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FLORIDA DEPARTMENT OF ELDER AFFAIRS
STANDARD CONTRACT
THIS CONTRACT is entered into between the Florida Department of Elder Affairs (Department or DOEA) and Northwest
Florida Area Agency on Aging, Inc. (Contractor), collectively referred to as the “Parties.” The term Contractor for this
purpose may designate a Vendor, Subgrantee, or Subrecipient.
WITNESSETH THAT:
WHEREAS, the Department has determined that it is in need of certain services as described herein; and
WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such
services as an independent Contractor of the Department.
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the
mutual covenants and conditions set forth herein, the Parties agree as follows:
1. Purpose of Contract:
The purpose of this co
ntract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments, forms, and exhibits which constitute the contract document.
2. Incorporation of Documents within the Contract:
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department handbooks,
manuals and/or desk books, as an integral part of the contract, except to the extent that the contract explicitly provides
to the contrary. In the event of conflict in language among any of the documents referenced above, the specific
provisions and requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s) or
other general materials not specific to this contract document and identified attachments.
3. Term of Contract:
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time July 1, 2023, or on the date the contract has
been signed by the last party required to sign it, whichever is later. It shall end at eleven fifty-nine (11:59) P.M., Eastern
Standard Time June 30, 2024.
4. Contract Amount:
The Department agrees to pay for contracted services according to the terms and conditions of this contract in an
amount not to exceed $$$$$$$$, subject to the availability of funds. Any costs or services paid for under any other
contract or from any other source are not eligible for payment under this contract.
5. Renewals:
By mutual agreement of the Parties, in accordance with Section 287.058(1)(g), Florida Statutes (F.S.), the Department
may renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer.
The renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs
for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original contract and
contingent upon satisfactory performance evaluations by the Department and the availability of funds.
6. Compliance with Federal Law:
6.1 If this contract contains federal funds this section shall apply.
6.1.1 The Contractor shall comply with the provisions of 45 Code of Federal Regulations (CFR) Part 75 and/or
45 CFR Part 92, 2 CFR Part 200, and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Contractor shall comply with all
applicable standards, orders, or regulations issued under Section 306 of the Clean Air Act as amended (42
United States Code (U.S.C.) § 7401, et seq.), Section 508 of the Federal Water Pollution Control Act as
amended (33 U.S.C. § 1251, et seq.), Executive Order 11738, as amended, and, where applicable,
Environmental Protection Agency regulations 2 CFR Part 1500. The Contractor shall report any violations
of the above to the Department.
6.1.3 Neither the Contractor nor any agent acting on behalf of the Contractor may use any federal funds received
in connection with this contract to influence legislation or appropriations pending before Congress or any
state legislature. The Contractor must complete all disclosure forms as required, specifically the
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Certification and Assurances Attachment, which must be completed and returned to the Contract Manager
prior to the execution of this contract.
6.1.4 In accordance with Appendix II to 2 CFR Part 200, the Contractor shall comply with Executive Order
11246, Equal Employment Opportunity, as amended by Executive Order 11375 and others, and as
supplemented in Department of Labor regulations 41 CFR Part 60 and in Department of Health and Human
Services regulations 45 CFR Part 92, if applicable.
6.1.5 A contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards
will not be made to parties listed on the government-wide Excluded Parties List System, in accordance with
the Office of Management and Budget (OMB) guidelines at 2 CFR Part 180 that implement Executive
Orders 12549 and 12689, “Debarment and Suspension.” The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared
ineligible under statutory or regulatory authority other than Executive Order 12549. The Contractor shall
comply with these provisions before doing business or entering into subcontracts receiving federal funds
pursuant to this contract. The Contractor shall complete and sign the Certifications and Assurances
Attachment prior to the execution of this contract.
6.2 The Contractor shall not employ an unauthorized alien. The Department will consider the employment of
unauthorized aliens a violation of the Immigration and Nationality Act (8 U.S.C. § 1324a) and the Immigration
Reform and Control Act of 1986 (8 U.S.C. § 1101). Such violation will be cause for unilateral cancellation of
this contract by the Department.
6.3 If the Contractor is a non-profit provider and is subject to Internal Revenue Service (IRS) tax exempt organization
reporting requirements (filing a Form 990 or Form 990-N), and has its tax exempt status revoked for failing to
comply with the filing requirements of the Pension Protection Act of 2006 or for any other reason, the Contractor
must notify the Department in writing within thirty (30) days of receiving the IRS notice of revocation.
6.4 The Contractor shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.5 Unless exempt under 2 CFR § 170.110(b), the Contractor shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR Part 170.
6.6 To comply with Presidential Executive Order 12989, as amended, and State of Florida Executive Order Number
11-116, Contractor agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the
employment of all new employees hired by Contractor during the contract term. Contractor shall include in
related subcontracts a requirement that Subcontractors performing work or providing services pursuant to the
state contract utilize the E-verify system to verify employment of all new employees hired by the Subcontractor
during the contract term. Contractors meeting the terms and conditions of the E-Verify System are deemed to be
in compliance with this provision.
7. Compliance with State Law:
7.1 This contract is executed and entered into in the State of Florida, and shall be construed, performed, and enforced
in all respects in accordance with Florida law, including Florida provisions for conflict of laws.
7.2 If this contract contains state financial assistance funds, the Contractor shall comply with Section 215.97, F.S.,
and Section 215.971, F.S., and expenditures must be in compliance with laws, rules, and regulations including,
but not limited to, the Reference Guide for State Expenditures.
7.3 The Contractor shall comply with the requirements of Section 287.058, F.S., as amended.
7.3.1 The Contractor shall perform all tasks contained in Attachment I.
7.3.2 The Contractor shall provide units of deliverables, including reports, findings, and drafts, as specified in
Attachment I, to be received and accepted by the DOEA Contract Manager prior to payment.
7.3.3 The Contractor shall comply with the criteria and final date by which such criteria must be met for
completion of this contract as specified in Attachment I, Section III. Method of Payment.
7.3.4 The Contractor shall submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre-audit and post-audit.
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7.3.5 If itemized payment for travel expenses is permitted in this contract, the Contractor shall submit invoices
for any travel expenses in accordance with Section 112.061, F.S., or at such lower rates as may be provided
in this contract.
7.3.6 The Contractor shall allow public access to all documents, papers, letters, or other public records as defined
in Section 119.011(12), F.S., made or received by the Contractor in conjunction with this contract except
for those records which are made confidential or exempt by law. The Contractor’s refusal to comply with
this provision will constitute an immediate breach of contract for which the Department may unilaterally
terminate this contract.
7.4 If clients are to be transported under this contract, the Contractor shall comply with the provisions of Chapter
427, F.S., and Rule Chapter 41-2, Florida Administrative Code (F.A.C).
7.5 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in
accordance with the provisions of Section 287.134, F.S.
7.6 The Contractor shall comply with the provisions of Section 11.062, F.S., and Section 216.347, F.S., which prohibit
the expenditure of contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
7.7 The Department may, at its option, terminate the Contract if the Contractor is found to have submitted a false
certification as provided under Section 287.135(5), F.S., has been placed on the Scrutinized Companies with
Activities in the Iran Petroleum Energy Sector List, the Scrutinized Companies with Activities in Sudan List, or
the Scrutinized Companies that Boycott Israel List, or if the Contractor has been engaged in business operations
in Cuba or Syria or is engaged in a boycott of Israel.
7.8 Board members shall have access to records of the organization in accordance with Chapter 617, Florida Statutes.
Board members shall not have unfettered access to records and/or protected or confidential information of clients
(recipients of services) unless specifically authorized by law. Protected health information and/or confidential
information (e.g., information involving a victim of abuse, sexual assault, crime) should not be shared with Board
members, or any other individuals, unless such disclosure is specifically authorized by law and necessary to the
performance of their specific duties.
7.9 Areas that intake or store protected health information and/or confidential information shall have restricted access
limited to those employees/volunteers who are authorized by law to access such information.
7.10 The Contractor shall secure all protected and/or confidential information and shall implement appropriate
safeguards to protect unauthorized disclosure of such information in accordance with this Agreement.
7.11 The Contractor’s Board shall hold all meetings in accordance with Chapters 286, Florida Statutes. No formal
actions shall be considered binding except as taken or made at a meeting that has been properly noticed.
7.12 The Contractor shall notice all Board meetings on their respective websites and in the Florida Administrative
Register (FAR). To set up an account with FAR, send an email to administrativecode@DOS.myflorida.com.
7.13 The Contractor shall also provide a notice, agenda and copies of any related meeting materials to the DOEA
Division Director for Statewide Community Based Services.
7.14 The Contractor shall comply with all applicable Florida and federal laws, including but not limited to, Chapters
119, 286, and 617, Florida Statutes.
8. Background Screening:
The Contractor shall ensure that the requirements of Section 430.0402 and Chapter 435, F.S., as they may be amended,
are met regarding background screening background screening for all employees, volunteers, and persons seeking
employment who are “direct service providers” as that term is defined in Section 430.0402(1)(b) and who are not
exempted from Level 2 background screening by Section 430.0402(2). The Contractor and its direct service providers,
must also comply with any applicable rules promulgated by the Department and the Agency for Health Care
Administration regarding implementation of Section 430.0402 and Chapter 435, F.S. Contractor shall submit the
Background Screening Attestation of Compliance-Employer (Screening Form) to the Department within thirty (30)
days of execution of this contract. Should the Department have a completed Screening Form on file for the Contractor,
a new Screening Form shall be submitted to the Department every twelve (12) months, and the Contractor shall also
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maintain copies of the new screening forms for its direct service providers as required herein. The Contractor hereby
agrees to correct all background screening deficiencies identified by the Department’s Contract Manager within thirty
(30) days upon notification.
8.1 Further information concerning the procedures for background screening may be found at
https://elderaffairs.org/about-us/background-screening
9. Grievance Procedures:
The Contractor shall develop, implement, and ensure that its Subcontractors have established grievance procedures to
process and resolve client dissatisfaction with, or denial of, service(s) and to address complaints regarding the
termination, suspension or reduction of services, as required for receipt of funds. These procedures, at a minimum, will
provide for notice of the grievance procedure and an opportunity for review of the Subcontractor’s determination(s).
10. Public Records and Retention:
10.1 By execution of this contract, Contractor agrees to all provisions of Chapter 119, F.S., and any other applicable
law, and shall:
10.1.1 Keep and maintain public records required by the Department to perform the contracted services.
10.1.2 Upon request from the Department’s custodian of public records, provide the Department a copy of the
requested records or allow the records to be inspected or copied within a reasonable time at a cost that does
not exceed the cost provided in Chapter 119, F.S., or as otherwise provided by law.
10.1.3 Ensure that public records that are exempt, or confidential and exempt, from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and
following completion of the contract if the Contractor does not transfer the records to the Department.
10.1.4 Upon completion of the contract, the Contractor will either transfer, at no cost to the Department, all public
records in possession of the Contractor to the Department or will keep and maintain public records required
by the Department. If the Contractor transfers all public records to the Department upon completion of the
contract, Contractor shall destroy any duplicate public records that are exempt, or confidential and exempt,
from public records disclosure requirements. If the Contractor keeps and maintains public records upon
completion of the contract, the Contractor shall meet all applicable requirements for retaining public
records. All records stored electronically must be provided to the Department in a format that is compatible
with the information technology systems of the Department.
10.2 The Department may unilaterally cancel this contract, notwithstanding any other provisions of this contract, for
refusal by the Contractor to comply with Section 10 of this contract by not allowing public access to all documents,
papers, letters, or other material made or received by the Contractor in conjunction with this contract, unless the
records are exempt, or confidential and exempt, from Section 24(a) of Article I of the State Constitution and
Section 119.07(1), F.S.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR’S DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT
THE CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Florida Department of Elder Affairs
4040 Esplanade Way
Tallahassee, Florida 32399
850-414-2114
doeapublicrecords@elderaffairs.org
10.3 Upon termination of this contract, whether for convenience or for cause as detailed in section 53 of this contract,
the Contractor and Subcontractors shall, at no cost to the Department, transfer all public records in their possession
to the Department and destroy any duplicate public records that are exempt, or confidential and exempt, from
public records disclosure requirements. All records stored electronically shall be provided to the Department in a
format that is compatible with the information technology systems of the Department.
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11. Audits, Inspections, Investigations:
11.1 The Contractor shall establish and maintain books, records, and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest, and expenditures of funds
provided by the Department under this contract. Contractor shall adequately safeguard all such assets and ensure
that they are used solely for the purposes authorized under this contract. Whenever appropriate, financial
information should be related to performance and unit cost data.
11.2 The Contractor shall retain and maintain all client records, financial records, supporting documents, statistical
records, and any other documents (including electronic storage media) pertinent to this contract for a period of
six (6) years after completion of the contract, or longer when required by law. In the event an audit is required
by this contract, records shall be retained for a minimum period of six (6) years after the audit report is issued or
until resolution of any audit findings or litigation based on the terms of this contract, at no additional cost to the
Department.
11.3 Upon demand, at no additional cost to the Department, the Contractor shall facilitate the duplication and transfer
of any records or documents during the required retention period.
11.4 The Contractor shall ensure that the records described in this section will be subject at all reasonable times to
inspection, review, copying, or audit by federal, state, or other personnel duly authorized by the Department.
11.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Department and
federal auditors, pursuant to 45 CFR Part 75, shall be allowed full access to and the right to examine any of the
Contractor’s contracts and related records and documents pertinent to this specific contract, regardless of the
form in which kept.
11.6 The Contractor shall provide a Financial and Compliance Audit to the Department as specified in this contract
and ensure that all related third-party transactions are disclosed to the auditor.
11.7 Contractor agrees to comply with the Inspector General in any investigation, audit, inspection, review, or hearing
performed pursuant to Section 20.055, F.S. Contractor further agrees that it shall include in related subcontracts
a requirement that subcontractors performing work or providing services pursuant to this contract agree to
cooperate with the Inspector General in any investigation, audit, inspection, review, or hearing pursuant to
Section 20.055(5), F.S. By execution of this contract the Contractor understands and will comply with this
subsection.
11.8 In accordance with Executive Order 20-44 which requires executive agencies to submit a list of entities named
in statute with which a state agency must form a sole-source, public-private agreement or an entity that, through
contract or other agreement with the state, annually receives 50% or more of their budget from the State or from
a combination of State and Federal funds. Any Contractor that meets one or both of the criteria listed must submit
an annual report, including the most recent IRS Form 990, detailing the total compensation for the entities'
executive leadership teams within thirty (30) days of execution of this contract.
11.8.1 The report must include total compensation including salary, bonuses, cashed-in leave, cash equivalents,
severance pay, retirement benefits, deferred compensation, real-property gifts, and any other payout.
11.8.2 The Contractor shall inform the agency of any changes in total executive compensation between the
annual reports as those changes occur.
11.8.3 All compensation reports must indicate what percent of compensation comes directly from the State or
Federal allocations to the contracted entity.
12. Nondiscrimination-Civil Rights Compliance:
12.1 The Contractor shall execute Assurances as stated in the Assurances-Non-Construction Programs Attachment that
it will not discriminate against any person in the provision of services or benefits under this contract or in
employment because of age, race, religion, color, disability, national origin, marital status, or sex in compliance
with state and federal law and regulations. The Contractor further assures that all Contractors, Subcontractors,
Sub-grantees, or others with whom it arranges to provide services or benefits in connection with any of its
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programs and activities are not discriminating against clients or employees because of age, race, religion, color,
disability, national origin, marital status, or sex.
12.2 During the term of this contract, the Contractor shall complete and retain on file a timely, complete, and accurate
Civil Rights Compliance Checklist, attached to this contract.
12.3 The Contractor shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures shall include notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
12.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance, and are binding upon the Contractor, its successors, transferees, and assignees for the
period during which such assistance is provided. The Contractor further assures that all Subcontractors, Vendors,
or others with whom it arranges to provide services or benefits to participants or employees in connection with
any of its programs and activities are not discriminating against those participants or employees in violation of
the any statutes, regulations, guidelines, and standards. In the event of failure to comply, the Contractor
understands that the Department may, at its discretion, seek a court order requiring compliance with the terms of
this assurance or seek other appropriate judicial or administrative relief including, but not limited to, termination
of the contract and denial of further assistance.
13. Monitoring by the Department:
The Contractor shall permit persons duly authorized by the Department to inspect and copy any records, papers,
documents, facilities, goods, and services of the Contractor which are relevant to this contract, and to interview any
clients, employees, and Subcontractor employees of the Contractor to assure the Department of the satisfactory
performance of the terms and conditions of this contract. Following such review, the Department will provide a written
report of its findings to the Contractor and, where appropriate, the Contractor shall develop a Corrective Action Plan
(CAP). The Contractor hereby agrees to correct all deficiencies identified in the CAP in a timely manner as determined
by the Department’s Contract Manager.
14. Provision of Services:
The Contractor shall provide services in the manner described in Attachment I.
15. Coordinated Monitoring with Other Agencies:
If the Contractor receives funding from one or more State of Florida human service agencies, in addition to the
Department, then a joint monitoring visit including such other agencies may be scheduled. For the purposes of this
contract, and pursuant to Section 287.0575, F.S., as amended, Florida’s human service agencies shall include the
Department, the Department of Children and Families, the Department of Health, the Agency for Persons with
Disabilities, and the Department of Veterans’ Affairs. Upon notification and the subsequent scheduling of such a visit
by the designated agency’s lead administrative coordinator, the Contractor shall comply and cooperate with all monitors,
inspectors, and/or investigators.
16. New Contract(s) Reporting:
The Contractor shall notify the Department within ten (10) days of entering into a new contract with any of the remaining
four (4) state human service agencies. The notification shall include the following information: (1) contracting state
agency and the applicable office or program issuing the contract; (2) contract name and number; (3) contract start and
end dates; (4) contract amount; (5) contract description and commodity or service; and (6) Contract Manager name and
contact information. In complying with this provision, and pursuant to Section 287.0575, F.S., as amended, the
Contractor shall complete the Contractor’s State Contracts List attached to this contract.
17. Indemnification:
The Contractor shall indemnify, save, defend, and hold harmless the Department and its agents and employees from
and against all claims, damages, losses, and expenses including attorney’s fees arising out of or resulting from the
execution of this contract or performance of the services provided for herein. It is understood and agreed that the
Contractor is not required to indemnify the Department for claims, demands, actions, or causes of action arising solely
out of the negligence of the Department.
17.1 Except to the extent permitted by Section 768.28, F.S., or other Florida law, this Section 17 is not applicable to
contracts executed between the Department and state agencies or subdivisions defined in Section 768.28(2), F.S.
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18. Insurance and Bonding:
18.1 The Contractor shall provide continuous adequate liability insurance coverage during the existence of this
contract and any renewal(s) and extension(s) of it. By execution of this contract, unless it is a state agency or
subdivision as defined by Section 768.28(2), F.S., the Contractor accepts full responsibility for identifying and
determining the type(s) and extent of liability insurance coverage necessary to provide reasonable financial
protections for the Contractor and the clients to be served under this contract. The limits of coverage under each
policy maintained by the Contractor do not limit the Contractor’s liability and obligations under this contract.
The Contractor shall ensure that the Department has the most current written verification of insurance coverage
throughout the term of this contract. Such coverage may be provided by a self-insurance program established
and operating under the laws of the State of Florida. The Department reserves the right to require additional
insurance as specified in this contract.
18.2 Throughout the term of this contract, the Contractor shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees, and agents of the Contractor
authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this
contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by
the insurance company, and consistent with good business practices.
19. Confidentiality of Information:
The Contractor shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally authorized
to give that consent or when authorized by law.
20. Health Insurance Portability and Accountability Act:
Where applicable, the Contractor shall comply with the Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191, as well as all regulations promulgated thereunder (45 CFR Parts 160, 162, and 164).
21. Incident Reporting:
21.1 The Contractor shall notify the Department immediately but no later than forty-eight (48) hours from the
Contractor’s awareness or discovery of conditions that may materially affect the Contractor’s or Subcontractor’s
ability to perform the services required to be performed under this contract. Such notice shall be made orally to
the Department’s Contract Manager (by telephone) with an email to immediately follow.
21.2 The Contractor shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of
a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number
(1-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon the Contractor, its
Subcontractors, and their employees.
22. Bankruptcy Notification:
During the term of this contract, the Contractor shall immediately notify the Department if the Contractor, its assignees,
Subcontractors, or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Contractor must
also provide the following information to the Department: (1) the date of filing of the bankruptcy petition; (2) the case
number; (3) the court name and the division in which the petition was filed (e.g., Northern District of Florida,
Tallahassee Division); and (4) the name, address, and telephone number of the bankruptcy attorney.
23. Sponsorship and Publicity:
23.1 As required by Section 286.25, F.S., if the Contractor is a non-governmental organization which sponsors a
program financed wholly or in part by state funds, including any funds obtained through this contract, it shall,
in publicizing, advertising, or describing the sponsorship of the program, state: “Sponsored by (Contractor’s
name) and the State of Florida, Department of Elder Affairs.” If the sponsorship reference is in written material,
the words “State of Florida, Department of Elder Affairs” shall appear in at least the same size letters or type as
the name of the organization.
23.2 The Contractor shall not use the words “State of Florida, Department of Elder Affairs” to indicate sponsorship
of a program otherwise financed, unless specific written authorization has been obtained by the Department prior
to such use.
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24. Assignments:
24.1 The Contractor shall not assign the rights and responsibilities under this contract without the prior written
approval of the Department. Any sublicense, assignment, or transfer otherwise occurring without prior written
approval of the Department shall constitute a material breach of the contract. In the event the State of Florida
approves assignment of the Contractor’s obligations, the Contractor remains responsible for all work performed
and all expenses incurred in connection with this contract.
24.2 The State of Florida is, at all times, entitled to assign or transfer, in whole or part, its rights, duties, or obligations
under this contract to another governmental agency in the State of Florida upon giving prior written notice to the
Contractor.
24.3 This contract shall remain binding upon the successors in interest of the Contractor and the Department.
25. Subcontracts:
25.1 The Contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the Contractor or its Subcontractors. Any subcontracts shall be evidenced by a
written document and subject to any conditions of approval the Department deems necessary. The Contractor
further agrees that the Department will not be liable to the Subcontractor in any way or for any reason. The
Contractor, at its expense, shall defend the Department against any such claims.
25.2 The Contractor shall promptly pay any Subcontractors upon receipt of payment from the Department or other
state agency. Failure to make payments to any Subcontractor in accordance with Section 287.0585, F.S., unless
otherwise stated in the contract between the Contractor and Subcontractor, will result in a penalty as provided
by statute.
26. Independent Capacity of Contractor:
It is the intent and understanding of the Parties that the Contractor and any of its Subcontractors are independent
Contractors and are not employees of the Department, and that they shall not hold themselves out as employees or
agents of the Department without prior specific authorization from the Department. It is the further intent and
understanding of the Parties that the Department does not control the employment practices of the Contractor and will
not be liable for any wage and hour, employment discrimination, or other labor and employment claims against the
Contractor or its Subcontractors. All deductions for social security, withholding taxes, income taxes, contributions to
unemployment compensation funds, and all necessary insurance for the Contractor are the sole responsibility of the
Contractor.
27. Payment:
Payments shall be made to the Contractor for all completed and approved deliverables (units of service) as defined in
Attachment I. The DOEA Contract Manager will have final approval of the Contractor’s invoice submitted for payment
and will approve the invoice for payment only if the Contractor has met all terms and conditions of the contract, unless
the bid specifications, purchase order, or this contract specify otherwise. The approved invoice will be submitted to the
Department’s finance section for budgetary approval and processing. Disputes arising over invoicing and payments
will be resolved in accordance with the provisions of Section 215.422, F.S. A Vendor Ombudsman has been established
within the Florida Department of Financial Services and may be contacted at 800-342-2762.
28. Return of Funds:
The Contractor shall return to the Department any overpayments due to unearned funds or funds disallowed, and any
interest attributable to such funds pursuant to the terms and conditions of this contract, that were disbursed to the
Contractor by the Department. In the event that the Contractor or its independent auditor discovers that an overpayment
has been made, the Contractor shall repay said overpayment immediately without prior notification from the
Department. In the event that the Department first discovers an overpayment has been made, the DOEA Contract
Manager will notify the Contractor in writing of such findings. Should repayment not be made forthwith, the Contractor
shall be charged at the lawful rate of interest on the outstanding balance pursuant to Section 55.03, F.S., after Department
notification or Contractor discovery.
29. Data Integrity and Safeguarding Information:
The Contractor shall ensure an appropriate level of data security for the information the Contractor is collecting or using
in the performance of this contract. An appropriate level of security includes approving and tracking all Contractor
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employees that request system or information access and ensuring that user access has been removed from all terminated
employees. The Contractor, among other requirements, must anticipate and prepare for the loss of information
processing capabilities. All data and software shall be routinely backed up to ensure recovery from losses or outages of
the computer system. The security over the backed-up data is to be as stringent as the protection required of the primary
systems. The Contractor shall ensure all Subcontractors maintain written procedures for computer system backup and
recovery. The Contractor shall complete and sign the Certification Regarding Data Integrity Compliance for
Agreements, Grants, Loans, and Cooperative Agreements prior to the execution of this contract.
30. Social Media and Personal Cell Phone use:
30.1 Inappropriate use of social media and personal cell phones may pose risks to DOEA’s confidential and proprietary
information and may jeopardize compliance with legal obligations. By signing this contract, Contractor agrees to
the following social media and personal cell phone use requirements.
30.2 Social Media Defined. The term Social Media and /or personal cellular communication includes, but is not
limited to, social networking websites, blogs, podcasts, discussion forums, RSS feeds, video sharing, SMS
(including Direct Messages (DMs), iMessages, text messages, etc.); social networks like Instagram, TikTok,
Snapchat, Google Hangouts, WhatsApp, Signal, Facebook, Pinterest, and Twitter; and content sharing networks
such as Flickr and YouTube. This includes the transmission of social media through any cellular or online
transmission via any electronic, internet, intranet, or other wireless communication.
30.3 Application to any direct or incidental DOEA or other state business. This contract applies to any DOEA or
other state business conducted on any of the Contractor’s, Subcontractor’s, or their employees’ social media
accounts or through personal cellular communication.
30.4 Application to DOEA and Contractors Equipment. This contract applies regardless of whether the social
media is accessed using DOEA’s IT facilities and equipment or equipment belonging to Contractor,
Subcontractor, or their respective employees. Equipment includes, but is not limited to, personal computers,
cellular phones, personal digital assistants, smart watches, or smart tablets.
30.5 Florida Government in the Sunshine, Florida Public Records Law, and HIPAA. Contractor acknowledges
that any DOEA or other state business conducted by social media or through personal cellular communication is
subject to Florida’s Government in the Sunshine Law, Florida’s Public Records Law (Chapter 119, Florida
Statutes), and the Health Insurance Portability and Accountability Act (HIPAA). Compliance with these laws and
other applicable laws are further detailed in the contract.
30.6 Prohibited or Restricted Postings. Any social media posts which include photos, videos, or names of clients,
volunteers, staff, or other affiliates of DOEA may only be posted when authorized by law and when any required
HIPAA authorizations and any other consents or authorizations required pursuant to federal or state law are on
file with the contractor’s records.
30.7 Assist DOEA with Communications. Contactors may be asked periodically to assist in distributing certain
DOEA communications through their social media outlets. Any such requests should be posted in adherence to
the social media requirements herein and the other provisions of this contract.
31. Conflict of Interest:
The Contractor shall establish safeguards to prohibit employees, board members, management, and Subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of
interest or personal gain. No employee, officer, or agent of the Contractor or Subcontractor shall participate in the
selection or in the award of a contract supported by state or federal funds if a conflict of interest, real or apparent, would
be involved. Such a conflict would arise when: (a) the employee, officer or agent; (b) any member of his/her immediate
family; (c) his or her partner; or (d) an organization which employs, or is about to employ, any of the above individuals,
has a financial or other interest in the firm being selected for award. The Contractor’s or Subcontractor’s officers,
employees, or agents will neither solicit nor accept gratuities, favors, or anything of monetary value from Contractors,
potential Contractors, or parties to Subcontracts. The Contractor’s board members and management must disclose to
the Department any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30)
calendar days of an individual’s original appointment or placement in that position, or, if the individual is serving as an
incumbent, within thirty (30) calendar days of the commencement of this contract. The Contractor’s employees and
Subcontractors must make the same disclosures described above to the Contractor’s board of directors. Compliance
with this provision will be monitored.
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32. Public Entity Crime:
Pursuant to Section 287.133, F.S., a person or affiliate who has been placed on the Convicted Vendor List following a
conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or
services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction
or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a
public entity; may not be awarded or perform work as a Contractor, Supplier, Subcontractor, or Consultant under a
contract with any public entity; and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, F.S., for CATEGORY TWO for a period of thirty six (36) months following the date of
being placed on the Convicted Vendor List.
33. Purchasing:
33.1 The Contractor shall procure products and/or services required to perform this contract in accordance with section
413.036, F.S.
33.1.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES THAT ARE THE
SUBJECT OF, OR REQUIRED TO CARRY OUT, THIS CONTRACT SHALL BE PURCHASED FROM
A NONPROFIT AGENCY FOR THE BLIND OR FOR THE SEVERELY HANDICAPPED THAT IS
QUALIFIED PURSUANT TO CHAPTER 413, FLORIDA STATUTES, IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 413.036(1) AND (2), FLORIDA
STATUTES; AND FOR PURPOSES OF THIS CONTRACT THE PERSON, FIRM, OR OTHER
BUSINESS ENTITY CARRYING OUT THE PROVISIONS OF THIS CONTRACT SHALL BE
DEEMED TO BE SUBSTITUTED FOR THE STATE AGENCY INSOFAR AS DEALINGS WITH
SUCH QUALIFIED NONPROFIT AGENCY ARE CONCERNED.
33.1.2 Pursuant to sections 413.036(1) and (4), F.S., the Contractor shall not be required to procure a product or
service from RESPECT if: (a) the product or service is not available within a reasonable delivery time, (b)
the Contractor is required by law to procure the product or service from any agency of the state, or (c) the
Contractor determines that the performance specifications, price, or quality of the product or service is not
comparable to the Contractor's requirements.
33.1.3 This act shall have precedence over any law requiring state agency procurement of products or services
from any other nonprofit corporation unless such precedence is waived by the Department in accordance
with its rules.
33.1.4 Additional information about the designated nonprofit agency and the products it offers is available at
http://www.respectofflorida.org.
33.2 The Contractor shall procure any recycled products or materials which are the subject of, or are required to carry
out, this contract when the Department of Management Services determines that those products are available, in
accordance with the provisions of section 403.7065, F.S.
33.3 The Contractor shall procure products and/or services required to perform this contract in accordance with
section 946.515, F.S.
33.3.1
IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHICH ARE THE
SUBJECT OF, OR REQUIRED TO CARRY OUT, THIS CONTRACT SHALL BE PURCHASED FROM
THE CORPORATION IDENTIFIED UNDER CHAPTER 946, F.S., IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 946.515(2) AND (4), F.S.; AND FOR
PURPOSES OF THIS CONTRACT THE PERSON, FIRM, OR OTHER BUSINESS ENTITY CARRYING
OUT THE PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR
THIS AGENCY INSOFAR AS DEALINGS WITH SUCH CORPORATION ARE CONCERNED.
33.3.2
The corporation identified is Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE).
Additional information about PRIDE and the commodities or contractual services it offers is available at
https://pride-enterprises.org/.
33.4 The Contractor shall provide a Certified Minority Business Subcontractor Expenditure (CMBE) Report
summarizing the participation of certified suppliers for the current reporting period and project to date. The
CMBE Report shall include the names, addresses, and dollar amount of each certified participant, and a copy
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must be forwarded to the Department, Division of Financial Administration, and must accompany each invoice
submitted to the Department. The Office of Supplier Diversity (850-487-0915) will assist in furnishing names of
qualified minorities. The Department’s Minority Coordinator (850-414-2153) will assist with questions and
answers. The CMBE Report is attached to this contract.
34. Patents, Copyrights, Royalties:
If this contract is awarded state funding and if any discovery, invention, or copyrightable material is developed or
produced in the course of or as a result of work or services performed under this contract or in any way connected with
this contract, or if ownership of any discovery, invention, or copyrightable material was purchased in the course of or
as a result of work or services performed under this contract, the Contractor shall refer the discovery, invention, or
copyrightable material to the Department to be referred to the Department of State. Any and all patent rights or
copyrights accruing under this contract are hereby reserved to the State of Florida in accordance with Chapter 286, F.S.
Pursuant to Section 287.0571(5)(k), F.S., the only exceptions to this provision shall be those that are clearly expressed
and reasonably valued in this contract.
34.1 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property, notwithstanding any agreement made pursuant to this Section 34.
34.2 If this contract is awarded solely federal funding, the terms and conditions are governed by 2 CFR § 200.315 or
45 CFR § 75.322, as applicable.
34.3 Notwithstanding the foregoing provisions, if the Contractor or one of its Subcontractors is a university and a
member of the State University System of Florida, then Section 1004.23, F.S., shall apply, but the Department
shall retain a perpetual, fully-paid, nonexclusive license for its use and the use of its Contractors, Subcontractors,
or Assignees of any resulting patented, copyrighted, or trademarked work products.
35. Emergency Preparedness and Continuity of Operations:
35.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety, or welfare, the Contractor shall,
within thirty (30) calendar days of the execution of this contract, submit to the DOEA Contract Manager,
verification of an Emergency Preparedness Plan. In the event of an emergency, the Contractor shall notify the
Department of emergency provisions.
35.2 In the event a situation results in a cessation of services by a Subcontractor, the Contractor shall remain
responsible for performance under this contract and must follow procedures to ensure continuity of operations
without interruption.
36. Equipment:
36.1 Equipment means: (a) tangible personal property (including information technology systems) having a useful life
of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level
established by the organization for the financial statement purposes, or $5,000.00 [for federal funds - 2 CFR §
200.33 and 45 CFR § 75.2, as applicable], or (b); nonexpendable, tangible personal property of a non-consumable
nature with an acquisition cost of $5,000.00 or more per unit, and expected useful life of at least one (1) year;
and hardback bound books not circulated to students or the general public, with a value or cost of $250.00 or
more [for state funds].
36.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 200
Administrative Requirements (formerly OMB Circular A-110) that include: (a) a property list with all the
elements identified in the circular; (b) a procedure for conducting a physical inventory of equipment at least once
every two (2) years; (c) a control system to insure adequate safeguards to prevent loss, damage, or theft of the
equipment; and (d) maintenance procedures to keep the equipment in good condition. The property records must
be maintained on file and shall be provided to the Department upon request. The Contractor shall promptly
investigate, fully document, and notify the DOEA Contract Manager of any loss, damage, or theft of equipment.
The Contractor shall provide the results of the investigation to the DOEA Contract Manager.
36.3 The Contractor’s property management standards for equipment (including replacement equipment), whether
acquired in whole or in part with federal funds and federally-owned equipment shall, at a minimum, meet the
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following requirements and shall include accurately maintained equipment records with the following
information:
36.3.1 Property records must be maintained that include a description of the equipment;
36.3.2 Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number;
36.3.3 Source of funding for the equipment, including the federal award identification number;
36.3.4 Whether title vests in the Contractor or the federal government;
36.3.5 Acquisition date (or date received, if the equipment was furnished by the federal government);
36.3.6 Information from which one can calculate the percentage of federal participation in the cost of the
equipment (not applicable to equipment furnished by the federal government);
36.3.7 Location, use and condition of the equipment and the date the information was reported;
36.3.8 Unit acquisition cost; and
36.3.9 Ultimate disposition data, including date of disposal and sales price or the method used to determine
current fair market value where a Contractor compensates the federal awarding agency for its share.
36.3.10 A physical inventory must be taken, and the results reconciled with the property records at least once
every two (2) years.
36.3.11 A control system must be developed to ensure adequate safeguards to prevent loss, damage, or theft of
the property. Any loss, damage, or theft must be investigated. 45 CFR § 75.320(d)(3).
36.3.12 Adequate maintenance procedures must be developed to keep the property in good condition.
36.3.13 If the Contractor is authorized or required to sell the equipment, proper sales procedures must be
established to ensure the highest possible return.
36.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $5,000.00 is part of the cost of carrying out the activities and functions
of the grant awards and title (ownership) will vest in the Contractor [for federal funds see 2 CFR § 200.313(a)
and 45 CFR § 75.320(a), as applicable], subject to the conditions of 2 CFR Part 200 and/or 45 CFR Part 75.
Equipment purchased under these thresholds is considered supplies and is not subject to property standards.
Equipment purchased with funds identified in the budget attachments to agreements covered by this contract or
identified in the sub-agreements with Subcontractors (not included in a cost methodology), is subject to the
conditions of Chapter 273, F.S., rule 60A-1.017, F. A. C., and 2 CFR Part 200 and/or 45 CFR Part 75.
36.5 The Contractor shall not dispose of any equipment or materials provided by the Department or purchased with
funds provided through this contract without first obtaining the approval of the DOEA Contract Manager. When
disposing of property or equipment the Contractor must submit a written request for disposition instructions to
the Department’s Contract Manager. The request should include a brief description of the property, purchase
price, funding source, and percentage of state or federal participation, acquisition date and condition of the
property. The request should also indicate the Contractor’s proposed disposition of the property (i.e., transfer or
donation to another agency that administers federal programs, offer of the items for sale, destroy the items, etc.).
36.6 The DOEA Contract Manager will issue disposition instructions. If disposition instructions are not received
within one hundred twenty (120) days of the written request for disposition, the Contractor is authorized to
proceed as directed in 2 CFR § 200.313
or 45 CFR § 75.320, as applicable.
36.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the Department. Real property
purchases from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35, Subchapter III,
Part A., Section 3030b United States Code (U.S.C.). Real property purchases from state funds can only be made
through fixed capital outlay grants and aids appropriations and therefore are subject to the provisions of Section
216.348, F.S.
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36.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested prior
to disposal to ensure no confidential information remains.
36.9 The Contractor must adhere to the Department's procedures and standards when purchasing Information
Technology Resources (ITR) as part of any agreement(s) incorporating this contract by reference. An ITR
worksheet is required for any computer related item costing $1,000.00 or more, including data processing
hardware, software, services, supplies, maintenance, training, personnel, and facilities. The completed ITR
worksheet shall be maintained in the LAN administrator's file and must be provided to the Department upon
request. The Contractor has the responsibility to require any Subcontractors to comply with the Department's ITR
procedures.
37. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
http://dms.myflorida.com/purchasing
In the event of any conflict between the PUR 1000 Form and any terms or conditions of this contract, the terms or
conditions of this contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained
in the PUR 1000 Form shall take precedence.
38. Use of State Funds to Purchase or Improve Real Property:
Any state funds provided for the purchase of or improvements to real property are contingent upon the Contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds provided
for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law.
39. Dispute Resolution:
Any dispute concerning performance of the contract shall be decided by the DOEA Contract Manager, who shall reduce
the decision to writing and serve a copy on the Contractor.
40. Financial Consequences:
If the Contractor fails to meet the minimum level of service or performance identified in this contract, the Department
shall impose financial consequences as stated in Attachment I.
41. No Waiver of Sovereign Immunity:
Nothing contained in this contract is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
42. Venue:
If any dispute arises out of this contract, the venue of such legal recourse shall be Leon County, Florida.
43. Entire Contract:
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or representations
shall be valid or binding upon the Department or the Contractor unless expressly contained herein or by a written
amendment to this contract signed by both Parties.
44. Force Majeure:
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other party
and takes all reasonable efforts to cure the condition.
45. Severability Clause:
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
46. Condition Precedent to Contract Appropriations:
The Parties agree that the Department’s performance and obligation to pay under this contract are contingent upon an
annual appropriation by the Legislature.
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47. Addition/Deletion:
The Parties agree that the Department reserves the right to add or to delete any of the services required under this
contract when deemed to be in the State of Florida’s best interest and reduced to a written amendment signed by both
Parties. The Parties shall negotiate compensation for any additional services added.
48. Waiver:
The delay or failure by the Department to exercise or enforce any of its rights under this contract will not constitute or
be deemed a waiver of the Department’s right thereafter to enforce those rights, nor will any single or partial exercise
of any such right preclude any other or further exercise thereof or the exercise of any other right.
49. Compliance:
The Contractor shall abide by all applicable current federal statutes, laws, rules, and regulations as well as applicable
current state statutes, laws, rules and regulations. The Parties agree that failure of the Contractor to abide by these laws
shall be deemed an event of default of the Contractor and subject the contract to immediate unilateral cancellation of
the contract at the discretion of the Department.
50. Final Invoice:
The Contractor shall submit the final invoice for payment to the Department no later than thirty (30) days after the
contract ending date unless otherwise specified in Attachment I. If the Contractor fails to do so, all right to payment is
forfeited and the Department shall not honor any requests submitted after the aforesaid time period. Any payment due
under the terms of this contract shall be withheld until all required documentation and reports due from the Contractor
and necessary adjustments thereto have been approved by the Department.
51. Renegotiations of Modifications:
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties. The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
level increases and changes in the rate of payment when these have been established through the appropriations process
and subsequently identified in the Department’s operating budget.
52. Suspension of Work:
The Department may, in its sole discretion, suspend any or all activities under the contract or purchase order, at any
time, when in the interest of the State to do so. The Department shall provide the Contractor written notice outlining
the particulars of suspension. Examples of the reason for suspension include, but are not limited to, budgetary
constraints, declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractor
shall comply with the notice and shall not accept any purchase orders. Within ninety (90) days, or any longer period
agreed to by the Contractor, the Department shall either: (1) issue a notice authorizing resumption of work, at which
time activity shall resume, or (2) terminate the contract or purchase order. Suspension of work shall not entitle the
Contractor to any additional compensation.
53. Termination:
53.1 Termination for Convenience. The Department, by written notice to the Contractor, may terminate this contract
in whole or in part when the Department determines in its sole discretion that it is in the State’s interest to do so.
The Contractor shall not furnish any product after it receives the notice of termination, except as necessary to
complete the continued portion of this contract, if any. The Contractor shall not be entitled to recover any
cancellation charges or lost profits.
53.2 Termination for Cause. The Department may terminate this contract if the Contractor fails to: (1) deliver the
product within the time specified in the contract or any extension, (2) maintain adequate progress, thus
endangering performance of the contract, (3) honor any term of the contract, or (4) abide by any statutory,
regulatory, or licensing requirement. Rule 60A-1.006(3), F.A.C., governs the procedure and consequences of
default. The Contractor shall continue work on any work not terminated. Except for defaults of Subcontractors
at any tier, the Contractor shall not be liable for any excess costs if the failure to perform the contract arises from
events completely beyond the control, and without the fault or negligence, of the Contractor. If the failure to
perform is caused by the default of a Subcontractor at any tier, and if the cause of the default is completely beyond
the control of both the Contractor and the Subcontractor, and without the fault or negligence of either, the
Contractor shall not be liable for any excess costs for failure to perform, unless the subcontracted products were
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obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule. If, after
termination, it is determined that the Contractor was not in default, or that the default was excusable, the rights
and obligations of the Parties shall be the same as if the termination had been issued for the convenience of the
Department. The rights and remedies of the Department in this clause are in addition to any other rights and
remedies provided by law or under the contract.
54. Electronic Records and Signature:
The Department authorizes, but does not require, the Contractor to create and retain electronic records and to use
electronic signatures to conduct transactions necessary to carry out the terms of this contract. A Contractor that creates
and retains electronic records and uses electronic signatures to conduct transactions shall comply with the requirements
contained in the Uniform Electronic Transaction Act, Section 668.50, F.S. All electronic records must be fully
auditable; are subject to Florida’s Public Records Law, Chapter 119, F.S.; must comply with contract Section 29, Data
Integrity and Safeguarding Information; must maintain all confidentiality, as applicable; and must be retained and
maintained by the Contractor to the same extent as non-electronic records are retained and maintained as required by
this contract.
54.1 The Department’s authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the Department. The Contractor is authorized to conduct electronic transactions with the
Department only upon further written consent by the Department.
54.2 Upon request by the Department, the Contractor shall provide the Department with non-electronic (paper) copies
of records. Non-electronic (paper) copies provided to the Department of any document that was originally in
electronic form with an electronic signature must identify the person and the person’s capacity who electronically
signed the document on any non-electronic copy of the document.
55. Contract Manager:
The Department may substitute any Department employee to serve as the DOEA Contract Manager.
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56. O
fficial Payee and Representatives (Names, Addresses, and Telephone Numbers):
a.
The Contractor name, as shown on page 1 of this
contract, and mailing address of the official payee to
whom the payment shall be made is:
Northwest Florida Area Agency on Aging,
Inc.
5090 Commerce Park Circle
Pensacola, FL 32505
b.
The name of the contact person and street address
where financial and administrative records are
maintained is:
Jeanne Griffin, CFO
5090 Commerce Park Circle
Pensacola, FL 32505
c.
The name, address, and telephone number of the
representative of the Contractor responsible for
administration of the program under this contract is:
Anna Dyess, Executive Director,
5090 Commerce Park Circle
Pensacola, FL 32505
850-494-7101
d.
The section and location within the Department where
Requests for Payment and Receipt and Expenditure
forms are to be mailed is:
Florida Department of Elder Affairs
Division of Financial Administration
4040 Esplanade Way, Suite 215
Tallahassee, Florida 32399-7000
e.
The name, address, and telephone number of the
Contract Manager for this contract is:
Staci Eppes, FCCM
4040 Esplanade Way, Suite 335H
Tallahassee, Florida 32399-7000
850-414-2135
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided
in writing to the other party.
57. All Ter
ms and Conditions Included:
This contract and its Attachments I – XV, including any exhibits referenced in said attachments, together with any
documents incorporated by reference, contain all the terms and conditions agreed upon by the Parties. There are no
provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all
previous communications, representations, or agreements, either written or verbal, between the Part
ies.
By
signing this contract, the Parties agree that they have read and agree to the entire contra
ct.
IN WITNESS W
HEREOF, the Parties hereto have caused this sixty (60) page contract to be executed by their
undersigned officials as duly authorized.
CONTRACTOR:
NORTHWEST FLORIDA AREA AGENCY ON
AGING, INC.
STATE OF FLORIDA,
DEPARTMENT OF ELDER AFFAIRS
SIGNED BY:
NAME:
TITLE:
SIGNED
BY:_________________________
______ NAME:
TITLE:
DATE:
DATE:_____________________________
________
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INDEX OF ATTACHMENTS
ATTACHMENT I ............................................................................................................................................... 18
STATEMENT OF WORK .................................................................................................................................. 18
ATTACHMENT II ............................................................................................................................................. 32
FINANCIAL AND COMPLIANCE AUDIT ...................................................................................................... 32
EXHIBIT 1 ........................................................................................................................................................ 35
EXHIBIT 2 ........................................................................................................................................................ 37
ATTACHMENT III ............................................................................................................................................ 38
CERTIFICATIONS AND ASSURANCES ......................................................................................................... 38
ATTACHMENT IV ............................................................................................................................................ 43
ASSURANCES—NON-CONSTRUCTION PROGRAMS .................................................................................. 43
ATTACHMENT V.............................................................................................................................................. 45
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST ................. 45
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST .................................................... 47
ATTACHMENT VI ............................................................................................................................................ 49
CONTRACTOR’S STATE CONTRACT LIST ................................................................................................... 49
ATTACHMENT VII .......................................................................................................................................... 50
BACKGROUND SCREENING ......................................................................................................................... 50
ATTACHMENT VIII ......................................................................................................................................... 51
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES (CMBE FORM) ...................... 51
ATTACHMENT IX ............................................................................................................................................ 53
ANNUAL BUDGET SUMMARY ....................................................................................................................... 53
ATTACHMENT X.............................................................................................................................................. 54
INVOICE REPORT SCHEDULE ..................................................................................................................... 54
ATTACHMENT XI ............................................................................................................................................ 55
REQUEST FOR PAYMENT .............................................................................................................................. 55
ATTACHMENT XII .......................................................................................................................................... 56
RECEIPT AND EXPENDITURE REPORT ...................................................................................................... 56
ATTACHMENT XIII ......................................................................................................................................... 57
COST REIMBURSEMENT SUMMARY ............................................................................................................ 57
ATTACHMENT XIV ......................................................................................................................................... 58
SERVICE RATE REPORT ................................................................................................................................ 58
ATTACHMENT XV ........................................................................................................................................... 60
SIMPLIFIED UNIT COST METHODOLOGY RATE INCREASE REQUEST FORM ..................................... 60
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ATTACHMENT I
STATEMENT OF WORK
I. SERVICES TO BE PROVIDED
A. Definitions of Term
s
1. Ac
rony
ms
Ac
tivities of Daily Living (ADLs)
Area Agency on Aging (AAA)
Access Priority Consumer List (APCL)
Adult Protective Services (APS)
Code of Federal Regulations (CFR
)
Corre
ctive Action Plan (CAP)
Community Care for Disabled Adults (CCDA)
Community Care for the Elderly (
CCE)
Enter
prise Client Information and Registration Tracking System (eCIRTS)
Department of Children and Families (DCF
)
Florida Adm
inistrative Code (F.A
.C.)
Florida De
partment of Elder Affairs (DOEA or Department
)
Florida S
tatutes
(F.S.)
H
ome Care for Disabled Adults (HCDA)
Home Care for the Elderly (H
CE)
I
nstitutional Care Program (ICP)
Instrumental Activities of Daily Living (IADLs)
Notice of Instruction (NOI)
Planning and Service Area (PSA
)
Sum
mary of Programs and Services (SOP
S)
U
nited States Code (U.S.C.)
2. Program-Specific Term
s
A
ging Out: The condition of reaching sixty (60) years of age and being transitioned from DCF’s CCDA or
HCDA services to the Department’s community-based services
.
A
rea Plan: A plan developed by the Contractor outlining a comprehensive and coordinated service deliv
ery
sy
stem in its PSA in accordance with the Section 306 of the Older Americans Act (42 U.S.C. § 3026) and
Department instructions. The Area Plan includes performance measures and unit rates per service offered per
county.
Area Plan Update: A revision to the Area Plan wherein the Contractor enters HCE-specific data in eCIR
TS.
A
n update may also include other revisions to the Area Plan as instructed by the Department
.
D
epartment of Elder Affairs Programs and Services Handbook (DOEA Handbook): An official docum
ent
of D
OEA. The DOEA Handbook includes program policies, procedures, and standards applicable to agencies
which are recipients/providers of DOEA-funded programs. An annual update is provided through a NOI.
F
unctional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to
remain independent and in the least restrictive living arrangem
ent.
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NOI: The Department’s established method to communicate to the Contractor the requirement to perform a
specific task or activity in a particular manner. NOIs are located on the Department’s website at
https://elderaffairs.org/news-events/
Program Highlights: Success stories, quotes, testimonials, or human-interest vignettes that are used in the
SOPS to demonstrate how programs and services help elders, families, and caregivers.
Summary of Programs and Services (SOPS): A document produced by the Department and updated yearly
to provide the public and the Legislature with information about programs and services for Florida’s elders.
B. GENERAL DESCRIPTION
1. General Statem
ent
T
he purpose of the HCE Program is to encourage the provision of care for elders in family-type living
arrangements in private homes as an alternative to nursing homes or other institutional care settings.
2. Home Care for the Elderly Program Mission Statement
The HCE Program assists caregivers of three (3) or fewer elders, living in private homes, through the provision
of a basic subsidy for maintenance and supervision, as well as other necessary specialized services.
3. Authority
The relevant authority governing the HCE Program includes:
a. Sections 430.601-430.606 and 430.608, F.S.;
b. Chapter 58H-1, F.A.C; and
c. The Catalog of State Financial Assistance (CSFA) Number 65001.
4. Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of the HCE Program.
The program services shall be provided in a manner consistent with the Contractor’s current Area Plan, as
updated, and the current DOEA Handbook, which are incorporated by reference. The Contractor agrees to be
bound by all subsequent amendments and revisions to the DOEA Handbook, and the Contractor agrees to accept
all such amendments and revisions via a NOI.
5. Major Program Go
als
T
he major goals of the HCE Program are to ensure that:
a. A basic subsidy is provided to the caregiver of each clie
nt; and
b. A
special subsidy is provided when essential to the well-being of the client.
C. Clients to be Served
1. General Descript
ion
T
he HCE Program serves elders age sixty (60) and older at risk of placement in a nursing home or other
institutional setting who can remain in a family-style setting with a caregiver through the provision of subsidies.
2. Client Eligibility
Clients eligible to receive services under this contract must meet the following requirements in accordance with
Rule 58H-1.005, F.A.C.:
a. Be sixty (60) years of age or older;
b. Be a current resident of the State of Florida with the intent to remain in the state; and
c. Meet the criteria for functional and financial eligibility set forth below:
i. Be at risk of nursing home placement based on DOEA 701B assessment; and
ii. Have self-declared income and assets which do not exceed the ICP limits established by Medicaid and
DC
F, or
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iii. Receive Supplemental Security Income (SSI), or
iv. Receive benefits as a Qualified Medicare Beneficiary (QMB) or as a Special Low-Income Medicare
Beneficiary (SLMB);
and
v. H
ave an approved caregiver who meets the caregiver requirements pursuant to Rule 58H-1.006,
F.A.C., and the dwelling requirements pursuant to Rule 58H-1.007, F.A.
C.
3. C
aregiver Eligibility
Caregivers eligible to receive services under this contract must
:
a. Be at
least eighteen (18) years of ag
e;
b. Be capa
ble of providing a family-type living environment for the home care client/recipient;
c. Be a relative or friend who has been accepted by the client as surrogate family, or a responsible adult with
whom the client has made an arrangement to provide home care services
;
d. B
e willing to accept responsibility for the social, physical, and emotional needs of the home care
client/recipie
nt;
e. Be phy
sically present and live in the home to provide supervision and to assist in arrangement of services
for the client;
f. Maintain the residential dwelling free of conditions that pose an immediate threat to the life, safety, health
and well-being of the home care client in accordance with Rule 58H-1.007, F.A.C; and
g. Be without record of conviction of abuse, neglect, or exploitation of another person.
4. Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk
of placement in an institution.
II. MANNER OF SERVICE PROVISION
A. Service Tasks
To achieve the goals of the HCE Program, the Contractor shall perform, or ensure that its subcontractors perform,
the following tasks:
1. Client Eligibility Determination
The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a
client is based on meeting the requirements described in Section I.C.2. and I.
C.3.
2. A
ssessment and Prioritization of Service Delivery for New Clients
The Contractor shall ensure the following criteria are used to prioritize new clients in the sequence below for
service delivery. It is not the intent of the Department to remove existing clients from services to serve ne
w
cli
ents being assessed and prioritized for service delivery.
a. Imminent Risk individuals: Individuals in the community whose mental or physical health condition has
deteriorated to the degree that self-care is not possible, there is no capable caregiver, and nursing hom
e
plac
ement is likely within one (1) month or very likely within three (3) m
onths.
b. A
ging Out individuals: Individuals receiving CCDA and HCDA services through DCF’s Adult Services
transitioning to community-based services provided through the Department when DCF’s services are not
currently available.
c. Service priority for individuals not included in a. or b. above, regardless of referral source, will be
determined through the Department’s functional assessment administered to each applicant, to the extent
funding is available. The Contractor shall ensure that priority is given to applicants at the higher levels of
frailty and risk of nursing home placement. For individuals assessed at the same priority and risk of nursing
home placement, priority will be given to applicants with the lesser ability to pay for services.
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3. Program Servic
es
T
he Contractor shall ensure the provision of program services is consistent with the Contractor’s current Ar
ea
Plan, a
s updated and approved by the Department, and the current DOEA Handbook.
B. Staffing Requirements
1. Staffing Levels
The Contractor shall assign its own administrative and support staff as needed to perform the task
s,
respo
nsibilities, and duties under this contract and ensure that subcontractors dedicate adequate staff
accordingly.
2. Professional Qualifications
The Contractor shall ensure that the staff responsible for performing any duties or functions within this contract
have the qualifications as specified in the current DOEA Handbook
.
3. Service Ti
mes
The Contractor shall ensure the availability of services listed in this contract at times appropriate to meet client
service needs including, at a minimum, during normal business hours. Normal business hours are defined as
Monday through Friday, 8:00 a.m. to 5:00 p.m. local time.
4. Use of Subcontracto
rs
I
f this contract involves the use of a subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the subcontractor. If any circumstance occurs that may result in a delay
for a period of sixty (60) days or more of the initiation of the subcontract or the performance of the
subcontractor, the Contractor shall notify the Department’s Contract Manager and the Department’s Chie
f
Financ
ial Officer in writing of such delay. The Contractor shall not permit a subcontractor to perform services
related to this agreement without having a binding subcontractor agreement executed prior to the
subcontractor’s performance. The Department will not be responsible or liable for any obligations or claims
resulting from such acti
on.
a. Copies o
f Subcontrac
ts
T
he Contractor shall submit a copy of all subcontracts to the Department’s Contract Manager within thirty
(30)
days of the subcontract being exec
uted.
b. Moni
toring the Performance of Subcontrac
tors
T
he Contractor shall monitor, at least once per year, each of its subcontractors, subrecipients, vendors,
and/or consultants paid from funds provided under this contract. The Contractor shall perform fiscal,
administrative, and programmatic monitoring to ensure contractual compliance, fiscal accountability,
programmatic performance, and compliance with applicable state and federal laws and regulations. The
Contractor shall monitor to ensure that the budget is met, the scope of work is accomplished within the
specified time periods, and all other performance goals stated in this contract are achieved.
c. Copies of Subcontractor Monitoring Report
s
T
he Contractor shall forward a copy of all subcontractor monitoring reports to the Department’s Contra
ct
Manag
er within thirty (30) days of the report being issued to the subcontractors, subrecipients, vendors,
and/or consultants.
C. Deliverables
The following section provides the specific quantifiable units of deliverables and source documentation required to
evidence the completion of the tasks specified in this contract
.
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1. Delivery of Services to Eligible Clients
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of functionally
impaired elders and their caregivers. The Contractor shall not provide Special Subsidies, case management, or
case aide services directly to clients or caregivers. The Contractor shall ensure that performance and reporting
of the following services are in accordance with the Contractor’s current Department-approved Area Plan, the
current DOEA Handbook, and Section II.A.1.-3. of this contract. Documentation of service delivery mu
st
inc
lude a report consisting of the following: number of clients served, number of service units provided by
service, and rate per service unit with calculations that equal the total invoice amount. The services include th
e
fol
lowing categories
:
a. B
asic Subsidy
The Contractor shall ensure that the Basic Subsidy is a cash payment of $160.00 made to an approved
caregiver each month to reimburse expenses incurred in caring for the client as detailed herein and in the
current DOEA Handbook. The Basic Subsidy is provided for support and maintenance of the care
client/recipient, including housing, food, clothing, and medical costs not covered by Medicaid, Medicare,
or any other insurance. A Basic Subsidy shall be paid to authorized caregivers when the client is in th
e
hom
e for any part of th
e month.
b. Specia
l Subsidy Se
rvices
The
Contractor shall ensure that the Special Subsidy payments are pre-authorized and are based on
additional specialized medical or health care services, supplies, or equipment needed to maintain the health
and well-being of the individual elder. The Special Subsidy for additional medical support and specia
l
serv
ices is a cash payment to reimburse the costs of any other service or special care not covered by
Medicaid, Medicare, or private insurance when these services are determined to be essential to maintain
the well-being of the home care client/recipient. A Special Subsidy shall be paid to the authorized caregivers
when the client is in the home for any part of the month. Special Subsidy services may be authorized through
a subcontractor agreement. All Special Subsidy services must be performed in accordance with the current
DOEA Handbook. Special Subsidy services include the following:
1) Adult Day Care
2) Adult Day Health Care
3) Assurance (Telephone and In-Person)
4) Caregiver Training/Support
5) Chore
6) Chore (Enhan
ced)
7) Congregate Meals
8) Congregate Meals Screening
9) Counseling (Gerontological)
10) Counseling (Mental
Health/Screening)
11) Education/Training
12) Home Health Aide Service
13) Homemaker
14) Home Delivered Meal
s
15) H
ousing Improvement
16) Information
17) Material Aid
18) Occupational Therapy
19) Other
20) Person
al Care
21) Pest Contro
l
22) Phy
sical Therapy
23) Respite (Facility Based or In-Home)
24) Shopping Assistance
25) Skilled Nursing Serv
ices
26)
Specialized Medical Equipment, Services and
Supplies
27) Speech Therapy
28) Transportation
c. Access to, and Coordination of, Services
The Contractor shall ensure, through case management and case aide services, that the HCE client’s need
s
are d
ocumented, and needed services are planned, arranged, and coordinated for the client and caregive
r.
2. Service U
nits
The Contractor shall ensure that the provision of services described in this contract is in accordance with the
current DOEA Handbook and the service tasks described in Section II.A. Attachment XIV, Service Rate
Report, lists the services that can be performed, the highest reimbursement unit rate, the method of payment,
and the service unit type. Units of service will be paid pursuant to the rate established in the Contractor’s Area
Plan as updated, as shown in Attachment XIV, and approved by the Department.
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3. Administrative Responsibilit
ies
T
he Contractor shall provide management and oversight of HCE Program operations in accordance with the
current DOEA Handbook and the Department-approved Contractor’s Area Plan and Cost Analysis.
Management and oversight of HCE Program operations include the following:
a. Developing a competitive solicitation process for allocation of HCE funds, including appeal procedures for
handling disputes involving local service providers;
b. Developing an Area Plan and updating it annually, at a minimum, as directed by the Department.
c. Designating appropriate and capable local service providers and establishing vendor agreements at the AAA
level, when applicable for local service providers and HCE services according to manuals, rules, and
agreement procedures of DO
EA;
d. Prov
iding technical assistance and training to local service providers, subcontractors, and vendors to ensure
provision of quality services
;
e. Monito
ring and evaluating local service providers, subcontractors, and vendors for fiscal, administrative,
and programmatic compliance;
f. Appropriately and timely submitting payments to subcontract
ors;
g. A
rranging in-service training for local service providers at least annually
;
h. Estab
lishing procedures for handling recipient complaints and ensuring that subcontractors develop and
implement complaint procedures to process and resolve client dissatisfaction with services. Complaint
procedures shall address the quality and timeliness of services, provider and direct service work
er
com
plaints, and any other issues related to complaints (other than termination, suspension, or reduction in
services) that require the grievance process as described in Appendix D of the current DOEA Handbook.
The complaint procedures shall include notification to all clients of the complaint procedure and includ
e
tra
cking the date, nature of complaint, and the determination of each complaint;
i. Ensuring compliance with eCIRTS regulations
;
j. Monito
ring performance objective achievements in accordance with targets set by the Department; an
d
k. Conducting
annual client satisfaction surveys to evaluate and improve service delivery.
D. Report
s
T
he Contractor shall respond within ten (10) business days, or within deadlines established by the Department, to
the Department’s request for routine and/or special requests for information and ad hoc reports. The Contractor
must establish due dates for any subcontractors that permit the Contractor to meet the Department’s reporting
requirements.
1. Area Plan Update and All Revisions Theret
o
T
he Contractor is required to submit an Area Plan and an annual update wherein the Contractor enters HCE-
specific data in the eCIRTS. The Contractor may also be required to submit revisions to the Area Plan as
instructed by the Department
.
2. eCIRT
S Reports
The Contractor shall input HCE-specific data into eCIRTS. To ensure eCIRTS data accuracy, the Contractor
shall use eCIRTS-generated reports which include the following:
a. Client Report
s;
b. Monito
ring Reports
;
c. Services Reports;
d. Mi
scellaneous Reports;
e. Fiscal Report
s;
f. Aging and Disability Resource Center Reports; and
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g. Outcome Measurement Reports
.
3. U
nit Cost Methodolog
ies
T
he Contractor shall require subcontractors to submit Unit Cost Methodologies annually, which reflect actu
al
cost
s of providing each service by program.
4. Surplus/Deficit Repo
rt
T
he Contractor shall submit a Consolidated Surplus/Deficit Report, in a format provided by the Department, to
the Department’s Contract Manager, by the 25th of each month. This Consolidated Surplus/Deficit Report is
for all agreements and contracts between the Contractor and the Department and must include the following:
a. A list of all subcontractors and their current status regarding surplus/deficit;
b. The Contractor’s detailed plan on how the surplus/deficit spending exceeding the threshold specified by th
e
D
epartment will be resolved
;
c. Re
commendations to transfer funds within the PSA or to other AAAs to resolve surplus/deficit spending;
d. Input from the Contractor’s Board of Directors on resolution of spending issues, if applicable;
e. Number of clients currently on the APCL that receive a priority ranking score of 4 or 5; and
f. Number of clients currently on the APCL designated as Imminent Risk.
5. Cost Analysis
The Contractor shall submit a completed DOEA Cost Analysis for Non-Competitively Procured Contracts in
Excess of Category II to the Department’s Contract Manager by June 30
th
of each year.
6. Pro
gram Highlights
The Contractor shall submit Program Highlights referencing specific events that occurred in SFY/FFY 2022-
2023 by September 15, 2023. The Contractor shall provide a new success story, quote, testimonial, or human-
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical term
s.
For a
ll agencies or organizations that are referenced in the highlight, the Contractor shall provide a brief
description of their mission or role. The active tense shall be consistently used in the highlight narrative, to
identify the specific individual or entity that performed the activity described in the highlight. The Contractor
shall review and edit Program Highlights for clarity, readability, relevance, specificity, human interest, and
grammar, prior to submitting them to the Department. These Program Highlights shall be prepared in
accordance with section 19 of the contract and may not contain any information concerning a recipient of
services under this contract except with the recipient’s written consent.
E. Records and Documentation
1. Requests for Paym
ent
The
Contractor shall maintain documentation to support Requests for Payment that shall be available to the
Department or authorized individuals, such as Florida Department of Financial Services (DFS), upon request.
2. eCIRTS Data and Mainte
nance
T
he Contractor shall ensure monthly collection and maintenance of client and service information in eCIRTS
or any such system designated by the Department
.
3. eCIRT
S Address Validatio
n
T
he Contractor shall work with the Department to ensure client addresses are correct in eCIRTS for disaster
preparedness efforts. At least annually, and more frequently as needed, the Department will provide direction
on how to validate eCIRTS addresses to ensure these can be mapped. The Contractor will receive a list of
unmatched addresses that cannot be mapped and the Contractor will be responsible for working with the local
service providers to correct addresses, and send a list to the Department with confirmed addresses. Th
e
D
epartment will use this information to update maps, client rosters, and unmatched addresses to disseminate to
the local service provider
s.
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4. Data Integrity and Back up Procedur
es
Each Con
tractor shall anticipate and prepare for the loss of information processing capabilities. The routin
e
back
ing up of all data and software is required to recover from losses or outages of the computer system. Data
and software essential to the continued operation of Contractor functions must be backed up. The security
controls over the backup resources shall be as stringent as the protection required of the primary resources.
A
copy
of the backed-up data shall be stored in a secure, offsite location.
5. Policies and Procedures for Records and Documentat
ion
T
he Contractor shall maintain written policies and procedures for computer system backup and recovery an
d
shal
l have the same requirement of its subcontractors. These policies and procedures shall be made availabl
e
to th
e Department upon requ
est.
F. P
erformance Specifications
1. Outcomes and Outputs (Performance Measures)
The Contractor must
:
a. Ensure
the prioritization of clients and provision of service to clients in accordance with Section II.A.1.-2.
of this contract;
b. Ensure the provision of the services described in this contract are in accordance with the current DOEA
Handbook and Sections II.A.1.-3. and II.C.1.-3. of this contra
ct;
c. Tim
ely and accurately submit to the Department all required documentation and reports described in
Section II
.E.;
d. Tim
ely and accurately submit Attachments XI, XII, and XIII, and supporting documentation, in accordance
with Attachment X, Invoice Report Schedule;
and
e. D
evelop and document strategies in the Area Plan to support the Department’s standard of performance
achievement, including increases for the following:
i. Per
centage of most frail elders who remain at home or in the community instead of going into a nursing
home;
ii. P
ercentage of active clients eating two or more meals per day;
ii
i. Pe
rcentage of new service recipients whose ADL assessment score has been maintained or improved;
iv.
Pe
rcentage of new service recipients whose IADL assessment score has been maintained or improved;
v. A
fter service intervention, the percentage of caregivers who self-report being very confident about thei
r
abi
lity to continue to provide care;
vi. Pe
rcentage of clients who are at imminent risk of nursing home placement who are served wi
th
comm
unity-based services;
and
vii. P
ercentage of elders assessed with high or moderate risk environments who improved thei
r
env
ironment sc
ore.
2. T
he Contractor’s performance of the measures in Section II.F.1. above will be reviewed and documented in the
Department’s Annual Programmatic Monitoring Report.
3. Monitoring and Evaluation Methodology
The Department will review and evaluate the performance of the Contractor under the terms of this contract
.
Monito
ring shall be conducted through direct contact with the Contractor through telephone, in writing, and/or
on-site visit(s). The primary, secondary, or signatory of the contract must be available for any on-site
programmatic monitoring visit. The Department’s determination of acceptable performance shall be conclusive
.
T
he Contractor agrees to cooperate with the Department in monitoring the progress of completion of the service
tasks and deliverables. The Department may use, but is not limited to, one or more of the following met
hods
for m
onitoring:
a. D
esk reviews and analytical reviews;
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b. Scheduled, unscheduled, and follow-up on-site visits
;
c. C
lient visits;
d. Review of independent auditor’s reports;
e. Review of third-party documents and/or evaluation
;
f. Rev
iew of progress report
s;
g. Rev
iew of customer satisfaction surveys;
h. Agreed-upon procedures review by an external auditor or consultant;
i. Limited-scope reviews; and
j. Other procedures as deemed necessary by the Department.
G. Contractor Responsibilities
1. Contractor Accountability
All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility of th
e
Contra
ctor and are tasks and deliverables for which, by execution of this contract, the Contractor agrees to be
held accountable.
2. Coordination with Other Providers and/or Entiti
es
Notwithstanding that services for which the Contractor is held accountable involve coordination with other
entit
ies in performing the requirements of the contract, the failure of other entities does not alleviate the
Contractor from any accountability for tasks or services that the Contractor is obligated to perform pursuant to
this contract.
H. Department Responsibilities
1. Department Obligations
The Department may, within its resources, provide technical support and/or assistance to the Contractor to assi
st
the Co
ntractor in meeting the requirements of this contract. The Department’s technical support and/or
assistance, or lack thereof, shall not relieve the Contractor from full performance of contract requirements.
2. Department Determinations
The Department reserves the exclusive right to make certain determinations in the tasks and approaches used
to perform tasks required by this contract. The absence of the Department setting forth a specific reservation
of rights does not mean that all other areas of the contract are subject to mutual agreement.
III. METHOD OF PAYMENT
A. Payment Methods Used
The method of payment for this contract is a combination of fixed-fee/unit rate, cost reimbursement, and advance
payments, subject to the availability of funds and Contractor performance. The Department will pay the Contractor
upon satisfactory completion of the Tasks/Deliverables, as specified in Section II, Manner of Service Provision,
and in accordance with other terms and conditions of this contract.
1. Fixed Fee/Unit Ra
te
Paym
ents for Fixed Fee/Unit Rate shall not exceed amounts established in the Service Rate Report (Attachm
ent
XI
V).
2. Cost Reimbursement
Payment may be authorized only for allowable expenditures which are in accordance with the services specified
in Attachment XIV. All Cost Reimbursement Requests for Payment must include the Receipt and Expenditure
Report (Attachment XII), as well as the Cost Reimbursement Summary form (Attachment XIII,), beginning
with the first month of this contract. Reimbursement amounts for administrative costs must be reflected on the
Cost Reimbursement Summary form and include only items contained on the Contractor’s approved budget
.
T
he Department reserves the right to review supporting documentation for any cost reimbursement requests.
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3. Advance Paymen
ts
T
he Contractor may request up to two (2) months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and amount
of funds released to the Department by the State of Florida (budget release). The Contractor’s requests fo
r
adv
ance require the written approval of the Department Contract Manager. For the first month’s advanc
e
reque
st, the Contractor shall provide to the Department Contract Manager documentation justifying the need
for an advance and describing how the funds will be distributed. If the Contractor is requesting two (2) months
of advances, documentation must be provided reflecting the cash needs of the Contractor within the initial tw
o
(2) m
onths and should be supported through a cash-flow analysis or other information appropriate to
demonstrate the Contractor’s financial need for the second month of advances. The Contractor must also
describe how the funds will be distributed for the first and second month. If sufficient budget is available, an
d
t
he Department’s Contract Manager, in his or her sole discretion, has determined that there is justified need
for
an adv
ance, the Department will issue approved advance payments after July 1st of the contract year.
a. Any advance payments the Contractor requests for subcontractors must be distributed within seven (7) days
of receipt of payment from the Department. The Contractor shall submit to the Department documentation
to support full distribution of advanced funds with Report Number 5, due to the Department on October 25,
2023, in accordance with the Invoice Report Schedule (Attachment X).
b. All advance payments retained by the Contractor must be fully expended no later than September 30, 2023.
Any portion of advance payments not expended must be recouped on the Request for Payment (Attachm
ent
XI
), Report Number 5, due to the Department on October 25, 2023, in accordance with the Invoice Report
Schedule (Attachment X).
c. All advance payments made to the Contractor shall be reimbursed to the Department as follows: At least
one–tenth of the advance payment received shall be reported as an advance recoupment on each Request
for Payment, starting with Report Number 5, in accordance with the Invoice Report Schedule (Attachmen
t
X).
B. F
unding Distribution
The Contractor agrees to distribute funds as detailed in the Area Plan update and the Annual Budget Summary
(Attachment IX). Any changes in the total amounts of the funds identified on the Annual Budget Summary form
require a contract amendmen
t.
C. Method
of Invoice Payment
Payment shall be made upon the Contractor’s presentation of an invoice subsequent to the acceptance and approv
al
by
the Department of the deliverables shown on the invoice. The form and substance of each invoice submitted by
the Contractor shall be as follows
:
1. H
ave a Remittance Address that corresponds exactly to the “Remit To” address provided to
MyFloridaMarketPlace (MFMP) during registration
;
2. Reques
t payment monthly for the units of services established in the Contractor’s approved Area Plan, provided
in conformance with the requirements as described in the current DOEA Handbook, at the rates established in
the Service Rate Report (Attachment XIV). Documentation of service delivery must include a report consisting
of the following: number of clients served, number of service units provided by service, and rate per servic
e
unit
with calculations that equal the total invoice amount. Reimbursement amounts for administrative costs
must be reflected on the Cost Reimbursement Summary form (Attachment XII) and include only items
contained on the Contractor’s Cost Analysis form. Any requested changes to the approved budget subsequent
to the execution of the contract must be submitted to the Department’s Contract Manager for written approval.
Any change to the total contract amount requires a formal contract amendment;
3. The Contractor shall consolidate all subcontractors’ Requests for Payment and Receipt and Expenditure Reports
that support Requests for Payment and shall submit the consolidated information to the Department using the
Request for Payment (Attachment XI), Receipt and Expenditure Report (Attachment XII), and Cost
Reimbursement Summary (Attachment XIII) forms for services and administrative expenses, which mu
st
inc
lude itemized expenditure categories;
and
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4. All Requests for Payment shall be based on the submission of monthly Receipt and Expenditure Repor
ts
beg
inning with the first month of this contract. The schedule for submission of advance requests (whe
n
av
ailable) and invoices is set forth in the Invoice Report Schedule (Attachment X)
.
D. P
ayment Withholding
Any payment due by the Department under the terms of this contract may be withheld pending the receipt and
approval by the Department of all financial and programmatic reports due from the Contractor and any adjustments
thereto, including any disallowance not resolv
ed.
E. Final Invo
ice Instructions
The Contractor shall submit the final Request for Payment to the Department no later than August 15, 2024.
F. HCE Subsidy Data Entries Schedule
T
he Contractor must ensure that all data for HCE subsidies are entered into the eCIRTS by the 15th of each month.
HCE subsidy data entered into the eCIRTS by the 15th of the month will be for payments incurred between the 16th
of the previous month and the 15th of the current month. Case management data entered into the eCIRTS by
the
15th o
f the month shall be for units of service provided during the previous month from the 16th and up to and
including the 15th of the current month or case management units of service may be entered according to the
Contractor schedule, in aggregate daily, weekly, or monthly. The Contractor shall ensure data entry for HCE
subsidies will cease on the 15th of the month and that the eCIRTS Monthly Service Utilization Report by clie
nt
nam
e and by worker is generated. The Contractor shall ensure the Monthly Utilization Report by client name
and
by
worker is verified, corrected, and certified no later than the 25th of the month in which the Report is generated.
G. eCIRTS Data Entries for Subcontracto
rs
T
he Contractor shall require subcontractors to enter all required data for clients and services in the eCIRTS database
in accordance with the current DOEA Handbook and the eCIRTS User Manual – Aging Provider Network user
s
(loc
ated in Documents on the eCIRTS Enterprise Application Services). Subcontractors must enter this data into
the eCIRTS prior to submitting their Requests for Payment and Receipt and Expenditure Reports to the Contractor.
The Contractor shall establish deadlines for completing eCIRTS data entry and ensure compliance with due dates
for the Requests for Payment and Expenditure Reports that Contractor must submit to the Department
.
H. Subcontra
ctors’ Monthly CIRTS Reports
The Contractor shall require subcontractors to run monthly eCIRTS reports and to verify that client and service data
in the eCIRTS is accurate. This report must be submitted to the Contractor with the monthly Request for Payment
and Receipt and Expenditure Report and must be reviewed by the Contractor before the Subcontractor’s Request
for Payment and Receipt and Expenditure Reports can be approved by the Contrac
tor.
I. C
orrective Action Plan
1. Contractor shall ensure that one hundred percent (100%) of the deliverables identified in Section II.C.1.-3. of
this contract are performed pursuant to contract requirements.
2. If at any time the Contractor is notified by the Department’s Contract Manager that it has failed to correctly,
completely, and/or adequately perform contract deliverables identified in Section II.C.1.-3. of this contract, the
Contractor will have ten (10) days to submit a CAP to the Department’s Contract Manager that addresses the
deficiencies and states how the deficiencies will be remedied within the time approved by the Department’s
Contract Manager. The Department shall assess a Financial Consequence for Non-Compliance on the
Contractor as referenced in Section III.J. of this contract for each deficiency identified in the CAP which is no
t
corr
ected pursuant to the CAP. The Department will also assess a financial consequence for failure to timel
y
subm
it a CAP.
3. If the Contractor fails to correct an identified deficiency within the approved time specified in the CAP, th
e
De
partment shall deduct the percentage established in Section III.J. of this contract from the payment for the
invoice of the following m
onth.
4. I
f the Contractor fails to timely submit a CAP, the Department shall deduct the percentage established in Sectio
n
I
II.J. of this contract for each day the CAP is overdue. The deduction will be made from the payment for th
e
inv
oice of the following m
onth.
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J. Financial Consequences
1. The Department will withhold or reduce payment if the Contractor fails to perform the deliverables to the
satisfaction of the Department according to the requirements referenced in Section II.C. of this contract. The
following financial consequences will be imposed if the deliverables stated do not meet in part or in whol
e the
perf
ormance criteria as outlined in Section II.C. or Section II.F. of this contract:
a. Delivery of services to eligible clients as referenced in Section II.A.1.-2. and Section II.C.1. of this contract
–
Fai
lure to comply with established assessment and prioritization criteria, as evidenced by eCIRTS reports,
will result in a two percent (2%) reduction of payment per business day. The reduction of payment will
begin on the first business day following the Department’s notification to the Contractor that the identified
deficiency was not cured or satisfactorily addressed in accordance with the Department-approved CA
P,
refere
nced in Section III.I.;
b. Administrative duties as referenced in Section II.C.3. of this contract – Failure to perform management an
d
ov
ersight of HCE Program operations will result in a two percent (2%) reduction of payment per business
day. The reduction of payment will begin the first business day following the Department’s notification to
the Contractor that the identified deficiency was not cured or satisfactorily addressed in accordance with
the Department-approved CAP, referenced in Section III.I.;
c. Timely submission of a CAP – Failure to timely submit a CAP within ten (10) business days after
notification of a deficiency by the Department’s Contract Manager will result in a two percent (2%)
reduction of payment per business day the CAP is not received. The reduction of payment will begin the
first business day following the Department’s notification to the Contractor that the identified deficiency
was not cured or satisfactorily addressed in accordance with the Department-approved CAP, referenced in
Section III.I.
IV. SPECIAL PROVISIONS
A. Final Budget and Funding Revision Requests
Final requests for budget revisions or adjustments to contract funds based on expenditures for provided services
must be submitted to the Department Contract Manager in writing no later than June 30, 2024; email requests are
considered acceptable.
B. Use of Service Dollars and Management of the Assessed Priority Consumer List
The Contractor is expected to spend all funds provided by the Department for the purpose specified in this contract.
The Contractor must manage the service dollars in such a manner as to avoid having a wait list and a surplus of
funds at the end of the contract period. If the Department determines that the Contractor is not spending service
funds accordingly, the Department may transfer funds to other AAAs during the contract period and/or adjust
subsequent funding allocations accordingly, as allowable under state and federal law.
C. Contract Limits
In no case shall the Contractor be required to incur costs in excess of the contract amount in providing services to
the clients.
D. Remedies for Nonconforming Services
1. The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely
,
com
pletely, and commensurate with required standards of quality. Such goods and/or services will only be
delivered to eligible program participan
ts.
2. If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services
not meeting such standards will not be reimbursed under this contract. The Contractor’s signature on the
Request for Payment form certifies maintenance of supporting documentation and acknowledgement that the
Contractor shall solely bear the costs associated with preparing or providing nonconforming goods and/or
services. The Department requires immediate notice of any significant and/or systemic infractions that
compromise the quality, security, or continuity of services to client
s.
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E. Incident Reporting
The Contractor shall notify the Department immediately but no later than forty-eight (48) hours from the
Cont
ractor’s awareness or discovery of changes that may materially affect the Contractor or any subcontractor’s
ability to perform the services required to be performed under this contract and in authorizing proviso. Such notice
shall be made orally to the Department’s Contract Manager (by telephone) with an email to immediately
follow, including the Contractor’s plan for provision of services authorized in proviso.
F. Investigation of Criminal Allegati
ons
A
ny report that contains allegations of criminal violations on the part of the Contractor or any Subcontractors and
that is referred to a governmental or investigatory agency must be sent to the Department. If the Contractor has
reason to believe that the allegations will be referred to the State Attorney, a law enforcement agency, the United
States Attorney’s office, or other governmental agency, the Contractor shall notify the Inspector General at the
Department immediately. A copy of all documents, reports, notes, or other written material concerning the
investigation, whether in the possession of the Contractor or Subcontractors, must be sent to the Department
’s
I
nspector General with a summary of the investigation and allegations.
G. Volunteers
The Contractor shall ensure the use of trained volunteers in providing direct services delivered to older individuals
and individuals with disabilities needing such services. If possible, the Contractor shall work in coordination with
organizations that have experience in providing training, placement, and stipends for volunteers or participants
(such as the Senior Community Service Employment Program or organizations carrying out federal service
programs administered by the Corporation for National and Community Service).
G. Enforcement
1. In accordance with Section 430.04, F.S., the Department shall rescind designation of an area agency on aging
or take intermediate measures against the Contractor, including corrective action, unannounced special
monitoring, temporary assumption of operation of one or more programs by the Department, placement on
probationary status, imposing a moratorium on Contractor action, imposing financial penalties for
nonperformance, or other administrative action pursuant to Chapter 120, F.S., if the Department finds that an
y
of th
e following have occurr
ed:
a.
An intentional or negligent act of the Contractor has materially affected the health, welfare, or safety of
clients, or substantially and negatively affected the operation of an aging services program;
b. The Contractor lacks financial stability sufficient to meet contractual obligations or that contractual fund
s
hav
e been misappropriated;
c. The Contractor has committed multiple or repeated violations of legal and regulatory requirements or
Department standards;
d. The Contractor has failed to continue the provision or expansion of services after the declaration of a state
of emergency;
e. The Contractor has exceeded its authority or otherwise failed to adhere to the terms of this contract with
the Department or has exceeded its authority or otherwise failed to adhere to the provisions specifically
provided by statute or rule adopted by the Department;
f. The Contractor has failed to properly determine client eligibility as defined by the Department or efficiently
manage program budgets; or
g. The Contractor has failed to implement and maintain a Department-approved client grievance resolution
procedure.
2. In making any determination under this provision, the Department may rely upon findings of another state or
federal agency or other regulatory body. Any claims for damages for breach of contract are exempt from
administrative proceedings and shall be brought before the appropriate entity in the venue of Leon County,
Florida. In the event the Department initiates action to rescind an area agency on aging designation, the
Department shall follow the procedures set forth in 42 U.S.C. § 3025(
b).
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H. Contract Modifications
The Department’s Contract Manager has the authority to modify and/or extend deliverable deadlines. All
deliverable extension requests must be made to the Department’s Contract Manager, in writing, prior to the
required deadline. All approvals for deliverable extensions must be communicated, in writing, by the
Department’s Contract Manager to the Contractor and are subject to the discretion of the Department’s Contract
Manager. The requests and the approval must occur prior to the established deadline. An e-mail writing (request
and response) is considered acceptab
le.
I. Rate Inc
rease Thresholds
1. For Service Provider Proposed Rate Increases up to 5%:
a. Service Provider rate increase requests received by the Department of Elder Affairs (DOEA) from an Area
Ag
ency on Aging (AAA) that are up to 5.0% above rate at time of contract execution are not required to
be reviewed and approved by the DOEA. The AAAs shall follow their existing agency rate review and
approval process which at a minimum shall include:
i. A detailed written justification from the Service Provider describing the reason(s) for the interim rate
adjustment. This explanation shall include a detailed assessment of potential organizational and client
impact. The written justification shall provide sufficient detail for the AAA to review, identifying th
e
serv
ice or commodity component(s) that are increasing Service Provider costs.
ii. A current rate and a requested rate unit cost methodology. (Attachment XV)
2. For Service Provider Proposed Rate Increases Exceeding 5%:
a. For Service Provider proposed rate increases of 5.01% or greater, the requirements detailed in i. and ii.
above shall apply PLUS sections i., below.
i. Service Provider Proposed Rate Increases of 5.01% or greater must be reviewed and approved by
DOE
A. The AAAs should forward all such requests to their Contract Manager and provide th
e
fol
lowing additional information:
(1) The Service Provider must also provide in their written justification, reassurance that all other
potential options to procure alternate suppliers, subcontractors, or other potential cost-efficiencies
that could reduce the proposed rate increase of 5.01% or greater have been explored and rejected.
(2) Contract Managers may request additional information from the Service Provider via the AAA.
Following DOEA’s review/decision, the DOEA Contract Manager shall notify the AAA via emai
l
of app
roval/disapproval and the AAA shall proceed accordingly.
3. No Service Provider rate shall be increased before October 1,
2023.
4. N
ote: All rate increase thresholds mentioned in the above language is cumulative from Service Providers’
rates at the time of contract executio
n.
END OF ATTACH
MENT
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ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Department to th
e Contractor may be subject to audits and/or monitoring
by the Department, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with 2 CFR Part 200 (formerly OMB Circular A-133 as revised),
and Section 215.97, F.S., (see “AUDITS” below), monitoring procedures may include, but not be limited to, on-site visits
by the Department staff, limited scope audits and/or other procedures. By entering into this contract, the Contractor agrees
to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Department. In the event
the Department determines that a limited scope audit of the Contractor is appropriate, the Contractor agrees to comply with
any additional instructions provided by the Department to the Contractor regarding such audit. The Contractor further
agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief
Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the Contractor is a State or local government or a non-profit organization as defined in 2 CFR Part
200, Subpart A.
In the event that the Contractor expends $750,000.00 or more in federal awards during its fiscal year, the Contractor must
have a single or program-specific audit conducted in accordance with the provisions of 2 CFR Part 200. Financial and
Compliance Audit Attachment, Exhibit 2 indicates federal resources awarded through the Department by this contract. In
determining the federal awards expended in its fiscal year, the Contractor shall consider all sources of Federal awards,
including federal resources received from the Department. The determination of amounts of Federal awards expended
should be in accordance with 2 CFR Part 200. An audit of the Contractor conducted by the Auditor General in accordance
with the provisions of 2 CFR Part 200 will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the Contractor shall fulfill the requirements
relative to auditee responsibilities as provided in 2 CFR § 200.508.
If the Contractor expends less than $750,000.00 in federal awards in its fiscal year, an audit conducted in accordance with
the provisions of 2 CFR Part 200 is not required. In the event that the Contractor expends less than $750,000.00 in federal
awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR Part 200, the cost
of the audit must be paid from non-federal resources (i.e., the cost of such audit must be paid from Contractor resources
obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization’s fiscal year.
Compliance findings related to contracts with the Department shall be based on the contract’s requirements, including any
rules, regulations, or statutes referenced in the contract. The financial statements shall disclose whether or not the matching
requirement was met for each applicable contract. All questioned costs and liabilities due to the Department shall be fully
disclosed in the audit report with reference to the Department contract involved. If not otherwise disclosed as required by
2 CFR § 200.510, the schedule of expenditures of federal awards shall identify expenditures by contract number for each
contract with the Department in effect during the audit period. Financial reporting packages required under this part must
be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the Contractor’s fiscal
year end.
PART II: STATE FUNDED
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This part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2), F.S.
In the event that the Contractor expends a total amount of state financial assistance equal to or in excess of $750,000.00 in
any fiscal year of such Contractor, the Contractor must have a State single or project-specific audit for such fiscal year in
accordance with Section 215.97, F.S.; applicable rules of the Department of Financial Services; and Chapter 10.550 (local
governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. Financial
Compliance Audit Attachment, Exhibit 2 indicates state financial assistance awarded through the Department by this
contract. In determining the state financial assistance expended in its fiscal year, the Contractor shall consider all sources
of state financial assistance, including state financial assistance received from the Department, other state agencies, and
other non-state entities. State financial assistance does not include Federal direct or pass-through awards and resources
received by a non-state entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1, the Contractor shall ensure that the audit
complies with the requirements of Section 215.97(8), F.S. This includes submission of a financial reporting package as
defined by Section 215.97(2), F.S., and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General.
If the Contractor expends less than $750,000.00 in state financial assistance in its fiscal year, an audit conducted in
accordance with the provisions of Section 215.97, F.S., is not required. In the event that the Contractor expends less than
$750,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the
provisions of Section 215.97, F.S., the cost of the audit must be paid from the non-state entity’s resources (i.e., the cost of
such an audit must be paid from the Contractor resources obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization’s fiscal year.
Compliance findings related to contracts with the Department shall be based on the contract’s requirements, including any
applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement
was met for each applicable contract. All questioned costs and liabilities due to the Department shall be fully disclosed in
the audit report with reference to the Department contract involved. If not otherwise disclosed as required by Rule 69I-
5.003, F.A.C., the schedule of expenditures of state financial assistance shall identify expenditures by contract number for
each contract with the Department in effect during the audit period. For local governmental entities, financial reporting
packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12
months after the Contractor’s fiscal year end. For non-profit or for-profit organizations, financial reporting packages
required under this part must be submitted within 45 days after delivery of the audit report, but no later than 9 months after
the Contractor’s fiscal year end. Notwithstanding the applicability of this portion, the Department retains all right and
obligation to monitor and oversee the performance of this contract as outlined throughout this document and pursuant to
law.
PART III: REPORT SUBMISSION
Copies of financial reporting packages for audits conducted in accordance with 2 CFR Part 200 and required by Part I of
this Financial Compliance Audit Attachment, shall be submitted, when required by 2 CFR § 200.512 by or on behalf of the
Contractor directly to each of the following:
F
ederal Audit Clearinghouse
Bureau of the Census
1201 East 10
th
Street
Jeffersonville, IN 47132
Pursuant to 2 CFR § 200.512, all other Federal agencies, pass-through entities and others interested in a reporting package
and data collection form must obtain it by accessing the Federal Audit Clearinghouse.
The Contractor shall submit a copy of any management letter issued by the auditor directly to the Department.
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Florida Department of Elder Affairs
Attn: Audit Repository
4040 Esplanade Way, Suite 235S
Tallahassee, Florida 32399-7000
Additionally, copies of financial reporting packages required by this contract’s Financial Compliance Audit Attachment,
Part II, shall be submitted by or on behalf of the Contractor directly to each of the following:
T
he Department at the following address:
Florida Department of Elder Affairs
Attn: Audit Repository
4040 Esplanade Way, Suite 235S
Tallahassee, Florida 32399-7000
The Auditor General’s Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letters, or other information required to be submitted to the Department pursuant to this contract
shall be submitted timely in accordance with 2 CFR Part 200, F.S., and Chapter 10.550 (local governmental entities) or
10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable.
Contractors, when submitting financial reporting packages to the Department for audits done in accordance with 2 CFR Part
200 or Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General, should indicate the date that the reporting package was delivered to the Contractor in correspondence
accompanying the reporting package.
PART IV: RECORD RETENTION
The Contractor shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of
six (6) years from the date the audit report is issued, and shall allow the Department or its designee, the CFO, or Auditor
General access to such records upon request. The Contractor shall ensure that audit working papers are made available to
the Department or its designee, CFO, or Auditor General upon request for a period of six (6) years from the date the audit
report is issued, unless extended in writing by the Department.
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ATTACHMENT II
EXHIBIT 1
PART I: AUDIT RELATIONSHIP DETERMINATION
Contractors who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200
and/or Section 215.97, F.S. Contractors who are determined to be recipients or sub-recipients of federal awards and/or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I
and/or Part II of Exhibit 1 are met. Contractors who have been determined to be vendors are not subject to the audit
requirements of 2 CFR § 200.38 and/or Section 215.97, F.S. Regardless of whether the audit requirements are met,
Contractors who have been determined to be recipients or sub-recipients of Federal awards and/or state financial
assistance must comply with applicable programmatic and fiscal compliance requirements.
In accordance with 2 CFR Part 200 and/or Rule 69I-5.006, F.A.C., Contractor has been determined to be:
_____Vendor not subject to 2 CFR § 200.38 and/or Section 215.97, F.S.
__X_ Recipient/sub-recipient subject to 2 CFR §§ 200.86 and 200.93 and/or Section 215.97, F.S.
_____Exempt organization not subject to 2 CFR Part 200 and/or Section 215.97, F.S. For Federal awards, for-profit
organizations are exempt; for state financial assistance projects, public universities, community colleges, district
school boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must
comply with all compliance requirements set forth within the contract or award document.
NOTE: If a Contractor is determined to be a recipient/sub-recipient of federal and/or state financial assistance, and has been
approved by the department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-5.006, F.A.C.
[state financial assistance] and/or 2 CFR § 200.330 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Contractors who receive Federal
awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a sub-
recipient must comply with the following fiscal laws, rules, and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR § 200.416 - § 200.417 – Special Considerations for States, Local Governments, and Indian Tribes*
2 CFR § 200.201 – Administrative Requirements**
2 CFR § 200 Subpart F – Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules, and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR § 200.400 - § 200.411 – Cost Principles*
2 CFR § 200.100 – Administrative Requirements
2 CFR § 200 Subpart F – Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules, and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT)
MUST FOLLOW:
2 CFR § 200.418 – § 200.419 – Special Considerations for Institutions of Higher Education*
2 CFR § 200.100 – Administrative Requirements
2 CFR § 200 Subpart F – Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules, and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in 2 CFR
§200.400(5)(c).
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**For funding passed through U.S. Health and Human Services, 45 CFR Part 75; for funding passed through U.S.
Department of Education, 34 CFR Part 80.
STATE FINANCIAL ASSISTANCE. Contractors who receive state financial assistance and who are determined to be a
recipient/sub-recipient must comply with the following fiscal laws, rules, and regulations:
Sections 215.97 & 215.971, F.S.
Chapter 69I-5, F.A.C.
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules, and regulations
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ATTACH
MENT II
EXHIBIT 2
FUNDING SUMMARY (2023-2024)
Note: Title 2 CFR, as revised, and Section 215.97, F.S., require that the information about Federal Programs and State
Projects included in Attachment II, Exhibit 1, be provided to the recipient. Information contained herein is a prediction of
funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CO
NTRACT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
TOTAL FEDERAL AWARD
CO
MPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200 – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
OMB Circular A-133 – Audits of States, Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLO
WING:
M
ATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE
FUNDING SOURCE
CFDA
AMOUNT
TOTAL STATE AWARD
STATE F
INANCIAL ASSISTANCE SUBJECT TO SECTION 215.97, F.S.
PROGRAM TITLE FUNDING SOURCE
CSFA
AMOUNT
Home Care for the Elderly
General Revenue
TOTAL AWARD
CO
MPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97 & 215.971, F.S., Chapter 69I-5, F.A.C., State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules, and regulations.
GRANT AWARD (FAIN#):
FEDERAL AWARD DATE:
UEI NUMBER:
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ATTACHMENT III
CERTIFICATIONS AND ASSURANCES
DOEA will not award this contract unless Contractor completes this CERTIFICATIONS AND ASSURANCES. In
performance of this contract, Contractor provides the following certifications and assurances:
A. Debarment and Suspension Certification (29 CFR Part 95 and 45 CFR Part 75)
B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes, section 287.133, F.S.
E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance
(Pub. L. 111-117)
F. Scrutinized Companies Lists and No Boycott of Israel Certification, section 287.135, F.S.
G. Certification Regarding Data Integrity Compliance for Contracts, Agreements, Grants, Loans, and
Cooperative Agreements
H. Verification of Employment Status Certification
I. Records and Documentation
J. C
ertification Regarding Inspection of Public Record
s
A. CERTIF
ICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS – PRIMARY COVERED TRANSACTION.
The undersigned Contractor certifies, to the best of its knowledge and belief, that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by a Federal department or agency;
2. Have not within a three-year period preceding this contract been convicted or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performi
ng
a publ
ic (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, Stat
e, or
loca
l) with commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or
4. Have not within a three-year period preceding this application/proposal had one or more public transactions
(Federal, State, or local) terminated for cause of defaul
t.
T
he undersigned shall require that language of this certification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall provide this certification accordingly.
B. CERTIFICATION REGARDING LOBBYING – CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS.
The undersigned Contractor certifies, to the best of its knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of Congress or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal lo
an,
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the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification
of any Federal contract, grant, loan, or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative
agreement, the undersigned shall also complete and submit Standard Form – LLL, “Disclosure Form to Report
Lobbying,” in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this contract was made or
entered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by 31
U.S.C. § 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
C. NON- DISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE (29 CFR PART 37 AND 45 CFR PART
80). - As a condition of the Contract, Contractor assures that it will comply fully with the nondiscrimination and equal
opportunity provisions of the following laws
:
1. Section 188 o
f the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination
against all individuals in the United States on the basis of race, color, religion, sex, national origin, age, disability
,
poli
tical affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted
immigrant authorized to work in the United States or participation in any WIA Title I-financially assisted program
or activity.
2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 80), to the end that, in accordance
with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or
national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from
the
D
epartment
.
3. Section 504 o
f the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by
or
pursu
ant to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in
accordance with Section 504 of that Act and the Regulation, no otherwise qualified handicapped individual in the
United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of,
or be subjected to discrimination under any program or activity for which the Applicant receives Federal financia
l
assistance
from the Department.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance
with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of,
be excluded from participation in, or be subjected to discrimination under any program or activity for which the
Applicant receives Federal financial assistance from the Department.
5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in
accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded
from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education
program or activity for which the Applicant receives Federal financial assistance from the Department.
6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment
practices including job application procedures, hiring, firing, advancement, compensation, training, and other term
s,
conditi
ons, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe
benefits, and all other employment-related activiti
es.
7. Contra
ctor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws
listed above. This assurance applies to Contractor’s operation of the WIA Title I – financially assisted program
or
act
ivity, and to all contracts Contractor makes to carry out the WIA Title I – financially assisted program or activity
.
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Contractor understands that DOEA and the United States have the right to seek judicial enforcement of the
assurance.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all
sub-recipients and contractors shall provide this assurance accordingly.
D.
C
ERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S.
Contractor hereby certifies that neither it, nor any person or affiliate of Contractor, has been convicted of a Public Entity
Crime as defined in section 287.133, F.S., nor placed on the convicted vendor li
st.
Contra
ctor understands and agrees that it is required to inform DOEA immediately upon any change of circumstances
regarding this status.
E.
ASSO
CIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE (Pub. L. 111-117).
As a condition of the Contract, Contractor assures that it will comply fully with the federal funding restrictions
pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub.
L. 111-
117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that
appropriations made under Pub. L. 111-117 are available under the conditions provided by Pub. L. 111-
117.
T
he undersigned shall require that language of this assurance be included in the documents for all subcontracts at all
tiers (including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) and that all sub-
recipients and contractors shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS AND NO BOYCOTT OF ISRAEL CERTIFICATION, SECTIO
N
287.135, F
.S.
In accordance with section 287.135, F.S., Contractor hereby certifies that it has not been placed on the Scrutinized
Companies that Boycott Israel List and that it is not engaged in a boycott of Israel.
If this contract is in the amount of $1 million or more, in accordance with the requirements of section 287.135, F.S.,
Contractor hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the
Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and that it is not engaged in business
operations in Cuba or Syria.
Contractor understands that pursuant to section 287.135, F.S., the submission of a false certification may result in the
Department terminating this contract and the submission of a false certification may subject Contractor to civil penalties
and attorney fees and costs, including any costs for investigations that led to the finding of false certification.
If Contractor is unable to certify any of the statements in this certification, Contractor shall attach an explanation to
this contract.
G.
CERTIF
ICATION REGARDING DATA INTEGRITY COMPLIANCE FOR CONTRACTS, AGREEMENTS,
GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
1. The Contractor and any Subcontractors of services under this contract have financial management system
s
capab
le of providing certain information, including: (1) accurate, current, and complete disclosure of the financia
l
resu
lts of each grant-funded project or program in accordance with the prescribed reporting requirements; (2)
the
sourc
e and application of funds for all contract supported activities; and (3) the comparison of outlays wi
th
budg
eted amounts for each award. The inability to process information in accordance with these requirements
could result in a return of grant funds that have not been accounted for properly.
2. Management Information Systems used by the Contractor, Subcontractors, or any outside entity on which
the
Contra
ctor is dependent for data that is to be reported, transmitted, or calculated have been assessed and verifi
ed
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to be capable of processing data accurately, including year-date dependent data. For those systems identified to be
non-compliant, Contractors will take immediate action to assure data integrity.
3. If this contract includes the provision of hardware, software, firmware, microcode, or imbedded chip technology
,
the un
dersigned warrants that these products are capable of processing year-date dependent data accurately. A
ll
v
ersions of these products offered by the Contractor (represented by the undersigned) and purchased by the stat
e
w
ill be verified for accuracy and integrity of data prior to transfer.
4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that
impede the hardware or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software programs to the same level of functionality as warranted
herein, at no charge to the state, and without interruption to the ongoing business of the state, time being of th
e
essen
ce.
5. The Contractor and any Subcontractors of services under this contract warrant that their policies and proced
ures
inc
lude a disaster plan to provide for service delivery to continue in case of an emergency, including emergencies
arising from data integrity compliance issu
es.
H. VERIF
ICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Department, Contractor certifies the use of the U.S. Department of Homela
nd
Secur
ity's E-verify system to verify the employment eligibility of all new employees hired by Contractor during
the
contrac
t term to perform employment duties pursuant to this contract, and that any subcontracts include an expres
s
requ
irement that Subcontractors performing work or providing services pursuant to this contract utilize the E-verify
system to verify the employment eligibility of all new employees hired by the Subcontractor during the entire contract
term
.
T
he Contractor shall require that the language of this certification be included in all sub-agreements, sub-grants, an
d
othe
r agreements/contracts and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this contract was ma
de or
ent
ered into. Submission of this certification is a prerequisite for making or entering into this contract imposed by
Circulars A-102 and 2 CFR Part 200 and 215 (formerly OMB Circular A-
110).
I. RECO
RDS AND DOCUMENTATION
The Contractor agrees to make available to Department staff and/or any party designated by the Department any
and
al
l contract related records and documentation. The Contractor shall ensure the collection and maintenance of al
l
prog
ram related information and documentation on any such system designated by the Department. Maintena
nce
inc
ludes valid exports and backups of all data and systems according to Department standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of Section 10 of the Standard Contract, sections 119.0701(3) and (4) F.S., and any other
applicable law, if a civil action is commenced as contemplated by section 119.0701(4), F.S., and the Department is
named in the civil action, Contractor agrees to indemnify and hold harmless the Department for any costs incurred by
the Department and any attorneys’ fees assessed or awarded against the Department from a Public Records Request
made pursuant to Chapter 119, F.S., concerning this contract or services performed thereund
er.
a. N
otwithstanding section 119.0701, F.S., or other Florida law, this section is not applicable to contracts executed
between the Department and state agencies or subdivisions defined in section 768.28(2)
, F.S.
2. Section
119.01(3), F.S., states if public funds are expended by an agency in payment of dues or membership
contributions for any person, corporation, foundation, trust, association, group, or other organization, all the financial,
business, and membership records of such an entity which pertain to the public agency (Florida Department of
Elder Affairs) are public records. Section 119.07, F.S, states that every person who has custody of such a public record
shall permit the record to be inspected and copied by any person desiring to do so, under reasonable circumstances.
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Additionally, I certify this organization does ____ does not ____provide for institutional memberships.
Contractor’s signature below attests that records pertaining to the dues or membership application by the Department are
available for inspection if applicable, as stated above.
By execution of this contract, Contractor must include these provisions (A-J) in all related subcontract agreements (if
applicable).
By signing below, Contractor certifies that the representations outlined in parts A through J above are true and correct.
Signature and Title of Authorized Representative
Street Address
Contractor Date
City, State, Zip code
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ATTACHMENT IV
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043),
Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please
contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
1.
Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management
, and
com
pletion of the project described in this applicati
on.
2.
Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the
award; and will establish a proper accounting system in accordance with generally accepted accounting standards or
agency directiv
es.
3.
Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes, or presents the
appearance of, personal or organizational conflict of interest or personal gain.
4.
Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency
.
5.
Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§ 4728-4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of
OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6.
Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI
of
the Civ
il Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin;
(b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683 and §§ 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.
§ 794)
, which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended
(42 U.S.C. §§ 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment
Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Sections523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§ 290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug
abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. § 3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific
statute(s) under which application for federal assistance is being made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the application.
7.
Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance
and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of
persons displaced or whose property is acquired as a result of federal or federally assisted programs. These requirements
apply to all interests in real property acquired for project purposes regardless of federal participation in purchases.
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8.
Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§ 1501-1508 and §§ 7324-7328), which
limit the political activities of employees whose principal employment activities are funded in whole or in part with
federal funds.
9.
Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. §§ 276a to 276a-7), the Copeland
Act (40 U.S.C. § 276c and 18 U.S.C. § 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§
327-333), regarding labor standards for federally assisted construction sub-contracts.
10.
Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or
more.
11.
Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the Coastal Zone Management Ac
t
of 19
72 (16 U.S.C. § 1451 et seq.); (f) conformity of federal actions to State (Clear Air) Implementation Plans under
Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. § 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-
205).
12
Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. § 1721 et seq.) related to protecting components
or potential components of the national wild and scenic rivers system.
13.
Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. § 470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U.S.C. § 469a-1 et seq.).
14.
Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of as
sistance.
15.
Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. § 2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities
supported by this award of assistance
.
16.
Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. § 4801 et seq.), which prohibits the use
of lead- based paint in construction or rehabilitation of residence structures.
17.
Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and 2 CFR Part 200.
18.
Will comply with all applicable requirements of all other federal laws, executive orders, regulations, and policies
governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
APPLICANT ORGANIZATION
DATE SUBMITTED
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ATTACHMENT V
FLORIDA DEPARTMENT OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name
County
AAA/Contractor
Address
Completed By
City, State, Zip Code
Date
Telephone
PART I: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE
THIS FORM.
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
____
________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Total #
%
White
%
Black
%
Hispanic
%
Other
%
Female
%
Disabled
%
Over 40
2. Population of area served
Source of data:
3. Staff currently employ ed
Effective date:
4. Clients currently enrolled/registered
Effective date:
5. Advisory/Governing Board if ap plicable
For questions 2-5 please indicate the following:
PART II: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE. IF N/A or NO, EXPLAIN.
6. Is an Assurance of Compliance on file with DOEA?
N/A YES NO
7. Compare the staff composition to the population. Is staff representative of the population?
N/A YES NO
8. Are eligibility requirements for services applied to clients and applicants without regard to race, color, national
origin, sex, age, religion, or disability?
N/A YES NO
9. Are all benefits, services and facilities available to applicants and participants in an equally effective manner
regardless of race, sex, color, age, national origin, religion, or disability?
N/A YES NO
10. For in-patient services, are room assignments made without regard to race, color, national origin or disability?
N/A YES NO
11. Is the program/facility accessible to non-English speaking clients?
12.
Are
employees, applicants and participants informed of their protection against discrimination? If YES, how?
Verbal Written Poster
N/A YES NO
N/A YES NO
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13. Give the number and current status of any discrimination complaints regarding services or employment filed
against the program/facility.
N/A NUMBER
______
14. Is the program/facility physically accessible to mobility, hearing, and sight-impaired individuals?
N/A YES NO
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES. IF NO,
EXPLAIN.
15. Has as a self-evaluation been conducted to identify any barriers to serving disabled individuals and to make any
necessary modifications?
YES NO
16. Is there an established grievance procedure that incorporates due process in the resolution of complaints?
YES NO
17. Has a person been designated to coordinate Section 504 compliance activities?
YES NO
18. Do recruitment and notification materials advise applicants, employees, and participants of nondiscrimination on
the basis of disability?
YES NO
19. Are auxiliary aids available to ensure accessibility of services to hearing and sight-impaired individuals?
YES NO
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE.
20. Do you have a written affirmative action plan? If NO, explain.
YES NO
DOEA USE ONLY
Reviewed by
In Compliance: YES NO*
Program Office
*Notice of Corrective Action Sent ___/___/___
Date
Telephone
Response Due ___/___/___
On-Site Desk Review
Response Received ___/___/___
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ATTACHMENT V
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county, city, or other locality. If the program/facility serves a
specific target population such as adolescents, describe the target population. Also, define the type of service provide
d.
2. Enter
the percent of the population served by race, sex, disability, and over the age of 40. The population served includes
persons in the geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. (“Other” races include
Asian/Pacific Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex, disability, and over the age of 40. Include the
effective date of your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their
percent by race, sex, disability, and over the age of 40. Include the date that enrollment was coun
ted.
a. Wher
e there is a significant variation between the race, sex, or ethnic composition of the clients and their availability
in the population, the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when
programs are sanctioned to serve target populations such as elderly or disabled persons
.
5. Enter
the total number of advisory board members and their percent by race, sex, disability, and over the age of 40. If
there is no advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR Part 80. This is usually a standard part of the
contract language for DOEA Recipients and their Sub-grantees. 45 CFR § 80.4(
a).
7. I
s the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population
is Hispanic, is there a comparable percentage of Hispanic staff?
8. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through
on-site record analysis of persons who applied but were denied services or employment. 45 CFR § 80.3(a) and 45 CFR
§ 80.1.
9. Part
icipants or clients must be provided services such as medical, nursing, and dental care, laboratory services, physical
and recreational therapies, counseling, and social services without regard to race, sex, color, national origin, religion,
age, or disability. Courtesy titles, appointment scheduling, and accuracy of record keeping must be applied uniformly
and without regard to race, sex, color, national origin, religion, age, or disability. Entrances, waiting rooms, reception
areas, restrooms, and other facilities must also be equally available to all clients. 45 CFR § 80.3(b).
10. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin, or
disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a
different race, color, national origin, or disability. 45 CFR § 80.3(a).
11. The program/facility and all services must be accessible to participants and applicants, including those persons who may
not speak English. In geographic areas where a significant population of non-English speaking people live, program
accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for
service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision
of services. 45 CFR § 80.3(a).
12. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries, or any other
interested parties. 45 CFR § 80.6(d). This should include information on their
right to file a complaint of discrimination with either the Department or the U.S. Department of Health and Human
Services. The information may be supplied verbally or in writing to every individual or may be supplied through the us
e
of an
equal opportunity policy poster displayed in a public area of the facility
.
13. Report
number of discrimination complaints filed against the program/facility. Indicate the basis (e.g. race, color, creed,
sex, age, national origin, disability, and/or retaliation) and the issues involved (e.g. services or employment, placement,
(July 2023 – June 2024) AH023
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termination, etc.). Indicate the civil rights law or policy alleged to have been violated along with the name and address
of the local, state, or federal agency with whom the complaint has been filed. Indicate the current status of the complaint
(e.g. settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc.).
14. The program/facility must be physically accessible to mobility, hearing, and sight-impaired individuals. Physical
accessibility includes designated parking areas, curb cuts or level approaches, ramps, and adequate widths to entran
ces.
T
he lobby, public telephone, restroom facilities, water fountains, and information and admissions offices shou
ld be
acce
ssible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, coun
ters,
and se
rving lines should be observed for accessibility. Elevators should be observed for door width and Braille or
raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installe
d
at an
appropriate height for mobility impaired individuals.
15. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-
evaluation to identify any accessibility barriers. Self-evaluation is a four-step process:
a. Evaluate, with the assistance of disabled individual(s)/organization(s), current policies and practices that do not or
may not comply with Section 504;
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate the effects of any discrimination that resulted from adherence to these policies and
practices; and
d. Maintain self-evaluation on file, including a list of the interested persons consulted, a description of areas examined,
and any problems identified, and a description of any modifications made and of any remedial steps taken 45 CFR
§ 84.6. (
This checklist may be used to satisfy this requirement if these four steps have been followed).
16. Programs or facilities that employ 15 or more persons shall adopt grievance procedures that incorporate appropriate due
process standards and that provide for the prompt and equitable resolution of complaints alleging any action prohibited
by Part 84 of Title 45, CFR45 CFR § 84.7(b).
17. Programs or facilities that employ 15 or more persons shall designate at least one person to coordinate its efforts to
comply with Part 84 of Title 45, CFR. 45 CFR § 84.7(a).
18. Programs or facilities that employ 15 or more persons shall take appropriate initial and continuing steps to notify
participants, beneficiaries, applicants, and employees that the program/facility does not discriminate on the basis of
handicap in violation of Section 504 and Part 84 of Title 45, CFR. Methods of initial and continuing notification may
include the posting of notices, publication in newspapers and magazines, placement of notices in publications of the
programs or facilities, and distribution of memoranda or other written communications. 45 CFR § 84.8(a).
19. Programs or facilities that employ 15 or more persons shall provide appropriate auxiliary aids to persons with impaired
sensory, manual, or speaking skills where necessary to afford such persons an equal opportunity to benefit from the
service in question. Auxiliary aids may include, but are not limited to, brailed and taped materials, interpreters, and other
aids for persons with impaired hearing or vision. 45 CFR § 84.52(d).
20. Programs or facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement, and
maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR Part 60
and Title VI of the Civil Rights Act of 1964, as amended.
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ATTACHMENT VI
CONTRACTOR’S STATE CONTRACT LIST
Contractor's State Contract List
REPORT PERIOD:
From:
CONTRACTOR INFORMATION:
To:
Name:
Phone:
Address:
Email:
FEID:
Contact:
Contract #
Contract/
Program Name
State Agency/
Program
Start
Date
End
Date
Description of Contract
Purpose/Types of Services
Contract
Manager
Phone #
Contract
Amount
1
$ -
2
$ -
3
$ -
4
$ -
5
$ -
6
$ -
7
$ -
8
$ -
9
$ -
10
$ -
11
$ -
12
$ -
13
$ -
14
$ -
15
$ -
16
$ -
17
$ -
Total
$ -
SIGNATURE:
DATE:
TITLE:
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ATTACHMENT VII
BACKGROUND SCREENING
BACKGROUND SCREENING
A
ttestation of Compliance - Employer
¾
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
employees or has volunteers in service who meet the definition of a direct service provider.
See §§ 435.02, 430.0402, Fla. Stat.
¾
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. 817.568. The term includes
coordinators, managers, and supervisors of residential facilities and volunteers.”
§
430.0402
(1)(b), Fla. Stat.
ATTESTATION:
As the duly authorized representative of
located at
,
Street Address
City
Stat
e ZIP code
I, 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.
Signature of Representative
Date
DOEA Form 235, Attestation of Compliance - Employer, Effective January 19, 2021
F.S. Form available at: https://elderaffairs.org/wp-content/uploads/background-screening-affidavit-of-compliance-employer.pdf
Section 435.05(3),
AUTHORITY: This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3), Florida Statutes.
Northwest Florida Area Agency on Aging, Inc.
Employer Name
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ATTACHMENT VIII
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES (CMBE FORM)
CMBE FORM MUST ACCOMPANY INVOICES SUBMITTED TO DOEA
CONTRACTOR NAME: __________________________________________________
DOEA CONTRACT NUMBER: __________________
*REPORTING PERIOD-FROM: ________________ TO: __________________
*(DATE RANGE OF RENDERED SERVICES, MUST MATCH INVOICE SUBMITTED TO DOEA)
DOEA CONTRACT MANAGER: ________________________________________
REPORT ALL EXPENDITURES MADE TO CERTIFIED MINORITY BUSINESS (SUBCONTRACTORS).
CONTACT DOEA CMBE COORDINATOR FOR ANY QUESTIONS, AT 850-414-2153.
If unsure if subcontractor is a certified minority supplier, click on the hyperlink below. Enter the name of the supplier, click
“search”. Only Certified Minority Business Entities will be displayed.
SUBCONTRACTOR NAME
SUBCONTRACTOR’S
FEID
CMBE
EXPENDITURES
DOEA USE ONLY -- REPORTING ENTITY (DIVISION, OFFICE, ETC)
SEND COMPLETED FORMS VIA INTEROFFICE MAIL TO: JUSTIN TAYLOR
CMBE COORDINATOR, CONTRACT ADMINISTRATION & PURCHASING, TALLAHASSEE, FLORIDA 32399-7000.
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https://osd.dms.myflorida.com/directories
INSTRU
CTIONS
(A) ENTER THE COMPANY NAME AS IT APPEARS ON YOUR DOEA CONTRACT.
(B) ENTER THE DOEA CONTRACT NUMBER.
(C) ENTER THE SERVICE PERIOD MATCHING THE CURRENT INVOICE’S SERVICE PERIOD.
(D) ENTER ALL CERTIFIED MINORITY BUSINESS EXPENDITURES FOR THE TIME PERIOD COVERE
D BY
TH
E INVOICE
:
1. E
NTER CERTIFIED MINORITY BUSINESS NAME.
2. ENTER THE CERTIFIED MINORITY BUSINESS FEID NUMBER.
3. ENTER THE CERTIFIED MINORITY BUSINESS CMBE NUM
BER.
4. E
NTER THE AMOUNT EXPENDED WITH THE CERTIFIED MINORITY BUSINESS FOR THE TIME
PERIOD COVERED BY THE INVOICE.
(E) MBE FORM MUST ACCOMPANY INVOICE PACKAGE SUBMITTED TO DOEA FINANCIAL
ADMINISTRATION FOR PROCESSING.
(F) FINANCIAL ADMINISTRATION WILL FORWARD ALL COMPLETED CMBE FORMS TO CONTRACT
ADMINISTRATION & PURCHASING OFFICE.
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ATTACH
MENT IX
ANNUAL BUDGET SUMMARY
1. HCE Services (Subsidies & Case
Management
Tot
al
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ATTACHMENT X
INVOICE REPORT SCHEDULE
Report Number
Based On
Submit to State on this Date
1
July Advance*
July 1
2
August Advance*
July 1
3
July Invoice
August 25
4
August Invoice
September 25
5
September Invoice
October 25
6
October Invoice
November 25
7
November Invoice
December 25
8
December Invoice
January 25
9
January Invoice
February 25
10
February Invoice
March 25
11
March Invoice
April 25
12
April Invoice
May 25
13
May Invoice
June 25
14
June Invoice
July 25
15
16
Final Invoice
Closeout Report
August 15
August 31
Leg
end:
* Advance based on projected cash need.
Note # 1:
Report #1 for Advance Basis Agreements cannot be submitted to the Department of Financial
Services (DFS) prior to July 1 or until the agreement with the Department has been executed and a
copy sent to DFS. Actual submission of the vouchers to DFS is dependent on the accuracy of the
expenditure report.
Note # 2:
Report numbers 5 through 14 shall reflect an adjustment of at least one-tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the agreement. The
adjustment shall be recorded in Part C, 1 of the report (A
ttachment XI).
Note #3:
Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the Department, payment is to accompany the report.
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ATTACHMENT XI
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
Contract # ___________________________
TYPE OF PAYMENT :
Contract Period _______________________
Regular __________
Report Period ________________________
Advance _________
Report # _____________________________
PSA # ___________ Invoice # ____________________________
CERTIFICATION: I hereby certify to the best of my knowledge that this request is complete and correct and conforms with the terms and the purposes of the above contract.
Prepared by:________________________________ Date:___________ Approved by: ___________________________________ Date:_____________
PART A: BUDGET SUMMARY
AAA Admin. Services TOTAL
1. Approved Contract Amount
$0.00 $0.00 $0.00
2.
Previous Funds Received for Contract Period
$0.00 $0.00 $0.00
3. Contract Balance (line 1 minus line 2)
$0.00 $0.00 $0.00
4. Previous Funds Requested and Not Received for Contract Period $0.00 $0.00 $0.00
5. CONTRACT BALANCE (line 3 minus line 4) $0.00 $0.00 $0.00
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st - 2nd months) $0.00 $0.00 $0.00
2. Net Expenditures For Month $0.00 $0.00 $0.00
(DOEA Form 105H, Part B, Line 3)
3. TOTAL $0.00 $0.00 $0.00
PART C: NET FUNDS REQUESTED
1. Less Advance Applied $0.00 $0.00 $0.00
2. TOTAL FUNDS REQUESTED (Part B Line 3, minus Part C Line 1) $0.00 $0.00 $0.00
List of Services / Units / Rates provided - See attached report.
DOEA FORM 106H
Revised 03/23/18
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ATTACHMENT XII
RECEIPT AND EXPENDITURE REPORT
HOME CARE FOR THE ELDERLY PROGRAM
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ATTACHMENT XIII
COST REIMBURSEMENT SUMMARY
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ATTACH
MENT XIV
SERVICE RATE REPORT
These rates are to be considered the Maximum rates possible for all services. Services shall be invoiced up to these
thresholds in accordance with Attachment I, Section IV. I.
DELIVERABLES
REIMBURSEMENT
UNIT RATE
METHOD OF
PAYMENT
UNIT TYPE
ADMINISTRATIVE COSTS
Cost Reimbursement
Cost Reimbursement
EPISODE
ADULT DAY CARE VENDOR - DAYS
Fixed Fee / Unit Rate
DAYS
ADULT DAY HEALTH CARE VENDOR - DAYS
Fixed Fee / Unit Rate
DAYS
ASSURANCE (TELEPHONE AND IN-PERSON)
Fixed Fee / Unit Rate
EPISODE
BASIC SUBSIDY
Fixed Fee / Unit Rate
EPISODE
BASIC SUBSIDY - LEGACY
Cost Reimbursement
Cost Reimbursement
EPISODE
CAREGIVER SUPPORT GROUPS
Fixed Fee / Unit Rate
EPISODE
CAREGIVER TRAINING/SUPPORT (GROUP)
Fixed Fee / Unit Rate
HOUR
CAREGIVER TRAINING/SUPPORT (INDIVIDUAL)
Fixed Fee / Unit Rate
HOUR
CAREGIVER TRAINING/SUPPORT VENDOR
Fixed Fee / Unit Rate
HOUR
CASE AIDE
Fixed Fee / Unit Rate
HOUR
CASE AIDE VENDOR
Fixed Fee / Unit Rate
HOUR
CASE MANAGEMENT
Fixed Fee / Unit Rate
HOUR
CASE MANAGEMENT VENDOR
Fixed Fee / Unit Rate
HOUR
CHORE
Cost Reimbursement
Cost Reimbursement
HOUR
CHORE (ENHANCED)
Cost Reimbursement
Cost Reimbursement
HOUR
CHORE (ENHANCED) - VENDOR
Fixed Fee / Unit Rate
HOUR
CHORE (ENHANCED) - VENDOR
Cost Reimbursement
Cost Reimbursement
HOUR
CHORE VENDOR
Fixed Fee / Unit Rate
HOUR
COMPANIONSHIP
Fixed Fee / Unit Rate
HOUR
COUNSELING (GERONTOLOGICAL) - VENDOR
Fixed Fee / Unit Rate
HOUR
COUNSELING (MENTAL HEALTH
COUNSELING/SCREENING) - GROUP
Fixed Fee / Unit Rate
HOUR
COUNSELING (MENTAL HEALTH
COUNSELING/SCREENING) - INDIVIDUAL
Fixed Fee / Unit Rate
HOUR
COUNSELING (MENTAL HEALTH
COUNSELING/SCREENING) - VENDOR
Fixed Fee / Unit Rate
HOUR
EDUCATION/TRAINING - GROUP
Fixed Fee / Unit Rate
EPISODE
EDUCATION/TRAINING - INDIVIDUAL
Fixed Fee / Unit Rate
EPISODE
EMERGENCY HOME DELIVERED SHELF MEALS
Fixed Fee / Unit Rate
MEAL
EMERGENCY HOME DELIVERED SHELF MEALS -
VENDOR
Fixed Fee / Unit Rate
MEAL
HOME DELIVERED MEALS
Fixed Fee / Unit Rate
MEAL
HOME DELIVERED MEALS - VENDOR
Fixed Fee / Unit Rate
MEAL
HOME HEALTH AIDE SERVICE - VENDOR
Fixed Fee / Unit Rate
MEAL
HOMEMAKER
Fixed Fee / Unit Rate
HOUR
HOMEMAKER - VENDOR
Fixed Fee / Unit Rate
HOUR
HOUSING IMPROVEMENT
Cost Reimbursement
Cost Reimbursement
EPISODE
HOUSING IMPROVEMENT - VENDOR
Cost Reimbursement
Cost Reimbursement
EPISODE
INTAKE
Fixed Fee / Unit Rate
HOUR
MATERIAL AID
Cost Reimbursement
Cost Reimbursement
EPISODE
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MATERIAL AID - VENDOR
Cost Reimbursement
Cost Reimbursement
EPISODE
OTHER - BACKGROUND SCREEN - VENDOR
Fixed Fee / Unit Rate
EPISODE
OTHER - BACKGROUND SCREEN - VENDOR
Cost Reimbursement
Cost Reimbursement
EPISODE
OTHER SERVICES
Cost Reimbursement
Cost Reimbursement
EPISODE
OTHER SERVICES - VENDOR
Cost Reimbursement
Cost Reimbursement
EPISODE
PERSONAL CARE
Fixed Fee / Unit Rate
HOUR
PERSONAL CARE - VENDOR
Fixed Fee / Unit Rate
HOUR
PEST CONTROL (ENHANCED INITIATION)
Cost Reimbursement
Cost Reimbursement
EPISODE
PEST CONTROL (RODENT CONTROL)
Fixed Fee / Unit Rate
EPISODE
PEST CONTROL (RODENT CONTROL)
Cost Reimbursement
Cost Reimbursement
EPISODE
PEST CONTROL INITIAL
Fixed Fee / Unit Rate
EPISODE
PEST CONTROL INITIAL
Cost Reimbursement
Cost Reimbursement
EPISODE
PEST CONTROL MAINTENANCE
Fixed Fee / Unit Rate
EPISODE
RESPITE - VENDOR
Fixed Fee / Unit Rate
HOUR
RESPITE IN-FACILITY
Fixed Fee / Unit Rate
HOUR
RESPITE IN-FACILITY - VENDOR
Fixed Fee / Unit Rate
HOUR
RESPITE IN-HOME
Fixed Fee / Unit Rate
HOUR
SHOPPING ASSISTANCE
Fixed Fee / Unit Rate
ONE-WAY TRIP
SKILLED NURSING SERVICES
Cost Reimbursement
Cost Reimbursement
HOUR
SKILLED NURSING SERVICES - VENDOR
Fixed Fee / Unit Rate
HOUR
SPECIALIZED MEDICAL EQUIPMENT, SERVICES,
AND SUPPLIES
Cost Reimbursement
Cost Reimbursement
EPISODE
SPECIALIZED MEDICAL EQUIPMENT, SERVICES,
AND SUPPLIES - VENDOR
Cost Reimbursement
Cost Reimbursement
EPISODE
TRANSPORTATION
Fixed Fee / Unit Rate
TRIP
TRANSPORTATION - VENDOR
Fixed Fee / Unit Rate
ONE-WAY TRIP
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ATTACHMENT XV
SIMPLIFIED UNIT COST METHODOLOGY RATE INCREASE REQUEST FORM
BUDGET YEAR:
RECIPIENT NAME:
PRIOR YEAR RATE:
Service
LINE-ITEM EXPENSES
Prior Year
Historical
Costs
Rate at
Contract
Execution
Current
Rate
Requested
Rate
%
Change
(between
Contract
Execution and
Requested)
Wages
-
Fringe Benefits (Formula Allocated)
-
Fringe Benefits (Manual Allocation)
-
Travel
-
Education/Training
-
Communications & Postage
-
Utilities
-
Printing & Supplies
-
Advertising
-
Insurance
-
Maintenance & Repair
-
Space Costs (Rent)
-
Equipment
-
Professional fees/Legal/Audit
-
Program Supplies
-
Depreciation
-
Food & Food Supplies
-
Other
-
TOTAL ALLOWABLE COSTS
$0.00
$0.00
$0.00
$0.00
0.00%
