,C 7401 et seq.),- (g)protection of' underground SOUrces ofdrinking water under the Safe Drinkin Water Act of 1974,
as amended, (P.L. 93-523)a and (h) protection ofendang ere d sjxcies under the Endangered Species Act of 1973), its, anlended„
(RL. 93-205).
12 Will comply wilh the Wild and Scenic Rivers Act of 1968 (16 L).S.C, 1721 et seq.) related to lirt.)tecting components or
potential components of the national wild and scenic rivers systern.
13. Will assist the awarding ag,ericy in assuring conipliancle with Section 106 of the National I listoric Preservation Act of 1906, as
L
amended (16 U S.0 4 70), EO 11593 (identification and protection ol'historic properties), and the Archaeological and I lisloi°ic
Z�l
preservation Act of 1974(16 U.S.C. 469a-I el seq),
14. Will cornply with RL.93-348 regarding the protection oHILIHIMUSUbJects involved in research.developrnent.and relatedwivilies
supported by this award of assistance.
15. Will conilfly with Ifie 1...aboratory Animal Welfare Act of' 1,966 (Rl— 89-544, as amended, 7 tJ S.C. 2 131 et seq.) pet-taining
M
to the care,, handling, and ireatnient of warm-blooded aiiinials field for research„ leaching, Or other activities supported by this
award ofassisiance,
16, Will coniply with the Lead-Based Paint Poisoning, prevention Act ('42 U &C. 4801 et seq.),which prohibits the use ol"leaned-
based paint in,construction or rehabilitation of resideiice SO-11clures,
17, Will cause to be pefformed the required fimancial and coniphancc audits in accordartce with the Single Audit Act Amendments
of 1996 and OMB Circular No. A-1 33, Audits of'Statcs, L,ocal Govemnients, and Non-Profit Organizations,
I& Will coniply Nvith all applicable requirements ofall,other f"ederal laws. executive orders, regulations and policies govenling this
program.
S K;NATI UZF' OF At,111ORVIT)C1 R1 I V YIN6 OFFR IAt 'I ITI,
Ab
AVIII IC AM'ORGANIZATtON OA -St MMITITID
Monroc C'ounty Board of County Commissioners, Social
Services/In-Ullome Services
Page 38 of'57
A,rl'ACH M ENTVI I
ALZH�EIME,R'S DISEASE INITIATIVE PRO�GR,AM
1-3 IJ DGE111" S LJ M ATA R V
The Ahiance slinall ruake paymeiM U.)the Provider Cor J'wovkion gal"sea vices up to a maximum nurnbor oft l4s ofsc'rvicc and zln the
nale(s) stagy ed bdow.
..........
Maximum
Service Unit Units of MaXiMUrn
Service to be Pr viided Rate Servi llars
Case Man:a errs ent $ 601,7'3 31 $ 11,885,3�-
Case Aide $ 115.00 6 $ 90,13
.. ..-.......... ..................................................
CareELiy2r Traini�nq Ind $
. ........................................
Geront C Ind $
,2-1919is.Ll ............... .......
EdUCation/1- ' $
)�2 5,817 $ 63,752.83
B� In-Home $ 24 22 mrv22,22738
S eciahzed ADC
Specialized Med�ica,l
S , eimb $ 2,744,92
_qu i ETt ...........
..-P.al- . ----...-[Cost� R
§_tppLiqlAssistance CV $ 301,90, 1,91 $ 58T10
�ne.Reassurance GV .
$ 27.37 19 $ 5201.03
............ ......... ................................
Tran�pjrtatiqn $
................
—---------------
Ota I
Page,39 (d'57
ATTA C"M F',NT V1 I I
ALZHEIMER'S DISEASE INITIATIVE
INVOICE REPORT SCHEDULE
Reliort Nuniber Bused 01,1, Submit to Allhince on
M Date
July tkdvnnce* July 1
2 Augmst Advance:* July II
3 JuO Expondhure Rqwrt Aquart 10
4 AtIgUS1 F-XPC,1RfikM-Q RerWrt sq)tenlber 10
5 (Wher 10
6 October Fxb)endkMv Rqwn 1 11D Mance mconcHimion November 10
7 November LXpend4we Rqwn i Mumba 10
8 [)eccrnbev ["'XI)endina-e Report t- I/101 advaricc reconci I iation Imp, 10
9 lanumy LNfienditure RqmH I M 0 Mance mumeMmWil Februa, 10
Fcbrtwy l.,,'xjwndi1ure Reliort a I C)mivance reconci I i'llion Adamh 10
11 'It I Xj:)ejj(j u`jjjfe Rqvrt I 10 to vnu 'ICU 1'eCom."i hat ion Apt 10
b2 A tau l Fx lienditure lkej:mn 110 Wame memwil WOn May 11()
13 May Fx pe nd h u re It uport 1/H)ad vance mconc 0 i w i m i We 10
l"'t JwwENwmMwvRTmv julf 10
15 l"inal `xpemfiture and ckuscow jut 31
Legend Advance based ori 1'irq vocd cash nevd,
Note k All advance papnems nudc to the %vider WH be rounted U)Te Alhuce as Whw
Onviendi of The sMance l-mymient, rece0d MmH he mpmled as an Wnce reconjownt cm each Requm
for Payalent, starlog WT rqmn 45. Re QWmnuml shall' be recorded in flan (" [Joc I of We mpm
(AWfunent I X),
Note 2: Sibmission mpm nmy w-may not generatea lmymclfl reclkiest. Ifl'inal c,vpendituru
vot)ort reflects Funds due back, to the Alfiaricie, pnyvnenl is to accoaq),".my 1he rej)ort,
Page 40 or 57,
ATTACHMENTIX
REQLJES'V FOR PAYMENT
Fonn 106
AM
Provider Narne,Address,Phaneg 'Type O�f Repain
.......................................... ..............................
Teflni-Awl e Rawnburseimaill, Report Ic foy�
...............
M-PCP pl
.............................................................. ...............................................................................—J,
CHTIFICAIMW I herel.)V ce,uWy 0,af thi�request or rehmid confouns with the teri-ris of O e iibove contraa
Prepared .................................._...... Date, Apjp aved By. --------.................................................................................- Carr!_..............................
HUDGCT SUMMARY ADII TOTAL
...............................................
................. -—----------------- ------�.....,............ .................................... ......................................................................................... —V- --- -
CowyactAurouw
............. —---------
0 0 00
0 IM E col rfarl Bfflarwa�
--------------- -------- . . .. ............. .................. ............................................
(,"L,prLwil fkndh All nuM BiHed 0 00 00
I � =- ........ "I",',—,."Illl—..�..�..�..",,.�..�..�..�.I.�1-1-----..........
-....
... .............
Cuafmf MmUl Pdv Payb,,40, 00
.................. - -—-----------
to klainih 0 0(1 0130
................ .................
CO-PAYMENTS CURRENTMONTH CONTRACT YTD Pdor may Yfu
Numbw off er5ans assc-ssad Co pappenis
2 Nupgbe�rM pr.1MG0.1.1 Pilt'I'llmalad for nuwpavneol
3 Numbeir of pa�os ans wsfi v,,,cl fioo i WnvrW f0i!Caere!papwl it
4-Ni r i n b e K o tl p u rs on s vea ke,0 dro j i i as,e s s i i e n
5 Nu"rtwr W porsuns exornp(Fain co-pay
...........-
6 Tolal amouug of co-pay assessed
7 Talal hTmum of Ccv,pay
T"Olal
P3A V I I AD Forms FN Yiserf :10;�D
Page, 41 cif`57
Attachment
RECEIPTS&UNITCOST REPORT
Form 105
DI
EUNPIN-9 AMU
d W sp tr
4p
(' yr k�c r f"drziv fJ
�F
p4e p raw i Prawir r6 fil
.......... .. ...............w.a..,..,.......
....................................._.......
�'��,;; P'Id A'C 4'W�A drrhrYrC a&a flftG;fr=„I u�ro2r¢�i�&Ira dare rl r��#rvri pa r.drr,CtktuaCl9r,r�.aiw Yiri r' uata'wl,.kw nnlrrt�rraR.xa¢R,�Iluir1��m4ya�li.,r,la.a�.rn+frww�nryr��,d✓:,v�.�emw F.r.rrlfv lva ....��� ..�.....
?h,ut.ryFuCFr.B erRW�uai Ir�wai,�F'L riat�t�ir�i Gkauta�rrd vrnnkNvly sai lYtP1:��oir��Pi wua ra r(P�IwnrloagaVt,x Pri cl waac,ul, irrCoaCls� r�p,rad ck.
Fr.ijuparealfr6'------------------------...------- fDar ................ w ............................................ Agjperrrard . ..... �.�.... lduatr±i
MI�. IC$.PT59, h AFr;[rrr!rg9F3u-E1,;X. H Arttit,.al.,fl'M�alWing kdEletg Y7 84zxY,tlpCrw,ar.r„C
fret phvus ra.^Pw,r„erk Yr„at 6,:n G,BwtuCt. Budget Priorl°a+%0 V�ke'ciflp tsY'TO
...........................- ,..�..�..e. ..
., ..rv. d`DIVID
9'rarLgr ivi Im,,urno
................. .... ..� _ �...:� .. ... .:� :.,.. _..m., , _ ...mm...
_... .,,......., ...,...:.. ......r .a ..,.�,..,.....,...y ...---- ---_....n..w ._.....mm�......,�_.d
tl_:rr a l lkO(to A M to r:Ma �h11J�.Y Rkl fi l",f f tLl
.._._._.... ..,........................... _................. -------`----
01.:.8'6,Al M,"'V'I�r�US '�'rC'd.00 t1 $ dPY:F6V10t
Bill ablrw01r:p_c-0
haxror,;es r;,::nprwt Bdl,.,ible UrM Ftra?. Amm.un[p.t,,ned Y.-'I--D YIN) fCEarFeVA hAr;'aNM
dhPrrc'eLm1G ,Jr?iCF V6i,5 Pr,,,,nur9 Url ble HillaUr:r IUplr up c,'llran15 6Slrrtrrpw Cprr'�'t s
Lhov cost. :a u!'•r°rar.=dul `re i'°�w:+,r9 _
FarMr'ar'4"I`V"�twotirrq�s V"rirar YTC:Y$..
pF $
.,
......... ...... .e, ........a .....
$
.,,.m..m, �..�..,...,��. ....... .... ..�.; ........ ., ...... ........ ,,,. ,,, vv.; �,.
........ ...a ........m .... .... ....:.......„`" ........., ,,,,,, ... ....,.,.........w '....
�_..f-------—-----
—p M- --�
r V,ey'JfAw,W4"d H�nmrre„,Idr A 1-Gu1&� rYrpC'I'Sr
ge 42 of 7
ATTAC I I I N)E N'T A
Title� Delmlirtmerit ol E.Ider Affaivs Pu�grams'k, Services Handbook
'J"t "M
Page of 57
ATTACHMEAT13
STATE OF FLORIDA DEPARTMENTOFELDER AFFAIRS
PARTh READ TITE AT FW IED INS JAVCTION'S FOR H J A STRAVIU INFOUNUUTON M1H0 I WH 1.103 A'%I NW)VIPILETI?HITS
IWRVI.
Rog IVA
5 0 6�7�sks
C Wes 1 4 'S 01 kivw tt,f
Z'6cid).111 I. god Q U(a
2. I10PU1,A HON OF AIZEA SERVED, Source of data:
17P�51im
q 42
;IS, R E N FLY I,-,[\41'1,OYI D Fffeclivedatc:
I 11 l e Disabled J'oW 4 Iran- Wad,
Iq 3
41 CLIENI'S C'URRENT.Y ENRO111.1)OR RLGJSTT,'RF`,D. Effieoive(late:
E7 0
o I .. __.�. .w w� __ .�.��„ m. _. � _w � �
5, ANJURNKS (A)VERNINO BOARIX IF APPLICABLE,
j , '"'_r"-,--1��'_�\�1-1 I',-v 5--Nlada7- 0�'
b cc)
Gib ...........
PANTIE IYEASEPARATKNITIVE1 Of PAPERFORANN EXPLAWOUMS REWIMS11 MIME M"(W
6, Is an Assurance ol'Comphance on file with FX)FA? jrNAA or Nth exp5h. WA YI,S NO
El 29 E
T CIMpare Ole 0aff Coll n t pos i�gaaun to the population, o['ffie
IWA (w NO swap I a i ii'n. PVA YES ba)
EJ 29 ED
to chent composhion to Me Impubdon, Are racc and sex chwouvi1stics reprusenuive
ofthe popidation"? 1J'N,1A or No ,explain. NAA VFS AW
-———--------------------------- --------......
9 Axe Q11hy tuRlbrurnents Ar suvIes applid to Was and upplicants "dIhour regard to race,
cost-,
1wation"11!origin,Sex, age, ncpupanaulu or diisWAH4? VNVA or W exyah' NAA YES NO
11 IQ ED
..........
10, Am aH heiwHisr servpces and facil his av=hk to applicomm and pank4mms in an elmlly Wbuke
manner regardless of race. sex. color, age. nalbrull origin, religion or disabdily? If N/A (,.lr NO,
explain. N/A Y FS NO,
E-1 El
I L For 61-palie'r1f service�"drC H)MIl usynmeMs ulade Whaid mpal to race, cokm� nalbud orighl
ordi.,,.itlihly? I1'N/Aol"N0, vxpkJn, N/A YES N()
n
Page 44 of 57
im/A dab,orWex1 N/A YES NO
EJ
.................—----
I I Am enoopes. appli and payidparris inhwnwd of dwk pmecdnn agAno disletimKidon? If
YET how? Wil-Wen Moner 615 N/A or O. exaAn N/A weed.S NO
El 54 ED
TIT-0ve -the-noniber '1111-�,-J" clwvent statns of' y xvartlinL" scrvides or,
employmoll filed agarrst the IV A NUNIBER
................ ...........
I I k Me pmpwWMdH0 QW0 ameolk W nWhy,hearIng, and hildivili'luals? 11,
N/A or N(j expkh, N/A )11.1.'S, NO
L1 14, EJ
.......................................... ——----............
PART HLI DE FAITOMING QrVSIIONS APPLVIO PROGRAMS AND rACUJTUS XUYU IS(IR MORE LVIPL(WES.
16. Ihs an WevahaWn f,wen condticted lo identify any barriem to savIng dkabkd 1mHvWuW and to
nuke any neciamay ivuWHcMkms? imh expNW, YES NO
17, Is 1here ani establikhed grivance pnmdwv dmi WoMmWin Aw pnwas W dw rvialwhin of
complahits? If NO,vxpIain, YFS NO
EJ
18 1 Ws as pvmon heoi JmQnawd to coorTnale SubmuMbb compMe ad K din? WN(hexjh. YES NO,
... -------
R W remahnien, andiuMcatimi nimerAls achvise appikunis, eirnplio.),ves and partitipiints of
ita)ii,disci-ii!iiiiniati(.riiii on ow ws orawAhl? jrNCK exNah, YES NO
P9 10
-------------
20, Aiv auxiliary aWs aWkWe to acme accessibihty of services to hearirig and sighll-in,q)aired
W&Wnak? If W vxphhi� y HS 14
IVART 10 INK PROC RAAB OR FAN I T=mwi io OR MORE.EMNSHIIS AND FEnERAL(VIN1RA( rsoFssRAmom MORI'.
�2 I Dol yoki have an action plan? If'N0,explain. YES NO
[E�.
ME ,
Reviewed Bye In Conji knee: YES E] N C) E]
Pi ORIC **Nofle, offorrective Acdon Sent
............... .................
lute F�,!�!?110 M Response Duc
(..)n-Sate 0 Desk Review Ej Response Received ........ ..................
.......................................
INge 45 or57
Awked Augum 2014 10ge 242
INSTRUCAONS FOR THE CIVIL. RIGHTS COMPLIANCE CHECKLIST
I Descinihe the gwgralfhk servim area mwh as a&VOW ccamy city, or o0reidocWhy WMe pmgmW6cMq smves
a specifiw target populaflon sucl,a as adolesceras. describe the target jwWulallon. Also, derine dre type of service,
provided.
Hiter the pemerd of be popilb6on smNed by rue and sm. 'Me populmh" saved lmlludw persms ki the
geogRAWA area Mr whicli sery Wes are lwovidod such as an ch,county or anther regional area, Pol:udationstadmics
can Inc ohmined hrum local channbeii of cun"mem, hKaries. or any publication Avrn also:, 1980 Cenws conmh in"',
Moddapopuladorislatisfics. lt'iclude,tliesotirceop'),oiiai-pn,-rpkiledondadsdc& C'Othee'races include A shn/PaciRc
lshmd"s and Aniericani lridim,VAkiskari Nativc-,0
3. liner the tonal urnber or fwwwc statrami 1hel povent by mce, sex art,d disability, Include the effective date of
your summary,
4, liner the total nurnhcr sal cliew\do atv wwWQQ regWovdi or cwmn* sowecl by tine progrwn ortAThy, mud list
Owk pautu by race,sex and disability, Include t4v dure that u"Unnent was counted,
5. Frour the tool number of advisory bmwd rnembas and their percom 1q, mce, sev and Wsabil hy, If there is im
odyisory or gcwerning board„ leave this section blank,
6, Ease la reopium ur N&nd financial mskiwice rnusi have (a, roe an ussunmrce owt oic l,irogran-, Quill I)e conducta in
ctunpliance 1AM al i noi drscrinninalory provisions as required in 45 CFR 8(1 It is is usually as standarcl part u F the
contract language for DOEA w6pienis and 16r wh1raniem 45 CTR 8M4 W).
7. Is Me race, sex, and worim cogs or me maifrerlect[vv of the g0MA40piladon'! IAW extunple, if WTI of the
popu Im ion is I I iqmnk, k there an corynimble percou'age of[I ispalifle st"'Iff",
%thov More is an sign i fican t varka ion between the race.sex or ellin 0 compositkni of the c Uns and their avai labi 11q,
Ire the popuknion„ dw pwpwnTwility has Ow rvqwnsihilky to ddennhe Me reauns, for such vadadim and take
whatever ulk"I may be ncocssary to Correct any kfiscrhl hadwl Sonw Wgithnate dispari ties may exist when
prognuns are sanctioned to serve rargo populations such as elderly or dis,'iblcd Isersons, ,45(AIR 803 (b),(601,
Do cligibilii)) requirenients, unlawflully exclude povms in pmwcwd groj)s lroln 111c provisicni of Services M,
jence col sued, l)e rudiCaj
cnil"floyrnera? l"N'k, , wd in staff aind client rcpresionation ((Jiuesrions 3 and 4)1 and also,
I%Mh uwMw record analya or persons "to upNkd bw wov denled semko or oqAVnmm 45 (TR 8M3 0),
aired 45 CFR 811 M)(2)
0. flarticipanis or dents =1 be provided services stich as muchul. musing and demal cm, lab own; seNkes,
Qvical and recrodhmal thwapivs,counsding au W smial senikes without rqard to race,sex,color, nation-al o6gin,
reUgAn,age or disability, CoWeV thkv NVoWment,scheduling and accuracy ofrecord keeping, must he aj,)phed
und'ornily, and wkhout reg"ard to raco.% scxu color, national orighl, religiclu, agge L"rurances, m"tiling
Nccptjonarem.resnuorns and other YOU mum also he equily andlable to all c&nK 45 UFR 8113 (h),
1, l"or in-patierr, services, resWenn mum be amfned to mom% "ardga ela, whhout regard to race. ccdon natibriall
origin or dkability, Alsko, resi(,lents aiust nor, be askQd whether they are willhg to Amw amommmialions whilt
persons,of as di ffurcrit race, color, national origin, or d isabi I ity,45 0'1, 03' tjl),
12. The pRqrarnAhXy and all services rriust Inc acces,able to participants and applicams, h,icluding those persons who
nmy not stpeak INglith, In geographic areas "Tetv as signifluant popiflalion o4'rrort4-,ngJish speaking people live,
prugram accadWhy nmy preclude the empkWment of hiLingual smW hi other areas, it is sufficient to have a.0 policy
c)r plan for service, such as a currern lim ofnatnes and wlephone numbers of b%ual frichyWrtals wbo = aniM h)
the Iwovishn ofse,r0c, 45 CIA M13 (0,
10age 46 of 57
I
I I PrugmIniNciliks mum mAw idbrnwhm rqwdhg Me rrandNairnhawry pnmrsions,WAU VI mm%k k)their
participants, henef'rchIrks or any other hamwed paNks. TV drould include inWrrnmion an their HgM to ON a
compkINI uf d&I-irnh-Imion with chWr the WK Depomero of Elcler Anbus Or` thO U.S. F)epartment ol'HFIS,
Tbe inf'ormadon may be supldied vclaHy or in wAng no evNy WKWA w"noW be mWrINd Mumllh Tee un of
an equal UPPOMMIny policy poster displayed hi H pulflic area oftlic C�,wifiry, 45 CF`R 816(d),
14.
cwecd, sex, age,nado& orIgh, r1kahilky rew=wy Me issues invoNuL a&,wnices or emplmymenn Qcmnem,
terruiruadon, etc. Wkwe dw eNH doas bw or polky %ged m have been Ocflauct alcjnps with dre nanu., and
address of the local, swe or Nepal agency whir whorn The complint has, [-icen riled. lindicate Ific currelim sIrAus.
eg. wukt no masonahle cause foundAllum to conciliate, fadure rap c0oper,ate% under re%dev, etc
I I Ile progrun/riacdtty nurst be QsWly amaMbN to dkabkd inciNkluak. Physiud accesibiliq Whales
desig,ptated p�,11114dng"u-Cas,cm-h CII or level approaches. ranips and adequate %vidths to entnances, HIC lobby. Public
Wleowne, restroorri facififies, water Ibumahm hAdmation and admkshns oftims MmuM be am"AW Dow,
Widths and nafhc areas ol'administrative ollces, ca(ster5%remmornsdvervation areav cmuHmA and s"vhg Wes
Mmulil be ohI Mr amessihMy. 140M)m dwuld be observed for door width, and Braille or raised nurribers.
SvVitches "Ind Conlrols Or IjhL WaL ventilation, Hm alartris, aiid other essentials should be installed auto art
apgoprIate heWhi Or rnobih, hipahvId Wdividuals,
("i, Sect III)rr 504 o f 0 w Rdw W HWH o n A cl of 197 1 requ Avs that at rec QW en!of Rdem I H n mw kd assh4mwe comh w L a sel f,
evaluafion to idenlify 'any accessibthly barlJers. sell cvaluadorli is a finu.mep p"-ocessv
a, "/Oh the arssrstauuau.ar of a rugs bled individimUorganizathmn evRate currem prao&s as pMlcks wh4h & not,
c(q-tiply with Seoion 504,
11, Modify policies and practices that do not nicet Section 504 requirernents,
In Tdc mmelol steles to e1hrrinme mV dkuhninmion that has been idendfied.
d. Makurtin self-evalum ion mi hie. (TTIscheck1k; may beum& tosmisQ H"irequhrernom WMese four steps have
bvc-rji lbllowedj, 45 CTR 84.().
T Pwgrams or&HAWs dud employ Q or morr person"must adqm g0vmwe pnxvdums Am hworpowe a"n,rimc
duv promss swn&wds and pruvide Q the pnmmpi and equitable rVsohoicm of Cornplaints rdleging actton
pi-ohibited by Section 504,45 CFR 84,7(b),
18. Pmemns or NeUdles that enildoy 15 or nowe qrsons must deignme at kam mm,nam to cooWhmu eMms a)
cornp y %vith Section 504,45 C"U'R 84,7 (a),
I A CondnuMg sups mum he tit an to nwil enappyem, and the public or the progmmWilly's polky crf
riondiscrnninmion on the bask or dkah%. This hdu&s recruUmmi matold, nwkcs WAY", newspaper
ack. and orlwr appmpriate wrntcir V0111,FII III 16cati on,45 (TIR,84,8 (it),
21 Pwgwrns/hdWW5MMcmpkq 15 ur mom pamms mml 1wovide appupdate amilbry aWs W peers ms whh WMAmd
sensoqq rnanual or speuking shills wherc necessary. AWAy W may hwhrdn bw area nw HmHW to iWupvWrs
For hearing 'ntpaired individuids, taped or [Inlillc uwelrals, or any ahernative resources drat can be used io provide
equa lly v ffWtivc services, 4 5 CFR 84,52 (d)
2 L Pnjrams/hacHi6csxvith 50 or mum ernplyves and $50MOROO in 1'ederal corm"acts utrust dcvOop,
tnain(airt a wrOten affirma6vv ac6on comMiame prngwn A accmdance \vkh Beewive Order 1 1246. 41 CAT NJ
nd Thle V! ollic Uvil Rights Act of 1r 64.as amended,
9° 10 1 (1/NII I I sq 2010
Page 47 of 57
ATTACI-IMENT'C'
AHWnee Mr AWn* 1w
Business Associaw Agreement
TMsBmhmsAmochteAgwomoiti (littetI by Me AWanec fGor Aging, Ine. ("Cbwred Entity")
and Nionroe(Tounly lbaxd of Clunly CV&Ss ano-q Social SetmictOln-11ome SoNlen,("Business Associate"I a nw
lImpproAl FlorMa cmpomOwi,
I A) Background,
1.1 Covered hnilij has wHered huo mw or more cm=N or agmemenh mith BuMnos MUM Hmt NvoWes Ow Lae of
Protecled Heahh (NII).
12 Covo-ed [,,mfity rewgWas Me rquVrernmili of the Health Insunance Porwhility and Accokintabilfly Act of 1996
(PUPAA)and has indicated its hHent to comply in the Chmmy's MAIO and Pawechwes,
13 HWAA iegukiticms establish specH-w condiflonN oni when alild how Covered! ortnies 111ay Share infornlation wifla
Providers who 1wrfi-wril kinctions f6r the Covered Fraiiy,
Of HJPAA requires Me Covemd 1104 and the HuMness Assochte to ova imo as cowract or agreemm ammOmOg
SpeCif're Ine(JUirearents to protect the cow"ifidentWhy and sear hy oQ;HQnW PHt as so fbmh ULL but nm 10ndied to tho
Ode uF Fedoul Fwgu[athm VAKRy specMeMh 45 (.OM. §§ 16410"Ney 16150jeh 1613OWb(, and 1613 IQ-
bX20 10)(as nwy apply)aml umadnai A ON agwernem,
IA 11w INAh InAwma6un TechnMogy Or Fconwrdc and Clinical HeafflL Ao (2009), dw Arnorican Recovery and
Reirrvestraaerrl Act (THW)and Pan I —Impmved Pr ivny 11nwkkms and Sec alry proKkum Imated at 42 United Sum
Cmk(USrj §§ 1 793 1 zind t 7934(2,010)wTOv Whess asmichriew O'covered entities to cornply with the 11 WAA
Saurly Rio us so Nab hL NA not MmAd W 45 CYR. §§ 16130& 1613 1 k 1643 11 amd 1643 16 (NNW)and mich
sectiom, whaH api-fly 10 a hnhwo n"ociaw tW a covered ow by Vn the smne immmer Omi sud wohns, apWy to the
covcrwJ cn1hy,
he piaies therek)re agrec as fi)Hows:
10 Definiflons. Fos purpows offliisagreernent,the fifllowing defirdfions
11 Amns, The ah H Hy or the mi eans necesKrL y to re ad,m0w. rnod 01. or coin m micale dMWK AmmMwi or oMerw ke me
anysysk"Tn res(Airce,
22 Admin6hmdve sareguards. Ibe adnihimrative w1mu. and poliKs and twoudum Ui nmrwpe aw se%ion,
cKdopment, impkmenwaHonr and niafimenance of securdy iumminvs, ki pn)wcl ekTinnde PaHwed lWalth
Inforination (ell[fl)W to martage Me conduct ofthe covered=Wyl warklInme in relation to the 1,u,otection offfiat
infornlaiirjn,
3 Al A. The American Recovery and Itchnwiment Ad (11109)
2A Authenficaflon, The corrobcaation that a pasoo is Ow ono Lkflnrwd,
2 5 Availability,. The propeny t1m, dwa orinfkawation is aeccsMble and uwabW tqwn demantl by mi mUmbrd pemon,
U Bruck Ito unamMorized aupkWon. accest use, in dkekwum of NM m1kh amiqwomkes the securiq or privacy
to stwh whnmmorl.
21 Compromisei The SauHq, Kmirig a dpdkam 00( offiruanciA, repulafional,or other harn'i to individuafs,
1%ge 48 or 57
22 ConAdenCiarily. Ile pnMety That data or intlornuHion is nut niade available or disclosed M unauthorized PCVSOnS 01'
pra cans set
2.9 EILTh-onic Protectni Health Information (ePH 1), Heakh inkinadon as spec Med in 45 CFR §401 Wj Q(O or
(1)(ii), rinirted now the inforination,created,or meeked by HiRms Associate IT= or care belmirof Cavered Frilly.
110 HITECH. IN Nalih InKmatimi I`cdrn(?Ty Rw Emmmic and C&Acaf [huhh Act(200Y)
211 WhamnRun SyMem, A" intemomnmted sat oF hbnvmhn resmwous under [be sarne dim inanugenumoconarot
that Mrares"murrton Ibnetionahty, A sysieni nonually includes hardware soffivare. inforinatkin. daw.arqihcations,
and people,
2.13 NU!Winus soffivare, Sofiwure, Or cxnnq& a virus,d0pwd W d1nage cam' krujs a Vmcrn,
114 14ri 1. Pad I -frnpawed PdvaQ,Novikins and Saurhy proKforis hxawd W 42 Unkd Sms Crack ULKrj
l 793H and I 793�1(20d )0),
2, 5 Passw(wd. (7miRdendulaulhookmkmWRmeoWncmnpowdorasvogorchmauas,
116 IT)ikal SaNgmr& Ile p4sic;d nwuumq policies, and procedures to proted as covered entity's electronic
int"onnation sysrertis and r0med bulklings and etpipnwro, axini nalwal and omkmnierual luizaids, and
unauduZzed indushmi,
217 PHucy Rink nw Smnhnb Qw P&wq oa6lradlvdduraally IdendlIaNe I Rallh InIhmathn M 45 CFR Part 160 and
Parl 164, subparts, A and E.
2.18 Pr oleeted 11uhh !Obnnuthu (N% Flealth inlianna,Wn as deHud in 45 CFR §166.103, thnHed to time
2J9 Rmpirned By Lam 164J03.
",10 S C c r C ta ry I b V %x M W ry 0 r A u D e p a rn w a cal' I a I I l i a n d I I u roan S envious o i s our 11 C!r d o'i g I I!e C
221 SecuMy hwidenL I he atlenipted or otccesiful unauthorized mcess, kisc., disc. osure, Inodification, cw destrucdon
offilforniation or int04'ere"111ce with sYmen'l openvions in an infiorn,ui6on Spy'StCIVL
222 Smudq or SecuMy nicusurew All ;d"aw Kninkimdvv rAysical, and welukWouNpatAs & an h0mmwh t
sysloni,
213 Secudy RuN Me Smuky SwndaMs CoNbe pngectkin ofElerurnk Powded Iledh h6bratwim a"5 (TR put
164, subj)arl C, thexetc),
214 Tuhnierd Safeguards, Ile welmalogy and Me palky aml procedures Or ids use Omi pnAul Revonk protecial
healdi hfforniaticmn and control ,uccess to it,
�225 Unsecnred PHL Ifawwd hedAi 41mmmAn Na N nm smured Anagh-ve use or ruchnMogy or nwTocWWgy
specified by Oic Secretary in gukhance ksued uruhr 42 USY section J7Y34hX2).
226 All o1a tams uwd. hut unman oketshe delirml in Claus Agmemon AmH hue 1he sanic tneaningas flmose wrills in
dre, Privacy RuIe.
3.0, Ohlig afions and Actis,,ifies(A'Business Associate.
3,1 Busiriess Asscwhm apvc to nm use or disclosc P]11 uHwr Hun as Ivan Wed or rup Wed by dis agremsern cw as
Rqphvd by Law,
let ge 49 oF57
3,2 Business Associaie agi%Ts to.
00 WWRmew pokis and pnwodures to pi-evenn dow emn-ain and correct Securny, violations in accordance
with 45 CFR § 164,306�
(h) Prevent use or dkcWswe orthe PHI odwr tan as pixivided Rw by Ilds AgmTrnent oras,required by law
(C) R-edsonabhy, and dppropdmely prolec; the corindentiality. WPM, and avadahflOy of dw ell[ll that ille
Bobess AsnoWe civinnanxW, nwhnd"m or haimmks on beltalf of We C4vewd 110y;and
d) Comply with the SmuNy RuW mquVemuts KludOg the Adinflnistrinive Safegua'Irds. Physical Safeguards.
Tednical SoRguards, and pilicies and procedures and docurnenw6on requireniews set lorth in 45 C-TR §§
161 MM. MA 3 A W?3 U, and 164 3 16
33 Mahms Aswc% agre" to mitigato to Me exim; praORM& wy hambWen, Ow N kmnsm to Buhiess
Associate ofa use ordisclostire ofl'HR by Business, Associak" 41 0ohiflon orthe wquirernents ofdds Agrecinent.
!A Bain ess AswcWe agron to promply rVom to(Awered Wly ail use ord0kisun, ofthe 1`411 itot 1wovided for
by this Agreenient of whWh it becurnes awam, Thk huWa mq rquw Rw KiMmohn.cqyhg m amvWmmu o�'
much inAwmath"and hwWdhg mV smuily &W Nvolvirig PHL
31 MmWess Anociaw aWvn U) noli(v Covcredl Frn4y without univasonable dcki), of any sccujrio+ breach pertahiing
tw
(a) Idendnealwn Of stny irldividw,.'d whow unwcured PIAI has been, Or is reason'fl"Ay bchc%'C('1 by, 01C Busaless
Asmwiate n)have been,accessed.acquired, or disctosed!during such wcnrity breach., mid
(h) All! required for Me Negkv to 11, Seavmqv QUR pf Wah (V1hm&4nW Poverwd WX
h'�fiwlniwi(m'
16 lusher /Uwdaw opw to mumv dmi my agwo 4wWdWg a sAumn-acror. to whm" 4 pRwWa NH received
firoin.,or created or received by Business Associate on hcha0F0f(,:'ovcrcd [,olity, agrees to dw siijue resirtcliolis and
conditions that apply%xigh Mis AWiveivent to Business Associate with rcspcut to such infin-mation
3.7 li'llusiness Associaw has Ill t I in a Desiva,lawd Record Sel:
(a) L'tus kicss Assoc We agmvs v;puvWc acces, at the request orcovered Enky(hning regulat-business hcnws,to
PIH in a Ikslnwcd RvcwA Set to Covered Why orgy ris dhvcwd by Ccwcred Fntky, to an individual ill order
to incet the requ irements undtr,15 CTR §t 64,524� and!
(b) Busincss AssoclMe agives to rnake any anwndmerMs) us PHI in a Desynated Record 91 that the Chvewd
Uby d4cm or agrees to pursuaro w �45 CFR § d64.526 at die requem ofCovered Lnfity or an Individual
wilhin RO buskicss days of rvceNing the rcrJuesl'
3,,8 Mousiness Associme agrees to nmke Wenwl pwkev tiouk and myrdy inchidbg Qcks and pnwedums and
1111l,rehiting,tcithe use and dischstmeof PHI received hDan orcmand or received by, Whiss,AswelteCana HOW
of Covered End, avaikible to the(Awovd Wily (w to die Scuelary upon requipst cad either party fl)r PUrI) e, Of
detert-nining Covered Entity's comp hance with the Privacy Ride,
19 Whom Assochte agrees to domment smh dhcWsmvs of 1411 and inkination rekaed to such disckstwes as%voukll
he m1dwd Mr Covered Fritity to rasp orid to a mquest by an WNW Rm an mcww% ofdWsums or Pi H it,
accordance kvilh 45 CUR § 164,52�8,
3,l 0 Business Associate agrees to Data vWe to Covemd Rdy or an individwiL tqion reques Whonnation collwed to
pennk Covered Enthy to respunid to a request by an Imhvkhmi Rw an acmurning W'disclowres of 1111 in accordance
with 45 CFR§ l64.528 and ARRA § 13404
3 A I Wnem Asso(:,ralc specifically agrees to use security jimerisures tat ivasonaQ and appmprim" pvvet ihe
Coll fidentiality, n1legrity,and availahifity offflf in elect rcwl I ic or any other forill"that it Cre'Res,receives,tnaivuairls.
or(ransirflts on behall'ofthe Covered Entity.
fuge 5o or 57
3,12 Bmh ass A noWe agrees to impkinent security mmmwes towcure pass)vords used W access C P I I I d I at fl accesses,
mainmins. (w Mourns as pan of Mk Agreement' korn mahchus soRwkwe and odim, rnown-tude and nawral
vOncrablWks to assum die availabOy, integrity,and conWHaAny orw inAwmadcm,
3 J 3 Bushwas Associate agrees to imlAcnien"ecurhy nwaRwes wouNguad ePhH INU 1 acceswwmainulis.w1ransmits
as part of this agrvenwru hvni muhduus soRwmv anti other rnan-made and alarta m! vulnerabRies ki amure Te
ava flability, integrity, and cout1dentiality of Such it)fornvu ion
3.14 Business Assochne agrees to tannply w1k
(a) ARR A § 1344)(1 tApplica6cin ol"UmOmWe ERnrems Associated with Cmilracts)�
ARRA § 13ME 4Res0diong on CoMin f1wWwres und Saks of Walth hdbnnwKnX and
ARRA § 134M(CondOmm w NOW Wcutcls as NO of HeWMi;(Are Operations).
4J) Permitted Uses and Disclosures by Business, Associate, Except as olharwhsa OwNed in AWvmwM or any rchwd
agivemem. Wriess Associrme may use or dkchmu PIH to pedOn R"iedons, activirOus, car setvices hw. or an hehalfW',
Cuverk,A F".inlity as specified in any and all omouN mOh Covered Untilv 1wovided that such use or chscloquire vvmdd not
vAUe be Nvacy Rule I dww lay Covered Wiq or the minknum me'cossary policies and utr th e, Covered
Wly.
Vt Specific Use aw] Disclumire Provisions,
II lkcqn as odwrwke Wed hi this agwonwnt or any rdatud ngmenrcm, Liusiness Assoc4tte amy me PHI Rw the
propel, 1111�LffidgCIncin arml adn%snathm of Me BusWess Amociale or to am, M Wogw wqx"nWhos of Me
Business As ociate.
52 Wup as ntheivise HmAd in 1Ws agmewwra w mq Wed agmement- BnsfiiesN Associale nhay tfiscdo.,,c� PIll for
the rwoper managernow aml UphishAlkm of the RNitess Aswciate, provided Wat disdasures are RequNdBy
Lam or Bmirrem AssnOw Kano wasomble anurances Som the pursuit to "bum Me hibnowkmN dkWal
1hat n will remain Confidential and used or Vurdivr discrosed only as Required By Law or for the purpose fi.,n,which.
n was, discdoied tub the person, and the person UWA PCs the Bushmss AsmUme of any watwes or which it is wwue
W whkh we cmawn6alov orke inroirtimion ims been twowhai,
53 Mishem A%uwiw may uw 1`4 11 to MuQu dwa ijVvgMion services to Covered Ewuy as pernnrued by 45 (TR
§1&43Ojc#2XO03j onb, Wim sap ecificaNy aulhuHzed by Ckwumd W1,
W BusWen AswcWc nmy use 1111 to wpon violations ot,haw to approj"wime Federal! and Stale"'anhonties,consk enf
W 45 CFR §M150OX 0,
60 Obligations of Covered Entity,
6 t ( ovvvcd Fnflty shM notify Business Asstwiaate ol'any hrnd,afion(s) in its notice: of priv'acy Practices orCovelvd!
in accordance with 45 CY'R,§ I 615M,to le cMevnt that such firnitation may affect Business Associate's use
or disdoswe of PHL by pawwwA as omy or ow nwsi current NOW or We Practices (NO11) tcp BtLsiness
Amodw FWure Notices and/or modiNcatimis to he AMP sh,A] be posted w Onemd Wys mmbshe al
62 Covemd Why AH nWQ Bminem Awochw oNmy Wridion to the use cu dkchmme orPHI Our Covmvd llihy
has agreed to in nccordatwe whh 45 CFR § 515n. W Hw exWM thl such wriction may afRct Bushmss
Associate's use or disclosure of[1-11.
W Permissible RequeWs by Covered Enthy. Wept dear dam aggregrakm or managernmu and admhAstmIN nahAdes of
11ohns Amodwe, Covered Fnhty shall not request BLISfilLss Associate lo use ojr disclose P1,11 in any rrianner Owl wou[d
not be peninisdNe under the Ptivaq), Rule id'M by Wyovd EnOy
Page 51 of 57
I 11w VaNics1wreby npvu Out Us agivonem amends, wates mW rephus my othr When A"Wate AgreenmA
currently ht effect twtween Covewd Why and HuNhem Asmwhre and lhal tk pivvkhns(d dis agmomenrl shalf
be efrcctivu "ris f1djmvs;
(n) These Bushc5s Assoc% Agmmmvi p"nkkmrs. with lhe excepdon of the e1ectroric secnniq pro"Mmo and
Me proWmrs martdated hy ARRA, d IlTIXII and Port I shaff be WON tWonthe lain AW ApH It 2W or
Me eflcctk�e dale of,the earbest contract entered huo hoween Makes Assodw and Caured FnWy dtat
involves Ow me of PHE
(h) Ile electrank seer Ny pwWotm hovofskH he unbetive the hro- of April 24 .'WI or Me effecOw date of
the Wilm conow anewd hrio bcmvcn 13m1was Amocime and Covemd Entir�y that inv(flves the use ot'Pl llM
and
(c) ProvNions hereof mandmW by ARRk I I HECI-I and/or Nut I shah be effecdve the hoer of[`ebruary 17. 20 l
or the effective date of the earliest cmmn entered imo bownn coured ernhy and huMness assochte that
Wolves Me me of PHI or W41,
8,2 Terininalion Rw Um, Qon NverS Endtys knowledge of a mmall breach Icy' ffilskess Associate, ('overed
Fndy Mull Ather;
(":0 [11-o0de an oppo"MAW IS Whess Assochre vi ctwe the twotch or etrd the Vii0lation and terminalle this
agreement il'Business Asockto dms not cure Me breach or und Me violathi wRWn Be the spednal by
Covmvd Fn6j,,
(b) Inlarediale1y terinirlate this agreorrem; ir Business Aswdme has Wachcd a niarcrial renin of this Agreernent
wid cure is not pussilah;01"
(c) If Wher termhuibn iror cure i.,, deasihle.t. overed, L,'ndry shaH roport the Viol"I'lion to the sccrel,ary.
83 Effect ol'Ternrirradon. Except as twovided W subparogyaph(b)orthis swctioji,upon of this agreernern,
for any reasum Rusinem Assockle{shaU remm all PFIJand&I df received Wn CAnard 11H,or created or mccNed
by Ilusiness Associate on: beliah"ot"Covered [')vky,
(,a) `Fhis provkron WH MV4 to Pill and el'i 11 that is in OW POSSMS0011 Of subcontractors or agams of Businns,
AsWas
(h) In the event that Rosiness Asscwimv or Nvewd Entity derernihnes awt returning the PI 11 or eFI 11 is infeasible,
notification condidIms that make rutuni of PHI or cl`111 inkasi!Ac shall he provided to rhe othier party,
14ushess AssockrIc Shou extold the protecticms of this Agreen'iew to sutch retained III I I and el"I 11 and hnfli'
Wher uses and dkchmures ofmich roWned PI H and ePHL Rw as mKinimn of&yeam and so Ong as Rusiricw
Associate rrunrimins such Pl ll and el"I IL bm no KmAmn six (6)ycors after Ile terminuidon cWthis agreemea
9J)"-Regulkitcul Rellretwes, A rercrencv in this agreeirrent to a section in the Privmy Rule or Sevwly Rule momrs
Section then in effect or as mmy be amended in the finture.
I U Amendment. The NOW agwc to take such actkm as is mussary to wnmd this agreement from Ave m We vs is
necesyuW Rm Covered bulty to comply whh die requKernenn; of the Privacy Rule, the Security Rule and Nie I lealih
h1surance Floru"IfAhty and Accur"naNity Act ol' 1991 Pub. 1. No. 104-19 1,
I LO SmMval. Any lenn,condit on. covenarri or obligation "Tich requixes perAnnance by citV Party hwvw subwquaH to
ofthis agreernm shall remaW enibmuible agairisl such: party subsequent to such termination
110 Any ambWuhy 4 this agmernent duill be resolve lo petaid Covovd End,to cnmply whii Me Nvacy
Rule ad WWI Rulc"
13A Innumpmallon icy referviuce, Any fiatire new requh-ernent(sl charips W d0v ho(,st e nacre d in federal law which create
new or WfIbrou oblyatitms whh mspect W FIWAA privuy ard/01' Security, shafl bcr mnotratically incoi por-wed by
to this Bushns Assochw A,�reement on the respective effiechve datc(s),
F%ge 52 of 57
,, I j I
lap Notices. All notices and communications required, necessary or desired to be given pursuant to this agreenrent,
M
including a change of'address liar purl.)oses of such notices and conimunications, shall he in writing and delivered
personally to the other party or sent by express 24-hour OU111-anteed, courict,or delivery somice, or by certified mail of
the United States Postal Service, postage prepaid and return, receipt reclUC%led, addressed to the other party as follows
(Or to SUCh other place as any paily inay by notice to the others specify):
To C"overed Entity'. Alliance for Aging, Inc.
Attention: Maas Rothman
760 NW 107 Avenue
Miami, Florida 33 172
To Business Associate: Monroe C'ounty Board of 'aunty Conu-nissioners, Social Services1n-1 Ionic Services
I t 00 Sinionton Street,2-257'
Key West, Ft 330-10
Any such notice shall be deemed delivered upon actual receipL If any notice cannot be dchvered or delivery the reofis refused,
delivery Nvill be deemed to have occni-red on the dole such delivery was auerripte&
15,0 C'overning Law. nic kiws of the State of Ilorida, without giving effiact to principles orcorifficl of 1'aws, govern all
nutters arising miler this agreement.
16.0 Severabillity. If any provision im this agrcerriem is unenforccable to any, extern, the rerna in der of'th is ag reem en 1, Or
apphemic"i of that provision to arly persons or circumstances other than those as lo which it is held mwidbrceable, will
not be aff"ected by that unenforccat)flily and will be crif"6rceable to the fullest extent permilted by law.
17.0 Successors, Any successor to Rusiness Associale(whether by direct or indirect or by fUrchase, merger, consolidatiow,
or otherwise) is required to assurne Business Associate's obhgations under this agreement and agree to peiform theme in
the Same manner and to The same extent that Business Associate would have been required 10 it'll1ilt Succession had not
taken place. This assuniption by the successor of the Business Associate's obligations shall be by written agreement
smishictory totovered Entity,
11 X,O Entire Aguement, This agreCV[1011 COTISOILneS The entire agreement ol'the parties relating to the subject
ject matter ofthis,
aurecrocni and supersedes all other oral or written agreements or policies relalin�,, thereto, except that this agiree
Socswent.
mot hn,iR the'amendment of agreement in accordance wilh section 10.0 of agreement,
Covered Entily: Alliance for-Aging, hm,
1L ................... Jul 29, 2022
B Date:y, Aax l�,mnth J d 1 2 9 2 0 2 2 L h 9 1 1 1
Business Associate- Monroe County Roard of County Commissioners,Social Services/1"410111c Services
(signature)
Page 53 o 1*57
ATTACHMENT D
11 Hill
BACKGROUND SCREENING
Attestation of Compliance-Employer
-1-1-11 ............-111-1-........
AUTHORITY:This farm is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3),Florida Statutes.
)0 The, term "employer" meains, ainy person or entity required by law to conduct background
screenings,including but not limited to,Area Agencies on Aging/Aging ands Disability Resource
Centers, Lead Agencies, and Service Providers that contract directly or indirectly with the
Department of Elder Aff airs(DOEA),anid any other person or entity which hires employees or
has volunteers,in service who meet the definition of a direct service provider.See§§435,02,
4 30 O 402, Fla,Sta L
A direct service provider is"a person 18 years of age or older who, Pursuant to a prograrrii
to provide services to the elderly,has direct,face-to-face contact with a client while providing
services to the client and has access to the client's living area,funds, personal property, or
personal identification information as,defined in s. 817.568- The term includes coordinators,
managers,and supervisors o'f residential facilities and volunteers." §430.0402(1)(b),Fla.Stait,
AIMMIM:
As the duly authorized representative of
—Movat -co-ity4v
Employer Narne if
Vo located at 11C)o SVACM-�K 5(fek key, tii>6+rp. 991,
..........
Street Address city State ZIP c8�ce
f1'�hg?H C-rr&6(Yk l,— Na Me of Representative do hereby affirm under penalty of
perjury that the above-named employer is in compliance with the provisions of
Chapter 435 and section 430.0402, Florida Statutes,, regiarding level 2 background
screening
.......... 0 2,Z.
lgnafrr(�of"Riip sentative Dale
DOEA Form 235,Attestation of Comphance-Employer,Fffective londouty 19,2021
F 5,Forpro avadabk at:hr 0 OU
t IE', 'V1 -
L 5 tnq��.�!ktrjck rqqnd creenin phg
Page 54 of 57
A'J""F/W11MFN1' E
REFERRAL PROTOCOL
Issue. Screenirig,'firiage,and Referral for Adivation under dw AN hKrnWs DInse WhOw(ADO Pmgmm,
pwwy: Rellnuls %&H be nwde basud cm aw0hubility of funk & actoahme w1h QwWartion requQuents,
Puqmw: To cmure MnWng is spen I expedhWsty and conwnwm am givan as choice ofc,',,ise nunagenient agencies,to
dw emma posdbk,
Pivredure.
1. Roles and Respons&hlks
/Y plane Rw Ag,dMaa Agirq g aiW Disability Resourec Center
0 ReemwHes uverM prog,,ram and Al)l Agency specit"ic spending levels on as rriwiMly basis w ensure 1he ALA
Agency is(qvradn,,,,withiu die funding alkqnfions.
4 SuvoN consumers to HAI w4h appxoprimc roources nad pdMtjZe for DOFA-fauded pro,oams and services,
8 ReNases cases Ar act hat,ion based upon Adi Agency Rcquem,
8 Rekaws cmus Rvm aw "AHng N Wned on ON juJoHkation score,
0 Monitors coliniphance with oulconne nteasures,
P Keviews, l'ile's per dw File Review Policies and Procedures,
0 RevOws dMa in WIRTS,
F1 ADI Agency
0 RequMs W ameys rokmak hun Me Aghg wd Djsa[,iH4y Resom-ce Cen er� to so,ve an opin"n,,d casehmd anct
to avoid surpluses or dehens in accordance whh the AN Mace hWqQuwDuAck WOW Qcy,
0 Refers inquiries fi-orn consunlus interested ill't wrVices, to a ADRC Rw hilburnalkni and ReNual to wn"rnunhy
ITSOUYCCs, Screening, 1'rjagc and l,ong-lknm Care OpHons Counsding, as ap1ropkic.
6 ('(nnp etes comrwAmn& aoesyrwras on nemy consutnom and antwal wass,esymma on cakOng constuners and
develops care plans and reviews CaVC JIM SeDIWInUally,
0 AwhotJzes service dehveo�i and enwrs d-al,-i n1to eclR]'S,
6 RHU A KIRTS as appDpHrue,
0 NloiJtor�,;,care 11ans A an ellWort to kcqi cogs dmvn mWe mWWAg to WNW& A Ow cornmutidy,
11, Management ot-the Amessul PrWized Clirrmunkr IS (APCI.),
A. chcrus am i,06-wd to the ADIRV clients are funvided in0nnathn on coo"muniq, rescourclus an,d progranns available
nicluding privwe pay options Persons are directed to diosc, resmirces, most tmplk of mcoing Me need dwy We
expressed to AI)RC WE Uses presenting stoing, identiNus Mm Wkw The ummunion n6ght heneAt Wom public]),
Wed lotWoerm cue services are screened,cruemd into WIRTS. h6god and providled ookuns counsQW.
I. Qnsmnmm applying for the Alzheirna's Dicase Initiative(ADJ)progniflu wifl be conilacled by lninAe t Inii slafl
and screened uAng Ke smawkie assessment lbrm developed I, the Depamment of Flder Af1hNs Rw thk puqwse
(Win 701SI The 701 S wdl doennine their ranking, on the appropriow w,,ijOng hsi(s) AP(J.,straws. .
2. Ile ADRC %= ivasmas conmimers on Te %mik, Ws ammAing to flic 2M8 [)eparin'ient cap'F'Ider Alfhfi's
Pmgmms mW Services I loan dbook,,or any mvisk.,ins made diereaher,
B, 111PAA forryis"Ill Nye sent to the cotBuxneras appropriale,
INge 55 of 57
Ill, ()pcnhi,,,,!,NeAvCases
A, Al-)J Chenss
I, lie AH We Fiscal Depar0itetit will niort nor A DI A gency sqvci fic spendilig levels cin as niondily bmis to ensure
each ADI Agency is operming withbi ils-speriding aulo0q. In addhibriahe Alkince W mm!"e suiflWHOW
priqedions. and We Me hbrmaHon whh We ADI Agemy to assist in Mcir deternihalkni MAW availabibly,
The AI)i Agency vviH rNmem rebW.-', directly froni the ADD C Ile Fkal Deparlincil wdt be 1106fied Orthe
timniber ufrw%v cases bving referred to Me ADI Agency Ibractivation.
2, Upon receyl of the request R)r rchortfs from Me ADI Agency., Me ADRC' Intake Unit Supavimir wi!H run Ore
Nitwitind Rkk Report to kJcnd y [Lie consurnon on die APCL to he opmwd.
3, In respmue to Me mquest Wr reRrivils,die ADRC IMAe Unh `qua emkm mIll refer wait Sued cHwits to up e AW
Agency Cor wivalion, W accordance miM primtkMion nNtdremems. The haake Unit will update the wah hst
enriflitnon wshig the appnopriate code k"arnhate kmn Me APCI, Rw rdarse w Ow ALM Agency HAFL),
-1 Wrion reckvt W"the Hm tWchwits rubawd from Ore, waiting lust, flie ADI a%gency wvill enter Oic AP111.cili-cflInlent,
couact cliem to oak pmgmm etwoHment, a"d pnwmd "Th be [wocess Or axtNalkin, The ACH AEwncy mdll
oiler suhsequent enroHmetits pater al IRIN 41 rellect client simus
5.1-1w AHNne mAl oveism Ow curtilirnent process Io onure relmak We Hrnely ommmus & WRTS,
6, Choice(for MisinisDade Count);nnlyj In die event to! WNW hinds become avaiNble at Me Alliance 10
alh%v Ar nem chent emv[lmew Wo ADL dw AD RC wild waxi wnsurners hmn Te waiting INHo oRr Owle
of ADI Agency. Ifthe efieln js t".) Ionger irnorested in i,cceivow MTOMM the apRoicate Wait HM OmAwwn")
Wdl t-)e(.,bosed and tire, next chew coi lire, dint will be cootactol,
a. Intake Unit Specialists will Contact the Clint to Obtain Choice M,Provider.The client rcferrai wild uhvn be smit
lo die AF)l Agency selected by the client.
W Halter two auemps by phorw die Wake IMH staff is unable to ratch the c.onsuirier,Me chalet will be assigined
CW rKase to an agwwy on as WHon bads.
c, Upon receipt oJ'rOerra�, tho ADI Agency, will eiiwr ihe APPI, enrollinent, and 14)
reflect cliela status, Conuld lutioldments will fbilow in umoMane with the ntinihor cur'clients relerred I"or
a0wroW
R, RuWwWe WNdWWd Nhunged (Ore Long 11mi Care Progivin Clients
1. lie LIepailment omcr ARW will nin the Matewide APO.(Assessed 111,411,0Y("onsul'i'la,List)lelx"'I to review
chents wail kwid kir the SNAMCIAW program, DOFA %"H proOde the ADW," with a hst M' hidividwils
ao(h00/.(,d for rt-dease froni the, Al'(1-
1 P'or chonts jideirlified ns active in ADI and authorized f6j,release kom Me SMINICLT01 waiting, list,the ADRC'
%011 be wsponsible AW Me SMSICIVITI, OPPI"ation process. For ADI active clicins., Be ADRC' will nofflry dic
ADI Agency in ordo,to wauvt,, the ADI co-pay.
IV, C"hents Changjugr AIDI Agericies
A, 10cuiuncy awl"Changes
1, CWnstrmos realty change ADIAgerdes(m as monrldy WN Wdwy w chmse,
2, Conummas will nced to requeo a chatWe of AD4 Agency by the first(I")ol'the mondi in order fbr the change io
be A WRI by M; 16P oS dealt smne mun 1.
3, 1 F the mquest is We after Be 1% of Me nionth, the change%vH I We e Neu by Me I W"a dw INhowing month,
B. Prcrocca slaver Changes
I Request's to Change curse i non agerwy mmi come Rvm Me Aent or their personal represent'ative to tile
ADRDINder Helphne. Requests nmde by as cmu mangentern agaigy W na A horiomd.
2, When requesting as clumg, Ow camurner "Al be askud by the ADRC .stall pawn to Aare Wer rnmms Mr
dubg w; W dwy Mule whh Mir mw nimlagemem agmigy Am ON coiicerns and if they would like to speak
with sorneone else al that,agency.
3, If Me coinmietr chooses to W Ow agency, nothing wild be doine u-niii the consunier calls the ADRC [mck
Page 56 or 5,7,
requisming a change,
I Ifthe cimstumi dws nm ww it) speak ;vhh flee AD! Agency and wanN m change. Me ADRC %01 inkhre die
mosbur pwcess. A vwbM cWK will he acceped and doctuneniied in die REFER dalalbase,
I Ile ADRC/ Wke Unit will, send as Transfer Form to the selected ADt Ngency and to the current A11)1 Ageticy,
Both AE)l Agencies %vill work ckscly w'%Jfl'l the "NDRC to ensure the transfer process is cmupORAJI, Ke 15"oV
the mon1h, as fong Hs the Iratistr mquest wus recKed an div ADR('by 1he first ofdw sartw inonth,
6. 11w AD RC ImAe 105 W change Tv owner pvvWer recoW & WRTS to We new Atit Agenc,
7. The mmmi, ADI Agency xvill teirndcate emolinient in WC s as or thew 15,or the mondi when the irandir is to
to pWce, Vwnnv,AF)T Agency%vH1 acl wanton erindOnern in KIRTS as ul"Me 16"orive imm"Wen dw tmnsNr
is to take 10c,
8, Each ADI Ag,ency will notfl,'y its mspeedve vendoirs or me 1m1pWa6cm �andf(m a0va(ion of services for the
h-anOcrred chent w approprhi�ca.
9. WNW W swo on We 161 of he nhmdi when the chaqve becut-nee OWN.
Phhen Thime ADRCAmIdes and procedures sire NMbjCCI to chmg, Any mWifications %vill he dmic throug4i .4 contract
arnendinent.
Page 57 or 57
iiiiiiiiiiiiiiiiiiiiiillillillillillillilliillillillillillillilliillillillillilillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillilliillillillillillillilliillillillillillillilliillillililllillillillillillillillI
uuuuiu �������lu 22
9111117
Final Audit Report 2022-07-29
Created: 2022-07-29
By: Stan Mcneese(mcneeses@allianceforaging.org)
Status: Signed
Transaction ID: CBJCHBCAABAAYgG_ygeldmTjSZ5Di3dBiBAP8NpNCCO9
"2022-2023 ADI Contract Monroe KZ 2297 - Provider signed" Hi
story
Document created by Stan Mcneese (mcneeses@allianceforaging.org)
2022-07-29-3:10:51 PM GMT-IP address:52.201.156.234
Document emailed to rothmanm@allianceforaging.org for signature
2022-07-29-3:12:14 PM GMT
Email viewed by rothmanm@allianceforaging.org
2022-07-29-3:14:20 PM GMT-IP address: 104.28.56.8
'r Signer rothmanm@allianceforaging.org entered name at signing as Max B. Rothman
2022-07-29-3:59:48 PM GMT-IP address:73.245.17.80
'r Document e-signed by Max B. Rothman (rothmanm@allianceforaging.org)
Signature Date:2022-07-29-3:59:50 PM GMT-Time Source:server-IP address:73.245.17.80
Agreement completed.
2022-07-29-3:59:50 PM GMT
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