Item V04 V.4
Coty f � ,�� ,' BOARD OF COUNTY COMMISSIONERS
�� Mayor David Rice,District 4
The Florida Keys � Mayor Pro Tem Craig Cates,District 1
y Michelle Coldiron,District 2
James K.Scholl,District 3
Ij Holly Merrill Raschein,District 5
County Commission Meeting
October 19, 2022
Agenda Item Number: V.4
Agenda Item Summary #11241
BULK ITEM: Yes DEPARTMENT: Social Services
TIME APPROXIMATE: STAFF CONTACT: Sheryl Graham (305) 292-4510
N/A
AGENDA ITEM WORDING: Approval of Amendment 4001 to Alzheimer's Disease Initiative
Contract 4 KZ-2297 between the Alliance for Aging, Inc. (AAA) and Monroe County Board of
County Commissioners/Monroe County Social Services to increase the budget by $44,387.33,
bringing the current budget from $91,807.74 to a total budget of$136,195.07 for the current contract
2022-2023 (07/01/2022-06/30/2023).
ITEM BACKGROUND: The purpose of this amendment is to restore the reduced prorated funding
originally in effect at the beginning of the contract, and to add 10 months of funding for the
additional clients released into the program for ADI services.
PREVIOUS RELEVANT BOCC ACTION: BOCC approved ADI contract KZ-2297 on
07/20/2022.
CONTRACT/AGREEMENT CHANGES:
Increase in grant funding
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
BACKUP 2022-2023 ADI Contract Monroe KZ 2297 -Provider signed- signed
adi amend 001 kz2297
FINANCIAL IMPACT:
Effective Date: 07/01/2022
Expiration Date: 06/30/2023
Total Dollar Value of Contract: $136,195.07
Packet Pg. 5052
V.4
Total Cost to County: 10% Cash Match
Current Year Portion:
Budgeted:
Source of Funds: GRANT
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: Yes If yes, amount: Approx: $8,000.00
Grant: yes
County Match: 10% cash match
Insurance Required: No
Additional Details:
10/19/22 NEW COST CENTER ADDED $44,387.33
125-6153622
REVIEWED BY:
Sheryl Graham Completed 10/05/2022 12:13 PM
James Molenaar Completed 10/05/2022 1:50 PM
Purchasing Completed 10/05/2022 3:08 PM
Budget and Finance Completed 10/06/2022 1:44 PM
Brian Bradley Completed 10/06/2022 1:45 PM
Lindsey Ballard Completed 10/11/2022 1:26 PM
Board of County Commissioners Pending 10/19/2022 9:00 AM
Packet Pg. 5053
AMENDMEivr om CONTRACT KZ- 2297 Page I
-171-1 IS AMEND MENT is entered into between the Alliance for A glng, Inc. herein if ter referred to as the
"Alfiance", and Monroe County Board of County Commissioners,Social Services/In-Home Services, hereinafter
referred to as the"Contractor',and collectively referred to as the "Parties."
The purpose of this amendment is to restore the reduced prorated funding at the,beginning of the contract
and to add 10 months Of funding for the 3 additonal clients released into the program for,ADI Services,
The new monthly average caseload for this contract is 10,
Current Additional Revised
Funding Funding Funding
$91,807.74 $44,387.33 $136,195.07
Funding is allocated and indicated bi Q
Q
F U —
Maximum Units ol'sel-Vice
T-7 ....Service nit 11,10 ...11 Increa—se'T' Maxinnim
1 E
Service to he Provided Rate Units (Decre Total ase) Dollars
S 60.73 31 16 47 S 2,83 TO 1
Cass Aide S 15.00 6 fo) 6 S 8996 E
!�J.)i t c I a,c i I I ty 'IS 1096 5,806 2,826 8,632 94,611,47
IfesL) Borne IS, 24.2 2 916 467 1,383 33,484.57 C14
--—---------------------
Specialized Medical I jt Lnlen�,— C. Reilub 4,0167.02 C�
�2 U('2 P 11-11 Lslim L 1 HS ('V S 3090 1 19 586.00
Telephone Reassurance CV $ 27,37 1 (0) it) 519.04
7 CN
CN
N
E:6,:l 9:5::.0 7]
All provisions in the contract and anV attachments thereto in conflict with this amendment shall be and are
as
hereby changed to conform with this amendment, All provisions riot in conflict with this arnendment E
are stiII in effect and.are to be performed at the level specified in the contract. This amendment and all Its
attachments are hereby inacle a part of the contract.
IN WITNESS WHEREOF, the parties hereto have caused this Arnemclrnent to be executed by their undersigned E
officials as dLiIy authorized.
Monroe County Board of County
Commissioners,Soci�al Services/ ALLIANCE FOR AGING, INC.,
In-Home Services
SIGNED BY: SIGNED BY:
NAME: NAME: Max B. R-othman,ID, LL.M.
TITLE: TITLE: President&CEO
DATE: DATE:
Prepared 9/16/2 Digitally signed by)aMC5 0,
hmes D. Molenaar M,olenaar
Date:2022.1 US 16:23:39 04'00'
Approved as to Form and Legal Sufficiency
James D. Molenaar Packet Pg. 5054
Asst. County Attorney
ALUMMER'S DISEASE INITIATIVE CONTRACT
2022-2023 Fiscal Vear
'I'll IS CONTRACT is entered into between the Alliance for Aging Inc., hereinafter referred to as the "Alliance" and Monroe
C I ou"tY Board of Coulity, Cont In issioners, Social services/111-flome Services, hereinafter ref'erred to as the "Provider," all(]
collectk,eiy referred u.)as the "par(ics."
Amichnieats 1, 11, M,V1, VIL,Vill, IX. X, A, B,C, and Dare incoiliorated 1wrein and made a part of this Contract,
WHEREAS,the Alliance has been c1csionated as the Area Agene k wn
y no Aging for Phnning and Service Atea t I encompassing lii i-
Dade and Monroe Counties-, and
WHEREAS, lhe floridit Duparlinew oft"Ider Arfairs (tile "Depahmeni") has entered into a Comract with the Alhanco to f"und
Alzbeirneo Disease initiative ProN,iders in Miami-Dade and Monroe Counties-,and
NOWTHEIMFORE,ijo consideration ofthe services to lair,perfiwilied and payinents to lie 11ittok,together%vith the mutual covenants
and conditions set towilt in this Contract, the Parlies agrecas fifllows:
L Purl.wose of C'oqtract,
I'lle purpose ol'this Contract k to Provide Services in accordance wiih the terrns and m1ditions,specified in flik contract including
ail attachments and exhibits,which conslitale the contract document,
2. lacorUoration of Documents within (lie Contract
HIC C0110aCt Will ifICOrl)0rilte attachnm& proposa)(s), State plan(s), graM r0evant Deparunent oft"Idu Affairs
handbooks, martuals or desk books, as im integral part of the contract, except to the extern that (lie Contract explicitly provides
to the contrary. in 111C event of Conflict in 1angU.,1gC W11011g,'Mly 01'the documents referenced above, the Specific provisicms .III(]
requireinolts of the contract domiinent(s)shall prevail over inconsWent provisions III the proposal(s)or other general materials
twn specific to this contract document and identified atutchments amisliall he governed in accor(hilwe with thoapplk%lblc laws,Matifts,
and oflier conditiolls"'et for 41 Olis Cornmet.
3. '1-'erm o-fCorktract
3.T Eff(Tciivc Date:
Ibis contract shall begin at twelve (12M) A N4. Hastern S[andard Thrie on July 1,2022 or (,)it the date the contract has
been signed by hoth parties, whichever is Liter. The contritct will end on June 30,2023,or such eadierdale as(lie contract
is tenninated pursuant to Secti(mi 51 hereni, except dult tile partics Shall continue to perf"kirm those limiied contract close-
out activities set forth in this contract.
12, Delivery ofservices, shall enif at I 1a59 VM_ F,astcrn Standard I ime ore wJune,30,2023, Iff SUCII earlier Orne as the contract
is terminated pursuant to paragnaph M ho'ein, LInder no circumstances will lira Alliance reimburse flieprovider f6rServices
provided after June 31),2023 or any earlier lernfimation date. No changes to fonding aakc•ationa Mit 1-)e made alleq Juiw 30,
7021 Onl Q y limited contract ektsQ-out activities are to be peil-ormed aflor June 30, 2023 consistin of'repoiling, invoicing
and payment as stipulated in ATTACHIWINT Vill,
4. Contract Amount
flies Alliance agrees to pay for contracted services acconfing to) the teniis and condition,; of,this contract in an, anlount not to
exceed$91,807.73 SUbjCCA to the availability of fimi(K Any costs or smice�s paid for under airy o0wr contract Or firom any other.
worn WV, not eligible for payment under,this contract,
4,1 Obt i-at ion to Pav
The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the
Legisiature In the Dep,,,ulment and funding received by the Alli,,Ince under its contract with the fkpamnent,
5, Renewals
TTe con'tr°aaet nosy be rencvved on a yearly hasis 1"or no niore than three additional years. Stich renewals shall he cont4igent
upon Satisfactory performance evatuations as determined by (],to Alliance and the avaikability of imuti, Any renewal of
contract dealt be subJect to loutuai agreernent,confirmed in writing,and SUbjec(to the Smile tertils and Conditions set 1,61111 ill tile
initial Contract, with the uNception oreslablishing unit rates which is described further in this section. The renewal price, or
inethod for determining a renewal Prim is set forth in the bid,proposal,or reply, Requests I o renegotiate Ihe or ieinal conitracuml
established rates are provided for in the Alliance's aj,)proved Reimbursement Rate Rcvic)v Policy, which is incorporaied by
rcference,
Tlw parfles shall re-evaluate the contract's reimbursement rates on an annual basis pursuant to DOEA's Notice of Policy
Oarificatiow Service Cost Repoits Notice 11092815-ITC-M TS elated September 28th, 2015 and (lie approved Alliance's
Reimbursement Rate, Review Poky,
In the event that contracts cannot be (=cutcd prior to the fitlY 1st start date, the Alliance may, at its discretion, extend this
Aurcenient upon written notice flor up to 120 days to ensure contino4y of service. Services provided under this extension will
be paid ft.a-otit of the succeeding agreement ani cnrrO.
Compliance with Federal Umv
6.1, The Provider shall noit employ an unnuthod'-ad abow "The Alliarice shall cmisidc.r the canployrueni ot'unatithorizeo]ahen's
a Violation of the Inintigration and Nationality Act (8 1 I,SC 1324 a) and the Immigration Reform and ('I ontrof Act of
1980(8 U,S,(- I M), Snch viotalion shall be cause for unilateral cancellation of this contract by dic AlfiaoM
6,21 Ifthe Provider is a non-profit provider and is subJect to firtertial Revenue Service(IRS)tax exempt organization reporting
requiretimits(fifing a Form 990 ca Fomi 990-N)Mid has its tax c\,enipt status revoked for it)conij-dy with thew filing�n
requirenients of the 2006 Pension Protection Act or For any ollicr reason,the provider must notify the ABiance in wrifing,
within thirty,( 0)(hies ofreceiving the IRS notice of revocafion.
63, The Provider shaft comply with fille 2 CFR,Part 175 it) Persons,
6A� Unless cxernpt under 2 FR Part 170,1 10 b), the Provider dizill comply with the reporting requirements of the.:
1'ransparency Act as expressed in 2(1-A'K 170
(0, Jo conilfly with Presidential F xecutive Ordei 12989 and State ol'Florida FIXecuGve Order Number I 1 -116,
firovido agrees to Litifize the I Es, Departmew of'I lonicland Securily's I%verify systern to verify the en-ttfloymeolt of aH
nem, cnlpfoyccs hired by Provider clurin- the contract term. Provider shall includc in related subcontracts a requirentow.
that subcontractors and/or vendors perf'onning work cat providing Services famrsuarit to the state conlract Utilize the 1:�(-
Verify systenr to verify employment of all Ilm employces hired by the subcontractor and/or vendor cluning the contract
tmir. Providers meeting the renris, and conditions, of the F--Verify System are deerned to tie in coomphance with this
7
7,l This contract is e%ecutcd and enicre'd into in dic State ot Horkk and Mmil he construed. Imformed, and enforced in all rcspck;rs in
accordance r%iih the I hridaa Lice„iiwluding I Iori&i provkions for cotfflk:t ot Im"s.
7,2 fhe Provider shoill comply with Section 2 15.97, FS and requireivients of , 287,058, F,S.as ainended.
721 Fhe Provider shall Perform all tasks contained in Atiachurent t,
7 22 Hie Provider shall provide units of deliverables, including various client services„ and in some instances may
include rqorls, findimp" and draRs. as sliecified in this Cotorut. which the Cmaract Managermu.st receive and
accept in Nviifirq, prior to payment in accordance with s, 215.971(t)and (2), Fha. Stitt- Expenditures niust be in
compliance with laws, rules, regulations, hlcludirrg, but not hinited to the Floricki Rel'erence GUWC 1'or State
Expenditures issued by the Florida Department of Finucial Services("DFS").
723 "I'lie provider shall comply with the criteria and final date by which SUCII criteria must be each for cornpletion of
this cmtract as specified in Atlachinent 1, Section 111, Method ofllaynieril,
7.2 A The Provider shall sulimit bills fiat,fees or other compensation for set-vices or expenses in suffi0ent detail fear a
proper fire-itudit and post-audit.
72,5 If itemized payment for travel expenics is pormilled it)this contract, the provider shall submit bills for any travel
expenses in MTOillahCe With S, 112,061, F,S,or at such lower rates as may be provided in this contract,
7.2.5 The Provider shall allow public access to all documents, papers-, letters, or other public records as defined in S,
119,0 11(12), F&, tmrde or received by the Provider in conjunction with this contract except For those records
vo,hiclr are made conficloitial orexefnpi.by law. I he Provider's rel'usal to comply with this provision will constitute
art irninediare breach ofu,)nlrad For which the Alliance may unflatcr,,ffly terminate the contract,
Page 2 of'57
73 If chents are to be transported under this coWract,the Provider shaf I cot nply with the provisions of Chapter 427. FS-and
Rule 41-2, 1% A, C,
7.4 Subcontractor's who are oil the Dkcriminator,y Voldol,List nuly lim transact husines�s with Public enmity, ill accordance
with the provision ofs,287,134, F,Sa
7,5 File Provider shall comphy with the provisions of sr, 11�062, F.S., and s. 2 16347, F.S- which prohlibit file expendin-ne of
contract I'mids for file purpose oflobbying the legislature, judicial brarich or a state agency,
C.
T6 The Alliance and/or Department 1-flay terillinate tile Contract iftho Provider is 6ound to have submitted a false certification
as provided under.287.135(5), FX, has been placed on the Scrutinized Cotilpanics with Activities in Iran Petrolemn Sector
List:,the Scrutinized(2ompanies wkh activities in Sudan List, cir the scrutinized companies that Boycott Israel fist, or ifffie
Provider has been ellvwyed ill business operations in Cuba or Syria or is engaged in a boycolt of Ismael.
8. Ba"Ch,Yround Scre
LEU-NUMCC-11
SA The Provider Shall ensure that the requirements of s. 430.0402 and Chapter 435, FS, as amended, arc met regarding',
back0tound screening for all persons who rileet file oefillition ofa direct Service provider and who are riot exernpt-ii-om the
I
Department's Level 2 background screoiing I)LB-SUM11 to s.430.0402(2)43), F'S The Provider must also comply with any
applicable rLAICS proriudguled by the Department and the Aoeiicy For I Whir Care Administration re , implementation
garding
of s. 430.0402 and Chapter 435, F.S. Fo denionstrale compHance with this provision, Provider shall subfilit to tile
Deparllyient, the Background Screening Affidavit 01'COMI)fiance, (Screening Forin) kiiion thirty (30)days ofexecution of
this contract. Should the Alhance have a coillpleted Screening,,Form can file for the Provider. an liew Screening Forin wild be
reqUired every twelve(I mondis.
8.2 Further information Concerning the PWMILINS for background screciflill.1; is Found at
9, Grievance mid C(unptaint Procedures
f Grievance Procet1hire
The Provider shall comply with arid ensure sub-Contractor compliance with the Minimum Guideline for Recipiew
Grievance Procedures,Appendix D„Department off"'Idel Affiltirs,Programs and Services Handbook,loaddress con-iplaints
regar&ng,(lie tennination,sugmisioll orreduclicin ofservices,as required forrecerpt of funds.
9,2 Complaint Procedurm
one Provider shalf develop and implerient complaint procedul-L.'S Mid CIPSUre that sub-Contractors devei(y mal implement
complaint procedures to process and resolve client dissatisficiction wvith services. Complaint procedures shall address die
quatity and finiefiness ofservices, Provider and direct service vvorker complaints,or ari.), other advice reWed to complaints
other than termination, suspension or reduction ill W� rvices that rcquiri.,the grievance process as described in Appendix D,
Department, of F'Ider Affairs Programs and Services I landt)ook. I"he complaint pi-Medkll-cl; Shall ifICIUCIC 1106111CWiOn to 'Al
clients of the complaint procedure and include tracking, the date, nature of the complaint and the cletermination of'the
Complaint oil a complaint, 101".
10, Public Records arid Retention:
10,d It,MR10 Olk(.011trdd Ow fIrm kler rs pmvikhng wiviccs and is acting on hChalf ot'flic Afliance md the Mpamnetil as rqovided undcr
s. i 11)011(2). Ffm idu Stmutoso Ow llrm ider, m0f)Ject ion thQ mins of's, 287.059 13(c). ilorida Slatuies,and anY offier applicabte iegal
and cquilahle remedies, agrecs its talk pro isimis ol'Chapter I Ha Stat,,and an) odiv a[ipflicublc la%%,and sludL
10,1,I Keep and maintain public rmmis that ordinarily and necessaffly would be mlUirLd by ' the public auncy in order
L11
to perform (lie Services
t 0,1.2 Upoll request From Ole Alliance or the Department, the Provider will provide a copy ot'llte request for records or
aHmv the records to be hispected or copies within a reasonabie tisanes at a cost that do"riot exceed the cost provided
iii Chapter f 19, Florida Statules,or as otherwise provOed by haw.
10,1 I"'Insure that pubkc records that are exempt or cfmifidential and exempt from public records disclosure requirements
-ire,neat disclosed except as ziudictrized by law.
Page 3, o,t'57
10,1A Upon completiort of this contract, the Providcr will (tatisfer, at no cost to tire Alliance, all public records in
possession of the Provic1cr or will keep and maintain public records reqUired by the Mhance or the Department, If
Ure Ilrovider transfers,it) public records to the Alliance upon completion ofthe contract, 11rovidershall destroy any
(triplicate public records that are exempt, or confidential and exerapt, front public records disclosure,requireaients.
If the 11rovider keeps and mainmulS PnbhC WCORIS Up)011 UOITIJ)IC,6011 Of tile CORIA"aCt, the Ilrovider shall meet all
applicable requircuients f6r, retakiiii6, public records, All records stored eleorrinically must be pim,ided to the
Alliance in at format that is compatible with the inl'ormatiori technology symenis of the Alliance.
10,2 Me Alliance may unilaterally cancel this contract n(thvithstariding any other provisions of Harr, (''ontract. for refusal tiy
Lire Provider to comply with Section 9 of"this Contract by not allmiqq public access Vo all dOCUrrleots, papers, letters, or
other material madc or received by the Provider in conjunction with flic conlract, miless the records are exempt, or
confidential and exempt, from Se0ion 24(a)ofArticle I oftlre State C'onsliftition and Seoion t 19.071l), 1",S,
IF THE 11ROVIDER 14AS QUESTIONS REGAROING THE APPLICATION OF CHAlf"MR 119, F'LORIDA
S'I'ATUTES, TO 'HIE PROVIDI,,R'S DUTY TO PROVIDE PUBLIC RECORDS, RELATING TO THI
S
CONFRACT,CONTACT'ITIE,CUS"I'MIAN OF 1-111131AC Ill,"CORDS AT:
Vublic Records Coordinator
Florida Department or I'Mer Affairs
4040 Esplanade Way
Tallahassee, Florida 32309
850-414-2342
a Iry
03 Upon termination of1his contract, whether for Convenience or for Cause as detaHed in this contract, the 11roviderand
subcontractors shall,at no cost to tlic: Alliance, lransf'cr aH public records in their pos,.wssion to thc Alliance and destroy
any duplicate priblic records that are exempt, or confidential and exempt, from public records disclosore
All rewords stored electronically sliall be provided to the Alliance in as forrnat that is compatible v0th the inforimifirin
rechriolqgy systears ofthe Alliance.
I I.i 'Fhe Provider shall establish and maintain books, records, and doctinterits(includiog electronic stora,Ce media)sullicierit
to reflect all asset�s, obfigationS, Urrobligawd balances, income, interest, and expenditures of hinds provided by the
AMMICC UMICI'thil;C01111110. provider(q)sh.,ffl adequately safeguard all such assos and assure they are Used solely frir•the
purposes authorized under rang coirtract or agreement which incorl)(m-ates this Contract, financial
should he related to perfiontlairce and larit cost chila,
I L2 "I'lie ProOder shall retain all Client records, firlariciai records, suj:)por6n,, documents, statistical records, and any other
drwmnents(including clectronic story e media)perfincra lo r a this contract for" period of six(6)years aliter completion of
t� 9
the contract or longer when required by krw% lit the event an audit is required by this contract, records shall be retained
for at monnitim period ot'six(6)years atrer the ittalit, report is issued or until icsolutiorl of"Iny audit findings Or fifiL„arion
based On the ternis ofthis contract,at flil Mlditiffl-Nd COM to the Alliance,
1 1 3 Upon demand,at no additional cost to the Alliatim the f1rovider shall facilitate the duplication,and transfer ofany records
or doctiments chrring the required retention period,
1 L4 The 11rovider shall assure 11-rat dye records described in lllaralr rap h 10 will be sub"feet m addreagonable tinies to inspection,
IVViM C0 M a 1)V41g, ( udit by fedeta w l,se,ra-other personnel drily AU010riZed fly the Alliance,
I 5 At all reasortable times 1'6 as lonL!as records are maintained,P(TSOnS(1111,V Ulth(miied by the Alliance and Idler Department,
pursuant to 45 CUR part 75,vv ill be allowed full access to and the right to examine any of the provider's contracts and
related records and documents pertinent to 1his specific contract.re artless ol'the lbrin in which kept,
I LO 'there Provider shall Provide a f-malicial and compliance audit to the Alliance ass specified in this contract and in
ATTA(FIRE N r HI and ensure disit all related ibird-party transactions are disclosed to the,auditor.
I 1.7 'I"he N-ovidei- agrees to comply with the lJopartment's Inspector General in any investigation, audit, inspection, review,
or hcarinp perfort-ned pursuant to s. 20,055,KS- By executirm of this ontract tire prOVidd-Understands and will comply
With this SUbsectum. Provider further a,,,,:rees that it shall include in related subcontracts a IV(JUilTinert that subcontractors
Page 4 ol'57
perf(miiing work or providing services JMYSUallt to this C011traCt Wfl,ee to Cooperate with the hispemll General it surly
investigation,audit, insipccdon, review,or hearing pursuant to s.20,055(5). F',S,
12. Noii(iiscriiiiiiiatioti-("ivit Rights(7ortMliance
111 The Provider shall eucsitc assurarices in A"I"FACHNIFNT 11 drat it %6H lml discriminate a�,Ainst any person its the
provision ot'servicus or beriefils under this colitract or in employntoit because of age, race, religion, color, disabilit,N,
national origin, marital stallis or sex in conspliance with state: and federal faw and regulatim,N, 'Ilse Provider farther
assures thief all Providers, sub-(..'011tR,1C(OrS, SO-grantees, or others with whom it art-tinges to provide sorvices or betiefits
in Connection with any of its,programs arid activifies,are ncm discriminating apaijist clients or employees because of age,
race,religion,color, disability, trational origin.marital status or,sex.
112 Durina the terns of this contract, the Provider shall complete and retain on file a timely, complete arld accurate C I ivif
Rhllhk COlTsj)fiW'KT Cheuklisi anac hed to this contract,
123 the Providcr shall establish procedur,es ps,irstlaw to f'ederal law to limidle compkiints ot'discrimiliation involving services
or bencfm throli-h this,contract, 1"hese procedures will include:notifying,Clients,employces,and participants ofthe right
to lifle at coltiplahn with the approprime feck-ral or state enthy.
12.4 These assurances are a condition of continued receipt ofor benefit from financial assistance. and Lire binding upois die
Provider,its successors,tratlsferec ,and assignees for die period durili&,which such assistance is provided. Hie, Provider
forher assures that all sub-Contractors, vendors, or others with whom it arrallges to provide Services or bellefits to
pmticiparlv or employces an Connection wifil ally of its prograills nalld activilies are riot discrittliflating aganist filose
participants or employees in violation of above SU0111M NgUliltiOPS,tjjliddincs,and stzlidards. In the event of ailure
to Comply,Ore Provicier understands,that the Alliance may,at its discretion,seck a court order retlUil-4111 CoMplialiCC With
Ille terms of'this assurance or seek other appropriate judicial or admilliSbUlfiVC relief; illCIU(1611,1:, but Wt fintited to,
iernlination of'and dellirell of further Fmjstance
11 MonitorinL,1)),the Alliance for SLIM
13,1 1lac I Irm ider sha I I p ermit persoris du I� authori/ed by the A f I imice to inspect and vtqiy mtt rocords.palms,docent ien I s.flici I it ics,goods
and services of'lhe Provider which are re levant to this contraci,alid to imerview ally Chents,employees and Subcontractor
employces of*the Provides- 'to assure (lie Alliance of the smisf4ciory performance of the tel-ros and conditions of this
C01111-40, FOIIOWitlpl SUCh NOON, the Alliance %viH provide as wriiien report of its findinp to the Provider, and lvlme
approptime, rise Providcr shall develop a ('orrective Action Plao (CAP), The Provider hereby agrees to correct all
deficiencies idelifified sit the CAP ill as timely mariner as delerolined by(lie Contract Manager. Failure to corriply with the
CAll shall sallim Provider to 'actions as described its this Contract,
13,2 11w Alhance will perforni administrative, fiscal, rind prograrninafic monitoting of the provider to ensure contractual
compliance, fiscal accountability.pro"r,"'Imniatic performance,and comphaitce Nvidi applicable slate and federal laws art(]
regulatiorm The Provider wilt SUPPlV PrOgrVSS Nl)011S,ill(Auding daut reporting as specified by tire Alliance
or tile Department to be nsed filar lortniforing progress or pellormance of the contractual services. Ixampfes o-freview
criteriit are surplus/deficit reports, independent audits, internal controk reimbursement requests, subcontractol
olOmforlsig, turgeting. progrant eligibility, outcolne MUSUres, service provision to chents, data intqrity, client
salisfactior),arid churn file reviews,
33 Retrospective Unit Cost Methodology Reports (RUCM) -- The Provider sflaH mthinit Retrospective Unit Cost
crids, Re RJAM sluffl reflect actuat costs of'providing each service by program ter the preceding contract year. C'osts
associated Mth Services Provided Under this contract shaH mfl3/ ioChl&allowable direct and indirect coqs as defined by
applicable state hm. If the Provider desires to reneaotiate its rears burscium rates, tire Provide shall make a request its
writing to the Alliance, with the inclusion of a Prospective I-Init Methodology, in accordance with the Alliance's
approved RCio1bLlr'SeTTlCTlt Rate Rcvie%N,, Policy,which is inci)rporated by referowe,
14, Provision of Services
The Provider shall provide services ill the rrianitcr described ill ill A ITACHMENT I of this cmaract and in the Service Provider.
Application (SPA) In the event of a coidlio between file Service Provider Application asid this contract, the contract kingwage
prevails.
15. Coordinated Morsitsirin2 with Other ALlencies
Pagc 5 ol'57
If"the Provider receives funding, froin one or more orher Si ate,of Florida lit it nan WIN ILL Wleticies, in tidt:I it iol Itt)Ili Dellairn I elit
of"Fader Affairs,then ajoint olonitoring visit including such other agencies nlay be schedtdcd, For the purf,)()SCS ofthis Contract,
and pursuant to s, 287.0575, FS as arriended, Florida's hunian service agencies shall inClUde tire Department of'Children and
Families, the Department (!It"Health, the Agwricy for Persow with Disabilities, Ific Deptinment of Veterans Affairs, and the
Department ofFIder Affairs, Upon,notification and [lie subsequent scheduling of'such a visit by (lie designated agency's lead
administrative coordinator. the Providershall comply and cooperate vvith idl monitors, inspectors,and/ol.in vest igarors.
10, Indemnification
--TTe I I-rm Her Tall imic I I I I I ifN save,defend a I td [I otd parr ndess tdw Dclim I I tml I.the Atlimwu-and its officers.aj,scms m"i employccs Ii'mn any
and all clahns,dviiiands.liellons,causes of ackort ofe,hmevel rimure m chantom arking ow of or b% mism tff lw execution this(."ontraet,
air lie Ili wl I I lit I cc of the SC r Vick!s pro%Wed ftu tie rei It h k I I ruk"l-smod a I I d agi-Ced I I I a I I he ProVicler I,,Jim recittired to indeilmifv the I)e1iltriment
or tare w A l I lance for c I aims,demands,actic"Is,or Causes W act toll ar is irIpt sole N,out oft the Depananent's or Al I imice's neg I igetl cc,
17� InsuraticLand Bon din,
1'7.1 Provider must provide continuous adetlLiate liability,insurance and worker's compensation Insurance coverage,duting the
oxistom!of this contract,and dUrrilg any renewal(s)or extcrision(s)of it. 'I lie Al I iance shall be included as an additional
insured on file provider's liability Insurance policy or policies and a,copy of the.Co-tificate of Insurance shall be provided
annually or when any chanoes occur, The Provider accepts full responsibdity Im- idenfif�,ing and determining the type(s)
and CNACTIt of liability inSUrance necessary to provide reasonable financial protections, lbr the Provider mid the clients to
be served under,this contract, Upon execlition ofthis Contract,the Provider shall furnish file Alliance,written verification
supporting both the and existence ol'such Insurance coverave, "Flie linots ol'covenige unclor each policy
lilaintailled hy the Provider do not limit tlw Provider's Hability and obligations under this Cortin'.'ItA, I'lle floiVi(h,"[ Shall
ensure that (lie Alliance lias the most careen[ written verification of insurance coverage throl.11.111IOIA the W1111 Of' this
contract. Such coverage may be provided by a self-insurance propram establHied and operating Iindertlic laws of the
Staic of Florida, The Department and file Alliance resmc the right to require addiii(mal Insurance as spocified by this
Contract.
I T2 'I'll YOU t"ORKIt the K'Ttri of this conlrad, file Provider must maintain arrr Insurance bond from at responsible cornmercial
insurance Company Covering all officers, directors, employees, anti agents ofilic Provider, authorized to handle funds
received or diSbUrsed under this contract, In an airlount Com i nerl su rate with the flinds handled, the degrcc of risk as
determined by Hie insurance company and cottsistem with good business practices.
'I 8, (.,o1IfidcQfialjtYjJ Information
Hie Provider shall not use or disclose any iril"ormation, concerning a recipient of'services under this contract for any purpose
firohi)itedby state ortederal law or roglakmions e,\cef)t with the writtell Consent of"I pers(in legally auditirized towylive that consent
(:it,when authori/ed by law,
19, 14colth Insisrance Portah_flity Rj:!q
Where applicable,the Provider shall Comply with the Health Insurance Portability and Accountability Act(42 USC 1320cf.), as
well as all W'O'LlIkitions pronitilgated theretmder(45 CITR 160, W2,and 164),
20, Incident ILIC-. i'main
2d.1 The Provider shatl notify the Alliance humediately but no later than forty-eight(48)hours from the Provider's awareness
or discoveiy or com,fidons that may materially affecr the Provider or Subcontractor's ability to perl'orm the services
required to be performed under this contract, �Licli notice shall be made orffly to the Contract Mariliger(I)),, telephone)
with an email to inimedraiely follow,
2W2 'llic Pmvider shah immediately report knowledge or reasonable suspicion of abuse, neolect, or exploitation of child,
aged person, cir disabled adult to the Florida Abilse Floffine oil the statewide toll-firee telephone number (I-900-
96ABT.PSF)� As reClUired by Chapters 39 and 415, F'S.. this provision is binding tipon both the Provider, subconfi"actors
and its employees,
2L Aan�r°utatew" rati eattdon.
During the teim of this contract,11te Provider shall immediately notity the Alliance if the Provider, its assignees.sub-Contractors
or affiliates file a claitill for bankruptcy. Within tcri ((0) (lays after notification, the Provider must also provide the following
information to the Alliance: (I) the date of Ifling of the; batik ruptcy petition: (2) the case nelniber; (3) file court name and the
division in which the Pethion was filed(e.g..Northern District ofFloricla, Tallahassee Division)-,and,(4)the name,address, and
telephore number ofthe hankruptcy attorney.
Page 6 of`Via?
22, SMLvso�rshi)Lind P—uhliciAt
22.1 As required b� s,286,25.Ila, `",tat- it die hmidor is as organiza6mi which spoosor�s a pro�pam hmanced tflaMN or
ill part b" State fikmds° hictudilig any funds obtained through this contract, it shall, in publiciling, advertking, or describing thc
spollsorship) of the, program, Moto° "Sl)ortiored by IMMVIlk"R NANIF"J, I he s%lhmwe ('c", AginF Inca.. mid the Srare of'Fkt rida,
Deparunent of F"Ider Affiairs ' If the sponsorship reference is in written material, the words"Alliance for Aging, hic," and "Sime of
1,k6da, DepanmenI ot'idder Affairs"slufll appear ill at least the same Si/c le-mrs or type iis dw rutim-W'the ougmizanon
212 1 Iw llrovi(tc°r shalt not rise the words"Alliance for Aging, Inc."or""file Slate of Florida, Department(it Elder Affairs" to indicate
jfa pjr,grar, therikke hilanceCL mfless specitlic aaaetlreari sttue>n has lwen ohtailrot Iffy the:Alliance p6m,io use
23. Ass i it i n e it�ts
'I Ila..J'rrr,)VlulCr mJjrjjj aunt assiull than rights alvd rc�;punsfl)Oilics undcr am contract%6thmrt die,prior mitleli approvol of the Alliance,Am
s Nu icel vx,'.vss ig n nwill.of rn jSf Cjr Dt 11 ,- j aaC(,,,i nji!w k,i floj tj t pfrol:wr i f M I approd v� C)I iho A I I iance)k i I t Const i me a i natorial hreac"h
0,1 Ile 1,.on traut 01,111gree I Ile 111,
23.2 Nis contrict,shAl renrain,binding upon Ole successors in nricrcm of the Piovider and the Afliance,
24, Subcoutiiicts:
24.l J-he Provider is respoosible fior gill work performed and for all contmodities produced pursliant to this contract, whoher
actually lurnished by the Provider or its submirtniCtors. Any subcontracts shall be evidenced by as written doullnent and
subjec,t to any condidons of'approvaI ihe Alliance deems necessary The Provider I'lirtheragrees thar the Alliance will not
be ha ble to the,subcollo-actor in any way or for any reason, The provider,of its expense,shall defend the Alliance"against
any Such cjailrfs,
24.2 flit Provider shall prornpdy pay any sahcontracwt-s upon receipt of flayrnent firoin the. Alliance or, other state agency,
Failure to make payments to any subcontractor hl accordance with s. 287.0585, Ha. Sun., unless otherwise Stated in this
contract betweerr the 11roviderand subcontractor, %vM result in a penalty as provided by statute,
24 Hic Provider"shall programmatically trionitor,at least once per year,each of its subcontractors, Subrecipients, Vendors,
ariwor consultants. 'rho irovider shall perf6rin programmatic inoniioranp to easure contractual compliance, and
pelf"brinance air(] compliance wirli apfflicable state and ledera I haws and regulations The Providor shall
monitor to ensure that thure schedirles arc rllct, the budget and scolle 0l'vvork are accomplished within Ore specified trine,
pettiock, and other peribrinance goats. 'life provider 4nill atso perlorm fiscal and administrative monitorint, for all
SL&,Otllrad0rs W enSfAre fiSCZit rCCOMIMbility,
24�4 TI re Provider sha I I have a proc u rear en t po I i cy(It at assures in ax i in n m free and open co rripet it,i on, `such proc urmeat cy,
must conform,as applicable,with F'ecicurl and State cowraCtilIg aild PIMUNIMM I'M118tiOnS,as SO f0i'th in Title 2 Code
R Pat00, Ci , 8T5 , U�S OffiMoff`ederal Regulations u gernew and Bud-et(OMB)Circulm.
110, Florida Departmem (.)I'Management Services (DMS) Rule 60A-1, F.A.C,and with the Department's Program and
Services I I,'lrldb0Ok,
24,5 The Provider shall dedicate the stall'necessary to mect Ow obfigations of this contmet and ensure that Subcontractors
dedicate ""Idequale stafll accordingly, The provider shall ensure that staff responsiWe for performing arry duties or
Irmcliions within this a.ontract has tire qualifications as specified in the Department's Programs and Services Handbook.
25� Unit Orst Methodoijollu
lie 1;re7)ji5cr shall submit Retrospective Unit Cost MethorlokqgY(RIA I M)to the A lliancc annually,but no Iater than ninety(90)
calmlar(lays after tire Provider Fiscal Year ends, The RUCM shall renect actual costs ot'providing each service by program
for the Preceding comract year. I osts associated with services provided under this contract shall allowableonly include allowable direct
and indirect costs as defined lay
applicable state law. If the Provider Mires to renegotiate its reimbursement rates, the Provider
sliall irrake a request in writim, to the Alliance, with the inclusion of as Prospective Unit Cost Methodolog_y, in accordance with
the Alliance's approved Reimbursement Rate Review Policy,which is incorporated by reference,
26, E"jitfinjObliliatious.,
26,1 "llicAlliance km, Aginp, Inc,acknowledges
arid responsibilities set lbrili ill this C"ontract.
Page 7 ol'57
26,2 The Alliance shall not be HaMe to the Provider fim- costs incurred or Imformance rendered unless such costs and
Pefforitlances are stricfly, ill accordance with the lerryls of this contract, including but not limited to ternisgover-ning OW
Provider's promised performance and unitrates aridJorreirribursement capiu.itions specified,
263 The A It iance sha I I not he I iabtc w I I ic Pro%ido-for imN to his ward it ot it I I umab I c costs as detlri cd io 2 CF R I'a rl 2(9)a I id
45 GIR Pao 91 as nmended,or Miich expendilures luive uot beeit lrulde in ucordance with"M appheat-de',lale aod fcdenal rulfes
26A The Alliance shall nor be liable to the Provider k",expenditures made irl violation ofregulations proinu I gate(I tin der thee
Older Americans Act,Department ruies, Florida StakttCS, or this contract.
27.
It is the intent and understanding of the Parties that the Provider, or any of its Subcolltractors, are independent Provider's and
are not employees of the Alliance surd shall riot hold theillsetves out as employecs or aggerits of"tyre Alliance without specific
authorization fiorii the[ Allialim It is the fimher intent and Understandiiig of the Parties that the Alliancedoes not controt the
Colploynient Practices of'the flrovidei°and will not lie ha ale for any wage and hour, ernploymerit discrinlitlation, Or other Iabor.
and Cillifloyinunt Claims at-aillst tile Provides era its Subcontractors. It deductions for soci"'d Security,withhokling taxes,incortle
to contributions to unemployment compensatiori funds and all rl"VSSM-V iMUrallCC fiat the provider.are tile sole respollsibihty
ol'the Provider.
28" Ea'I 'mcm
28�1 Payn-terits shall be made to the Provider as services are rendered and invoiced by the Provider. The Alliance will have
Phial approval oI the invoice for Payment and wilt approvc the invoice for payment only it"tho Provido'has inet all ternis
and conditions of'tile contract, oarless the bid specificalions, purchase order, or this contract specify otherwise, 1he
approved invoice will be submitted to the Alliance's fiscal department for budgetary approval arld processhig pot,
ATTACHVIFINT V111.
28 2 "Ife Provider shall IlKlillUtill dOCUCnenlmion to support payrnent requests which shalt be avail&e to the Departillm of
Financial Services, (lie Dep artinenr. or the Alliance upon rVCIUOSL Invoices must be SLIbillitted in suffitcient dotail for a
JWOper JWC audit alnd J)OSI fludn thereof, fhe Provider shall comply with all satiate and federal laws governing payments to
be made under this,contra(A including,but not lirniled to[lie following:sections 210 18106)(a)&(b),215.422,Fla,Sml-',mid
[lie Invoice Requirerrients ofthe Reference
atde for State Expenditures from the Department of'Firlanci,,il Services au
mi"H,�� dach k:oul ,ik�JOH dd H�AHH,�k qt,'WHH1,2W-, k,
The Provider Shall mailltail)detailed docurnentation to support each item on the kemized invoice or payrilent requost for
Brost reirlibursed expenses, fixed rate(it-deliver ables. for this contract, il!Ckldirapl paid sub-contractot invoic,,es,and will be
prodUCC(l Upton r(XILIeSt by the Alliance.The ProvidershaH sandy request reimburserunt for allowable expenses as do rimmed
in time Im'N's and guidirig circulars cited in this Contract section 6, in the. Reforence Guide f`or State LApoiditures, and ally
offier tmvs or regulations,as apjilicable,
2 8-3 The Provido and subcontractors shidl provide twits(A'dotiverables, hicludin!g reports, i-indaigs,arld drafts as specificcl ill
this contract to be received and accepted by the Alliance prior to paymont.
29. Return of Ftinds
Tile--Provider shall return to (lie Alliance any overlwymems (file to unemned flunds or funds disaHowecl arld ally ha erect
attributable to such funds purstUlilt to the tCURB arld COINRiOrB Of' COIllract or agremma incorportaing this Contracr [,ry,
reference that were disbursed to the Providor by the Alliance, In the event that the Provider or its independent auditor discovers
that an oveirpayrnent has been made,the Provider shall repay said overpayment irimiediately %vithola prior noti ficat ion fi-om the
Alliance, In the evelit that the Alliance first discovers an overpmqnent has beem made, the Contract Manager-Mil notify the
Provider in \vrifin- of'such tindirws. Should i'epit)ATIeW lie(be remade lbollwith, the Provider shall be charged at the kawfifl rate
of interest oil the outstanding balance purstiant to s,55.03,R&,ifler Alliance's notification or Provider discovery,
30.
The Provider shall ensure an appropriatee level ofdala security kyr the, illf'orlm"llion the Provider is C0lICCtiJlg or Millp' in Ille
pc,rformance of this contract, Ali approprime level of'security includes approving and tracking ah Provider employees that
rC(JLlQSt SyStell'i or kil'orination access and ensuring tkat user access has been removed from all terminated employeei, The
Provider, among other requirmients, must anticipate and prepare for the loss of information processing capabilities. All clata
arld software must be rominely backed tip it) insure uTovet-y fail losses or outages of computer systems. The security over file
back-up data is to be as stringent as the protLvtion required ofille Primary syslons, The Provido shall insure all sub-Contractors
Page 8 of 57
maintain written Procedures fear cornpater system backup and recovery, 'Flee Provider shall,prior to execution of this,agreentent,
Complete the Certification Regarding Dara Integrity Comphance fOr Agreements, Grants, Loans.and Cooperative Agreeirienis
prior to the execution of this contract, as pan WA I TAClJMFNf 11,
31. Social Media arid Personal Cell Phone use;
31A Inappropriate use of social media and personal cell pliones may pose risks to DOEA's confidential and proprietary
information and may Jeopardize ccrsrtplianc.e with tegtd otfligations, By sjgniug this contract, Provider agrees to thc
t'oflowing social media and person,,ll cell I)II011C Use rftjLjirenlents.
3L2 Social Media Define& The wrin Social Media and star personal cellular corommicalion includes, but is not limited to,
social oetworking websites, blogs, Podeasts, discussion forums, RSS I`eeds, videt) shming, SMS (including Direct
Messages(Ws), Messages, tcxt mcssagcs,etc.); networks like Instagram,Tik'Tok, Ssmpchal, Google ll'aflgoms.
�NlhatsApp, Signal, Facebook, Pinicrem, aod fwilier, and content sharing networks such as Flickr and Voul'ubc, This
inchicles the transmission(Asocial media ffirough any cellular or ordine irmismission via any etectronic, internet,intran et,
or other wircless coinmuniLation.
3 13 Application to airy direct or incidental DOEA or other slate business. flik contract applies to any DOFIA or other
state bitsiness conducted on in'Y of the Provider's,Sub con tract or's,or their employees' social media accounts or through
personat ceflulat comnsunieafiOrl.
31.4 Application to DOFA and Provider-S EtIllij)[11ent. this Wfltract applies regardless of whether the sociat niedia is
accessed using DOEIA's ITfacilitics and equipmentor equipment belonging to Provider,Subcontractor,or theirrest-wctive
enIP10YOCS. EALripRICI)t illCkftles, but is not Hillited it), persolill cofrljlwers, Cellular phones, personal digital assistants,
smart watches, or qinai't taWev,'.
31.5 Florida (,'Oj,rCj-jjjjjCjjt in tile Sunshine, Florida Public Records L,mv, and HI AA, Plovider acknowledges that any
DOEA or other state Imsiness condLI(Aed 1)
y social media oI- thl'OUgh IM-SOMM MIUkIr COITIMLWiCa tiOn is subject lo.,
Florida's Government,in the Sunshine L,aw,Florida's Public Records Law(C'hapter 119,f1orida Statutes),andthe Health
hisurance flortabifity and Accountability Act(141FIAA).Comphatwe with these laws and oilter applicable laws are flurther
deraded in ific contract.
31,6 Prohibited or Restrietcd Postings.
Anly social media posts which include photos, Videos,or narnes ofelionis, vokutteers,staff, or other affifiaies ol'DOF.A
may only be poocd %vtien audic)rized by law and when any required H)PAA atilhorizalions and any other coments 01'
atidlorizations required Pursuaw it)fedeial,or simic laNk, jille e)rr tile k%,jjjj tjj(^ Jrf)Vider's records
31.7 Assis( DOEA with Communications. Contactors ma y be asked periodically to assisa in distributing certain F)OFIA
communications through their soeiaal media outlets, Arty such re(ptests should be ponied at adherence to the social media
requireinoms herein and tile other provisions of this contract,
32, Conflict of Interest
Cite Provider OmH establish sa6egiKu'ds to proltibit employees,board members,manag,onent and subcontractors from using their
positions for a purpose that constitwes, or presents the appearance of persoind or organizational conflict of interest err personal
gain.
No ernployee, officer, or agent of the Provider or subcontractot Shall participate its selec"fion, or in Ore award ol'an agreement
supported by slmc or federal funds if'a cotiffici of"interest, reai or apparent, would 1w involved, Such a conflict would arise
when: (a) (lie empJoyee, Officer, or agent; (b) any menflm of his/her immediate famOY (c) his or her partnet� or (d) an
organization which employs, or is ahoul to eniffloy, any of the above, has a financial or other interest hi the bran Nw,.dcctcd for
award, I'lle Provider or subcontractor's officers,employees or agents will neither solicit nor accept gratuities,favors or anything
oftilonetary value['turn Prov iders,pate racial Providers,or pall ies to subcontracts.
Pursuant to Chapter 4. Section 2 ot'die Deparmient.of"Elder Affairs Program and Services I landhook,no Provider may employ,
in any capacity.any member of its governing board or any Idirlily member of as person on the board
The Providers' board members and management must disclose to the Alliance any relationship which may be, or may be
I'm-ceived to be. ,a coriffict of interest within thirty (30) calendar days ofatt individual's original appointment or Placcrocin its
that position, or it'tile individual is serving as art incumbent, within thirty (30) caleudar day" of'(lie Commencenwnt, of this
Page 9 of.57
contract.The Providers'employees and subcontractors must make the same disclosures described above to the Providers' Board
ol Directors. Compliance with this Provision will be 11-tortilcire(L
33, Public E
1-11 Ifl— Al"tLCHITIC
Pursuant to s. 28T 133, F,S,,a person or affiliate who has been placed on the convicted vendor list followinlo a conviction for a
public endiy Crime May not Submit a bid, proposal, or rqAy on a contract to provide any go(ids or services (l)a public enifty;
ula)' 110t SUbtuir u bid, proposaf, i-n reply on as contract with as public entity for the construction of-repair of a public building or
public work-, may riot submit bids. proposals. or replies area leases of real property to a public entity: may not be awarded or
perfimn work as a Provider,suppher,sub-Contra0or,or Consultant fordo,as contract with any public entity-1 and may not fransao
busitiess with any public entity in excess of the threshold amount provided in es. 287LO P,F.S., for Category Two for as period of
36 months 661 lowinle the date of being placed on the convicted vendor list If the Provider or any of its officers or diren)is is
convicted of at public entity ci-nne during the period offlus ag"reenient, flie Provider shlflf rwtif; the Alliance itomedialely. Not).
C()lut)fiWlCC With thiS SURtUte shall constitute a breach of this agrecarent,
34 Purcha h IL
34.t Me Provider may purchase articles which are the sub ect(Wor are re(lainA to carry out any contract or airecineut from
Prison Rehabiliultive Industries and Diversified Imterprises, hic.,(PRIDE)Weiltified under Chapter 946,f1a,Stat- in the
sarne niariner and under the procedures set fbrih in ss 946,5 15(2) and (4), Fla, 'Start. For purposes of this contract, the
Provider shall be deemed to he substitUMI for the Mliance insofir as dealing�w with PRIDE, 111k ctauso is not appficable
ro Subcontractors uniess(tOlViViSC re(lt,ired by law. Ar) abbreviated list of'products/services available firorit PRIDF' Illay
be obtained by contacting PRIDE, 800-643-8459,
34,2 Hie Provider may procure any recycled products or materials,Which UC the subject of orare required to carry this contract
in accorcharce willf the provisions ofsecfion 4033063. Fla, Suit.
3/43 I lie Provider many purchase articles that arc the iUbjCCf Of' or required te carry out, any contract Or agaecknent front a
tionprofit agency for the,Wind or R)r the Severely I landicapped that is(ILUdified pursuant to Chapter 4 t 3, 1,Ia. Stal-in the
"Ole fuliMler lind under the sarne procedures set forth in s. 413.1330(1) and (2), Fla. Start.. For purposes of this, contract,
file Provider shall be deemed tif be SLJbSd(Med lor the Alliance" ins(Aht,as dealings vvfth suck qualified rionprofit agency
are concerned, Additionaf inlortuation 'olbOUt the (kSip,111ale'd nonprofit agency and the Products it offers is available ,It
This clause is not applicable to subcontractors uriless othel,wisc required by law,
35, l a6a Ut,,(LoLiji w hhRo altitN
_
35J 11, this contract is awarded state funding,and if any discovery, inverition or copyrightable material is developed, prodaced
or for which ownership was pLffCIKiSCd in file course of or as a result of work of-services perfornied under this contract
the Provider slildl refer the discovery, invention or ifiaterial to the Alliance to be reforred to the Department. Any and aH
patent rights or copyrights aCCrUing nuclei, Of is contract are hovby rescf ved to dife State of'Horida in accordauCC NA'kh
Clhapter 286, F.S.Purstram to s,287,0571 (5)(k)„as airicirded,die only exceptions to this provision shall be those that are
cleady expressed and reasonably valued in this contract,
35.f If thu primary purpose of this contract is the creation tat` irate 0ecitial property, the State of Fiorida shi.01 reiain ari
Lifiencumbered right to use such property,notwillislanding any agreement made pursnant to this section 33.
35 2 If this,contract is awarded solely, f6derat funding,tile tortils and conditions are governed by 2 CFR Part 200315.
36, EmSer
- j_,eitc2, 1-1,Lrgmireduess and continuitv orQgLrations
The Providcr shall, Nvithin thirty (30)calendar days of the execifflon of this contract.subtuit to file Alliance Contract Manager
verification of' an emergency preparedness plan. In the event of'tna entergency, the Provider shall notify file Alliance of
eniergency provisiorli.
In the event as siafation results fit a cessation sal"services by as sub-Contractor. the Provider shall refain responsibilny Air
performance under this contract and must f"OHOW pWOCC(WlVs to ensure corifinuity of operations WithOL11 ititerruptioli.
37, PUR 1000 Form:
F,—PUR 1000 Form is herehy incorporated by refer(mice and available at:
hu rn [w �)i H crq dwo,11 kweud N�R l 000 hc I tl 't a„l_t oW[ tc ti Ok ,w
Page III (yf'57
In the event or tiny conflict l,)ctNveoi the PUP 1000 Form and any terms or conditions of'any contract or agreement rernii or
conditions tho contract shall take precedet ice over tlic PUR WOO Forro. I I owever if the coil fliefing terms or conditions in ihe
PUR 1000 Form are required by any section of"the Florida Staitites, 1he terms of conditions contained in Oie PU R 1000 Form
shidl take precedence,
3& Use of State Funds to PUrchase or Irnirrove Real Pr2jjqat ,
Any state funds provided for the purchase of or ill)prov ern Nits to real property are coniingent upon the Provider or political
SLII)(IMSiMl "TantiIIIJ to the State a security interest in the propcHy at least to the aillount ofs'tate funds Provided for at feast 5
years l'rorn the date off,°rurchase or the completion oftlw improvenicnts or as fOrther required by law,
39, DispLite Resolution
Any dispinc concerning perf'ormance of'the contract Mull lie decided by the Contract Manager, who shall reduce the decision to
wonting,and serve at copy on the Provider,
40t No Waiver of Sovereip-11.1.1n.a tin
Nolhin contained in this agreeknew is knended to serve as a waiver(lFsovereign iriln)till ity, by aily 0110ty to Which sovererppg
irmilunity Inlay be apphcabk%
4L Venue
ll"any dispute arises out ol'this Contract,the Venue, of'SUCII legal I-CCOLU-Se Nvitt be Nflqtfi-Dade County, I'lorida,
41 Entire Contract
TITI Cont"uns all tire ternis and conditions agreed upon by the fatties. No oral agrecilieNts or representations shall be
L_ C,
valid or binding upon the Alliance or the provider unless expressly contained herein or by a writtert arnendnreW to this contract
signed by both Parties.
41 Force Mah
E WrIC
The Parties will not be liable R)r any delays or fifilures, ill Performance(file to circurnsuinces beyond their control, Provided the
party oxperiencimt the force irtaicure condition provides irmiredi've written notification to the.oilier party and takes all retiscinable
efforts to cure the condition,
44� S eve ra 1)At i b-I—C.1 111!_see
,I he parties a.-Tee that if'a court ofcompeteril Jurisdiction deems any torn) or condition herein void or unerffiwceable, the other
provisions are severable to that void provision and shall rernain in fult I'orce and efIca
45, Condition Precedent to Contract-. Aj&rOj)riafioris,
The Parties agree that the Alliance's perfixuance and obligation to pay under this contritct is contingent upon an annual
appropriation by the Legislature to the [)eparunent and a corresponding allocation under contract Froin the LWepam rtent ill the
Alliance,
46 Addition/Deletion
The Parties a 4aree that the Alliance reserves the right to act(I or to delete any of the services required under this contract when
deemed to lie in the State offlorida's best interest and reduced to a written amendment sioned by bofli Varties, Ifte, Parties shIH
negotiate compensadon for any addittowal services added.
47, Waiver.
Fhe delay or fiiikire by the Alhance to exerci,.-,c or enforce any oi'its rights under this sonar wt will not constitutes or be deoned
a waiver of the Alliance's right thereafter to enforce those rights,nor will any single.or,partial exercise ofany such right preclude
any other or furt-her exercise thereof or the exercise ol"any Mier right,
48. ClonijAiance
Fhe Provider shall abide'; by all applicable current federal stattites, laws,rules and regulations as well as applicable current state
MIMICS, kAWS, 111fCS aInd f0gulations, policies o�f the Departmew,and the terror ofthis Contract,The Pariie�agree Oiat railare of
fl,w Provider to ahidu by these laws, rules,rq,ulalions, policies, and terms of'Ons Contract shall be deenied an event of(lefilult
of the Provider and subject: the Provider to disc il)I inary action including corrective action, unannounced special nionitoring,
temporary assurription ofthe operation of
one or niore contrachial services, plaCeolent (if the Provider on probationary status,
imposing a moratorium on Provider action, imposing Financial penalties fir nonperformance or noncompliance, or other
achninistrative action to inimediate,unilateral (imeellation at the discrefion ofthe Alliance.
Page 11 ot'57
If t I ic A I I iance finds drat im tile provider fails to abide by a I l app I icah IC current fedel a I and state statutes,laws,rules and regulations,
as we I I as c.onditions ofthis Contract, the A Ih ance shall provide tile Provider a Notice ot'Violation whiel I shall inch I dc as concise
statement of the specillic violations ofthe Provider and the fiacts relied upon to estabhsh the violation,
Upon receillf ofthe Notice oI"Violation, the Provider Shall have to enly-one Q I I days to respond to tile Nonce W'Viokution, The
Provider's response must include as statement of any disputed issues of material fact and a concise statement ofthe specific facts
the Provider contends warrant reversal or deviation from the Alliance's proposed action, including an explanation of flow the
alle,,Cd facts retate to the specific rules,stattiles,or contractuat term,
t,
Failure ofthe Prov icier to respond to the Notice or Violation widlin twenty-one(2 l)days shall he(IMUCLI it waiver ofthe ri 4 g i ts
m.utlined above and the Alliance will procced against the llrovidcr by del'ault,
Fhe Alliance,upon receiving a Oinely filed response to a Notice of Violation, will fonvard the response and Lill accornpanying
doclinierltation to the C ontract Managel to ivview and Consider. file Colmart Mkinager shall. tvithill 10 days aftor tile receipt of"
tile Provider's response, file W1 order which lays out the final determination of disciplinary action by the Alkatim
49, Final Invoice
T`710 F,I 11-1—id,shal I suhniii ibe final i I I\oico,f'm,I m%moit Let the A I I imcc as spwcriIicd in(his("'on n-ao I H he Provido,Cdi Is I(� ;ubrnI kraal request
tkw tmymont as�pecifiecl in thii contract.them atl rightS lO p),eTnent ma) be, Iotfintod and the Mfiance ma� mg honor m&) requesk subinntcd,
Any paymon due midei diet icruis of this conuact nlav bV, t%ithheld ikmii all rcjmrv,duc fmin Oh-Provido and nCLcssmN ad,iwomcws thelcio
lm e beea ar)pro"ed lly Ow Alhmce
5W Modifications
70ifications cd'provisions of this contract Shall Only he valid when they have heen reduced to Writing and duiv
signal by both parlics,
51" a�nsgnsj�qnqf Work.
1 he Alhance may in its sofa discretion suspend any or all activities under dais contract when in the Deparmici-it eat`E"Ider AlTairs
ari&or the Alliance determilics that it is in the best interests of State to(to so. fhe Alharice shall provide the Provider written
notice outlining the particulars ot"Suspensiow F"A'ampfes of(lie reason 661,Suspension include, but are net hinited to, budgetary
Constraints decktration or mergency, or cilher such circurostariccs. After receiving a suspension notice, (lie Providel—shall
Comply with OW notice and shall riot accept anY purchase orders, Within, ninety days, or my longer period agreed to by tile
Provider,the Alliance shall cilher(I) issue as notice authorizin- resumption of4ork, at which time activity shall resurne, or(2)
terminate the Contract oi-purchme order. Suspension of,worik Shall not Nithle the Provider to any additional compensation.
51 Termination
52.1 Termination for Convenicnce.This contract may be terminated by either party without cause upon no less than thirty(30)
calendar thtys' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice
shall be delivered by U,S. Postal Service with verit"ication or delivery oi-any exj-.)ecfited clelive or mn-vice that provides
veriftealion of'delivery or by hand cIefivery to the Contract Manager tar the representative of the Providei,responsible for
administration ofthe contract,The Provider shall not furnkh any product after it receives tile notice ofterinination.except
a, necessary to complete the confiiii,[Cd portion of tile contract, ifany,The Provider shall not be entitled to recover,any
cancellation charges or lost profits. See notes oil entail re2arding this parkqlaph,
52 2 Terillination for(,'tmsc, Hic Alhaticemay terminate this Contract it tile Provldin,fails to(I)deliver the product within tile
little spocified in the contraci or any extension, (2) manitairt adC(ILIMC firOgrCSS, thus endangering performance ofthe
contract,(3)honor any ierrit oI'lhc,(4)abide lay any statutory requirement,regulatory W(JUil-C11101t,licensing rCCIWirCloellt,
or Department policy or(5) in [lie event runds for paynient become unavailable for this Contract. The Alliance will be
tile final authority as to the availability and adequacy offlunds, In tile event of terniniation,of this contract. the Provider
will lie conipensated for any work satisfactorily cornpIleted prior to the date of termimidon. The Provider shall continue
work on any work not terininated. Except Cot-defaults ot'subconvaclors at any tier, tile Provider shall not be liabtc for
aTly eXCOSS COMB WOW CHROM to IWrf0fATl tile('10inl1lCt arises from eveills completely beyond the control,and without ihe
rault or negligeace. of the Provider. if then thilure to perforin is caused by the default(A'a subcontractor at any tier,all(] if.
the cause of the clefinull is Completely beyond the control ofboth the Provider and tile subcontractor,and without the finult
or negligence of eitho,,the ProvidershaH not be liable for any excess costs Liar fiailure to perforru,unless the subcontracted
products or services were(tbtainaWc from other sources in sufficient dilate for the provider to locet: the required delivery
Schedule. f I".after,terrilination, it is determined ihat tile Provider was not in default,or(hat the defaull was CXCLlsaWe,the
rights and oblil,,ations ot'die Parties shall be the same, as if tile termination had been issued for the convenience Offlic
Alliance. flic riohts and rentedies ofthe Alliance in this clause are in addition to any other rights and remedies provicied
Page 1.2 tit`57
by law or under die C'ontract
523 t Ilion expiration or termination of'this Contract, the Provider and subcontractors iluall transf'cr all public recimls in its
possessicirt to the Alliance and destroy any (hiplicate public records that are exerillm or confideritial and exenqm from
puhlic records, cfis(losure requirements af no cost to the Alliance, All electronicatly store(] records shall be provided to
the Alliance in as tbrmat that is compalible with the Alliance's inf'orroation technokwy system(s),
53, S u ecesso rs
his contract shall remain bindino upon the successors in irfwrcst oi'ekher the Alliance or the Provider ,�aihjcct to ihe assipmieni
pro6simrs ahove,
54, Electronic Records and S
. - EaMUi arratrrre
54 1 Hie Alfi;.,mce authorizes, but (foes nor require, (lie Provider to create and retain electronic records and to rise electronic
signatures to conducil transactions ticces5ary to carry oul die terms ol'this Contract. A Provider diat creates and retains
electrouic records Wld USCS ClCcironic signatures to conduct tran mct ions shall comply with the requirements cornaineff in
the Uni6orm Electronic'Transaction Act, s, 668.50, Ha,Stat. Ail electronic records rnust be flilly audiu,"ible;aresubjcCt to
Florida's Public Records Law, Ch. 10, and Fla. Snil.., ITILIS1 C011110), with Section 29, Dam Intepity mid Saloomarding
In f'orniatiow flitist niklitltaio all confidentiality,as applicable-and niust be retained and maintai tied by the Provider for the
Same extent"As rion-Clectronic records are retairwd and marinaimed as required by this Contract,
54.? File Alliance's authorization pursuant to this section does not authorize efecti-curio transactions between the Provider and
the Alliance. 'Fhe Provider is mabc)6zed to conduct clecurmic (rairsactions with die Alliance only upon fintlierwritten
consent by the Alfianec.
543 Upou requost by the Alliance,the Provider shall provide fire Alliance with non-electronic(paper)copies of'records, Not)-
clecironic (paper) cripies piovided to the Alliance of"any doctiment that was originallly in electronic dorm with all
electronic signature must indicate the person and the person's capacity who electronically signed the document on any
non-electronic copy ot'die docament,
55. !a gievial Provisions
"I'lle Provider u-recs to Ific l'oHmVin- Pri,wisions:
5.5.1 1 ovestigation of Criminal Allegatimm
Any report that impkes,crifit inaJ hitent on the parr ot'llie Provider or any Alb-C'ontracfors and reirerred to a governmental
or uivcstig,atory agency must be sent to the Alfiance. lFthe Provider has reason to believe that the allegations will fie
reCerred to the State AtIonley, a law enf6rcernent agency, the United States Attorney's office, or other governmental
agency, the Pmvider shaH turfif.w tire contract nianagm. A copy,okilf documoit",reports, noto's,or other written nuncrW
c(PICerning (be it)vest igaif ion,who(her in the Possession ol'the Providor or Sub-Ccuitractors,rnust be seat to the Alliance's
contract manager with a sunintary of'the invesiigafioa and fllCgddoaS.
55.2 Volunteers:
Ric Provider sludl enstire the USC kit'trairied voltancers in providing direct services delivered to older Individuals all(!
individuals with disabihHes nCedill(Ill such SCV-OCCS, lt'l1OSSibk,, the Provider shall work in coordination with organizations
that have experiencu in providing,training, placernent, and stipends for VolnilteerS or part icipanis (such as organizations
Call-yiog OUI rederal scrOce prograrns administered by the Corporafion ter NaLioural and Community Service), in
community service settings,
553 Enftwcement:
Hre Alkance ma.y.m ithom to an1v iniennediate,mewofle'S m ailahlc to it Ow hmidco , tcscind ibc conuau. if'the Alhance
Brads that,
553 1 Ali inlcrrtkmal act of,the Provider has mawriidty afl"ecled ific HeAlh,welfilire,or satet v I)LIF'SUMM
to this contract.or subsumlialh and nqatkdY affcctcd the operalion ot"set-vices cmered under this couor:�a :
5 JS.3,2 The Provider lacks financial siahiky Sulficierit to meet Comractual obligadows or That cowracaull Vumk 11mv heen
misappropriale(I
55,33 1 hk- Plovidor Luis conllnil[CI multiple or repeated Viokarmis of lqg;O and rCgukuory standards. regardless of wllwthcr such
haws or unibrced by thc Alliancc.ordw Plovidet hasmmnMcd of tcpoom]violuflon�ol'theAlliance or the
Page 13 of 57
Deparianew
5%14 'Me MvOder his JWled to carom imic Me pro"sOn muWansim Wen 1"s alter Owdechurhon"a Aute uNniulmmy;md/or
5131 1 he I)uvhkr has Wd I a adhem to the wrnn5 of this combact,
In the ahcrnad,,c, die Alliance nia). at its sole disuroW lake intowdiaw nwourvs ugaillM the PRA idCl-, illChidilll'CMCLJf%C U6011,
"nannomiced special iinmHwhy 1mripmmy numqKm of olio.lalwahm dmw oi"ww wnmwwM wmIn plusuem WE Vmvidor
oil probakomirm stiltu% SPAW a MMVOHWU on Pnwww, adim, intposing Wilchl powhics Cot ot olhvi
administrative acfion
W! In ma&g any &wmQw&n Wer U pamMon Te AlUmm im) wl; upn be HnWngs of anedwr slate or Woui agwrq of
c4lier wgidmoD huQ� Nn) chtims for daniages Aw bmuh ormk LMMO UM CWMN Amin mhuhistnilhe proixedbgs W shMI he
bmight khm trite appVrime emit in Me vowe M AdArrikDWe CowAy.
515 NO 01 Surocu Wdhm�
Hie d"Xclw uk°r Ni ill opti"91C OW lNe ofconarmt Mwls Q smIT dw nladmwn NudWe nunlwr oV didiviTiMs"it the serNes allo"M
day IS awad, I he Prm Wer"M voW rail I"Os pnivWed h) this ennuma to gyro vicle sudi anNiWes,
55.6 Surphis/Deficit Repm-r
I'lle Prokidet will SW)lnn,a umiswkwed stirl&KN11ch ivpwt A as kwmm pin"Jed 4 Me Wwo w the AlAnKs numo Manger
W c"NuAn WM the impized morlit"WUNg sAmWom TO mpwt k Ar Mb coutma betwen Ow PmWa wO Hw AlTmen Hie
selmn wKWO;dome WAK"hg:
55A 1 1 he PmOd&s detailed pWn on Nm be mqMm o"Wih MwAing nueoldig the I%Oiresfudd kOh he remOR
5i,62
S5,63
516A AWN of chants ornd mid AgWgmW lAmNlit-yResnurce(L"enter("ADRO)SeW.UmRacts,
INd pMoAl dimts arras;wait for services,the Alliance in its sole Wscroimi can relice RmdMg awaixis Wlhe Pnwider
is not spcinckrigaccordirtg W nuinkly pWns wd N piqlvoui W me m a wq*m m the mW of We yvar
517 TWAW The Provider will attaid all wqWral tminings and nieetinp schedade by the Alliance,
56
The AHNnce;nay submihne arty Allhance eniployce to scrvcas the Contract Manager
57. Official Ps ee and It
Ile nmn,Wdrem, and telellmw nwam"rthe wpmwramw Or the Alhunce 1hr this conimcit is:
Kax B. Rothm an, K), LLN. President and Cl`'O
760 NW 107th Ave, Hittite 214
NEW FhrWa 13 172
(305)670-6500, Ext.224
f1ge 14 of 57
flw name, address, and telephone 111.11111)CJ Of the ft-prescia'ative ofllw rlrovidci° responsible for administration of the program
under this Contract is:
.......... ......
Ube Provider name,as shown on page I of,this Contract, Monroe County Board of Comity CommiIssigners,
a, and mailing, address od'the official payee to whoull the Social services/111-110111C Serviccs
payment shall be made is: 1100 Simonton Street,2-257
1:1, 33040_L
Sheryl Grahmn, Scnior U.)ireclor
h. The name of'ihe contact person and strect address where Monroe County Board of'County Commissioners,
Financial and adillinistrative records are maintained is: Social Services,'ln-Home Smice-s
f 100 Simonton Strect, �-257
Kq , West, H, 330,10
.............................................................. ..... ....................
The name, address, and t0cphou numbor ol" the Slw.�I/l Graham, Senior Director
representative of' tho Provider responsibIc For Monrm�County Board ofCounty Commissioners,
administration ofthe prograrn under this coniract is. social services/hi-1[011ie Services
I I00 Simonton Street,2-257
--—-----------—--------- ..........................................! cw-W-e2i.,tv..--33040-- .......................................
f lie section and location wilhin the AAA where Requests Vice President for Finance
& for for Aging, hic,
r Payment and Receipt and F-,xpcnLfimrc forms are tobe L,
madW is 760 N\V 107th Avciaw,SUitc2k
Miami. F"lorida 33 172-3 155
...............----..........
Comraci rvloililor
Alliance for Aging, Inc.
File twine,address,and idephone numberofthe Comract V
1 760 NW Wih Avome, Sidle,2 14
Manager for the, AAA for this cormuct is� M iarni. Florida 3 3�7 1 2-3155
.............................................. ............. ............................ J
In tile event (fifferent representatives are designated 1.)Y either papa my after execution of'this conn-act, notice of Ole name and
address of,thc new representative will be rendered in writing w the otho- party and said notification atlached to originals ofthis
contract,
58. All "Forms and Conditions Included
This contract and its Attachments and ari y exhibits referenced irl said attachments,togellict with ally docmnents incorporated by
referencc, contain, all the lernis anal conditions a�;rew upon i)w tire r,arties, rhere, are no Promlons, terms, conchlions, Or
Obligations other dian thow conWined hercin, and this conti-nett Shall SUI)CNedC,till Previous COMMLMiC,160ns, representations or
agreernents,either written or verbal between the Parties.
Page 15 of 57
Cm-tt ac.t Nuaaflm IQ 2297
By signing this contract,the Parlies agree duet tdae� 'queue read and agiree to the contract.
[IN WrNESS T'IIER O ,the Parties hereto have c ss ,e.R cou^atml,to be executed by thehr unde wm xucd officials as duly authorized,
Monroe County Board of County
Provider- Commissioners,Social Sery ices/]n-Hom e ALLIANCE FOR AGING,INC.
„,,,D, GZtGlf7
NAME: David Rice NAME� MAX B.ROTHMAN,JD, 11-M.
TITLE�— "Mayor IJTI.E� PRESIDENT AND CEO
"ate ,
�.m dam, "Ju ..29 a..2022...
adok, Clerk
NqWfy signed by James 0,
1 James D.
� A'bbuaBamnaa�u
IMolenaar
Appw�rv+rd to F say andz¢�aaz.rar cr�a a.0�o�a-c�ro°ears°
LegalSuMiclancy
As Deputy Citirk Jan**D.Molenaar
Asat County
MONROE COUNTY ATTORNEYS OFFICE
Page 16 of 57
INDEX TO A,t"rACI-IMJ",.N'rS
Attachment I SERVICE PROVISIONS ALZHEIMER'S DISEASE INITIATIVE
Attachment If CERTIFICATIONS AND ASSURANCES
Attachmoit III FINANCIAL AND("ONIPLIANCE AUDIT
Attachment)II ASSURANCES NON("'ONSTRUCTION PROGRAMS
Attachment Vil BUDGETS1 IM MARY
Attachment Vill INVOICE REPORTSCHEDULE
Attachment IX REQUESTFOR PAYMENT FORM
Attachment X RECEIPT AND EXPENDITURE REPORT
Attachment A DOEA IiANDBOOK
Attachment B CIVIL RICIFFS COAIPI,.,IAN(-'E CUIECKLIST
Attachment C BUSINESS ASSOCIATES A(,'IIEI,'MLN'I'
Attachment 1) BACKGROUND SCREENING AFFADAVITOFCOMPLIAN(E
Attachment F REFEIIRAL PROTOCOL At, AND DISABILl"I'Y' RESOURCL CENTER (AI)IZC).--
Page 17 ol'57
ATTACIEMENT1
ALMLIMER'S DISEASE INITIATIVE PROGRAM
SECTION 1.SERVICES TO BE PROVMED
A. I)t',FINI'I'IONSOF'I'EIZMSA NI)A(:R(I)NYMS
1, ACRONYMS
Alzheititer's Disease(AD)
Alzheimer's Disease Initiative(ADI)
Acl ivii ies M'Dafly Living, (ADL)
Area Agency on Ag.;iq�, (AAA)
Assessed Priority Const"ner List (APCL)
Adult Protective Scrvices(APS)
Client Information and Registration Frackirlo System (ec'IR IN)
Corniminity ('are For Disabled Adults(CC DA)
lirrective Action Plan(CAll)
Denientia Care&(ure Initiative(DCCI)
-(r)0EA)orDqarnncnt
Department ol'E'Ider Affairs Progrant and Sow ices Handbook (DOFA I IAN DBOOK)
I lome('are f"or Disablcd AdUhS(H(,'DA)
lusn'lunental Activities of Daily Living(lADl
Memory Disordet°Chnic WDC)
Manning and Service Area(PSA)
2,. PROGRAM SPE( IFICTERMS
Department of Elder Affairs, 11andbook: Ali OffiCad (10CUITICht Of' D(1EA `III W)L'A I landbook includes prograin
fioficie,s, procedw-es, nand standar-cls applicatfle ro agencies which are of DOFA l'undcdprograrns. An
Z,
aivioal update is provided throng �a Notice of,Instruction(NOI).
j
Functional Assessment: A cornfirchensive, systenlatic, and mohidimensimu'd rcMevv of as person's abilky to remain
independent and in the least restrictive hving arrati-emern. DOEA Form 70113 is lised by case inanagers to conduct the
functional asses snient.
Memory Disorder Clinic: Research oriented programs CA-0aled pursliaw lo Sections 430.502(I) xid (2), F,S_ to provide
diacgmo,stic and ref"en-al services,conchio hasicand service-relined multidisciplinary rcseardi,and develop tridning niaterials
r and edlICIltiortal oppotundfics tier hiy and protessionat careg,ivers of individuals with Al.),
PrOViSO: LAMUMI&IC USed in as"efteral appropriations bill to qtiahf or restrict the way in which as specific approptiatioa is to
M
be expended,
Progrnin 1-lighfights. Success stories, quotes,testinionials,or hutnan-interest vignettes that are used if]tile Department's
Summary of'Progranis and Services,(SOPS) to inchide iniorma(ion that helps Celt the story ofhow prograinsiind services
help elders, fatudies,and caregivers.
Specialized DaY Care. Licensed Specialized Alzheimer's Services Aduh Day Clare Centers, licensed in accordance with
Section 429,9 f 8, FS., that are considered models becaLISC they provide specialized Alzheimer's services for AD clients.
provide all raja-tea-date listing of all Specialized Mzheirner's Services Adult Day Care Centers,
Specialized Altzheimer's Services-Specialized Alzbeinrers services,offered in day care centers include,bill are neat limited
to,those listed belmy�
at. providing education and training on the specialized needs of persons with Alzheimer's disease or rehited memory
disorders and caregivcrs.
b. Providing specialized activities that promote,rnaintain,or enhance tile AD]client's physical,cognitive,social,spiritual,
or eirlotional heillh.
e Providing therapeutic, beh,,.iviorat, health, safely, and security interventions,,chnical care,and support services far the
AD[client and caregiver.
Page 18 o 1'.5 7
1, General Statement
The purpose of the. DI is to address the special riceds of indivicklidS with AD,their families,and caregivers.
1 Alzheimer's Disease Initiative Mission Staletnent
The ADI progfam assists persons at'llicied with AD and oltier li,a-ins ot'donlentia to live as indepc,,ndenfly as possible with
support to fancily members and caregivers.
3. Authority
The relevant aillhoritV oovenung ADI program are:
a. Rule 581)-t, Horr&,i Administrative Code
b, Sections 430.501 throu-1i 430.504,F.
c, zn
1 lie Catalog of State 11nanciat Assistance(('St-A)Nombers are 65004 and 6.5002
at. Scol)e of Ser~viee and Eligible Individwals
The, Provider is respollsiMe ibr the programmatic,fiscal,and operational managenrerutt of dw as program per this contract,
I'lle program services shall be provided in a illanner consistent with the Area PLID, as UI)CIMCd alld 0U.' CUIT010 1,)O[,-,A
Handbook, which are incorporated by refierence. file Provido a,o,rCCS M fit' b0011(l by 111 SUbW(jUClH 3DIUMINIC31rS and
revisions to the DOEIA l landhook, and the Provider agrees to accept all Such amendinents and revisions,
C Clients to be Served
1, Gvneral Eligibility
The AM Proormil addresses tile speei"t) need's ol'irldividuals with AD or tlthcq.relaled ofisim'ders and their careg6vers,
I Client Eligiltility
Clients eligible to receive services under this contract must:
a. Be I IS years,ol'age or older and have a(fiagnosis ofAD or a related disorder,or be SLlSPQdCd ofhavilig AU)or a related
disorder;or
b. If enrolled in Specialized Alzheimer's Services Adult Day Care, be a participant who has a docurriented diagnosis of'
Alzheimer's disease or a derrientia-related disorder(ADRD) t`rom a licensed physichlll. licull"wd physician assisullw or
ficensed advanced registered nurse practitiorlct%acid
c, Not Ile enrolled in any Medicaid catinated long-term care firo-rarn.
3. Targeted Groups,
Priority for services providel-I under this contract Miall be givers trf 11losc Cligible persons assessed to lie at risk oflilacement
ill arl institution.
SECTION IL MANNER OF SERVICE PROVISION
A, Service Tasks
ro achiew the goals ofthe ADI prot-ram, the Provider shall perfi'li-ni, or ensure flial its subcontractors ped,01111,the following
tasks:
1. Client Eligibility Determination
'rhe provider shall ensure that applicarru data is evakiated lo determine eligibility. Fligibility to becorne a client is based on
meting the requiremews described In Section I.C.2,
2. Assessment and Pr-ioritization of Set-vice Deliveq for New Clients
The Provider shall ensure tile Rdlowing criteria tire used to prioritize now clients in the sequence below for set-vice delivery.
It is not tile intent of the Deparfillent to reolove exisfine clients firom services to serve new clients being assessed wid
prioritized for wrvice delivery.
Page 19 (A'57
iii. Imminent Risk in(fividwifs. Individuals in the' COMMUnity whose mental or physical heakh condition has deteriorated
to the deorce that:self-care is not possible,thcre is no caliable caregiver,and nursou, home placement is likely within a
month or very likely within Ifiree(3)months.
b. Service I-wiority for individuals riot included above, rcga s rdlc� of referral source, will be determined Huron the
Depart,ment's functional assessment administered to each applicant, to the extent ftinding is available. The Provider
shall ensure that priority is given to applicants at the higher levets of trailty and risk of nursing home placeinern.
31 Task Limits
Fhe Provider shall not perform any tasks related tr.0 the project other than those described in this contract without the C,,,,p1-Qss
written consent offlic, Departiner1r,
H. Staffing 11equirments
I. staffing Levels
The Provider shaIl assign its ovvn administrative and Support statTas necessary ua meet the obligations of"this contract and
shall ensure tImt subcontractors dedicate adequate stuffaccordiiq.,Illy.
1, P-ofessional Qualifications
The Provider Mull erasure that the staft,responsible for performing any duties or functions within this contract have the
qualifications as specificd in the current DOHA hand
Set-vice Times
I'lle Provider shall ensure Ole avirflabilify of Oic services fisted in this contract at thries uppropriate to meet Client service
needs including, at as min rnum, during normal business hours, or as otherwise specifiecl in proviso or the Subcontractor's
approved service providerapplicaficin.Normal business hours are defined as Monday through Friday,8:00 ami, to 5M p.m,
local finm
4, Usc ol'Subcontractors
If this contract involve"tile,use ofil subcoritractor or third party,then the Provider shall not delay,the inipleawritation of ns
a,grecment with the Subcontractor. It'any CiRJH11Sfi'MCC OCCUrS that may result in a May f'or as period of sixty (60)days or
more ofthe inkiation of the saibcornract or flie performance of the Subcontractor, the Provider shall notify the Alliance's
Contract Manager ot'such dekly, The Provider shail not permit as Subcontractor to perl'orm services related to this contract
without heaving, a binding SUbcoraractor agreement executed. ]'lie Department will not be responsible (it liable tbr any
Obh�"MiOoS OrChlinIS NSUldrII!, h-OM such action,
a. Copies of Subcontracts
Me Provider shall submit a copy of all subcontracts to ilic Alliance Contract Manager withill thirty- (M) (LIVS ofthe
subcontract bcin,�t�executed,
b, monitoring ttic i,erformance or Subcontractors
The Provider shall monkor, at Icast once per fiscal year, each of its Subcontractors, subrecipiews. vendols, and/or
consuharns paid ficini funds provided under this contract, 'I lie Provider shall fierlbrin fiscal administrative, and
pro-rammatic monitoring to ensure contractual coinphance. f-iscat accountability, prograrnmatic pert Linn ance, and
comp hance with as lira ble state and federal laws and regulations.J lie Provider shall monitor,to ensure that the[)udget
is met,the scope of'work is accornpliMied within the specified fime pei1ods,an(]w1w performance goals stziied in this
contract are achieved,
c. (:,opies of Subconfiwtor Monitoring Iteports
The Provider shall lbrward a copy of,alI subcontractor Monitoring Reports to the Miance Marta ger within
c'thirty(30)days of"dw report heing issued io the Subconlractors, Subrecipicirts, Vendors,and/or CMISUIWMS.
C. Deliverables
Hie I"ot low hig section provides the specific quantifiable units ofdeliverki[fles and source documentation required to evidence the
coinpleflon ofthe tasks specified in this contract,
1. DON er), of Services to Eligible('"lients
The Provider shall ensure the provision of a continuum of'services addressing the diverse needs of individuals with AD and
their caregivers. T'he Provider shall ensure performance and repoiling, of the forlovNing services in accordance with [lie
current. DOEA I landbook, which is incorpormed by reforencc,and Section ILA,of this contract. Documentation ofservice
Page 20 ol'57
delively must include a report consisting of'thc fiAlowing: number oi'chents servecL ntunbcr of service units provided b
4n Y
service,and raw per service unit with Calculations that equal the toW illWiCC-,UnOUnt, The continuum ol'survices provided
under 1his contract incItide those idemifiwd by fhe following service cats gorim
Respite aoid Other Services
(I)Caregiver Training/SupPort,
(2)Case Aide.
(3)Case Manauement.
(4)Counseling((icronfolou ical),
(5)("OHnSehoO(Mental Ifeakh/Screcliiiig).
(6)Education'Tunning,
(7) 1 lonie Dchvered Meals
(8)11OLlsing huprovement
(9)NlaturW A id
f()) Respite(Facility-Based),
I I) Respite(111-Home),
t 2) Respite(In-Facility, SpeciaHzed A)zheimer's serviceq)
13)Speciali/,cd Medical Equipment, Serviccs.and Supphes; and
t 4)],rawqxwUll ioll,
1 Services and Units of Set-vice
The Provider shall ensure that tile provisioll of services described ill this comma is im accordance with the current DOLIA
I fandbook and the Sol-vice tasks describod in Section ILA, The Budget Sunmun)! (Auachmem X11) fists the smiiices that
can be the reirn bursemen( unit rate, the method of payrnent,and the set Vice will type, Units of'Service vviH be
paid pursuant to the.Budgct Summary(Amichnlent VI I),
3, Administrative Responsibilities
The Provider shall provide managwimit and oversight of'ADI plodNlnl Opffilk()IIS ill lCCOf'ddHUC With [Ile CLU'rellt DO FA
I landbook, Managmictit and oversight of Al)) program operations include the foIlowitlg�
a, Fstablish contractual ageeniclits with appropriate and capatfle subcontractor and vendoragieements,when applicable,
1) Provide rechoical assistance to subcontractors and vendors to ensure Inovision ol'(plahty Services
c, Monitor and evaluate subcontractors and widors fol appropriale programmatic wid fiSU11 Ck)inf)HaoLC,
(L Appropriately subunit payumits to subcontnactors.
e, 11,stablish procedures for handling recipient complaints and OISUre that subcontractors develop and implement
complaint proccdures to process and resolve ckent dissatisraction with services, Complaint procedures shall address
the (11tahly and tinleliness of'Services, provider and direct service worker complaints, or any other advice related w
complaints other than termiwfli(ffl.SUSIleflSiOn M NdUclion in services that require the grievance process as described
in Appendix 1),Department M'E'Ider AtTairs Programs and Services I landbook, Fhe complaint procedures MWI incIude
notification to aH chems of the complaint procedLIN MKI include tracking the date, nature of comphlini, aml the
determination of each compIaillt.
f Entire comphance with Client InForination and Registration TrackJqg Sysiern (cCIRTS)regulalions.
Monitor outcome measia-es in accordance with targets set by the Department,
11, Conduct client smisfactioll Surveys to ev"Au"Ite and improve Service delivery,
11. REPORTS
The Provider shall iespond to addidond routine or special lecluests I'm ildbrinatioll and reports required by the Alliance in a
timely manner, as deternlined by the Alliance Conti-act Manager. ']'Ile Pt'OVider 01HII eSWIfliSh rCj)OT1ir1g dOC, daWS f6r
Subconhactors that permit the Provider to meot Ow contract reporting requironlenK
t Retrmpective Unit Cost Methodology(RUCA1):
The Provider shall submit a Retrospective Unif, Cost Mohodology(RUCM) to the Alliance annually no later than ninety
(90) calendar days after the Provider F isufl Year end, The RUCM M1,111 NNO aCtLnd COStS OFPWVidnl,'' each service by
program for the preceding Provider fiscal year. Ifthe Provider desilles to reneg .
C, ouate its reimbursenient rates, the Vrovidor
shall make a request in writing,to the Alliance in accordance with the Alliance's approved Reimbursement Rate Review
Policy,which is, incorporated by reforence.
2, (&IRTS" Reports:
The Provider shaH crisure timely inplit of ADI specific daut into cCIRTS� to ensure &1RTS data accuracy, the Provider
shall adhere to the Alliance's eClRYS Dam Intelgit 1) 11 itlelil y Policy aid use eCi RTS-gerwrated reports w ic de the fctllow irlg
d1 Client Repom�
b. Monitoring Rcports:
c. Service Rq)orts�
& Miscellaneous Repoms;
C Fiscal Reports; and
l', Outcome Measures Reports.
3, Surphis/Deficit Report;
The Provider will wbmil a consolidated SUrj1IUS/(JCfiCit NpOrr in as format provided by the Alliance to the Alliance's 'ontract
g Manager in Colt.junction with the iequired monthly bilfin=submission, The report will inc tude tile flillowing:
,i, Acitial contracted funding utilized each month and YJ 1)
1), Nomber ofactivc clients Compared to tfie average numbei of churns Funded in [tie clontrad
c. Monthly and Y I'D number ofunduplicwed clients served
(l, Detailed plan on how any prc,1jected surplus (or deficil) spolding exceeding the Sm-iflus allowance threshold in the
Alliance Policim inecirporaled here h.y refercnice,I will be resolvecL
fir accordance with Alliance surpius!deficil inanagement lxflicie ,in order to inrmimizo availihh.!ftinding and minimize the
tithe dhlt I)Otefflial LfielitS MUSI wait kor services,1he AllifflILC in its 1":OC(fiSO'COOT)U111 I-C(IUCC I'Linding awards if the Provider
if,not whiiin the Alliance poliq surphis allowance,
4. Co-111a), Collections Repor(
1 lie 11tovidel shall Submit a Consolikintod armlial co-payment collmions report to the Athance Contract Manager by July
31, 2023,usim, Aliacliment 5, located in Appendix B ot'die Programs arid Services I landbooL.
5. Program Highlights
The provider shall submit Proaram Hi gliligMS reft'rencing specific events that occurred in the previous fiscal year by
Sepronber 151h of ihe current contract year. Ific Provider shatl provide,a iwnv success story,quole, iesliinoniaL or lititylao-
intecest vignene. Hie highlights shall be written Im, as gciwnd audicricc, with no acronyms or technical let-ills. For all
wyencic-i or organizations that are referericed in flw highlight,the Provider shah provide a brief(lescription of'theirinission
or n)te. The active tense shall be consistently used in the highlight narrative, in order to idetilify it qpecific or
emity that perfolined itte activity dewribed in the hi.ghlighi. The Provider shall reviov and edit Program Highlights for
clayit , teadability,retevace n ,Sp a d g Specificity,hilinn ililerest,anrammar, prior to subr mn iiining il It)die Alliance.
Y
L RECORDS AND DOCUMENTA"FIC)N
the Provider will ensure the collection and maintenance of chent and service inf'ormation on a morillity basis from. the Client
lnfiormat4)n and Registradon Tracking System (c("IRTS) Maimenance includes valid exports and backlips of all data and
systems according to Alliance and Department standmcls,
1. Requests for Payment
The Provider shall marmain documentation to support Requests for Payment: that shall he available to the Alliance, the
Deparunent,of rat6reraaaatlararize,cl agencies and individuals Much as die Florida Deparnnent ofFinaticial Services(DFS),upon
request.
2, eCIRTS Data avid Maintertarkm
The Provider shalt (mSure, on a monthly basis, coltection and maintenance ofchent and strvice int"ormation in e("IRTS or
any such system des4matet]by the Alhatwe. Maintenance includes aICCLJI'Me and CLUreni data,and valid exports and bact,tips
ofall data and s ysicais according to the A Him,=and Ficpartntent sVindards,
3, Plata Integrity and Back rip Procedurm
IIw Provider Shall anticipate and prepare for the toss ofudormation processing capabilitim Hie rolitine backing, up of all
data and software is required to recover from losses or outages of the COMPLIter systeni, Data and soffivare essential to the
continued opera tiott ofilrovider functions milst lie backed up. The security controls over the backtip resources shall be as,
stringent as the protection required ofthe primary resources, It is recommerided that as copy of the backed tip daata be stored
in a secure, offsite location,
Page 22 of'57
4. Policies and Procedures for Records and Doctjmentation�
The Priwider shill mainmin written pAcies arid procedures for computer system backup and recovery and shall have the
sante requiremem of its,Subcontractors, These policies and procedures shall be made available to the AllkMCC UP(M rcquot,
F. PERFORMANCU' SPECIM ATIONS
I Outcom CS
a. ElISLIN the 114-OViSi011 Offfic services described in this contract arc in accordance,with 01C CLUTC111 DOEA
Handbook and Section 11 A,arid Section ILD,ofthis comract;
1), The Provider shait timely submit to the Mliance all reports doscrilml in Section. ILD ofthis contract;
b, "I'lle Provider Shall 111"lillmill aII information describull ill Section fLF.,of this contract:
& Fhe Provider shall ensuj,e the prioritization and set'Vice provision ofelicas in accordance with Section H.A.2 ofthis
contnam
e. Fhe Provider shall timely and aCCUrately submit I(,)the Alliance Attachments A. X and supporting documentation ill
accoidance with Attachment Vill ofthis contract
1 Criteria
The pi,,46i'marice ofthe Prm'00-ifi JWOVkklll', the Wrviccs(Jcscribod ill this contract shall be.measured by the current SPA
strategies for the CoHowing criro-ia:
a. Pment of APS referrals who are in need(ifirrmiedime services to prevent further harm who are served within 72 IIOLHS,
b. Permit of elders assessed Nvith hi?h or moderate risk envirollments who improved their onvironment scorc�
c, Percent of new service recipients with high-risk two ition scores whose nutritional status finprove(k
d, Percent ofnew service recipients Nflimse ADL assessment score has bmi maimaitwd or iinproved�
c. Percent of new service recifyients whose IADL aswssment Score has been maiimdned or improved;
f Percent offiamily and family-11"'Sisted Caregivers who Self4eport they are likely to provide care:
g Percent of earegivers whose ability to provide Care is niainwined or irliproved after one year of service intervention(as
determirted by the caregiver ztild tI)o assessor),
11 PCCC01t 01'MCISt C1161 CIdUrs who remain w home or ill tile COMMUllitV iHStC3d Of O(Jills4 4110 a1TMt-Sijlt.!,home;
i, Percenw-e of,active,Cfients eating t",t)(it,inore rneals per dity,
mler Service intervention, tile percentage of caregivers who self rep orl being very confident about their ability to
continue to provide care.
3. The Provider's performance of the measures ill FD,2, above will be reviewed and documented in the Alliance's Annual
flro�rammatic Monitoring Report.
4. Monitoring and Evaluation
The Alhance will review and mduate the performance of the Provider under(tic lerryis of this contract, Monitoring sImh he
conducte(.1 thiough direct contact with Ole Provides- through telephone, in writing, and/or on-site visit(s), ']'lie Alliance's
determination of aceeptalAe perfi:mmurce shall be coriclusive Hic Provider a.grces to cooperate with the AiHatice in
monitoring the progress ofcornple6orl awl the Service taSICS and deliverables, The Alliance may use, but is nol hmited to,
Cruet.or more of the fblfowing melfu,)ds for rrloniroring:
a. Desk reviews and anat,yaficai revievvsl'
b. Scheduled, unschedrifed, and frrllerw calr on-Sile Vnsits;
e. Client visitsa
d. Review ofindependent auditor's reporm
e, Review ofthird-parly documents and/or evaluation'.
C Review Of progress reports;
g. Review ot'cmstorTler Satisfaction surveys"
It, Agreed-upon procedures review by ao external auditor or consultalll;
i Lfinife(]-scopv reviews;arid
J Other procedures as deemed necessary,
C.', Provider Re.sponsibilities:
Page 23 ot"57
I, Provider Accountability
All service msks and deliverables pursuant to this contract are solely all(]exclusively the responsibility ofthe Provider and
a,re tasks and delivenrblos for which, by e\ectlfion ofthio,contract,the Provider agrees to be held accountable,
2. Cuor-dination with Other Pr-oviders andlor-Entities
Notwithstanding those services for which the Provider is field accountabie involve coordination with other elflities in
Performing d'w requireniclits of, this Contract, tile fifilure of tether entities does not alleviate the Provider from any
accountability for tasks or services that the Provider is obligated to perl'orm purswaiii to this corilract,
K Alliance fbt°Agiutg Responsibilities
Alliance Olihgafions:
Hie Alliance may,withiti its resources,provide technical support and assistance to P flee rovideo as
sist the f1rovidern m in
the re(p6rements of thins contract, I he Alliance sup port and assistance. Or-lack thereof. sliall not relieve the Provider fiuli kill
performance ofcon�ract requirements.
SEX-VION III, METHOD OF PAVMEN'T
A, Payment Methods Used
The method of'paynient rear this contrao is a corribination of fi\ed fec/unit mute, cost and advance Payinents,
Subject to (be availability of flunds mid Provider performance. Hie Alliance eAjjj pay the Provider upon safisfactory completion
Of the Tasks/D(fliveratfles, as specified in Secliorl IL, fVlantier of'Service Provision, and in ;xcordance with other terms and
Condition's of this cmnuaa
1. Fixed Fec/ullit Rate
Payrnem",r(w l"iXed I've/Unit Rme Shall not CNeced artiounts established in Arlactiment V11,tier unit of service.
2, ("'(list
Pavillo-it may tie authorized mfly Im aHowable expoidinires svliich aro in accordance with the, services specified in
Attachment VIL All (,'ost Reimbursement Requests for Paymew must include the Receipt and Expenditute Report,
bcginnin,g with the first month ofihis contract,
3. Advance Payments:
Non-profit Providers nia'v rect Lie st a inonflity acivan ce Ica"sery ice costs f6reach of the first tN�,otiioiitlisof'tiwcotitrrictl)ot�iocl,
N,ised on antic c ted ash needs, For- the first morith's advance request, the Provider sliall provide to the Alliance
documentation JUStif)'ill€� the rieed fear in advmlce and describing how the funds kvifl be distributed, If the Provider k
requesting two(,)) months (,if advaiices, documentation must be provided reflecting the cash needs ofthe N-cwider wiihin
the initial mo (2f months and shoidd be supported through a cash-flow analysis cir other inlivaiation appropriate to
demonstrate(lie Provider's Financial need for the second month ofadvances, 11re Provider must also describe how the funds
will be distributed for the first and second month, ll'SLIft"iCient buduct is available,and the Departinent's Contract Manager,
ill his or her Sole discretioll, has determined that there is justified need for at) advance, the Department will issue"'[ppitived
advancc payments after J it ly I st ofthe contract year.,
A IN advan cc payments jo ade to the Provide.slial I be re irilbu rsed to the At I im ice as fo I loNm all least i nie-tenth o f the advance
paylnent reecived shall be reptaUd as Wi t1dWAVICC f-CCOUI)i1mit on each Request for Payment(Attachment Xl),starting with
the.invoice submission ofthe third nionth activifiesand bilhir-,hi accordance with the Invoice Repot-t Schedlfle(Attachinern
If.
B, Method of invoice Payment
Payment shall be made upon the Provider's presentation of att 4ivoicc subsequent to the acceptance and approval by the Affiance
of'the defiverables shown can flier tnvoice and payment has been received from D0EA. "File form and substarree of each invoice
submitted by the Provider sharp be as fbilms:
I. Request payment on a monthly basis for the"nits ofservices established in this contract, provided in cont"ormance with the
requirements as described in the IR)EA Prograrris and Services fLmdhoolc, and at the rates established in Attachment VII
Of'the CONIUCL DOCLUTICTItiltion ofservice deliver), 1110SI include a report consisting of'the following number of clients
served, munher ofservice units provided by service, and mate per service imit with calculations that equal 1110 total invoice
artiount. Any change to the total contract amount requires a fi-trinal amendment.
Page 24, of'57
1 The Provider shall consolidate aH subcontractors'RCtJUCMS for Payment and Expendiorre Reports that SUj)l)0rt RC(jLlCMS lOr
Payment and shall submit to the Alliance using, Romas Request fool, Payment (Artachincrit IX), Receipt and Expenditure
Reports(Attachment X) for C'ase Management and Special Subsidy Services,
3 All.Requests for Payment shall be based iiii tire submission of'rnonthly F"xpencliture Rep orts beyinning with the first month
ofthe contract. 11-te schedule For subriiission ofadvance requcsts and invoices is Invoice Schedule, Altachment VHL
4, fit the event that services o,cre not billed during the regular billing cycle,(tic Provider may request payment for services no
hater Ikul 90 days Mier the month ill which the expense was incurred, except that reitnests cannot lie made after the contract
ClOWOUt (1411C. RC(ll,10t for pa)"mon of services rendered 90 clays after the monde in whicJi the expense was iricuired wilt
require approval of tile Contract licanagei,Prior to flte billing of such incurred expenses Late service billing requests will
not be Pat(] unless Justification is submitted and approved by the contract inattaver,
5. 1"he Provider Shall mainmin docunientildon to supporl payment rccloests which shall he iovaiktblc to the, Alliance, die
Defiartment,and Ow Department of Financial Services, or other authorized state and federal personnel uptin request; and
6. All paytirents under the icrins ofthis contract are contingent upon in annual appropriation by the Legislature, arid subpo
to Ole availabitity offiinds.
C, Payment Withholding
Any payrroent due by the Deparunent taider the rerons of this contract may be withheld pending tire receipt and approvill by the
Department of all famucial and programmatic reports (low from the ('oWrutor and any ad umnlents thercio, including any
disallowances,
D, MUM 111810iVC InStrUCOCHIS
The Flrovidei�shall subi'llit the Final Reellicst flor Papimit to the Alliance no latter than 30 days after the contract period ends, and
its referenced in Attachmni V111, ll'the contract is tenrinated prior to fliv oid date ofthe contract,then the Provider niust suhrrlit
the final request for payment to the Alliance 110 MON than 30 da.YS after the Contract is terminated. if tile provider faikto dc)so ,
all right to payinent is Forfeited, and the A Mance will not honor any requests submitted afier thew id'oresaid tints period,
E. eCIRTS Data E'ritries for Subcontractors
The 1110vider must require Subcontractors to enter all recluned dara for clients and scivices in the cORTS dmahaw per the
Dt. EA, Proprium and Services I tantfi)ook and the Q( IR FS User Mamiifl -Aging Provider Network users(located in Documents
on dic cC1RJ S Enterprise Application Smiecs), Subconirackirs illust enter this dam into the K lit FS prior to Submitting their
requests for paynrem and ex1midituro reports to the Provider. I lie Provider shall establish deadfiroes for compleOng e0WIS
dilia entry and to assure, C011opHance with (lite dates For the reques s for paynient turd expendilure reports lhat Providerniust
suMnit to the Alliance.
F,, Providers' Monthly eCIR"I'S Reports
The Provider niust run nionthly eCIRTS rports and verify client aitc]service data. rot the eC IRTS is accurate, 1"his report MUSI
be sotomitted to the Alliance with the monthly rel,piest I'm pityinent and eXpellditooT reilOrt ani]nrust be reviewed by tic Mliance
befoi-Q the Provid(m"s request for payinent and expenditure rep orls can he approved by the Alliance,
IV. SPECIAL PROVISIONS
A. Provider's Fiamicial Obligations
I. Matching, Level ol"Efforl,and F"arroarking Reqniremcut:
The Provider must provide a inatch of at teast 10 percent of the cost too-all Al.)I sQjwrjCeS, yhe snatch will be made in the
form ofeash and/or rtkind rosources. At the oil(]of the contnact period,all A furlds expended Must be properly,matched,
State funds catmot lie used to ji'latch anothei suale-finided protg,rartt
2, Cost Sharing and Ct)-payinents:
The Provider in con,jouriction with the Alliance shall establish im annuat co-payrrient goal (arricount to lie: collected fi,om
clients), Using the method prescribed io Appendix B of'the current Department of Elder Affairs 111'roorain and Services
Handbook, the provider shall project the annul co-payrrients to be collected ftorn cach active client in ail hiconic ranges
pric)r to the Snarl of'each fisud yeiur, The provider is required to inco the establigied goal, Co-payments collected in tile
ADI proolrarn call be used a%part ot'the local matc.1r,
Page 25 ot'57
3. Managernent and Use of Service Dollars and Continuity ofService.
a, The Provider is expected to spend all Cunds provided by the Alliance for the PUI-I)OSC specified in this contract, The
Provider must man"I'l'c tile service dollars ill SLICII a tufflIfler so as to avoid having a surplos of"Finds at Oic end ofille
Contract period. If the Alliance determines that tile Provider, is not maxomAng available f'undin4g, the Alfiance, in
accordarice with its Fiscal policies, may transfer funds to other Providers and/or atljust SUbseqkient funding allocations
accordinoly.
b. 1 lie Provider shall ensure that contract services will be provided tinfil the end of the contract period, In orcler to enable
tile, Provider to better mtnmt;.'C the SCTVileS Under this contract and to rnaNiinize the use of available resources, the
Alliance has eslatilished a spending authork), as idemilied in IlUdgd SUIrmiary, Attachment V11. flie Provider is
responsible for niamiMing the spending authority s lhat as contiluty of'service can be maintained for the maximum
HU111110-OfCMISUMCI-S. ThC Provider a-rees to raSsuratc responsilAily for any contraClUat deficit that imly be incmr ,d.
1, Midget Summary:
The Alliance has estalilished a spendingauthority based on services and rate detailed in the SPA and the BmLget Summary,
Attachment Vil and any revisions theroto llf:yproved fly the Alliance. Auk!Chanl"WS ill OW-tOtHI afflMluk ofthe funds identified
on tile Budget Summary require as contract arnendment,
11. Rernedies for Nonconforming Services
I. The Provider shall ensure that all goods imd"or services Provided under this contract are delivered timcK, completely and
COITHIMISUralc with required standards orcItallity, Such lg.00ds and/or services will only he delivered to eligible program
participillits,
2, 11 the Provider filids to meet tile prescribed qualily standards for services, such services will not lie reimbursed under this
contract. Ili addition, any non coil l6rill im, goods (including home delivered meals) and/or services not meeting soch
standirds will riot be reirribursed under this contract, T'he Provider's signature on the reqijcst for payment form certifies
inaintemance of supporting doconlentation and acknowledgemelit that the Vrov idor shall solely bear the, cosls, ,lssociated
Mill preparing orproviding nonconilormimy goods andAm,services. Fhe Alliance requires Immediate rimice ofany significant
and/or systemic kilradions that compromise the cluality.security or continuity of'services to chants.
C. Investigation of Criminal Allegations
Any repoll, that hilphes crimirrat intent cart the part of the Provider or all.)/ Subcontractors and referred to a governmental (it
invesfiypatory agency must be sew to the A Malice which MH in terra rorward thc° ilifionnation to[lie It'tile Alliance
has reason to belicvc that the rdlegations will 1iw refcrred to the Siate Alloriley, a law enforceniew agency, the United States
Attorney's office,or other,governmental agency,the Allhince shall notify the Inspector General at the Departmetil immediatcl y.
A copy ofall dOCUMCIAS, NpOrtS,notes or other"Aften material concerning tile investigation, whether in the possession of the
Provider or Subcontractors, must be sent to the Alliance which will in turn send the material to the Department's Inspector
G,Cneral with as smornal,y of the invCstivV
ation and allegations.
D, Volunteers
The Provider MGM ensure the tise of trained volunteers in providing direct services delivered to older individuals and individuals
willt disabilities needing such services, If possible, the Provider shill work in coordination with organizations flitil have
experience in providing trainiti-, placement, and stipends for volunteers 01' 11'arficipants (such as organizations ciwrynig oto
Federal service programs administered by tile Corwration fim,National and Cloinnilinity Service), it)colimminity Service scttlllgs.
E. Use of Set-vice Dollars and Management (if Assessed Priotity Consumer List
'file Provider is, expected io spend all federal, stale, and other funds provided by the Alliance liar the purpose specified in (lie
contract Ifie Provider must manage flic, Service dollars ill such a manner so as to avoid having a surpIns offunds at tile o"d of
the contrad period, for each program managed by the Provider. flie Provider understands and a-rces to the reaHocation of
funding as described in AMichment 1. Section 111J, offlik contract,
Page '26 of 57
ATTACUMENT11
CERTIFICATIONS AND ASSURANCES
f he Alliance will not award this contract unless Provider conilfletes the('11RTIFICATIONS AND ASSURANCE'S comained in this
Attachment, In perforillance of this contract, Provider provides the fiollowing certifications and assurances:
A Debarment and Stus w C usion erlif
I_ Lt2
M Certification Re;,ardii 129 CFR 1'1anj 93 and 45 CFR Vast 91
Nondiscriminatiog,& E a5 CFR Part 801
qual Oppqjj!jqjtj_A���FR Part 37nd 4 1). C I ertification Reuardfiw Public Entit v Crimes.Lection 228677JI3333, IKS.
E, ssociation of("oummunnAl L_QEgAjjjMjjons For Reform Now ORNLUundii
A-A—C __iLj Ito,frictions AssuraLick 1lub. L.
IILL17
I
1^",, cefliqca
G C -tification R il�
11 �-om )Iiq�ncc for�AlrKtnieuts, GKm"—'t'SJUla muk 11 L'I'toL)mamihs
AaL(Eml C I—It-S
It. Verification of'I'mm loy~"left(Status Cel-tification
1, Records and Documentation
J,
A. CERTIFICATION REGARDING DEXARMENT,SUSPENSION,AND OTHER kESPONSIBILITY MAT"I'L34S
PRIMARY COVERt"D TRANSACTION.
"Hw undersioned Provider certifies to thC,best col" knowled-eand bdict' dial it and its priticipak
t� �X' I
1, Are not presently dek".Irred,suspended. proposed rot,debarment,declared ineligible,or voluntarily oxchoded frorn covered
trunsactions by a Federal depart-rient or a'gellcy:
1 t Lave not within a 1hree-year period preceding this Contract been convicted or lidda civil jud-nicta rendered against them
for conunission offraud or criminal offense in connection with oblarning, attempting to obtain,or perfonnino a pubhc
(Federal,State,or local)transac6lm or contract LffldCrls public transacflon, virikation ot'Foderal or State amitrust stalutes or
coninlission ofembezzlement,thefi, f6r'gery'bribery, GlIsification(.it'destructim ofwcords,makint,false statements,or
rcceivillu stolen property.,
3. Are rica presently indicted or otherwise crinlimflly or Ovitly Charged 1oy a govemment entity(Federal, State or local)with
Commission oraliv of'Olu offenses enumerated in paraoraph A,2 ofthis certHIcation,an(For
4. Have riot within,.,t three-year period preceding this applicortion/proposal had one or more public transactions(Federal,State,
tl
or local)terminated f6t,cause ot'defiank.
B. CERTIFICATION RECARDING LOBBV ING -Certification for Contracts,Grants,Loatis,and Cooperative
Agreements.
The undersigned Providef certifies,tea the best of its knowledge and hehef diat:
Page 27 ()1'57
No Federal appropriated funds have been paid or will Ile paid,by or on b half'offhe undersigned, to any person for influencin,-,
M'attempting to influence all orficer or eniployee ofCongress,or an employee of'a Member ot'Corlgres,.,in contieclion witf',the
awarding ofany Fedcwal coniract,the makingof any Federal grant,file making ofarry Federld loan,file entering into ofany
cooperative agreement.and tire extOlSiOn,L011MILUltrOn, WIIQWrtI,amendinent or rnodifiuition of any FederA contraci, g1rant,
loan or cooperative agreenrcrit.
11'any hunds other thati Federal appropriated furlds, have been paid or will be paid to any per-soil fior influencing or attempting to
influence at) officer or eniployce of any agency, a Member of'Congress,all off ices,or employees of"Congress,or employce of'a
t,
Menifter of'Congress in connection with a Federal contract,fn,ant, loan,or,coolurative agreernerit,the undersigned shall also
corrlp cw and subillil Standard Form -LILL, "Disclosure Form W Report L(Albyirrg," in accordance with its instructions.
the undersigned sh,,fll require Ilun Wiguage ofthis certificalion Ile included in the doctiments for all subcontracts at all tics°s
(including subcontracts,sub-ggailts and contracts under grarlts, loans "'id coop erative aurcenients)and that all sub-recipients
and Providers shaft certify and disclose accordingly.
This Certification is a material representation MAad LIJ)Orl MIMI rCHMICQ Was placed whert(his Cortmact was inade or entered
infiL SLJbIIliSSiOH of this certification is a prerequisite for makiny,or entering into Olis Contract kuposed by 3 l f��SJ'� 13-52. Any
persoll who rails to fife the required ccrtification sliall be subject to a civil penalty cffriot less than $10,000 and not nrore thall
',)'100,000 for cach such ficliture.
(% NON-DISCRINIIINAPION" & FIQUAL OPPORTUNITY ASSURANCE(29 CFR PART AND 45 CFR VART 80). As
a condition of the Contract, Provider assures flurt it will colillify fitilly with are nondiscHminmion and equal oppoilunity
Provisions of the fiflkovirw taws:
Section 188 of the Workforce Inveminent Act of 1998 (WI A),(Pub,L, 105-220)� which prohibits discrimination against all
individuals ill the I l"ited States on the basis of race, c,okw. religion, sex national o6girt,ag,c, disability,pobtical affiliation,
or belief' and against beneficiaries on tire basis ofeither•cifizenship/swus as a lawfully admittol irantigrallt authorized to
work in (lie United States or participation in any WIA Title 1-tinancially assisted Program Or activity„
t,
2, Vide VI ofthe Civil Rights Act of 1964(Pub, L, 88-352), as amended.and all requirelncnts impose([by OrPLH-SlAarit to the
Rq,114itioll ofthe Departilleni offleahli and HUMM SCI'ViCCs(45 CFR Part 80),to Ow crid that, in accordance with Title VI
Onflat Act and the Regida(ion,no person in the United States shall.on the o,rourid ot'race,color,or national origin, be
excluded frwn participation in, be dertied 0 le benefits of',or,be otherwise subjected to discrimillation under ally Program or
activity fior which tire Applicant receives Federal Cinancial assistance frorn the Alliance
3 Section 504(Wthe Rehabilkation Act of 1973 (Ilub L 931 to?)as arnended,and all requirements imposed by a:ar i:wrsilarit to
the Regulation of1he Department ot'llcalth and Hunian Services(45 (TR Pan 84l,to the end that, in accordance with
Beckon 504 of that Act,-urrd (lie Regulation,no otherwise quahFwd handicapped in(fividual in the United States shall,
solely by reawn ot'his fraridicap. be excluded front participation in,be denied Ore benefits of" or be subjected to
discrim ination undei any prograill or activity ror which Ihe Applicant receives Federal finimcial assktancL° pi-oin the
AMance.
4. The Age Discrininvaiion ,'Acts of 1975(Ptlb. L,94-135),as arriended, and all requirements imposed by orpurst,kint to tile
Rellulation elf the Dqartrnem of Heahh and Hurnan Services,(45 CFlk flart 91),to the end that, in accordance with the Act
and'dre Reguknion, it(.)person in the United Stwes shall,on the basis of'agc,be denied file benefits of'.beexchided froril
participation in,or be subJected to discrimination under any program or activity for)vhich the Applicant receives F cdcml I
financial assistance froin the Alliance,
5. l'ille IX ofthe I;ducalional Aniendinents of'1972 (Pub, t_ 92-3 18),as rimended,arid all requireiltei its imposed by or
Pursuant to the RCI'UlatiOrl Ofthe L)Qpartrnent of Health and Human Set-vices(45 CUR fart 86)�to the end that, iii
accordance with Title IN and the Ruptlation, no puson ill the United States shalt,on the basis of sex.,, be excluded from
participation in,be denied the benefits of,or be otherwise sub'pected to diserinifiratioil,wider any edneation prograrn or
activity for which the Applicant receives F"ederal financial assistance from the Alliance,
6. 'rhe Arncrican with Disabilities Act of 1990(flub. L 101-336),prohibits discrini inal ion in all ernployment practices,
including.Job application procedwes, hiring, firino,advancernent,compensation,training,and other ferias,conditions,and
privileges ofeniployment, It applies to recruilinent,advertking,tenure.tayoff, leave, fi1nge benchts,and;fll other
eniploymentrelated activities, arida
Page 28, o f 57
Provider also assures that it wil)comply with 29(TR Part 37 and all o1her rQgIllations implemcnting,the hms hSted above This
assurance appkes to Provider's operation ofthe WIA fide I- fimiriciaIty assisled pro grarn or activity,and to all agreements
Provider makes to carry out the WIA Title I-financially assisted program or activity, Provider undermands that (fie Alliance,
IDepartment.and the United States have the right to seek judicial enforcement of the assurance.
C I 1,101FICATION REGARDINC PUBLIC ENTITY CHIMES,SECTION 287,133,KS.
Provider hereby certirles that neither it, nor any persoll or affiliate of Provider,has been Colivicied of"I Pubbe 1"Ahly Cringe as
defined in section 287.130, FS,nor pkiced on the convicted vendor list,
Provider understands and agreos that it is roql,jired to inform DOEIA immediately upon any clialige of'circilmstances regarding
this slaws,
L as Of' COMMUNITV MICANIZA"HONS FOR REFORM NOW (ACORN) 11INDING
RESTRICTIONS ASSURANCE(Puts, L, It 1-1 17),
As as condition ol'the Cowl-act, Provider assures that it will comply fidly with the Cedend fundin- restrictions pellaining to
41
ACORN ifflid its SUbsidiaries per the Consolidated Appropriations Am 20 10, Division El, Section 51 1 (Pub. L I I I-117). I"he
Confinuilqy Appropriations Act,2011, Sections M I mid l03(llub, 1,, I I I-242).provides that appropriations made tinder Pub,
1- 111-1 17 are available under,the conditions provided by Pub L. i 11-117,
The undersignedsliall NClUire.that lammige ofthis assurimce be blChl&d in the LIOCUMCIAIS fear all suhcontracts at all tiers
(including subcontracts,sub-orams and contracts under graws, loaris and cooticrative agreementsb and that all sub recipients
and Providers shall provide this assurance accordingly,
F SCItUTINIZEM COMPANIES LISTS C1,TTIFICATION,SECTION 287.135, 1,S
In accor(hince with section 287.1.35, KS- Provider hereby ccrtifws 0mt it is not participating in it boycott ofisrael.
If this Contract is in the amictunt of SI rndlicm or Inore, in "'Iccordance Nvith,the requirelnews ofsection 287.135,F.S., Provider
hereby certifies that it is not list"I oil either tile Scrutinized Companies Mill Activities in Sudan List or the Scruthii/ed
Companies with Activities in the ball fletrolemil Energy Sector List and that it does not have busitwss operations in Cuba or
Provider undelstands that ptosluiw to section 797.135, 1-`.S,,the subfuisOn of a i'alse certification may r"oh: in the Alliance
and,fm Department terminating this contract and the submission of'a ftflse cerfif`icatitml,may SubJect the Provider to civil
penallies,anorncy's fees,and/or costs, including costs for investigations t1w led to the funding of Calse certification,
IfTrovider is unable to ccmifv to kitty ofthe statelnents in this certification. Providet shall attach an explanation it)this Contract.
G, CERTIFICATION IM I tARDINC DATA INTE.CWTV COI A1 PIL IANCE FOR AGREEMEN'T'S,GRANTS, LOANS
AN0 COOPERATIVE AGREENII..NTS
I. file Provider and any Subcontrwors ofservice's under this contract have financi,,fl nianagement syslenis caftable of'
providing certain information, inckrdim (i)accurate, cunent,and complete disclosure ofthe financial t"esults of each
grant-funded Project or program in accordiince with the prescribed reporting requirements; (2)the source and application of
funds for all agreement supported aclivitim and(3)the comparison 01"outlays with budgeted innounts for catch award. the
inability to procm information in accordance with these requi I remenis COUld r"till in a retum ot'graw funds that have not
been accounted ("or property.
2, ManaLlernent Information Systems used by the Provider, Subcontractors, or any outside;entity on which the Provider is
dependent for data that is to be reported,transmitted or calculated,have been assessed and verified to be capable of
processing data acenrately, including year-date dependent data. For those systents identified to be non compliant, Providers
Nvill take finniediiltc afthill to asswe data integrity,
C,
2. 1 l this contract includes the provision(.A'hardware,sofiware, firnmare,microcode or io*C(ldCdChiP WC1111010g)�, the
undersigned warrants that these products are capable ofproces�sing year-date dependent(Law accuritteiy, AH versions of
dleSC 111.0CILICIS offcred by the Provider(represented by the undersigned)and purchased by tile state will be verified for
accuracv and integrity of data prior to transfer.
Page 29 of'57
3. In the evert of any decrease in fittrictionality related to time and date related codes and internal subroutines that jolpede the
hardware or software,programs front operating properly,the Provider agrees to Immediately make required Corrections to
4-1 C,
restore hardware and soffivare programs to the same level of unctionality its warranted herein,at no charge it)the state,
and without interruption to the ongoing business of the state,time being of the essence.
4, The Provider and any Subcontractors ot'services,under this contract warrant their policies and procedures include a disaster
plan to provide for service delivery to colnillUe in case of all emergency including emergencies arising From data integrity,
compliance issues.
11, VERIFICATION OF EMPLOVMENT STATUS CERTIFICATION
As a condition of contracting with the Alliance. Provider certifies the use of the L.S. Department of Homeland Security's E.-
verify system to verify the employment eligibility of all new employees hired by Provider during the contract term to perforate
employment duties pursuant to this contract and that any subcontract&ilICILide an express requirement that Subcontractors
perfortning work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment
eligibility ofall new employees hired by the Subcontractor during the entire contract letio,
L RECORDS AND DOCUMENTATION
The Provider shall make available to the Alliance and the Department stat"Fand/or any,party designated by the Alliance and the
Department any and all contract related rccordsand documentation. The Provider shall WSLIN the collection and maintenance
of all program related information and documentation on any such systern designated by the Alliance and (lie Department,
Maintenance includes accurate and current data, and valid exports and backups of all data an(]systems according to
Department standards,
J. CERTIFICATION RECARDING INSPECTION OF PUBLIC RLCORDS
I. Ili addition to the requirements of'section 9 ofthis contract,and 1 M070 1Q)and(4)F.S.,and any other applicable law, ifa
civil action is commenced as contemplated by Section 119.0701(4), 1°'.S., and the Alliance arid/or Department if Elder
Affairs is named in the civil action. Provider agrees to indemnify and hold harmless the Alliance and/or Department forany
costs incurred by the Alliance and/or Department,and any attorneys' fees assessed or awarded against tile Alliance and/or
Department from a public Records Request made porstiant to Chapter I 19, f'.S"Concerning this contract or set-vices
perftwined thereunder.
1 Section H 9,0 1(3), F.S., states ifflublic funds are expended by an agency,in payment ofdLICS or membership contributions
for any person.corporation, fbUndation, trust,association,group,or other organization,all tile financial, business,and
membership records ot'such,in entity which Pertain to the public agency(Florida Department of Elder Affairs)are
public records. Section 1 19.0T F.S,states that every person who has custody of such a public record shall permit the record
to be inspected and copied by any person desiring to do so, under reasonable circumstances.
The Provider shall rcqUiN that the language ofthis certification be included in all sub agreements,subgrants, and other
agreements and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of*tlact upon which reliance was placed when this transaction was made or entered
into. Submission ofthis certification is a prCre(jLliSitC for making,or entering into this transaction imposed by OMB Circulars A-
102 and 2 CFR Part 200(I'onnerly OMB Circular A-1 14
By signing below, Provider certifies the representations outlined in part,,A through I above are true and correct,
-trq
(S'ignatUre aid Title of Authorized Representative)
ICAL J'6W1"-
P eider Date
(Street Address)
(City .......
arc Zip code ........
PagL 30 of 57
ATTACHME'NT111
FINANCIAL AND COMPLIANCE AUDIT
The administration ot,resources awarded lay the Alliance for Aginot-, fire. to the Provider may be Subject to michts and/or nionitorim,
C,
by the Alliance or the F'lorida Department of Elder Affairs,,Is described in this section,
MONITORING
fit addition to reviews of audirs condaicrcd In accordance with ONIB OrCUlar A-133, as revived, an(] Section 215.97, F.S- (see
"AUDITS"below), monitoring procedures may include, but riot be limited to,on-site visits by the Department of Elder Affairs and
Alliance staff" hinitcd scope audits as defined by OMB Cil-CUlar A-133, as revised, and/or rather pr(wedures, By emering into 0,fis
aoreemera, the Provider agrees to comply and cooperate with any monitorim, procedures/processes deemed ai)r)rot)riate by ille
Alliance or the Department of Elder, Affairs, In the event the Alliance for Aging, Inc. detertithics that as limited scope audit ofthe
Provider is appropriate. the Provider agrees to comply Nvith any additional instructions provided by flie Alliance for Aging, Inn, to the
Aging;,
Provider rquirdirw such audit, 'I"Ire Provider furdwr agrees to comply and cooperate with my inspections,reviews, investigations,or
audits deemed necessary by the Chief Hnmrcial Officer (CFO)or Auditor GeneraL
A U D[TS
PART 1, FEDERALLY F"UNDED
I his jx.trt is applicable N'the Providet is a State or locall gmertrjjjo t ot,a 1101,1_pr()fij organ imlion as defined in OMB Orcidar A-1.33 1,
as revised.
In the event that the Provider expends S750,000 or more in fedend awards during its fiscai year, floc, 11rovidei must have a single or.
prog rini-speci tic audit conducted in accor(fivice with they provisions of(")M 13 C I ircu lar A-133,as revised, I'M I I B I I' I to this aagreenr en t
indicates rederal rem.nlrces awardcd through the Department of[-Jder Affairs and the Alliance by this agreemoit, Ili determining the
federal awaards expended in Its discard year, the Provider shall consider all sources of federal awards, including (edcrat resources
rece ived from the A ll lance or the r)ep,,irtment (If 1"ider Affiiirs The cletennination of anIonins of federal awar(N expended should be
in accordance%vith the 1,wit-lel ines estabhshed by OMB Circu 6-A-133,as revised, An aLidit orl lie Provider conducted by the ALILH(01
General in accordance with the provisions ol'ONIB Circular A-l 33,as revised,will meet the of this part.
III comwction Mill the audit requireilwrits addressed in Part L paragraph l,tire llrovkler shall fulfill the requirements relative to auditee
responsibilities as provided in Subpart C of OMB Circutm A-133,as revised,
lf'flre Provider expends less than 5750,000 in federal amards in its fiscal year, ,III atidit conducted in accordance with the promlons
of OMB Circular A-1,13,as revised, is not required, III the event that the ProOdor expends less than$750,000 111 federal awards In its
list year kuld elvets to have an audit con(hicled in accordance with the provisions of'OMB Circular A-1 33,as revised,the cost of the
midit must be paid front non-l"edmil resources(i.e., tree cost oJ'SUCh Unfit must be paid firmI Provider resources oblailled from other
than fecleral entities)
An am it conducted in accordance with this part shall cover the entire organization for the orp pnization's fiscal year. Compliance
findings related to agreements with the Alliance For Aging, Inc. shall be based oil the agreement's requirements, including any rules.,
reguhations,Or statures refcrenced in the agreement. The financial statements shall disclose whedrer car not the matching requirement
was met fior e,ich applicable agreement All questioned costs and hilbilifieS due 10 the Alliance Im Agin-, Inc.shall be fully(fisclosed
in the audit repoll with mference to the Alliance for Aging,Inc,agreemm involved, Knot otherw ise disclosed as required by Section
31 O(b)(2)orOMB Circular A-133,as revised.the schedule of'expenditures offedcral awards shall identify expenditures by agreement
miniber for each agreernent with flie Alliance for Aging, Inc. III efl ct chirim, the audit.period, Financial teporling packages required
under this part must be submitted within the earlier oaf'30 daysaflei't-CCCipt OfthC audit report or9 mortflisafterthe end okhe Provider's
fiscal year eitd,
f 5 7
PART IU STATIE FUNDED
Fins part is applicable if the Pr(,')wider is a non-slate entity asclefined by Section 215 97(2),Florida Statutm
In the event that file Provider experlds, a total amount of staw financia,J assislance equal to or in excess of$750,000 in afty fiscal year
ofstich Provider(fin-fiscal VLNU'S Collin, September 30, 1004 or 1hervafter), the Provider must have a State Single or ploject-specific
audit For such fiscal year ill accordance with Section 2 15,,97,I'lorida Statntes;applicable rules ofthe Deparlinet)(ofFinancial services;
avid Ckafners 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Roles offliv Auditor Gent.m-al,
EXI 111311"1 to this agreement indicates staW financial assistance awarded through the Alliance for Aging, Itic, by Ous agivetrient, In
determilling the state Cillaricial assistance exponded in its fiscal year,the Provider shall consideralf sources of'siate financial assistance.
including statc Financial assistance received frmn the Alliance for Aging, Inc.,odder state agencies, and other non-�Oalc entities. State
financial "'Issistance does not include federal direct or pass-through awards and resources received by a non-state entity for Federal
program inatching rcquiremoits,
In connection with the audit requircments addressed in 1"o-1 It, paragra'Iph i„the ProvidtT ShO 01SUre 111,11 f1lC Urdu COMpIHCS With the
requirements ol'Scefloo 2 15,97(8),Florida Statutes, This includes subinission ofa Financial reporting package its dermed by Scctioij
2 15,97(2), Florida SUIWWS,arld Chapler l0,550(local povernmeliml enfities)or 10.650(notiprofitand fior-profil orpanizations), kules
of"alas:Auditor General,
Ifthe provider expends less than S750,000 in state financial assimanct� in its fiscal yeat (for fiscai years ending September 3(p, 2004
or thereafter),an audit conducted in accordaiwe with the provisions ol'Scctiorl 215,97, Horida Statutes. is rua requit-ed. In file event
that the Provider expends less than $750,000 it) state firrancial assistance in its f"kcal year rJjjd elects to have an audit conducted ill
accord"111CL° wkh the provk.,ions of Section 2 1 5,97. Florida Statutes, the C(O 01'010 aUdit Most be paid fl-0111 the wort-state e'lltity's
WISOIA'C(rs(i,e_tile cost of'smil all"ludil mum liv, paid from the Provider resources obtained from oillerthan State entities).
An atidit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. COMP14111CC
finclings related to agreements with the Alliance fior Aging, file, ghatl be based on the agreement's requirements, including any
applicable ir.11es,WgUkAiOtls,or s(motes. Hic (Imancial statements sludl dis'Close whether or not the ulatching requirement was met liar
C,101 applicable agreentent, All(plesdoned costs arld liabilities due to ihe Alliance for Aging, Inc, shall lie Frilly disclosed in the aticlit
report with reference to file Alliance f"or Aolling, Inc, agreement involved. 11"not otherwise disclosed as rC(jUirCd by Rule 691-5,003,
Fla,Admin. Code,the scheclule of-expenditures ofstate fiiiancial assistance shall identity',cxpenditures by agreement nurnbcr for each
agreenient with the Alliance for Aging, Inc. in effect during lite micht poriod, Financial reporting packays required under this part
nitust be submitted within 45 days after delivery ofthe audit report,taut no later than 12 rrionths after the Provider's fiscal yearend for
local tgovernnicntal entities. Non-profit or f"or-profit mganizations arc tequited to lie submitted Nvidlir145 days wafter delivery oftliv
audit report, Ilm no Wer than, 9 months aller the Provider's fiscal year orid, Nomidlstatrding [lie applicability ofthis portion, tile
Alli,ance and the Department of Elder Affairs retain all right and obli"'nion to nionitornamed oversee the perforntance ofthk agrecluent
,'is 0(flHoCd 011`000�d110W thiS(JOCUllient and pursuant law,
PAR'I 1W REPORT SUBMISSION
Copies, of'rq)orting Packages 1`01-MUMS COYHRICtUd in iWcordance with OVIR Circular A-133, as revised, and required by PART I of"
this agreement shall lie subm ktQd,when reqUired by Section.320(d),OW Cireolar A.133,as revised,by or on hehalfof'the Provider
cLicescwLly to Qach of the folklwhlg�
The Alliance for Aging, Inc, at each offlie following addresses
Alliance for Aging, Inc.
Alitm Fiscal Monitor
760 NW 107"' Ave, Suite 214
M Wit 1, FI.,33172-3155
The Federal Awdi( learinghouse designated in OMB I...'irCUlar A-133, as revised(the nuiliber of'colno required by Sections 320(d)
t)and(2),OMB Circular A-133,as revised,should be submitted to tire Federal Audit Clearinoliouse),at the following address:
Federal Audit Clearinghousc,
Rureau of the Census
1201 East 1011 Street
Jeffersonville,IN a17132
Other,Ndural agencies and pass-throLlof i entities in aCCORkInCe with Sections.320(e)and(f),ONIR Circular A-I33, as revised,
Page 32 of"'57
dour suani lo Sections .320(�""l, (YMB Ckahr Ad 33,as revised, the 10vider AMU nmmw a Copy nfihe reporling in
Soo ion .320Q 0N413 Clrcuku'A-133, as r0W mul any mairagaNelo I evor iSMWLI by I he aWUm. to I e A H A me Rw A Ono hwAn
each of flic,
Alliance Nr Aging Im.
Attn: 17iscal Pdonifor
760 NNV 1071 Ave. Suite 214
Minnii, Fl.33172-31550
AdditJonult, wMies of Anandal reporting packagcs required, by Part II or this agmemem Ed! be suhtnihed by or tm behWf of Ae
Provido,wLwcqjy to each cA"the fol dowing�
Me A HWwe Rw Aging, h at each of the folk'm ing addl,Qs�es�
Alliance liar Aging, Inc.
Attn: fiscal MoniNr
760 NW 107111 Ave. Suite 214
Miand, FL. 33172-3155
'I"he Auditor General's Officleat the following Wen:
Stile of Florida Anditor CenerM
Claude Pepper Building, Romn 574
I I I West Madison Strect
Tallahassee, Florida 32399-14,50
Any repork� lener, or whicr inibnmation r"ptired to he mMmiaed to IN Allince t6r, Aging" Inc. ptua''buuanu to this
agreownt shall be m0mitted thnely in auuMatwc with OM13 Circular A-133, Fhm-kW Mama. and (Impop; IM550 Awal
governmonMemilie0or 11650ptonpaTtand RwpoM orgaril adm&), RuIes ofthe And ilor(le:neral.as appheahk:,
Providers, when subni ill ing, finalicial reporting packages to dw AHGwe For AWn& We. An muMs dmw in unm5nee MA CAW
0mular /0133 or Umplers 115% (had gmenintwal enihis) or IOA50 (nonpmni and kippotii orp"anizations), Rules of ffie,
Auditor Ccnei'ad-4tould indicate The ilue 1hal the repordrig pdage "as deNvored to de Novider in correspondence accompanying,
dw repwkg padutge,
PART IV: RUAIRD RETENTU)N
lie proymer SwIt re win Sufficient 1vowds demomnstMg fits complimme wkh Ow lanns of Ohs agreemem IN a petiod ors yvars
Rom the date We Wit nToll is Wel wW AmIl allow the Uhme Mr Agkg, NCAW its designee, flic CF0 or Auditor General A,ccess
Gore notch records upon request, HIC Provwer SWU OUMV mat MW woking pymn mv imade available to the Alhance f6r Aging. Inc-
or its desig"nee, drawl epartm ent or its clesynce,CEXX or Wilm Gerwral upan repw Am as lwrhd of is yeats Rum the date We aull
report is tssucd, Lniloss extended in ;vWhW by Me A himme few Aonj In,
FIge 33 of 57
ATTA CI I NI F T I I I
EXHIBIT—I
L STATE RESOURCIES AWARD[,",[) TO°r`HE RECIIIIENT PILl IISUikN']"'TO'TIJIS ,,%(,'IIEEMENI'C'ONSIS'r OF THE
FOLLOWING.
MA'I'(,'IIIN([.' ItESOI,,]R( FOR FEDERAL PIIOr�RAMS
---VRO(;14,N-M.."'TITLE FLINDING SOURCE ("IFI)A A NI F)ITN f
TOTA I�ST ATE AW A R 1) Iso..............
STA"m FINANCIAL ASSISTANCV, St.)BJECTTO,Sec. 215.917, F.S.
14—0(;'RA M—,f I—ITE FUNDING SOURCE AMOUNT
A loll einler's, Disease lnifiafiy 65,002 S91,807,7 3 RevCIMc
-——-------------------
.......................
............. .............
TOTA 1,A W A R 1) 9l,80V 7.73
CO Ml P L I A N CT R EO,Lf I R E NII F'NTS APPLICABLE TO STAIT RESOURCE"S AWARDED PUI RSUANT"TO THIS
AClif"EMENT ARE AS FOLLOWS:
Slate Fimanchil Assistance
Section 215.97 1,�".S.
Char (c r 691-5 Fla. A d nt i mi ist ralive Code
Page 34 of'57
AT'J'A C'I I N1 E NT I I I
EXHIBIT12
PART 1: AUDITRELA]"10INSI IIP Df,"I'EAM"INATION
PmvWwn who mceive sme or Ndcra I resom,ces inay or nmy m he sull a i to Ow mdh repiremoits of()NIB Circadar A-1:33, as
reviksak an&ur s. 21197, Fla, SWC PmAdas m0o we deemiked to k redpients or sukrujoents of kdeml awarclk and/or sm
finmidal assisumce nmy he subject mi he andh rmWire mien m if We atidd threshold mquiro"ems sa f(mnh in Pan I andWr PaN 11 of
Fxlrdbi( l is rnel, Prov41ers who havc, been doonbcd to he vmKorm mv nW skiliject to the amlit requirements of ONTH Omwhtr A-
133, as rev0d,Wom 21 19T 11ia, Steat. Re gard less of whether the mel, Pcoviders who have beeni detervnined
ki be rvellAw or ml-ralpfems of federal awards and/or state I manci�,d assimance must comoy "Th qVhcable pmgmnmmi and
nscal comMience requiremem.
In accurdmwe m itch Sea 2 io orom Ckaikv Ad 33 andArr RuW 66-5.0106, f'AC, Provider li&,4 belen det+brniined to be:
Exempt organization iL sr�.jbject to 2 CFR Pan §200 anWor s, 21197, FA, Fm Ndeml awadt fugrOrt mjmQadms are
exenipt; for state finandal a555tance pmods, publK unWerskWq camnnmky&Wges, d3vict school boards, branches cof
Mao IjWda)governaient, and charter schools are exempt Exempt orgyarlilatiOlIS MU5t comply with 4 compliance
fref1t)irennents set forth Mthin the contract or award dock,iment,
No IT: I 1'a Provider is d0onnimed lo bc m reckhem /sW>rvcQAen1 of0deral W or mme hnmxkd uWatwe and has hmn appmed
lay dime D,nmao to subconum drey niml amply Nvhh s. 2 11917, 1',S , and R(de 691-.006(2), l,A(,' [stale Hnanci,,d assistancej�
and Seakon 400 DME3 CHWA-133 I WNW mank),
PART 11m FMCALCOMPLIANCE' REQLJJR,1,',MENTS
FEDERAL, AW'ARDS OR STATE MAT(Al ING FUNDS,ON FEDERAL AWARDS,. Providers wvho receive fi:mdcr'al aw'ards or
Stale marching i'linds on fedmfl awarck nnd W two dounnined to he a sub-mdphA nmm milfly wkh flie killowing fiscap k1ws,
roles and reim lal ions�
STATES, WC AL GOVERNMENTS AND INDIAN TRIBES MUST 1�'OL1.,ONW
2 C. Pan 225 (INI Pdndpks Or Smi, 1mcW and Win 111WO Clovenmenis(I'mmerb, 0MB Circular&801
OMB Clmuktr A-W?- Adininisiralive Reclkin-enwmis
NIB Civeo lar A-13 3 - A udi� Rcqjnrcint,,ws
Reference Goide for State Lxpetidilmes
CHher 11%ml requiremerns so 10h in prograrn ki)vs' rojes and rcg"Ldaflorms
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
I CFR 100 230 Cosl Principles Rw Ws1°a4h (hgmWzWkms(Homerly Ott It Cinnflar A,-122 —Costs Princip es)"'
2 CFR Pml 2 0 AAh-thnistraAw Repimnenis(Formaly OMB Ckmkw Ad I0 —Adminiswadve Requhments),
Re(p,6renients)
0MB(irciflar A-133— Awfit RqL,nrmems
Relmme Cukle Ir Sme Expendwres
Other Fiscal Fet]L1frCr11Cn1S SO Wrth in pmpmu law, nAs mW rqu%ms
EDUCATH)NAL INSUITITIONS(EVEN IF A PART O+' A STAT'E OR L,OCAL(.;0VERNMENT)MUST FOLLOW,
2 ClR Parr 220 Cost PAwoks Mr Eckww5mal WMAms CMIB(I'mmerly L"irctflar A-21 --Cost Principles)*
2 CTR Put 35 AdimbkoWive R,drernents j,'ormiefly (JMB Ch-colar A-1 W—Administrative Reqnircments)
(WWI("imilar A-133 — Atichl ReqLifirenwnts
Refomme 6mWe Ar Sm ExNnWmes�
Other fiscal so lboh in pmgmm laws, ruhs and myWons
*Sonm Want programs nmy he exmnped Jhrn compliance kvhh the Cost PArcipts Clrcuktrs as nmed in the ON413 Cimidar
Page 35 of 57
A-133 Comphp uice SuppUtient, Appendix k
FINANCIAL ASMSTANCE. PnmWcm who muNv maw MmMM a%ktamc M Mo am dounifirw(l to bea rccipicnllsulb-
recipient ITILINI CWTIMy wih Ow Rlhwipig, fisuil laws, rk lcsaud reguklic)ns�
Scokwi 21 97, Fla, Stat
Chapter 691-5, Ila, Aclinin. Code-
staw Ph&os Mowme S"PkMNII
RuNmmv(Me Ir SM Expnhwws
Olhur f6cal requhumems so tbnh K pmgmn hwv Mee and regulalions
THE REST MMIS PAGE WAS LEFT BLANK INTENDONALLY
F%ge 36 of 57
wrTAC11 54 ENT VI
ASSURANCE&—NCON-(�ONS'I'l�(�(."I'ION PROGRAMS
TIZIblic repo—mingbmr—den—Mr this cWkoionofinR)nnmion isemirmawd to average45 In W u tes per re spo Ilse,includingdirrie for reviewing"
invanmW wenrrhing e6ming dWa souivu%galuHng and nmirvah1g,Ow dwa needed and =pIeGg wd wWwAg dw cdkohn
offifl'ormation, Send con-nments ivgaWMg dw Wen esthwe or wiy other aspect or 06s coflectkin Of JIflov"IaGon� incluch"go
suggestions Rx- redticing IN hurda. us Me 01'fice of Managervent arId Budget. Paperwork Reduction llrqject (0348-00/43),
WaAhipow DC 20501
PLEASK Do N0T RETURN VOUR CONWETE51FORMT0141F OFFICE OF KANAGEAVIENTAND BUDGET,
SEND IT TOWE ADDRESS PROVIUM) BV IMU, SPONSORINC AGLNCV,
Note: Ccrtain ofthwe assurances may not be appUeabhv to your pnqmf or prognm. Kyou have Cluesfions, ple"Ise,Contact
the awat-Trig agency. Fun-ther,certain federal awarding agencies may require applicants to echij to addhiianal
assurances. If such is Me cans,you W he noHRol.
I, Has the legal aulodV to apMy Am Wad nnWwwe,and Me hwhutknK nmwgaQ and Wancral capabih,jinteludhig
fitwk swat filcient Io pqy me Am.wmi miare car Kyea caKo to cruure pmpa piannimg, rasa agernew- and ccirnplelion cd'the
prqjecl described in, his appfic,,,tflon.
IMM gWe Me awmAing agency, Ow CornpimHerGeneml of the Unned States,and ffapprop6aic,the to tkmlh wV amNnNal
represernative,access ummd Me Qo to exartirneall rucork bookv Impery,whwunwras related W Me awwd:and W eWkh
as prcq1cr acominting systeni in accordance wiih gencrallyaccepted accounting mandards or agency directives.
3, YAM esta=safeguads h)prohiNt enqTgan hvm using Neir positions Rw as puquve drat constaiaes or Presents theappearance
o r 1mrsuria I or.calan Wad o na I con 0 id 0 f i n West.car pniona I gkd n,
4, W I t I i i I!i t iate an a I co n-r p le tc t lie work %v 4 h i n I he apfil wahl e i hn e kan w a R er recio,i pt o Vapprov an I of the as w ard i ng"Ig-CI 1 cy
5. VVUl covnpt, vOT the hiroVovemmcmal Pasomiel Act or 1970 (42 1,J,S.C% 4728-4763) rekaing to prescribed siaridards lbr
=0 syswnis 1br programs Wed under orie ot'die 19 SIMMS or IvgUirroons specified in Appendix ,A of011N/1's Standards for as
Merh Symms it Personml AdnAnWi-MV Q CIAR, 9WI Subparl F),
6, W011 comply with ad Iderd smaws wlmhg to nmulNoVitMaKE Hiese inchide tiol are not hIrdwd to: (a)11fle V1 ofthe C'ivfl
RWMs Act of W64 (PJ. H8-352) which prohibUs disudinhimion w the basis of mace,Color or nadmmkKow(W 114 IX oldie
Eckwatfun ArneMnious of 1972, as wrnc,ncdccd(20 LV(iV 1681 d681 and 1685-1086), whic]'u prohibits discrindnmicmi ori the
hasis of sex; (c) Seri On 504 or Te lichalAWation Ac, and 1 QTV as wnended(29 LATC.
the bads of humficaps� (d) the Age Discrimination Act of 1975. as amended (42 10V 6101-6107, mdvich jwvhib6i
dWrnhiadon on die basis of age; (e)dw Dwg Abuse ()fficu and TmWmmn Act of 072 (111. 95255,as wnNided, mblhg to
nomliscriniination on Ow hasps dad chng abw(r)the Comprdiensive ANoNd Ahme and Alcoholism Prevention, 1'reatinent and
Reh,bihwion Act of 1970(PA.,91-616). as rumended,rdaling to nwidiscrinibration on Me basis owcohO We or akuWisw
(g) 523 and 527 of MeAhIblic With SoNke An cW 162 (4,2 USN C 2W) d?3 and 290 cc 3, to amended, whidng to
cmfidenhh, ofalAwl as drug abuse pwient rvc',ords 00 TWe VW ofthe CNH RWhB A0 of 1968 (42 U&C 3601 d
seq.). as ainended. rdmhg to in the sak wwW or Amuwhg of housing: 0) any udwr nondimim final iun
pRiVions in the specii'ic matutc(s) undn which apokadon (iw Idera1 anktame is being nnade; and 0)the requhwivenas car uny
other nondiscriminatkni swMeN which may apply to 1he applic"'Ation,
7, WIM comp". Wias aludy compUL m4h We mqukonovs or hly; H nad Hd of die WWI Rvkwakm Assistance and Read
PnMemy Axquisit% Policks Act of 1970(KI. 91146) wh1h 1wovide for fair and eqi6tabL treatment ol,persow"; displaced or
whwe proper, k acydi-ed as a rest.th of Fcclend or ledendy amWed propmmv These vquhunents apoy to all hwerests in real
property aaccptuiredu hor pulMet ptuposes regar(Uess offedeud partic ipavion in purchases.
8, Will Comply, as applicable, wilh the ptsvivican of die Hwch Am (5 U.S.0 1501-15,08 and 7324-73281 "Tich Unrik We
poirticaj achwes orempwyees whoNe prindpal empkInient actIvitis are RindW in whole or hi pwa m6WQduM Funds.
MAH comp", as apokabk, wUh he provisimn or Me WoBwon Ao (40 U&C 276a to 276a-7), dic Copeland Act (40
US.C. 276c and 18 US,C, 8 74)and the Contract %Vtwk Hows and Sa1dy Smn&Ms Ad (40 t I'S'C' 327-333), regarding
labot,standards for fcderflly assisted ccrnslirucfion sut)-agreenients.
Goa ge 37 of 57
102(a)ofthe Flood Disaster-Protection Act of
1973 (RL 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood
ilISLII',IIICCif the total cost OfilISLli°ablec,oji,st,i-tictiori,iiida,icqtjisitioji is S 10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the followill": (a) institution ofenvironmental
quality control measures under the Nafionafl Environmental Policy Act of 1961) 9 1-190)and E xec tit i ve Order(EC) 1 15 14
(b)notit ication of violating facilities purstuml to 170 117 M (c) protection of'wellands purstiam to E0 1 1990, (d) evaluation of
llof,xf hazards in floodplains in accordance with EO 1 19M, (e) assurance of project cousistoicy with the approved State
management progran'l developed under the Coastal Zone Manageniew Act of1977 (11 6 U.S.C, 1451 et seep.);(r)confonri ity
of' federal actions to,State,(Clear Air) Iniplementation Plans under Section 176(c)ofthe Clear Air Act of 1955,as amended (42
U.S.0 7401 et seq.); (g) protection of' underground Sources ot'drinking water under the Safe Drinking Water Act of 1974,
as amended,(P.L. 93-573)o and (fit protection of endangered sf.)ecies under the Bdanvered Species Act of 1973, as, amendecL
(RL. 93-2051.
12. Will comply willi (lie Wild and Scenic Rivers Act of 1968 (16 L).S.C, 1721 et seq,) related to protecting components or
potenfial components of the national wild and scenic rivers system.
13. Will assist tile awarding a-ency in assuring compliance with Section 106 of the National Flistoric preservation Act of 1966, as
LI
amended (16 U S.0 470), EO 11593 (ideritification and protectic)n ol'historic properties), and the Archaeologlical and I listoric
Preservation Act of 1974(16 U.S.C. 469a-I et seq),
14. Will conlply with P.L.93-348 regarding the protection oHlUITlau stjb,iects involved in research.devele pnient.and related activities
supported by this award of assistance.
15. Will coniffly with ifie I...aboratory Animal Welfare Act of 1,966 (RI.- 89-544,as amended, 7 LI.S.C. 2 131 et secl.) pertaining,
to the care, handling, and Ireatnient of warm-blooded animals field For research, teaching, or other activities supported by this
award ofassislance,
16, Will comply with the Lead-)used Paint Pc)isoning Prevention Act(42 U S.0 4801 et seq.),which prohibits the use of lead-
based paint in,construction or rehabilitation of residence struclures,
17, Will cmise to be performed the required financial and comphancc audits in accordartce with the Single Audit Act Amendments
of 1996 and OMB Circular No. A-1 33, Audits of'Statcs, Local Govemments, and Non-Profit Organizations,
I& Will comply with all applicable requirements ofall,other f"cderal laws. executive orders, regulations and policies governing this
prograni.
SIONATIM'Ot 'I I FIT
ID
AIIIII]CM YORGANIZZAI f0,N OATI-St MMITITID
Mon,t-oc ''ounty Boat-d of County Commissioners, Social
Set-vices/In-Home Sri-vices
Page 38 of'57
ATTA CH M E NT V I I
ALZHEIMER'S DISEASE INITIATIVE P�RO�GR,AM
BUDGET SUMMARY
The Ahiance shall mAc paymei!M [c)the Provider Cor provkiori of'services up to a maxhnum nurnbor ohm4s ofscrvice and zl� the
nale(s)slaWd bdow
Maximum
Service Unit Its of Miaximum
Service to be Provided Rate Service Dollar
gemen s
Case Mare apt $ 601�7'3 31 $ 11,885,35
Case Xde............ ............. $ 15.00 6 $ 90,13]
CareWar j!��ahqq Ind $ -................
$
.. .................. ........................—...................
Education/1-rainir $
E2�spiLe b irity $ 110� " 5,817 7§g:83
Res ite In-Home $ 24,22 918 $ 22,22738
S 6 1 a1h ze d ADS_
Specialized Med�ica,l
Cost IReimb $ 2,744,92
§_�2ppLiqA.�_�,sistarLce CV $ 30,90 19, $ 587,10
Le!fp�_��e.Reassurance GV $ 27.37 1911, $ 5201.03
............... .....................---------
...........-
M.
............ 1-.807.73
Page,39 of'57
OfTTAC H N1 KPOW I I I
ALZHEIMER'S DISEASE INITIATIVE
INVOICE REPORTSCIAEDULE'
Report N uni be r Based On Subinit to A116ince on,
thil Date
I July Advance" July 1
2 Augto Advance:" Jut 11
I July Expenditure Rqwrl Angum 10
August Fxpendnure Rerwrt sel)t Vill be r I Ot
5 Sepemba H"endhwu Rpon ; I 10 advance mumdhmbn October I(:)
6 October J-,xlicndkUrc Repwi i PW advance wconcifia0iors November 10
7 November Fxpendhure Kopwl i Doc'ember 10
9 [)ecvnflw-r I,,,,xj)endRwv RTon v 1110 advame mcmd H M hn Jamian, I()
9 Janwuy 1,,N,i)end it tire Rw I M 0 ahame mcmO HwWn Februan, 10
F`cbruary ExI)endilwe Rqwn u 140 Mane wcmcHWKn WWI 110
11 March 1,`xj:)encfiwrc KqwM 1110 adwame mend HM On Apt 10
p2 A 1,id I I-,,x lienditure Repon I A 0 Wane mcmwihm kill Ndray 11(,1
d3 M ay Ex pe nd i Rue Report 1/H)advance reconc 0 i w i ol i We 10
J4 110advimeemconcilMon MY 10
15 1"imil, 1"'xPCr1(fiwre and Closeow, July 31
lxgend v° Advance based ova jlrq vcted cw"h nee&
Noe It AH ahwwe pyawnN mate to the lAvvider AnH be retunned U)dw Wwwc:B ROnvo
011e-Gcnlh ofthe advallce payment, receNcd MuN he njamed as an advance mcmWirnciv on each Roqwst
for llay'alc"nt' starting "it rqmn 45. Ile ao0stnumt shMI be, recorded in Part C', Line d (w se ivport
(Attachment IX),
NoIQ 2: Su&niission of expenditure mporm nmy wAmy nw gowraw to paymem mquo. W Anal c"endhure
raport Meets finds chm back to the Alhanon paymeni, is lo acconipmky the repon.
Fly 40 or 57
REQLIE `G FOR PAYMENT
Fcaaralin 106
AD
PrY7'xtC:leir ....... .. ,. ......... ......&. .. ......,.,.
Aarddt'a': G CR]r➢%"'act Pamo
Tab I�allornr �� i2r�orrrkrura irmaarrq Report cm,
� �. .,,�.�... ..._.
CERTIFIt:e"atpJ"W I hereby, PP•rar f i,s request or rehmid rr„ahfrreu ns with the terms of the lbove rCont:rar:t.
Prepared R'�b ,Date, . , A pl:m w e d By: .. Date...--................................
T SUMMARY
HUDCIE
ADII TOTAL
�� .......... ........ ..m -..— -.-
.... ... ' , .A..... ......�....
1.11.1
AY .rrcf ,acr ...P wo 440
..biCw[P
Prom 0ro b#o41a rd4a Mlla.¢I � _........... ......... .....�W.... ...��.._ w�.. CI tl1da .. ��,.,.. .._..... . ......... m..e..m..,. . ...,�... � @.00
arAbf0h Forrfim,d l,rahkfacl Itaparwo 0].riwa 000
(,rurirr:utl fkralh J'6l wrrh9 fWled ro FIXI
.........— — t
V ti sa�CmIrertl dWN.�mUl A JV awyt)acW 0(10
R aunw4r rr.la ri l rur9rlss l n r{uaa.sts.d try N�ainiRr e., .....e................. .....�...... .. .�..,.,.,_YL 00 ,.,.,.,.,_____ _....�....� ... ...... w._..�.. --- ,.,,,,..� ...000
O,PAYM Ndi'N';S GURREN 9"N4 ONTH CON U AICTWD Friraar,Mo.YIU
N umbrsu'rwNpeaf,wans a,sa ssed Cr)-paPiti'ragas
Lk.6smsP5b(:rof par:rr rams pa�t'al¢NrIalad for unrvua•pav new
m fr>war'rr ttaulrvrin tna'rare r la wrywaWrtd
4.Number s.'npper onsydrkewPa�om:,"aa,rssmei3O �� .......... .�
5 Nssurebrwrar W parsons exornapsfl(Fairnti ra.pnary
d T"raVaaI rarre'u r r,r aaP of 1a7 Pa a y as f a_a s,ad
7.TalaI Anwratjm of f,,t'w•daayGKa IIa,Mar'd
d,rol a9 rtanrroijhntrat r a-p 1!ay'ea,pamnrded
i'fA Va 1 A DF rrrhra wisel Dece un e,20210
Attachment
RECEIPTS&UNIT COST REPORT
Form 105
ADI
.... _.... ..... ......................... ,,,,w .,�.,��,,.. w
AN
�..�. .....� ......
�, r unmrkr�r fsrwiv�.. �— _--- —_
Jw7
c�F
ItP�,�Pr.19tTdv: {J .. �e,.,e.., .,.e,..,..,..e..e..�
wt+„"pId t R deNe4rr vrru late,fr=„I,�roA N1 ryJ&n addl„flup;;,r srrrt mr.s hf&lmwribEri r�pwe sruatpe aqe,auiI,rwrre.:t idallaraMT� sv7Fnrlh lero .. .......�
4b,ad.ryputr Fu,.t F er fl6�off�i r�was Y'y�thtet 7Yis�isrsta�rscl to nnOR�uly ni 1 YI"4A r�oar��a wu.ra rlshrrr rloagaVe mPri cl waarvrCs irrFeGaela rrrcrrr esk.
P r"jut hared h'V _ ...--- ......... ............f 6 yr ............... r .... ......... V'+ppn wrl prp Datr.i
.
W
......_. ,
'�6. �"���T"�. A �«}tt'rrcee9{3�w-dal.w,R. h'S lVrttir,.etT'r.tP�all�ggld�n',rT 4'.;t "G'Mrrf0dEietrT IV 8r0Japtrvr;a.r„t
tar lhis r9."6'anrt YF'-w r,h..Yst a Budjpt PriortMh'o,Ruceip tsYTO
p'roru„mTMr Irtr rHr ---..�.... ... . .... �. m,,.
Cac'lw hV4;atir,,Br
m....... ,,,
V.el.dff3MIA t;,IwtieY'i 4+'r..,rrP'at�5'-
h:ral IVr Pv,ltd Amr.Ar:kw �h11'7al RbPAI\fftAh
--___________ ._____..,_..._._.._._.,.,..,.,.,.,..,, ........... .......... ...... __ -------`--�..
i jpq n p rP c r iA) sa y
ha;ror,;,es Cr,:;v�M"art Bdl,.,rble S lrm E awe Amrr arat Lmried Y"I D Y I 1� ) (Chew hu!befNh v"{'.'D
Arrr AMl Ijolts Di,s ilenud B rlaNalnt HillaA.Ar.) 1,.,9t16,4irht filirA.rv1,5 ArdupwDtKiyll>s
Llr'tr9w cost pau:ar"rAr'.:el VeeVmxJ
F!iorYTPAauo4s Prior YM
,. ,
M ........ ....... �„
T
Y M
+,p
,� .,......r � y —
r iA'01 Ava,D k nn'tiR, Id6 A}a No °eip'I'!'d
T wge 42 o
ATTACI I NJ ENTA
Tlide� Dep"llirtnient M L-Ider Affaivs P�'ogranis& Services I bindbook
J)h� -�J, h Y�G�-,N G� ,,2
Pz,,tg,,e 3 of 57
AT"I'ACHMENTB
STATE OF FLORIDA DIA"AwrmENT OFELDER AFFAIRS
PARTIJ READ THE ATTACHED IMINI 1"THINS IQR 11 JA ORNINFION 1111RI I WH 1.11 V(H I(IMIPI 111:11 ITS
FORM.
1. W.desobe belpol-imphik area saved by be pmpmnl1acHity mid the tyq� Rop"C*
awr-el 0000 Q -Xti me, end &C-41110 w1p,Ime,
es
Q
2.
7 7
42
3, SNA F F Q R R EN I'LY D, Fffcctive da(c.,
A W'hilc Wad, 11'I IVF F0 1111117d
CWNIS CURRENTLY ENROLLEJ.")OR RL,,(JISTLRf,.',D. Effedive(hate:
iValli- -- —; . ..........Pr
E-2 . ..... 11.11111-15
51 ADVISORY OR(JOVERNING BOARD, IFAPPIKABIJ.�._
NPR �PARI It FIT A SEPARATE SHEFI Of PAPEK FOR ANN EXPLANATIONS RI,,QI'11RIN(;MORE NPA(V,
6. h an Aummue ofCoi n I-)I ia nice,on the with FWA? V NAA or NCI exp5h. N)A YFS NO
El 29 01
7, CouWare Ow WcortipNiidon w Me pialiuMdon, Is sta H)vpvwn an Ne a r I e popW w 1 W
If WA or NO. exp I a W. IVA YES No
Ej 09 F—]
—----------
S. C'ornpre the chent composhion hi the poIndation, Are race and sex chwacturimiks repewri
ofthe populaiiion"? If WA or No ,explain, NAA VFS IX)
9. Aye chgWy i'vquirenicil'As fiw services pp.alied to clients and applicants without repu'd to race,
cost-,
nation,at origin,sex, age, reUgimi oribsAddy? If NWA or W explain. NWA YES NO
11 va 10
...............
10, Am all hownK services and heilhies available to allAkanim and partil"ants in an elmlly ellictive
manner regaiallss of race. sex. color, age. naltonal origin, religon or dkal-nMy'? WN/A NO,
explAirl. N/A N'I"S NO,
.............. ......
I L For 61-patient servicc�,are rt'wn'i usynmeMs nwde WhotH mpal to race, cohn,n0mudculgin
ordis,ohilily? I1'N/AorN(.), vxpkdn, N/A YES N()
EJ El
..............
Page 44 of 57
11 kdwpmgmnVMdhyamnsiMetonool>gHdigmakh,clEiB? pp'N/AorAK).cxj,)1ajn, N/A Yk,S NO
------------— 0 x 1-1
..................
13, Are empIoyces. appika s and payidpanis inh.mmed of Mck powaion agminst discrimination? If
)"E'S,f1mv") ,
IVHUen Momer 915 N/A or NU expWK N/A YES NO
EJ It EEj
TIT-Givv, the nuniber aWld currvilt Matus of' any discriminalion compUints reg',ayclTi sery
employmcm l"Hed ag"dirm the p-cfgrani/racHity, IV A NUNIBER,
......................
I Is Me pmpmnVMdH0 p4skilo ameWbk Umobility,hearing, and sight-knpaired indivicluals? 11'
N/A or NQ explik, NK YES NO
L1 141 0
PARt HL11W FMAMING QIVI"ONS AITLA 10 PROCRAms,NNI) um,wir IF NN'ruill 15
16. 1 Ws a sdPevaluabon been cmducted (o Wen H Q any buthus ro suOng dkahkd imhvWuM,and to
mle any necemay muWBcmkms? I r NR expWI, YES NO
17, Is Hicre an estabikhed grivance pn=Ame Owl KoMmums Aye prawns l.ua the mMmAn of
compkdnls? If NO. vxpUn, YES NO
D1 E-J
18 1 Ws as pvmon bcon dmQnawd to comdAme Secdon 5014 coninpliance ackines? If NU explak "tip S NO,
IQ. Do recruihncn� and notificaaion materials advisc applicams, and pailicipants of
yacaoaa on Ow bads or may imh expWh, YES NO
P1 ED
.............
20, Am audhapt Ads available u) asum accusibihly of services to hearirig and, siz hl-krlpaircd
MvWuak? If N(X explak YES AR)
L1
PAR JAV: FOR PR(Hi RAMS 014 FAA WAVES NVFH 150(114 NH)RE KAIPISIVEES AND mERAL timmms OF 5510MLOO(M NJORL
21, Dn pu have as ritm afHmm6ve actimi papas m? ICN(lexplk YES N()
E-1
Re0wed By In (Zomphance: N1 FS NO*
............Pmgmm Op)y e *Nolice ofCorrective Action Sew
[Me felepholic ResponseDw
()n-Sfte Desk Review E] Response Received ........ ../..................
............ .....................
INge 45 or57
An ked Aug 2014 Nge 2 of 2
IMSTRUCTONS FOR THE CIVIL. RIGHTS COMPLIANCE CHECKLIST
as jxci Ac tayet popubtl ion sucl,a as adolesceram describe the Wry MQW&YA ko, ddhe ow type or servicv,
provided.
2. kraer the percent of Me popdathmi solve I, race and sex. 'Me popubHon wrwd kxWdn pemms in Me
geogrqkkal awaRm wh0h sacs ices acre pusided such as a chycouray. Poptdation stalkaks
can he ohmined rivm local chambos cW commem, hhar-ies, or any publication Avm Te 19HO Cenws conmin W")
Morkla popubdon, slatisties. Include the Source of),011n.Populationstakisfics. ("Othei"races include AsiarI/Pacific
Islanders and Atucriuiri lndiaTVAkiskari Naiivc-s)
liner the kni number of Whc Wand their percent by raco, sex and (fisability, Include the effective date c0'
U"Iluer III(:, total mmilhcr ail chews who we mrol6d, regimewd or coreritly served by the 1111"0g],0111 or facility, and list
Owis purcent by rut sex and dNaWlity Include thie date thot unrcOln-rent was cutnibod,
5. I-rruer the twal munber of,advisory board IrIellibers and their Percent by race, sex, and If the re is no
adyNory or governing NmnQ lene 05 section WIN,
6,, Lacli recipioa tip' ederal finarwial assk W lice n-ursi have on Ilk mi asstuAnce that the program will he conducted in
C01411plifflWC W411 aU 110ndiscrintinalory provishms as ruNired h 45 CFR 80, 1 his k usually a standard part ol'the
conunct language Rw DOEA acipiems mW dkr wbjmnWnA5 CTR 8M4 W),
7. Is the race, sex, and national origh or Me Maffreflectivv cad the ge;mmQwQWotV I`or artmNe, iNWA (T the
populmhon is I lispank, k Mew a corqmi-able pemenye of Hispan-ic marl?
MMWV thou k a signincaw Variation between the race,sex orethinic corriposirion ofthe.clivnks and dieiravajlabih y
in lf'W populaticm„ dw PropummWility Nn Ow rusNmsibilky lo ddernihe the reamms for such vadadim and take
Windever ulk"I may be nect.'sSary to correct any discrifohm5w Some legitimow dNprides rmy exist wkn
progrwvs are sanedoned lo setwe tsar cat populaWns stwh as ekhrly or disalAcd purumv 45 CFR 803 (W(0)1,
Do eligjbjliu)) requiremerds, urdawflully exclude posms in prowcwd groups fi-011,1 the provisicni of servick.r's or
Cnil"floymen't", I""VidL ay l)e rntjiCajj ed hi stnR aW client repi-rwrainkn (QueslAns 3 and 4) and alsiri,
throu"ll rota-s recc)rd anaoW W)mrsens who applied bw wov dabd servicc or etrip8oyrocni,45 (J'R 803 (a),
W 45 CFR 811 Qj(2)
0. Par0cipanis or cNits mol be pnwkkd services such as medluL nursing and deriml cram„ Wmwq seNkes,
physuv,fl and recreational thcl'apies.Counseling andsociall services without regard If,,) race,sex,cohor, nation-al origin,
rehgioo,age or disability, Courtesy InIvs. appointment schedW&g nd accuraq,cWiveord keeping mum be applied
Wmaly md withoto mgad Ui race, sex, voW natimml ou agh. rdigkm, age or disability, Uxtrunce& wahkg,
roomy remption awas.reshuonis and otfier NOW mum also be aptally nwiAable to all cNoW 45(Ali W (b),
1, I"or in-I'),atiern services, wsklents must be amigned a) mom% mWsa dc- wifliout regard to race, color, rl"'Itional
origin or disabihIy. Also, resklents aiust nor bo askcd whether Illey arc willing to share amonn-notiatims With
persotis of as diffurent raco, color, national origin, or disabibly, 45 CTR 803 lot);
12. The programllaciliq and 0 services must be accessible to participants and applkanM indudbg We pef3mv who
may not speak English, In geographi areas m1civ as syniMuM popIrttion of non 4,,ngJish speaking people live,
pmgrarn ames,111111, nray du clude the empkWivent of hilingual stufr, A other areas, it is sufficient to have ,,I policy
Or 1IOA RWSCI-ViCC, such as,as current list ofmanies "Ind teleplwne numbers cal biltriNuW WHY&WIs wito wiH amiM N
Ihe provision ofservjcoa, 45 Clli 803 (a).
INge 46 of 57
I
I I Pmgmrrr&AdHtQs mum mah inforinmion regardOng he notWkellahmoy plarvisions 35%VI mm%k k) Ulds,
participants, hene fic hubs or any other hacivmed parils. TU MwuW include in6orniation orl, their HWH in MR a
compW&I uFdiscr-irninmion whi chher the 9Awk1a Deprimera of Idder Anbits or Ow ILK DvpurtmNit or HHS,
TI-W alay he sqVINd vulaHy or in w6dug to every WKWind o"mW be s"Idied dumqh We uw of'
au equal opporlullAy policy pt6acr dis1flayed in a pia)iic area orke ktcHy�H CFU 816(d),
14. Rupon ninnber of discrinihimAn comphinis Okd agAnst the progrrirn/facd4y, lrtdicate the tmsis,e,g., race, ccikir,
creed, sex, age, national orighy,TsabHiq, relah,,,ition; the issues involved,e,g,smNkcs or mnpioyrrien phcon=
termin,ation, etc. inditzme dw cNH rights bw or Qicy b4ged w have heen OoUet] alonpt with the nanle arld
address orlhe lacaL swe or Idual agency widi whom dire compkim has been Xd. Indlate 1he mu-ren; SIMUS.
eg. seukd,no reasonable cause foundSOure io conciliate, la ure to cOOPet"Ac. under NOOIV, etc n
II Ile PMgMM1kH4—rnim be jAysOMly ameWbk to 0bled indN[choh, IT)AUd accesAbdi, hOwles
&sQrrawd par&g amw clut cuts or ON approaches. mqn,ad ahjmte widths to entrzinces, F]w lobby. public
Ileoiane, rewoonil facilifics, waler fouruadry hAdmathn wnd admOssions offices OwuM he am"Abie. Emor,
wu alw iramc areas oradrikimnaive onkeL cafawrks,reswoons. mcma6mi awav cowrleiA and servirigAhes
Owuid be oANNed for acc�.-,,ssibility. Fievasms dnmW be o1selind for dmw width, and BmWe o"AAd iwn+ers.
S itches and coiands 1br light, [waL venfOadort Mv ubmis, md (der esseiahk sNndd be AmoNed at ari
apgoprime heigM Aw rnobibly irnphmi VHO&wls,
16, Section 504 4% Rchahihwhn Ad of 1973 rapOws diat a rucydent of f1deml AnnOW asaktane colWua a self-
evaluation to idenlify arly accessibdry bar6ers. self-evaluatiorl, is a r(nir step procvss�
W Mom Ow a"Hulce cd,at disaIfled individnal/clq ganliz,atiwn evattale currulA praclices and pedicies which clan not
conipty wiihSeciion 504r
b, Mocfifv policies and practices that do not nicet 'Section 504 requirements,
r TAe rerneTM szqis to Ohninwe any dkerimiamikin &a has beeri Wemifi&
V Adakurrin self-evoluation mi Aly (ibis cheek1k, may be urns i to smisQ, H44 mquirenren; dKese War steps have,
bt�erl l',ollowedj, 45 CTR 84.6.
17, Pmgmmn or NdMies War eniffloy 15 m more personsr niust adopt gliname protwfores Kai QoTonou Nqvoprime
due prmxss swn&vds mid pmvWc lair' die pnirnpl and eQaWc rustdotion of compNhas allcong any mAhn
poh tied by Semimi %M AS CFR 817 1),
18 Prounarns or facOhles that ernMoy 15 or nowe qrsons niusl desynwe al Nam carte pnom to couWhmu eMms U)
corrvply %vith SevOori %1,45 Cf"R, 84,7 (a),
19. CondnWng meps mum be Uken to notify erriployces, and the public of' the progtinai/facifity's, 1)(flicy of
nondisernnination on Phe bask or dtsahiiij. This &cW&s recruitrinein rnatelial, notices, flor hearnip. newspaper
aik. and wher appnipriate wriun c.alaurruuwtrrieaatfu,awua 45 ('1`9,84,8 (it),
21 Progwrn9hiciNks Mm cinp�oy 15 or more persons trimr,provide appiqnime aux%j aids w persms whh Apaired
senso,ruanual or speuking skiHs where necessary, Auxihiary aids uray inchid, bw am nut lWhahn imopwrs
For hearing Yniriaircd indivWurlIN laped(w BraHQ mawriaK or my aWww6ve resources Oull can he used io pnitide
cqua Hy cffi"ctivc services, 4 5 CU'R 84,52 (d)
2 L Pn%rarns/facihfics x6th 50 or niore ernpkl yees and $50MO4r OO A f`ederal Conlracts mu'sit devOop, itoplerrient aid
trudivain as w6lteli affirrilative act4nl cornmiame Prowwri 61 accordance Nvith Lxccutive Order 1 UZ16,4 p CFR (it)
and Ilk VI of Tic Ovil Rights Awl of 1964.as ranended,
INWA Fjmm 10143,kovi"'C(l Al,q ls�201 o
PAge 47 of 57
ATTAC14MENT C
AUlance for Aging, Inc,
Hushiess Associate Agreerneill
TUs Bmhns Wochw Agrearion rs dated _�?
' z
y tdae W ging, i . "Coered Entity")A foAIn ( v
W NionrueCounty Ehmxd orCumMy Corni�iss oners,Sociml SeimicesIwHomv SaKes ("Busnns PomwiNe"L a not-
fi)r-profit 11orkta cort.)oradon.
1,0 Background,
1A Covaed End I has ovemd Wo one cw imore corOmeN or agmemenis mith But=lusodMu Omt invoNes dw kiss of
Prolected I feahh (NII).
L2 ["'mitily recogni/cs the mqukmmm of Me Health WmAnce PortandAty and AccomimMQ at or dean 6
(HIPAA)and has WIMM its hHoU to coQy in the County's FTHOWs mid Pixwelnvs,
13 "WkA rytdalicins establish spe6fic coirditions on %010i a11111d 110W COM°C`d carutptde; umaaay share inhnmation vOlh
I_r,w.(,IVi(jlellniWgl(l,l;WILt't)l.tlI JjniCtj()jjs fOfJheCOVe1Vd
Of 141PAA, requires lhc Covemd Why W Me Husiness Associate to o1a iWo a con1rut or apvemwH amdning
SPCCuf'we jneqvj$.CfTjCvtS tm) protect the confidentiahly art(] security ofpaHents' P111, as sel fOrth in, but not linrited wj�tile
())dc or'Vcderi.d Reguladons ((%FA(J. specMeAh 45 C10. §§ f6,4.502(e). 1615OMe, 1613OWbL and 16131ya-
bX20 10)(as rnay appo)aml umiSnai A this agreemcm,
I A Ilic I-NaM InAinnadon Schnology 11or Fconornk amf CA&W fkaWi Ad (NWQY Ow Anwrian Reunovery mid
Reinwomm Act (ARM)and Pail I —Improved Privacy Plovismons arld Securky pn,)visions lociaedgat 42 Unked States
Code(t t,Sl',) §§ i 7U p zind f 7934 (2cii o)require havess mmwoms orcovored emides to mmipiy Wit the I I HIA/A
SmuHty RW us set f'orth in,but nor firttited to 45 (".FR. §§ 161301C 161314 1643 11 and 1643 16 (W)and mich
swkml�s ,,haH apfily to a fmsiness aqsociwe of a covwvd civil in the saine niamer Om mich woklns apWy to Te
=mS emity,
I he po"ics therefore ktgi-Ve fl; 16H,MVS:
W Det"inhioms. NY putpows of Us agreernotc We WwAg dAnitims ant,:
11 Accn& lbeandhyorkeni(,,�,iriisriiecessat"yte)m'ead,miiw. nioddy. orconimmAaWdWAnMmutwiwoMawkeme
am y pry=n resomme,
22 Achnin6hmikive Safeguords. Ile adnihimrative aokm& and pokies and twoudum hi rnampo Ow sekohn,
developrilefil, and inahoenance of sectishy incusun.,s to proted L.Iectronic Protected Health
Infornialion (efffl)and to inanage the conduct of the covcred=Wyl wwtkime in relation to the l!'n,otection of that
informahoir,
2 3 AR RA. The An-icrican Recovery aild RedwstmetH Ad (NMI))
2A A"Hwntkaiion, Ile corroboration that a rserson is Me oric chlin'led,
2 5 Availability. The propeily that dala or inkltmion is uces?ihk W usmhW upm demwW by mi m1ndnd pawn,
2A Wub. Ile unianthorized acquisition. acces, usc or disckwure of NM m1kh cmnpronikes the secur"; or privacy
to Mich hnwrinmiorl.
21 Compromises (he Scenrity, Wing a siydficarn rkk of finandaL mputmiona1,or Wher Kai to individuads,
iNge 48 of 57
J. ConhidenHaUq. IS pnqxtiy that data or information is not madc avakble or disclimed to unauthorized persons or
rwocesses
2.91 Electronic ProWded With I n Mrma%n (04H", HeMb ARmumbon as specified in 4 5' CFR §1W 103(I)(i)or
(1)1(6), hnnied w the inforniation created or meeked by Wilms AswcWc koln man beimWof Covered Enky.
110 111TEC11. IS A= InKmadmi AdvilokTy Aw Earnw-nic wW ON&M WMA Ax"2N,))
211 Whin,moHon Syslium, Aii intQrcounumd set of WRvinatimi resourms under [be same disco wuramgm-nain contrid
IWA Mmms amm-ron functionafity, A sy,.4ciri norintljdy includes, hardware. sofiNsare. infolrnafionw dam.al phcalions.
and peolfle,
112 InWgrhy Ite propeny At dMa or WWwOun htive not Imen ahcred w WMA A an unaudlorized nmm'.
2.13 RUlkinus snAwarc. SoHwam, A ewnpl, as vKv&Aglicd W dhipVc Wkmps u synion,
114 W! L Pail I -Wpaned Privacy Pmvidons ad Smutty providuils ImMed W,42 thiiied States Code(U,Sn(`.) §§
t 793H and t 7934 (20)0,),
2A3 Pumvord. CMdWMWW WheMication WmWim=,qxlsvd of'a string cld'Charackcrs,
116 isysm sareguards, Ile physical mcmureq po1kks, and procedures to protect as covered entity's clectronic
irl firril lilt i on )'yslenis and relmed bulkhngs and eqQwn Two ruilwM and u0srnmenta1 1=6% and
unauihorlzed jrnrusiorl.
2A7 PH"cy Ruk Hie SmmhWs Rv PrNacy of fndividkjaldy Ideinifiable I lcahh hifin"wation tit 45 (J"R 11,an W)al'id
Parr 164, subpans A aAd E
2.t 8 1"rolected IWO InIbruiviHnia HRHIJ Huhh Wkwula6m as defined ii!i 45 CFR §JW603, linikki qc.r the
hAgmaHonumamdorrueNed dry BusMnsAmodMckmno agar bdmdof(lwovdlWOq,,
2J9 164JO3.
2,2 ecurily incideN I he Wisnpted or successNI irnaudiodzed imcess. uu% WaWsmv nwdMoAmy or&Mw5n
cd,inforrilation in-kno fct-cjlcc Ivith symon opennions in an in forn'lal ion syscclw
212 SixuMy or SmuHq musnew AH of Me rldnihistswive, physical. and WON saNgurds in an inAnnatiort
Sys fern,
213 Suudq RuW%Smurky SmWards dear floc pwwokm of%ownk Pinvected' Heahh Inforniation ill 45 CFR part
164, sublmil and ailicridn'roirs theretc),
214 TuhnkO Safeguords, Yhe tahmNogy and Me po1ky ad pnWurcs Rir ids use- tht"It prolect edectlonic protwed
heahh and controlaccess w it,
225 Unseccured PIR f1mmued heAh intIll-inwimi but is nm smumd Humgh, the use or melllock-dogy
specified by Oic Secretary in guidance ksued under 42 t I.S.C, section d 7932(11)(2),
226 AH Wher bxms UW& Na nm okeivise dcNw& in Mis Agivemern WH hue Te swore nwan-ing as Owne terrors W
the Privacy RL.fle.
3.0, (.)bfiglifions and Activities cABusiriess Associate.
3,1 Busiriess Assochw agrew to MA use or dischse F111 o1her Man as peanrued or mcpked by this agivemew w- as
I?qMhvd by Law,
INge 49 of 57
3,2 Business Associate agrees 1w
laa InWOrnalt palcies and pwaWres to prevent, detect., contain and correct Security violations in accordance
w1h 45 (TR § 164306�
(h) Prevent use au-discloswe orthe PHI oler tan as pmvWcd Rw by this Agmwienl or a.s,required by ham,r
(c) R-easonably and approprimely protect the conNendahy. imeg6j. and avattabdOy of 0're ePHI duo Me
Bushmss AosaWe amWwhs, or Imnsinks on bdudf ol'the Uovewd EnQ;and
(d) ComMy w4h be Saud, RuW reWidamnis bwWdMg Ow Adt1fl1'JSU-a1GVC Saf'Cgtlar&S� PhySiUfl Safe�,URVds.
Technical SoRguards, and policies and pnwedures and duct,unwaaOon! a-equireniews set forl in 45 CFR §§
164,-3'08, 164 310, 164 312, and 164-3 16n
33 Mahns Aswcble agre" to mitigm, to Me exim; praORON ally harnill'id C'Ifeci that is known! to Business
Associ,'He ofa use,or disdoswv or Of If by RuNness Asmwivilv in vinkRion o,r Te rapAmmos ordis Agreement.
3A Bohem Aswuhaw agren to promptly rqwl to(Awavd Entily any we ot,thsclosure W the 11111 not provided f6r
by this Agreement ,,),r moth it bmwnm awmu TbN Wclu&s my rquw R)r inspeWov.copying or mnendrnuil W'
mwh inhwmation mW hwWdhg mV smuiJty AW houlving RJR L
15 Mishns Associate agrees to nwily Cowred End, wOwl uwammWe ddq, of our swuNy bmach pawhirig,
to;
(a) Idendficalion of any individui.111 nnseCtijlred III II has been, or is reasolufl'Ay twheve(I by, the
Associate to have been,accessed, acquired, c'ir dkclosedl during,such awcnrity breach., mid
(I)) A It n1filrp-Ia,11[j()il l,-V'qtj jjled fi)rn the le) the q( Brvoch U'�m c`cnrcd Pron'xlcd Fleallb
bra or
3 Cu lhisirwo Amocime agmus to wwwv Olai my agm hwWding a sAumn-nks to whmn h pnwWa NH rocived
Ihmn cw cmated or receNd by BuNnem Associate on hidwworCOvered Wity,agrees us the sunre restrVions and
condhions that apply dmmgh Mis Agreernem to Bushns Assadme with rvspect to such nflon-nation
3.7 11'Business Associaw has Ill I I in a Designawd Record set;
(a) Bustness Associate agmvs V;pavide access, M the request or L:o%;mvd Why diming reguhu business hoturs,to
14H in a lksignmed Word Set to Covered Why no as Owed by Covered 121h,to un hWi0dual in onler
to niect dre requirenmMs ndur 45 CFR §540Nq mul
(h) Busincss Associzile agwes to note any mwndrnent(s) ho PHI in a DeQqwed Ruvrd So dmt Me (W"wd
Entity d6'ects or agum hj pumumil w 45 CFR § 164126 at be rnRies of Covered Ln6ty or an Individual
wilhin M busincss dqs of mKing the mqust.
3A Mishms Ass,odwe apves to inake interim! pracilev, books, and mcordy including 1wilks and pnwedures and
11111,relating,to the ruse and dkchmwe of PHI received WL or created or received by Bushnns!"Wate on behif
of Covered Endy, avaiNble to We(Awovd Ady or to dic Sectetrary upon request ofeiflier party fbr PLo-I)OSes 01'
dWurn0nWg Conmd Entilys compliance with the Privacy Rule,
31 Bmhem Assockite agrees to docuinent such chwWres of 1411 and infiorniation related hi sudi clisekwures as would:
he m1dred for Wered IThly to respond to a requat by un WOW A an necomIAM of di-scloslovs, or PH i in
accordaticc wilh 45 CUR § 164,528
3,10 Business Assoc% agrees to lwovWe to Covered Endly or an indivWmL upon, request, Wnitation collected it)
peank Covered Enthy to respond to a request by an &TNWwd A mu mmunting ofdisclosures of 11 in accordance
W 45 CFR§ 1 U028 and A RRA § 1504,
3,11 Business Assoc,,rale specifically agrees to use, securky jimeasures that reasonably bond appropriately protect the
confidentkflity inlegrity,and availahifity(AT HI in elect rcun ic,or any other t'orrn,dial it cre,tes,receives,rnafivains.
or transtnks on bdiall"of the Covered Entity.
Flage 50 of 57
U2 Bwshess Assochw agen uAmplernent gecurity awasums to smwe pnommnis used 10 access UPH I dim U wCusses,
mainmNy or MnsnAw as part of IN Agreemem korn nralkhus soRware and odwr nrimpt-nadc and nahwal,
vuRKHRIcs to assure Ow andialAlky. inwgAy,and conrinday orw warnam,
3 J 3 Bushium Assochte agrees to 4nMerriera smurty mewums tosaIguad cPHI dEa H accessey nrainwhn.wimmsroks
as part: or this agmeniew Avrn nwhibus soRware mul (Alwr rnan-matle and md-umf vuMerabilhies to aumm Me
avaflability, nlregriry, and cour"identiahty of Such infornvoion
3.14 Bushess Aswiciare t19,rees lo contpiy witt
(a) ARRA § 134,04 (Applivaion of'KnusOmWe ERments Assuchned with (umitracts);
ARRA § 13MU(RoWohns on CaMin NwIlosums nnd Saks of I Wahh hOnnatAX ornd
ARRA § 13MM Qmdhons wi NOW LAWN as Poo of He%CAre Operations).
4A Nrmithsd Usn and II)NAmums by Buniness Amodw, Except as Wherwise hinifed in this Agrecinwril or any rejatecl
agmernenL !Winess AAsociuue iway use or dirschmu PIH to pertUri hinctious, activrOes, cm-services i6r. or on befialf of,
Covered 14-nity as specified in any and nH owacts mOh Covered EnNy provided that such w or ad closum imnhd not
vkhte the Nucy Rule I dww hy Covered FAY w Mv mhOwn "emmary pAlks and p-om&Has of Me Cbvemcl
Fraity.
5.0—Spedne Ne and FINOwwr F%viNions.
II FAcqn as odwrwke limited A flues agmuinmg or aij rdaWd agreemem. Business Asso6are, amy use 1-1111 Rw the
pmper nunageniem and adn6nisiration ofdre Busirwss Associate or to czwry out HIC legat responsibifilies ofAw
Rmhey Asweime.
52 Enep as ciMovise hmAd in As agreemem or as Wed agmemeni- BusinesN Associate rinay djsido,,u� PIII for
the proper imanagemna aml adminiswOon nf A Hushmss Associat, provided that disAsures are RequAdBy
Lmc cw Biwinns AssnAw Knits wawwbW awwances Rom the person to whoni the inforinationi is&cloml
thal it will reinatil confidential and used or fitrdic°r discrosed only as Required By Law or frw the purpose fi.w which
it was, Ifiseklied to Ille per on, and tire person nolifies the HmAm Associaw ofauy suns; ances of'witich it is irware,
In which Te cw0dentiality of le inronswWri lures houn brumbed,
53 Mrshem A%uwiw nmy uw Pill to Imuvide data iWVwagabon sawAs tEl Covemd EnHV as qnnbW 1, 45 (TR
§1643Ojc#2XiXBj oidy "tun spmifludt mudwHzed by Owet-ed LAH,
iA Busitiew Assoc agate niay use 1111 to wpon violatio"s 4 law Ul Upproj,"wiate Federal!arld state"'tuthon6es,consk ent
W 45 CFR §M15NOX 1)1,
to, Obligations of('overed Entity,
6�i (,'ovei"ed F",nfity shM notify Business Asswiate of dny lirnIta6mr(s) inik notice of privacy Practice's of,Covered
E�','nfity in accordance with 45 Cf,R,§ 1615M,W the Mwl that such Frnitation may aff" ct Business Associate's use
or disclu,w,suro of fill,, by wwwwA an copy or Ow nwsl c:uuarerut froWe or Pride Practices (NIT) to Btisiness
Amadal, Ftnure Notices and/or moffinUms to he NWP shall be posted on (,!overed Entity's, website at
62 Covemd Endy diall nwHy Bushess Assoc%onmy remHown to the use cu drsclomwe orPHI Owl Covered 110,
has arced to in accoMmice wHh 45 CFR § 164.522, to the exwn: Mal sudi mKohn may andt Bmirress
Assmiatel use or dhdamve of PFIL
7A) Permissible Reqncsts by over Entity. Acept for daw aggregation or trianagemen; and admitAmnHA actividn of
Hirshem Asw6we, Covered F),rh,y AA tiol ro.,juess Business Associate to use or disclose Pffl in aDY F11,RTIHer 0101 would
w he pennNAble uirder the Pdvaqy Dunk I dww by Uovemd Entky.
INge 51 of 57
,if Efreel i,ve Date and Termination,
I The Var-tics herby ngreu Owl dds agmement amenK mswws and wpWces wW oW Bushes Ansudate Agmarrtmt
Currenfly irt effect lmween Covered [iltity and Business Asscwiale arrr-,l 1hal tile agreeinvilit Shah
be effective ,is roljowv's;
(a) These NsWs Asociate Agremnent proviskAm. with the es,cepdon ofthe e1ectronic secuniq pro"Morn and
die piroviMmrs mmWated by ARRA, l lVITC11 and PaN I small be WON tWon Ow Nwr or April It 2003, or
Me enhebw date or ow Woo commet critervi in howwn I�3usiness Asisociate and Covered Eniky twat
involves the LNe of V!W
b) 'I'lle C lectror 1 ic see u rRy Iwo v idons h urvW A in H he e ffect j ve t h le Wer of A pri 1 2 1, 2005 or I he effeci ve date o I'
Me ewhlbsi; conmwl oitered huo between Bushwss Associate and Covered Fritit�y that involves 1he use ot"PI flM
and
(c) ProVions hereof amndmed by ARRA, HRECII Wor Pon I shall be effective the lawr of February 17., 201
or the effective date of the earliest cmrao emered hrio between cowmd entity mid huxiness assochte that
invkdves the use ofP111 or eel il,
82 TwmWatWin Rw Came. Upon Covered Endtys knowkdge of a niMahli breach Iwv Business Associme, Covered
Fndq Mull Aber:
(a) Pro0ck an oppor(wAW lbr Bushas A°rsociate to cnre the breach or end the 0okation aInd terrnirtaw Ons
agieernent WBUSiueSs Associate dms not ewe t1w breach or ond the 0oNrtion widdil the dille specified by
Covmvd SO,
(b) InirnediateIy terminate titis agmernem ir Bud= Aswdate hus breached as irweHal ter in of toads Agreeawnt
and cure is no o"'Sihle or
(c) If Wher to rnlination nor etwe is fbashlAe.(Tivewd LnMy AaH rep oii the viol;xtiorilo the Secrew,
8,3 Effeel of"Ferntimadon. ExcqM as provided in suNmmpson orthk Won upon tcnidjuation ofthis agreement,
Wr any trasuru Business Assockle shall remm uH PM1 and vPHI rece1val hom Covered Lntity or crearei�l or received
by Business Associate on behalfol"Covered F"nlky
(a) It is provkhn dmil ag�b, to 1111 and ePI 11 that is in die possemion or subconvactom or agents of Budness
Asweim, Whins Assodate Wh Wn no copies of Me PHI and ePHI.
(h) In the event dial Rushwss As uciate or Qver-ed I"'wity deterninies O'lat returning the PI 11 or eFli 11 is infeasible,
notificatiorl of conditions CA make return tW P1 N or el'Ill hilasible W be pirovided to flee other party,
Whom AssodWe shidl exwnd Me prowebms of dds Agwmwm to sawh retained PI" and ePI H and lbrit
Wher uses and dischmtaes ofsuch rowhad 14 M and ePHL kv as mirSiurn of Q yeam and so Kng as Business
Assochite mainiains such PI H areal cP"L bw no Whan W (6)years after 1he wnirinotion of Ns agrennent,
9,01 Regidalory Reft'rences, A rerunmee in Ods agreement lo a secdon in the PHvacy Rule or Secturby Rule mens Q
wcom own &em or as may be anwndml K the Raum,
1011 Amxndmxnt The 1100 agree to take such actiorl as is necessary to amend Ids agmewwrit kom h-ne Ui tirne as is
necessary d611 Covered Emky to compo %vhh die requKernents of Te PHucy Rule, the Security Rule and Ow I leahl)
hisurimme portability and Accmnitability Act or I got pub. i. rqo. 104-19 1,
III SmwNW. Any teen,c tract don. covenant or obhgathn which requires per ilonnance ley chha liarty hvmu)suWequem tu
Me tertoinalion ofthis agreement shall remain mdbrceable agairisl such pearly subsequent to Such
12A hdayumlWo "y arnQuity in Miis agrceinient shall be resolved to permit Covered Enli to corrqjply ivdd'i the Privacy
Rule ad WWI RW
13A InmoirpomHon by reWcnce. Any ftaure new requLivrnent(sy clianges of dclel iou(s)Vilacted irt fedo"al lavy Which Creale
new or different obligations %xidi respect to I IWAA privacy anci/or secudly, shafli Ix., autornaticaiby incorporawd by
to 1his Business Aswelit Agmelvern on this resficoNe e0hvkm dmoq
INge 52 or 57
14.0 Notice.s. All notices and communications required, necessary or desired to tv given pursuant to this agreentent,
including as change or address k)r purposes, ol' such notices and conimunications, shall he in writim, and delivered
personally to the Other party or sent by express 24-hour guaranteed, courier or delivery service, or by certifieLl mail of
1�
the Uniteci States Postal Service, postai4e prepaid and rewril, receipt requested, addressed to the other party as fiollows
for to such other place as any panty volay by notice to the others spent"):
TO Covered Entity-. A Mance for Aging, Inc..
Attention: Ma,,; Rothman
760 NW 107 Avenue
Miami, Florida 33172
To Business Associate: Monroe County Board OrComity Conimissioners, Social Services,'In-I Ionic Services
I 100 S i ni onton Street,2-25 7
Key West, Ft 33040
Any such notice shall be deemed delivered 11pon actual receipt. If any notice cannot be dehvere(l or delivery thereof`is refused,
delivery will be deemed to have toured on the(late such delivery was attempted.
15,0 Coverning Law. The laws or the State of Florida, without giving el7fiect to principles of Conflict of haws, govern all
niatters arising ondvr this aercement.
16.0 Severability. Irany provision in this agreenlem is unenforceable tar any emern, the rernain(ler of'this agreement, or
application ol'thai provision to any persons or circninstarices ollier than those as to whicli it is held mwntlorceable, will
not beaffecte(I by that uncrof'or-ccability and will beenrorceable to the lbilesi extent permitted by law.
1 TO :Successors. Any successor to fito�,iness Asmwiale(whether by direct or inclirect or Icy purchase, merger, consolidation,
or otherwise) is required to assume Business,Associate's obfigations under this agreement and agree to perform them in
the Same Inaviner and to the Same extent Iliat Nosiness Associate wouki have been required 10 it'111ilt succession had not
taken place. 'rhis assumption by the successor of the Business Associate's obligations shall be by written agreement
salki'actor-Y to Covered 11"Mlily
11 X,O Entire Agreement, His agmen'1011 COTISOILI(CS 111C Crnire agreement orthe parties relating to the subject matter oFthis
aurecinent and supersedes all oilier oral or written agreements or policies relating thereto, except that this agreentent
does not UslO the ainenLiment ol,this agreement in accordance Wilh Section 10.0 ol'this agreement,
C'overed Entity: Alliance for Aghig, Inc.
AkLi a6l� ........................... Jul 29, 2022
By (�j A 29,2022 11 f 11.1.) Date:
(Signature)
Business Associate: Monroe County Roard of County Commissionet-s,Social Services/in-"Orne Set-vices
By:
.. ............................ ............. Date:
( .........S ignall.lre)
Page 53 o f 57
i J
ATTACHMENT D
F11-1 1"'IR A[,TA
Ji
Wii 11101;�Ifl
BACKGROUND SCREENING
Attestation of Compliance - Employer
AUTHORITY:This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05J3),Florida Statutes.
The term 'employer" means any person or entity required by law to conduct background
screenings,including but not limited to,Area Agencies on Aging/Aging and,Disability Resource
Centers, Lead Agencies, and Service Providers that contract directly or indirectly with the
Department of Elder Affairs(DOEA),and any other person or entity which hires ernployees or
has volunteers,in service who meet the definition of a direct service provider.See§§435,02,
4304 O 402, F Ila,Sta L
A direct service provider is"a person 18 years of age or older who, pursuant to a program
to provide services to the elderly,has direct,face-to-face contact with a client while providing
services to the, client and has access to the client's living area,funds, personal property,, or
personal identification information as,defined in s. 81.7.568. The term includes coordinators,
managers,and supervisors of residential facilities and volunteers." §430.0402(l)(b),Flag Stat,
AIMMILUN:
As the duly authorized representative of
_M01II ublIf "m al VICII
Employer Narne
located at key, tA>s+, rp , 3,;0(/0
15
Street Address City State . ) ' ZIP c8N
I,— ISNhoAl C-W&6111I do hereby affirm under penalty of
NaMe of Representative
perjury that the above-named employer is in compliance with the provisions of
Chapter 435 and section 430.0402, Florida Statutes,, regarding level 2 background
screening
............
§7- -
Ig narur offT6presentative Dale
FS Forrnovadubkat:hr cquy 1p ckgrouludscreeningph2
Page 54 of 57'
Al"'FA01MEWE
REFERRAI, 11110TOC'01,
Issile. Screening,'firiage,and Referral WT AWWMWn uinder Me AkhAmWs Dhimse Initiative(A DI) Program,
PWWY SEW %&H be ninde bwwd on ovaibbilij; of hinds, in accoahme whh pkwhimion ruquimiments,
PUqOW: To cmure bunIng is spent expedihousy and consuniars are given it diole okase managonew agencks,to
Me emmit pmshle'
Piveedure:
I, R(Oesand Resporisibflides
/V Uhnee Rw Agh,/Aghg and FWWWy Rewmte Cmwr
6 Recotwifes ~0 pnqmm awl All Agoicy specHic spenclOg Inek on as nwrWfly basis 'to ensure d"ie AD�
Agenq is opuming,withiri 1he funding allocaHun&
0 Scivots cwBumem to HH! whh appvpHatc roourccS''Int] j)jj,)rjtjZe f('qr DOFA-fundcd progranis and services,
8 Releases cases I'or activation based upon, Adi Agency Rcquestu.
8 Rekaws cases Rom aw w5ning list h.ased on their,lit jorki/,adon score,
0 "vlorfltors coiriphance wOih service standards and outconne, mc,Asums,
0 Rev icvvs lifer per We He Rev Ow INA Q ks and Swedwes,
0 ReOws alma in eCIRTS,
B A DI Agcney
0 Rcqwms and wxepN mfea& Aurn 1he Aghg and UsAAH, Rauume Linter, to swwe an opumal amekwd ant]
to avoid surpluses iv thwheils in acemdarice vvhh the Alliance SurplriwDefick AnMpk polky,
0 Refers a'tquirics fi"oni consunivrs iwe'rostea'l in wrOces to the AD RC for lid'on"nadoili avid RCRITd W C0n1111VU]'1hy'
ITSOHFCC Screening, 1'rjagc�and l,onglknn Care Opthovs Counseling, as arliropi-We.
6 Coalrdeles corno-eliensive assessi'trents on new consuniers and annal reassesyment on eximing cwnwrrms mid
develops ewe Qns and revi= care plans sernikannually,
6 Authorizes service delivery and enters diia into ec"W']'S,
0 RHU 0 eCIRTS as appDpHm,
4 Nlonitojn'; Caw Iflarl's in an eflbru to keep MtS Lkmvn WO susminAg We individuals in he comrnundy,
ll, W.mageinvot of'Ove Assessed Prioritiled Cbnmmia IS (APUL),
A.As chcrus am w16-ced lo the ADRC%cWts are fmovided inhannothn on evinmu"ity resources iui,d progyanns avadable
including private pay optW Mons are dirmwd lo Muse roaumes niust capable ofniectn'no dw need they have
expressed tee AL)RC slifff, (-'ases prewmhg mnmg idenHhers that indkime ke emmmner ivi& henefit horri publQ,
A"Wed Imig-tear ewe soNkes my savowd,mucred inin eCIRTS. htWod and pmvWed ofithms counschng'.
1. Cbrisrutims appyibg Rwtlic Abheirrier's Disease Inhiative(ALA)pruWarn wild w coiWiched tdmak 141 mafl
and screened uAng dw switewide assessxnent Rmn develulmd by the Department of[Ader AITaris Ar Us purpose
(Form 701SE The 7W S will doerinhe tkir mnkhg on Me apprWriute%v,,66nV,, isl(s) AP stkiwk .
2. Ile ADRU w0l reassess conwmem on Te w;WhW 1has aacadhg h; flyer 2MS Dej,')arnnent of Eder Affair's
Progmuns mW Services I landbook,or aq, revi[sions inadc thervaHeir,
K I IIPA A forins will be sent to the consulnerm"'Ijlpropr4ne
Nge 55 of 57
Ill, 0pcnhrgNcwCases
A, AD! Chenis
1. Ile AM= Fisal Ckpatiment wM numMr Am Agency s1weiHe spendOg cin a nicnithly bmis tea ensure
each ADI Agency is openning svithin RoWeiWitig awhorly. In acklilion,the Alliance ",011 analyze surplus/deficil
1,)ro�cctions, and share the infort'narion with We AEH Agengy to maim In Own-deiam4mlit"if AW availaWhfiy
The AL)f Agency will request reI'errals directly front fl-te ADRC% the jocal DeparoWnt W01 be innihHed orde
nmniber ufrw%v cases being it)Me ADI Agency [oractivation.
2, Upon racyl of die request R)r rellerifs hom Me ADI Agency. OR: ADRC' Intako Unit Supervism. NvHl run the
PAWOnd Rkk Report to klcndfy the conmuiers on he APCL to he o"ned.
3, In response to the request Maur referrals,Me ADRC IWAe Unh Supervisor "dill refer wail hsled clients to Ow ADI
Agency for wiv�adon, in accordance with pt-iorid7afiort rcquirenietns. The Wake LOR "Al qWme Te wah Hst
emolhnent using dre appropriate code warrihaw fronthe APCL, Rw rekne w Ow PUN Agency OAFL),
4 Upon receipt of the list ofcljen�s rtdcased from dine,wakilig" list, Ific ADI a\gency vii1t enler irnc�^ APPI- ou"ollnikia,
cmuao clOws U, o0h pmgmm ctirtlOwnt mid In(weed will the process for aclivation, T'he ADI Aj�,�ency wdl
enter suhsequont enroMnents into eCIRTS to rellect clint suttus
5, The Alhance%vill oversee the emidirnent process M enswv mthnwk line Ilan Ay owcomesin cORTS,
6 (.:'hoice(for Wainbl)nde County null # In the event that unallocaled hinds become ava!Nble at IS Alliance 10
alh%v Air new chent emOmmins,Wo Al L die ADK' Avid conlact consumers frt"'i't the railing li"'a to ofler choice
M'ADI Agencyo If be chem is no longer lnhuruswd 0 rcm%g savices flues appropriate wok Hm
W he Xsed and the nom chero on the hm W11 he conwcted,
w Imak thth Specidkls wild conWct the client to Wain choke WhavideL The climm rethr,ral will Au" be smu
lo die ADI Agetics, seleded by the client.
IL iranvy ima,Amps by phmic ow Intake I% stalTis unable to reach the consittrier,bc�chent will lie assigliled!
CW wrlaw to an agawy on an wHon baW
c, Upon recetpt of referral, the ADl Agency will ci-oer Me APPI, enrolhinenL, �and
reflect clieni stahis, Conitscl arnmidmcnt4 %01 lbllow in nuorimme whh the number o(crients yeferred for
aoww%
H!, AHWWW10 AUdicaid Nbnqed Cam lmn"TeirmAlre nmgmm ON=
I. 11te Wpartnicin,or 1SWer ARW%&H run the sMwwWe A PCL (Assessed flriotliy Consul"I'ler List)report to review
dients W lWal Pit- the SNANICIAW pmgmm, DOFA %vill prurvide lhe ADRC with it list of wndividwals
atOwHad For release Rom Me APO-
1 P'or chonts jidendHed ns avNe in All and awhoHzed Or release from Me SMNKI,'I'(:I' waifing list,the L)RC
"Ill be ruspolWbI Air Ow SMM('I-T("I1' apphcation process. For AD] active clicols., the ADR(: xvdl notify the
ADI Aggency new ordei,to waivc, the ALA co-pay
IV,
A, J%quency W"Changes
1, Lkinstuncis nmy climinge AEMAgeticies, on as ni,iorahly basis lfth*, so ehclose,
2, CHmmias",'lip nced tea requesiachatWe()TADI Agency by the tbsi (northennonih in err leer har le.chongetag
be in cllc�ct by the 1611'of that sanie mornh.
3, 1 Me mcltrem is nuide after Be IS; or the month, die change wO I take cMcOj dw 16*a Ow INkiwing moruh
13, proccu s for Changes
I RmjucsN to change case manageinalt ngmiwy must come from Me diem or IQ "moml mpnemmive W die
AI)RCVIJder Help1hy Reqwsls made I,as casu nianaganwil agucy %WH nm he honmvd.
2, When recluestOg as change, Me consmwr will be asked by 1he ADRC W permni ro sham Wonvimotis hor
dubg mi; W Mey spin Ac wMi Mir case marwgemeni rqmigy abota their concerns and iflhey would I d(c to speak,
;vkh so,neone else at that agency.
3, If Me cmsmitsr chooses ter caH be age=y, nolhg ,slip be dwic until (lie consunter calk the ALAC back
Page 56 o C 57
requeming as change,
4, irbe conntnier d(ws not Avant to qieak wilh the ADI Agency Fund wants to cl=,ge, the, ADRC wfll initime (lie
tran&r pmcov. A tiro bM dwice wiH he auceped and documented in the REITR choahase
5.'De ADRC/ Intake Unit wvdt send as Transfer Funn to Te sulemcd AVA Ag,,ency and to the current AI)l Agency,
Both AE)l Agencies avill work cksely w,%Jth dw ADRC U) emum Te umnfer prmxm N compOuVI—Te 15"ot'
the inon1h, as Ang as he Imnstr mqunt was mceivoJ at the ADRC ty Me W of Ot %une nuxiffi.
6. The Ad)RC ItUAe 104 wHkTange the mvner pmvider recoul in KIRTS to the new ADI Agency.
7 1 lie currera ADI Agency will lenuhme wroUrnum in eCIRTS as arme 15,orwe inwah when Ow imnsfer N to
QcpWce, The nov A,IN Agency%Y H I act Nate ennOnem in KIR TS as of Me 16"or me imm"h"ton that ansIr
is U3 take palace.
9. Each at" DI Agency will nobt,), its, respeuive vendors or me lurnkmkin wifor uuNmh" or wrOus R the
tranOerred chem as approprkite
I Semicus will suio on Me I OW Ow nmmh when flie change beconies efiective.
Notc Thme ADRC IW!dn and pmudums am suNuf to cWung, Any madincannswUl he done duvugh a conixact
urnendinent.
Pop 57 of 57
um
20221-2023 AD! Contract Intl I KZ 22917
Rrovider signed
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
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
C 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
:. Adobe Acrobat Sign