HomeMy WebLinkAboutExhibitContract Number KL 2506
LOCAL SERVICES PROGRAM CONTRACT
2025-2026 Fiscal Year
THIS CONTRACT is entered into between the Alliance for Aging Inc., hereinafter referred to as the "Alliance" and Provider
Name, hereinafter referred to as the "Provider," and collectively referred to as the "parties."
Attachments I, II, III, VI, VII, VIII, IX, X, A, B, C, and D are incorporated herein and made a part of this Contract.
WHEREAS, the Alliance has been designated as the Area Agency on Aging for Planning and Service Area 11 encompassing
Miami -Dade and Monroe Counties; and
WHEREAS, the Florida Department of Elder Affairs (the "Department") has entered into a Contract with the Alliance to fund
Local Services Program Providers in Miami -Dade and Monroe Counties; and
NOW THEREFORE, in consideration of the services to be performed and payments to be made, together with the mutual
covenants and conditions set forth in this Contract, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract
including all attachments and exhibits, which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department of Elder Affairs
handbooks, manuals 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 and shall be governed in accordance with the applicable
laws, statutes, and other conditions set for in this Contract.
3. Term of Contract
3.1 Effective Date:
This contract shall begin at twelve (12:00) A.M., Eastern Standard Time on July 1, 2025, or on the date the contract has
been signed by both parties, whichever is later. The contract will end on June 30, 2026, or such earlier date as the
contract is terminated pursuant to Section 51 herein, except that the parties shall continue to perform those limited
contract close-out activities set forth in this contract.
3.2. Delivery of services shall end at 11:59 P.M., Eastern Standard Time on June 30, 2026, or such earlier time as the
contract is terminated pursuant to paragraph 10 herein. Under no circumstances will the Alliance reimburse the provider
for services provided after June 30, 2026, or any earlier termination date. No changes to funding allocations will be
made after June 30, 2026. Only limited contract close-out activities are to be performed after June 30, 2026, consisting
of reporting, invoicing and payment as stipulated in ATTACHMENT VIII.
4. Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to
exceed $1,000,000.00 subject to the availability of funds. Any costs or services paid for under any other contract or from
any other source are not eligible for payment under this contract.
4.1 Obligation to Pay
The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the
Legislature to the Department and funding received by the Alliance under its contract with the Department.
5. Renewals
The contract may be renewed on a yearly basis as per annual legislative appropriation and shall be contingent upon satisfactory
performance evaluations as determined by the Alliance. Any renewal of a contract shall be subject to mutual agreement,
confirmed in writing, and subject to the same terms and conditions set forth in the initial contract, with the exception of
establishing unit rates which is described further in this section. The renewal price, or method for determining a renewal price,
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is set forth in the bid, proposal, or reply. Requests to renegotiate the original contractual established rates are provided for in the
Alliance's approved Reimbursement Rate Review Policy, which is incorporated by reference.
The parties shall re-evaluate the contract's reimbursement rates on an annual basis pursuant to DOEA's Notice of Policy
Clarification: Service Cost Reports Notice #092815-1-PC-SCBS dated September 28th, 2015 and the approved Alliance's
Reimbursement Rate Review Policy.
In the event that contracts cannot be executed prior to the July 1st start date, the Alliance may, at its discretion, extend this
Agreement upon written notice for up to 120 days to ensure continuity of service. Services provided under this extension
will be paid for out of the succeeding agreement amount.
6. Compliance with Federal Law
6.1. The Provider shall not employ an unauthorized alien. The Alliance shall consider the employment of unauthorized
aliens a violation of the Immigration and Nationality Act (8 U.S.C. 1324 a) and the Immigration Reform and Control
Act of 1986 (8 U.S.C. 1101). Such violation shall be cause for unilateral cancellation of this contract by the Alliance.
6.2. If the Provider 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 2006 Pension Protection Act or for any other reason, the Provider must notify the
Alliance in writing within thirty (30) days of receiving the IRS notice of revocation.
6.3. The Provider shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.4. Unless exempt under 2 CFR Part 170.110(b), the Provider shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
6.5. To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number 11-116,
Provider agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of
all new employees hired by Provider during the contract term. Provider shall include in related subcontracts a
requirement that subcontractors and/or vendors 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 and/or vendor during
the contract term. Providers 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 the Florida law, including Florida provisions for conflict of laws.
7.2 The Provider shall comply with Section 215.97, F.S and requirements of s. 287.058, F.S. as amended.
7.2.1 The Provider shall perform all tasks contained in Attachment 1.
7.2.2 The Provider shall provide units of deliverables, including various client services, and in some instances may
include reports, findings, and drafts, as specified in this Contract, which the Contract Manager must receive
and accept in writing prior to payment in accordance with s. 215.971(1) and (2), Fla. Stat. Expenditures must
be in compliance with laws, rules, regulations, including, but not limited to the Florida Reference Guide for
State Expenditures issued by the Florida Department of Financial Services ("DFS").
7.2.3 The Provider 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,
7.2.4 The Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre -audit and post -audit.
7.2.5 If itemized payment for travel expenses is permitted in this contract, the Provider shall submit bills for any
travel expenses in accordance with s. 112.061, F.S., or at such lower rates as may be provided in this contract.
7.2.6 The Provider shall allow public access to all documents, papers, letters, or other public records as defined in s.
119.011(12), F.S., made or received by the Provider in conjunction with this contract except for those records
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which are made confidential or exempt by law. The Provider's refusal to comply with this provision will
constitute an immediate breach of contract for which the Alliance may unilaterally terminate the contract.
7.3 If clients are to be transported under this contract, the Provider shall comply with the provisions of Chapter 427, F.S.,
and Rule 41-2, F. A. C.
7.4 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in
accordance with the provision of s. 287.134, F.S.
7.5 The Provider shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the expenditure of
contract funds for the purpose of lobbying the legislature, judicial branch or a state agency.
7.6 The Alliance and/or Department may terminate the Contract if the Provider is found to have submitted a false
certification as provided under s. 287.135(5), F.S., has been placed on the Scrutinized Companies with Activities in Iran
Petroleum Sector List, the Scrutinized Companies with activities in Sudan List, or the scrutinized companies that Boycott
Israel list, or if the Provider has been engaged in business operations in Cuba or Syria or is engaged in a boycott of Israel.
8. Background Screening
8.1 The Provider shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met regarding
background screening for all persons who meet the definition of a direct service provider and who are not exempt from
the Department's Level 2 background screening pursuant to s. 430.0402(2)-(3), F.S. The Provider must also comply with
any applicable rules promulgated by the Department and the Agency for Health Care Administration regarding
implementation of s. 430.0402 and Chapter 435, F.S. To demonstrate compliance with this provision, Provider shall
submit to the Department, the Background Screening Affidavit of Compliance (Screening Form) upon thirty (30) days
of execution of this contract. Should the Alliance have a completed Screening Form on file for the Provider, a new
Screening Form will be required every twelve (12) months.
8.2 Further information concerning the procedures for background screening is found at
http://elderaffairs.state.fl.us/doea/backgroundscreening.php
9. Grievance and Complaint Procedures
9.1 Grievance Procedure
The Provider shall comply with and ensure subcontractor compliance with the Minimum Guideline for Recipient
Grievance Procedures, Appendix D, Department of Elder Affairs Programs and Services Handbook, to address
complaints regarding the termination, suspension or reduction of services, as required for receipt of funds.
9.2 Complaint Procedures:
The Provider shall develop and implement complaint procedures and ensure 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 worker complaints, or any other advice related to
complaints other than termination, suspension or reduction in services that require the grievance process as described in
Appendix D, Department of Elder Affairs Programs and Services Handbook. The complaint procedures shall include
notification to all clients of the complaint procedure and include tracking the date, nature of the complaint and the
determination of the complaint on a complaint log.
10. Public Records and Retention:
10.1 If, under this contract the Provider is providing services and is acting on behalf of the Alliance and the Department as provided
under s. 119.011(2), Florida Statutes, the Provider, subject to the terms of s. 287.058(1)(c), Florida Statutes, and any other
applicable legal and equitable remedies, agrees to all provisions of Chapter 119, Fla. Stat., and any other applicable law, and shall:
10.1.1 Keep and maintain public records that ordinarily and necessarily would be required by the public agency in
order to perform the services.
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10.1.2 Upon request from the Alliance or the Department, the Provider will provide a copy of the request for records
or allow the records to be inspected or copies within a reasonable time at a cost that does not exceed the cost
provided in Chapter 119, Florida Statutes, 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.
10.1.4 Upon completion of this contract, the Provider will transfer, at no cost to the Alliance, all public records in
possession of the Provider or will keep and maintain public records required by the Alliance or the Department.
If the Provider transfers all public records to the Alliance upon completion of the contract, Provider shall destroy
any duplicate public records that are exempt, or confidential and exempt, from public records disclosure
requirements. If the Provider keeps and maintains public records upon completion of the contract, the Provider
shall meet all applicable requirements for retaining public records. All records stored electronically must be
provided to the Alliance in a format that is compatible with the information technology systems of the Alliance.
10.2 The Alliance may unilaterally cancel this contract notwithstanding any other provisions of this Contract, for refusal
by the Provider to comply with Section 9 of this Contract by not allowing public access to all documents, papers,
letters, or other material made or received by the Provider in conjunction with the contract, unless the records are
exempt, or confidential and exempt, from Section 24(a) of Article I of the State Constitution and s. 119.07(1), F.S.
IF THE PROVIDER HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO THE PROVIDER'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 32309
850-414-2342
do eapublicreco rds(a, elderaffairs.org
10.3 Upon termination of this contract, whether for convenience or for cause as detailed in section 52 of this contract, the
Provider and subcontractors shall, at no cost to the Alliance, transfer all public records in their possession to the
Alliance 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 Alliance in a format that is
compatible with the information technology systems of the Alliance.
11. Audits, Inspections, Investigations:
11.1 The Provider shall establish and maintain books, records, and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest, and expenditures of funds provided
by the Alliance under this contract. Provider(s) shall adequately safeguard all such assets and assure they are used
solely for the purposes authorized under any contract or agreement which incorporates this Contract. Whenever
appropriate, financial information should be related to performance and unit cost data.
11.2 The Provider shall retain all client records, financial records, supporting documents, statistical records, and any other
documents (including electronic storage media) pertinent to this contract for a period of six (6) years after completion
of the contract or longer when required by law. In the event an audit is required by this contract, records shall be
retained for a minimum period of six (6) years after the audit report is issued or until resolution of any audit findings
or litigation based on the terms of this contract, at no additional cost to the Alliance.
11.3 Upon demand, at no additional cost to the Alliance, the Provider shall facilitate the duplication and transfer of any
records or documents during the required retention period.
11.4 The Provider shall assure that the records described in Paragraph 10 will be subject at all reasonable times to
inspection, review, copying, or audit by federal, state, or other personnel duly authorized by the Alliance.
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11.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Alliance and the
Department, pursuant to 45 CFR part 75, will be allowed full access to and the right to examine any of the Provider's
contracts and related records and documents pertinent to this specific contract, regardless of the form in which kept.
11.6 The Provider shall provide a financial and compliance audit to the Alliance by a third -party independent audit firm as
specified in this contract and in ATTACHMENT III and ensure that all related third -party transactions are disclosed
to the auditor.
11.7 The Provider agrees to comply with the Department's Inspector General in any investigation, audit, inspection, review,
or hearing performed pursuant to s. 20.055, F.S.. By execution of this Contract the Provider understands and will
comply with this subsection. Provider 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 s. 20.055(5), F.S.
12. Nondiscrimination -Civil Rights Compliance
12.1 The Provider shall execute assurances in ATTACHMENT II that it will not discriminate against any person in the
provision of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, marital status or sex in compliance with state and federal law and regulations. The Provider further
assures that all Providers, subcontractors, sub -grantees, or others with whom it arranges to provide services or benefits
in connection with any of its programs and activities are not discriminating against clients or employees because of
age, race, religion, color, disability, national origin, marital status or sex.
12.2 During the term of this contract, the Provider shall complete and retain on file a timely, complete and accurate Civil
Rights Compliance Checklist, attached to this contract.
12.3 The Provider shall establish procedures pursuant to federal law to handle complaints of discrimination involving
services or benefits through this contract. These procedures will include notifying clients, employees, and participants
of the right to file a complaint with the appropriate federal or state entity.
12.4 These assurances are a condition of continued receipt of or benefit from financial assistance, and are binding upon the
Provider, its successors, transferees, and assignees for the period during which such assistance is provided. The
Provider 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 above statutes, regulations, guidelines, and standards. In the event of
failure to comply, the Provider understands that the Alliance may, at its discretion, seek a court order requiring
compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, including but
not limited to, termination of and denial of further assistance.
13. Monitoring by the Alliance for Aging
13.1 The Provider shall permit persons duly authorized by the Alliance to inspect and copy any records, papers, documents, facilities,
goods and services of the Provider which are relevant to this contract, and to interview any clients, employees and
subcontractor employees of the Provider to assure the Alliance of the satisfactory performance of the terms and
conditions of this contract. Following such review, the Alliance will provide a written report of its findings to the
Provider, and where appropriate, the Provider shall develop a Corrective Action Plan (CAP). The Provider hereby
agrees to correct all deficiencies identified in the CAP in a timely manner as determined by the Contract Manager.
Failure to comply with the CAP shall subject Provider to enforcement actions as described in this Contract.
13.2 The Alliance will perform administrative, fiscal, and programmatic monitoring of the provider to ensure contractual
compliance, fiscal accountability, programmatic performance, and compliance with applicable state and federal laws
and regulations. The Provider will supply progress reports, including data reporting requirements as specified by the
Alliance or the Department to be used for monitoring progress or performance of the contractual services Examples
of review criteria are surplus/deficit reports, independent financial audit, compliance audit (if required by Attachment
III of this contract), internal controls, reimbursement requests, subcontractor monitoring, targeting, program
eligibility, outcome measures, service provision to clients, data integrity, client satisfaction, and client file reviews.
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13.3 Service Cost Reports (SCR) — The Provider shall submit a SCR to the Alliance annually, but no later than ninety (90)
calendar days after the Provider Fiscal Year ends. The SCR shall reflect the actual costs of providing each service by
program for the preceding contract year. Costs associated with services provided under this contract shall only include
allowable direct and indirect costs as defined by applicable state law. If the Provider desires to renegotiate its
reimbursement rates, the Provider shall make a request in writing to the Alliance, with the inclusion of a Unit Cost
Methodology, in accordance with the Alliance's approved Reimbursement Rate Review Policy, which is incorporated
by reference.
14. Provision of Services
The Provider shall provide services in the manner described in ATTACHMENT I of this contract and in the Service Provider
Application (SPA). In the event of a conflict between the Service Provider Application and this contract, the contract
language prevails.
1.5. Coordinated Monitoring with Other Agencies
If the Provider receives direct, or pass through funding from one or more other State of Florida human service agencies, in
addition to the Department of Elder Affairs funding passed through the Alliance, it is expected that the provider cooperates
with all monitors, inspectors, and/or investigators should a state agency joint inquiry or investigation begin.
16. Indemnification
The Provider shall indemnify, save, defend, and hold harmless the Department, the Alliance and its officers, agents and employees from
any and all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the execution this
Contract, or performance of the services provided for herein. It is understood and agreed that the Provider is not required to indemnify the
Department or the Alliance for claims, demands, actions, or causes of action arising solely out of the Department' s or Alliance' s negligence.
17. Insurance and Bonding
17.1 Provider must provide continuous adequate liability insurance and worker's compensation insurance coverage, during
the existence of this contract, and during any renewal(s) or extension(s) of it. In the event there is a need to process
any claims that may arise that the same protection will be afforded by the Alliance. Supporting documentation should
be either a Certificate of Insurance naming the Alliance as an additional insured on the provider's liability insurance
policy (or policies) or if the Provider is self -insured or a local municipality or county, and to be in compliance with
and subject to the limitations of Florida Statutes, Section 768.28 and Chapter 440, a signed letter from the municipality
or county stating that it will fully indemnify the Alliance against any claims The Provider accepts full responsibility
for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial
protections for the Provider and the clients to be served under this contract. Upon execution of this Contract, the
Provider shall furnish the Alliance written verification supporting both the determination and existence of such
insurance coverage. The limits of coverage under each policy maintained by the Provider do not limit the Provider's
liability and obligations under this contract. The Provider shall ensure that the Alliance has the most current written
verification of insurance coverage throughout the term of this contract. Such coverage may be provided by a self-
insurance program established and operating under the laws of the State of Florida. The Department and the Alliance
reserve the right to require additional insurance as specified by this contract.
17.2 Throughout the term of this contract, the Provider must maintain an insurance bond from a responsible commercial
insurance company covering all officers, directors, employees, and agents of the Provider, authorized to handle funds
received or disbursed under this contract, in an amount commensurate with the funds handled, the degree of risk as
determined by the insurance company and consistent with good business practices.
18. Confidentiality of Information
The Provider 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.
19. Health Insurance Portability and Accountability Act
Where applicable, the Provider shall comply with the Health Insurance Portability and Accountability Act (42 USC 1320d.),
as well as all regulations promulgated thereunder (45 CFR 160, 162, and 164).
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20. Incident Reporting
20.1 The Provider shall notify the Alliance immediately but no later than forty-eight (48) hours from the Provider's
awareness or discovery of conditions that may materially affect the Provider or Subcontractor's ability to perform the
services required to be performed under this contract. Such notice shall be made orally to the Contract Manager (by
telephone) with an email to immediately follow.
20.2 The Provider shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child,
aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number (1-800-
96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Provider, subcontractors
and its employees.
21. Bankruptcy Notification
During the term of this contract, the Provider shall immediately notify the Alliance if the Provider, its assignees,
subcontractors or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Provider must also provide
the following information to the Alliance: (1) the date of filing of the bankruptcy petition; (2) the case number; (3) the court
name and the division in which the petition was filed (e.g., Northern District of Florida, Tallahassee Division); and, (4) the
name, address, and telephone number of the bankruptcy attorney.
22. Sponsorship and Publicity
22.1 As required by s. 286.25, Fla. Stat., if the Provider 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 City of Miami
, The Alliance for Aging, Inc., and the State of Florida, Department of Elder Affairs." If the sponsorship reference is in written material,
the words "Alliance for Aging, Inc." and "State of Florida, Department of Elder Affairs" shall appear in at least the same size letters
or type as the name of the organization.
22.2 The Provider shall not use the words "Alliance for Aging, Inc." or "The State of Florida, Department of Elder Affairs" to indicate
sponsorship of a program otherwise financed, unless specific authorization has been obtained by the Alliance prior to use.
23. Assignments
23.1 The Provider shall not assign the rights and responsibilities under any contract without the prior written approval of the Alliance
Any sublicense, assignment, or transfer otherwise occurring without prior written approval of the Alliance will constitute a material
breach of the contract or agreement.
23.2 This contract shall remain binding upon the successors in interest of the Provider and the Alliance.
24. Subcontracts:
24.1 The Provider is responsible for all work performed and for all commodities produced pursuant to this contract, whether
actually furnished by the Provider or its subcontractors. Any subcontracts shall be evidenced by a written document
and subject to any conditions of approval the Alliance deems necessary. The Provider further agrees that the Alliance
will not be liable to the subcontractor in any way or for any reason. The Provider, at its expense, shall defend the
Alliance against any such claims
24.2 The Provider shall promptly pay any subcontractors upon receipt of payment from the Alliance or other state agency.
Failure to make payments to any subcontractor in accordance with s. 287.0585, Fla. Stat., unless otherwise stated in
this contract between the Provider and subcontractor, will result in a penalty as provided by statute.
24.3 The Provider shall programmatically monitor, at least once per year, each of its subcontractors, Subrecipients,
Vendors, and/or Consultants. The Provider shall perform programmatic monitoring to ensure contractual compliance,
and programmatic performance and compliance with applicable state and federal laws and regulations. The Provider
shall monitor to ensure that time schedules are met; the budget and scope of work are accomplished within the
specified time periods, and other performance goals. The Provider shall also perform fiscal and administrative
monitoring for all subcontractors to ensure fiscal accountability.
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24.4 The Provider shall have a procurement policy that assures maximum free and open competition. Such procurement
policy must conform, as applicable, with Federal and State contracting and procurement regulations, and the
Alliance's procurement policy.
24.5 The Provider shall dedicate the staff necessary to meet the obligations of this contract and ensure that subcontractors
dedicate adequate staff, accordingly. The provider shall ensure that staff responsible for performing any duties or
functions within this contract has the qualifications as specified in the Department's Programs and Services Handbook.
25. Service Cost Reports:
The Provider shall submit Service Cost Report (SCR) to the Alliance annually, but no later than ninety (90) calendar days
after the Provider Fiscal Year ends. The SCR shall reflect the actual costs of providing each service by program for the
preceding contract year. Costs associated with services provided under this contract shall only include allowable direct and
indirect costs as defined by applicable state law. If the Provider desires to renegotiate its reimbursement rates, the Provider
shall make a request in writing to the Alliance, with the inclusion of a Unit Cost Methodology, in accordance with the
Alliance's approved Reimbursement Rate Review Policy, which is incorporated by reference.
26. Funding Obligations:
26.1 The Alliance for Aging, Inc. acknowledges its obligation to pay the Provider for the performance of the Provider's
duties and responsibilities set forth in this Contract.
26.2 The Alliance shall not be liable to the Provider for costs incurred or performance rendered unless such costs and
performances are strictly in accordance with the terms of this contract, including but not limited to terms governing
the Provider's promised performance and unit rates and/or reimbursement capitations specified.
26.3 The Alliance shall not be liable to the Provider for any expenditures which are not allowable costs as defined in 2 CFR
Part 200 and 45 CFR Part 92, as amended, or which expenditures have not been made in accordance with all applicable
state and federal rules.
26.4 The Alliance shall not be liable to the Provider for expenditures made in violation of regulations promulgated under
the Older Americans Act, Department rules, Florida Statutes, or this contract.
27. Independent Capacity of Provider
It is the intent and understanding of the Parties that the Provider, or any of its Subcontractors, are independent Provider's and
are not employees of the Alliance and shall not hold themselves out as employees or agents of the Alliance without specific
authorization from the Alliance. It is the further intent and understanding of the Parties that the Alliance does not control the
employment practices of the Provider and will not be liable for any wage and hour, employment discrimination, or other
labor and employment claims against the Provider or its Subcontractors. All deductions for social security, withholding taxes,
income taxes, contributions to unemployment compensation funds and all necessary insurance for the Provider are the sole
responsibility of the Provider.
28. Payment
28.1 Payments shall be made to the Provider as services are rendered and invoiced by the Provider. The Alliance will have
final approval of the invoice for payment and will approve the invoice for payment only if the Provider has met all
terms and conditions of the contract, unless the bid specifications, purchase order, or this contract specify otherwise.
The approved invoice will be submitted to the Alliance's fiscal department for budgetary approval and processing per
ATTACHMENT VIII.
28.2 The Provider shall maintain documentation to support payment requests which shall be available to the Department
of Financial Services, the Department, or the Alliance upon request. Invoices must be submitted in sufficient detail
for a proper pre audit and post audit thereof. The Provider shall comply with all state and federal laws goveming
payments to be made under this contract including, but not limited to the following: sections 216.181(16)(a) & (b),
215.422, Fla. Stat.,; and the Invoice Requirements of the Reference Guide for State Expenditures from the Department
of Financial Services at
hops://www.myfloridacfo.com/division/aa/manuals/documents/ReferenceGuideforStateExpenditure s.pdf
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Contract Number KL 2506
The Provider shall maintain detailed documentation to support each item on the itemized invoice or payment request
for cost reimbursed expenses, fixed rate or deliverables, for this contract, including paid subcontractor invoices, and
will be produced upon request by the Alliance. The Provider shall only request reimbursement for allowable expenses
as defined in the laws and guiding circulars cited in this Contract section 6, in the Reference Guide for State
Expenditures, and any other laws or regulations, as applicable.
28.3 The Provider and subcontractors shall provide units of deliverables, including reports, findings, and drafts as specified
in this contract to be received and accepted by the Alliance prior to payment.
29. Return of Funds
The Provider shall return to the Alliance any overpayments due to unearned funds or funds disallowed and any interest
attributable to such funds pursuant to the terms and conditions of any contract or agreement incorporating this Contract by
reference that were disbursed to the Provider by the Alliance. In the event that the Provider or its independent auditor
discovers that an overpayment has been made, the Provider shall repay said overpayment immediately without prior
notification from the Alliance. In the event that the Alliance first discovers an overpayment has been made, the Contract
Manager will notify the Provider in writing of such findings. Should repayment not be made forthwith, the Provider shall be
charged at the lawful rate of interest on the outstanding balance pursuant to s. 55.03, F.S., after Alliance's notification or
Provider discovery.
30. Data Integrity and Safeguarding Information.
The Provider shall ensure an appropriate level of data security for the information the Provider is collecting or using in the
performance of this contract. An appropriate level of security includes approving and tracking all Provider employees that
request system or information access and ensuring that user access has been removed from all terminated employees. The
Provider, among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data
and software must be routinely backed up to insure recovery from losses or outages of computer systems. The security over
the back-up data is to be as stringent as the protection required of the primary systems. The Provider shall insure all
subcontractor maintain written procedures for computer system backup and recovery. The Provider shall, prior to execution
of this agreement, complete the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans, and
Cooperative Agreements prior to the execution of this contract. as part of ATTACHMENT II.
31. Social Media and Personal Cell Phone use:
31.1 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, Provider agrees to the
following social media and personal cell phone use requirements.
31.2 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.
31.3 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 Provider's, Subcontractor's, or their employees' social media accounts or
through personal cellular communication.
31.4 Application to DOEA and Providers Equipment. This contract applies regardless of whether the social media is
accessed using DOEA's IT facilities and equipment or equipment belonging to Provider, Subcontractor, or their
respective employees. Equipment includes, but is not limited to, personal computers, cellular phones, personal digital
assistants, smart watches, or smart tablets.
31.5 Florida Government in the Sunshine, Florida Public Records Law, and HIPAA. Provider 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
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Contract Number KL 2506
Health Insurance Portability and Accountability Act (HIPAA). Compliance with these laws and other applicable laws
are further detailed in the contract.
31.6 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 Provider's records.
31.7 Assist DOEA with Communications. Providers 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.
32. Conflict of Interest
The Provider 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 Provider or subcontractor shall participate in selection, or in the award of an agreement
supported by state or federal funds if a conflict of interest, real or apparent, would be involved. Such a conflict would arise
when: (a) the employee, officer, or agent; (b) any member of his/her immediate family; (c) his or her partner; or (d) an
organization which employs, or is about to employ, any of the above, has a financial or other interest in the firm selected for
award. The Provider or subcontractor's officers, employees or agents will neither solicit nor accept gratuities, favors or
anything of monetary value from Providers, potential Providers, or parties to subcontracts.
Pursuant to Chapter 4, Section 2 of the Department of Elder Affairs Program and Services Handbook, no Provider may
employ, in any capacity, any member of its governing board or any family member of a person on the board.
The Providers' board members and management must disclose to the Alliance any relationship which may be, or may be
perceived to be, a conflict of interest within thirty (30) calendar days of an individual's original appointment or placement in
that position, or if the individual is serving as an incumbent, within thirty (30) calendar days of the commencement of this
contract. The Providers' employees and subcontractors must make the same disclosures described above to the Providers'
Board of Directors. Compliance with this provision will be monitored.
33. Public Entity Crime
Pursuant to s. 287.133, F.S., a person or affiliate who has been placed on the convicted vendor list following a conviction for
a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity;
may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building
or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded
or perform work as a Provider, 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 s. 287.017, F.S., for Category Two for
a period of 36 months following the date of being placed on the convicted vendor list. If the Provider or any of its officers
or directors is convicted of a public entity crime during the period of this agreement, the Provider shall notify the Alliance
immediately. Non-compliance with this statute shall constitute a breach of this agreement.
34. Purchasing:
34.1 The Provider shall procure products and/or services required to perform this contract in accordance with section
413.036, F.S.
34.1.1 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
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Contract Number KL 2506
CONCERNED.
34.1.2 Pursuant to sections 413.036(1) and (4), F.S., the Provider 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 Provider
is required by law to procure the product or service from any agency of the state, or (c) the Provider determines
that the performance specifications, price, or quality of the product or service is not comparable to the Provide's
requirements.
34.1.3 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 alliance or the Department in accordance
with its rules.
34.1.4 Additional information about the designated nonprofit agency and the products it offers is available at
http://www.respectofflorida.org.
34.2 The Provider 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.
34.3 The Provider shall procure products and/or services required to perform this contract in accordance with section
946.515, F.S.
34.3.1 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.
34.3.2 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.
34.4 The Provider 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 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 (ATTACHMENT F).
35. Patents, Copyrights, Royalties
35.1 If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed,
produced or for which ownership was purchased in the course of or as a result of work or services performed under
this contract the Provider shall refer the discovery, invention or material to the Alliance to be referred to the
Department. 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 s. 287.0571 (5)(k), as amended, the only exceptions to this
provision shall be those that are clearly expressed and reasonably valued in this contract.
35.2 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.
35.3 If this contract is awarded solely federal funding, the terms and conditions are govemed by 2 CFR Part 200.315.
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Contract Number KL 2506
36. Emer2ency Preparedness and Continuity of Operations
The Provider shall, within thirty (30) calendar days of the execution of this contract, submit to the Alliance Contract Manager
verification of an emergency preparedness plan. In the event of an emergency, the Provider shall notify the Alliance of
emergency provisions.
In the event a situation results in a cessation of services by a subcontractor, the Provider shall retain responsibility for
performance under this contract and must follow procedures to ensure continuity of operations without interruption.
37. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
https://www.dms.myflorida.com/content/download/2933/11777/PUR 1000 General Contract Conditions.pdf
In the event of any conflict between the PUR 1000 Form and any terms or conditions of any contract or agreement terms or
conditions the contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in
the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions contained in the PUR 1000
Form shall take precedence.
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 Provider or political
subdivision granting to the state a security interest in the property at least to the amount of state funds provided for at least 5
years from the date of purchase or the completion of the improvements or as further required by law.
39. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager, who shall reduce the decision
to writing and serve a copy on the Provider.
40. Financial Consequences
If the Provider 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 agreement 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 will be Miami -Dade 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 Alliance or the Provider unless expressly contained herein or by a written amendment to this
contract signed by both Parties.
44. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control, provided
the party experiencing the force majeure condition provides immediate written notification to the other party and takes all
reasonable efforts to cure the condition.
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 Alliance's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature to the Department and a corresponding allocation under contract from the Department to the
Alliance.
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Contract Number KL 2506
47. Addition/Deletion
The Parties agree that the Alliance reserves the right to add or to delete any of the services required under this contract when
deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties
shall negotiate compensation for any additional services added.
48. Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract will not constitute or be deemed
a waiver of the Alliance's right thereafter to enforce those rights, nor will any single or partial exercise of any such right
preclude any other or further exercise thereof or the exercise of any other right.
49. Compliance
The Provider shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable current
state statutes, laws, rules and regulations, policies of the Department, and the terms of this Contract. The Parties agree that
failure of the Provider to abide by these laws, rules, regulations, policies, and terms of this Contract shall be deemed an event
of default of the Provider and subject the Provider to disciplinary action including corrective action, unannounced special
monitoring, temporary assumption of the operation of one or more contractual services, placement of the Provider on
probationary status, imposing a moratorium on Provider action, imposing financial penalties for nonperformance or
noncompliance, or other administrative action to immediate, unilateral cancellation at the discretion of the Alliance.
If the Alliance finds that the Provider fails to abide by all applicable current federal and state statutes, laws, rules and
regulations, as well as conditions of this Contract, the Alliance shall provide the Provider a Notice of Violation which shall
include a concise statement of the specific violations of the Provider and the facts relied upon to establish the violation.
Upon receipt of the Notice of Violation, the Provider shall have twenty-one (21) days to respond to the Notice of Violation.
The Provider's response must include a statement of any disputed issues of material fact and a concise statement of the
specific facts the Provider contends warrant reversal or deviation from the Alliance's proposed action, including an
explanation of how the alleged facts relate to the specific rules, statutes, or contractual term.
Failure of the Provider to respond to the Notice of Violation within twenty-one (21) days shall be deemed a waiver of the
rights outlined above and the Alliance will proceed against the Provider by default.
The Alliance, upon receiving a timely filed response to a Notice of Violation, will forward the response and all accompanying
documentation to the Contract Manager to review and consider. The Contract Manager shall, within 30 days after the receipt
of the Provider's response, file an order which lays out the final determination of disciplinary action by the Alliance.
50. Final Invoice
The Provider shall submit the final invoice for payment to the Alliance as specified in this contract. If the Provider fails to
submit final request for payment as specified in this contract, then all rights to payment may be forfeited and the Alliance
may not honor any requests submitted. Any payment due under the terms of this contract may be withheld until all reports
due from the Provider and necessary adjustments thereto have been approved by the Alliance.
51. Modifications
Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly signed by
both parties.
52. Suspension of Work:
The Alliance may in its sole discretion suspend any or all activities under this contract when in the Department of Elder
Affairs and/or the Alliance determines that it is in the best interests of State to do so. The Alliance shall provide the Provider
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
Provider shall comply with the notice and shall not accept any purchase orders. Within ninety days, or any longer period
agreed to by the Provider, the Alliance shall either (1) issue a notice authorizing resumption of work, at which time activity
shall resume, or (2) terminate the Contract or purchase order. Suspension of work shall not entitle the Provider to any
additional compensation.
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Contract Number KL 2506
53. Termination
53.1 Termination for Convenience. This contract may be terminated by either party without cause upon no less than thirty
(30) calendar days' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said
notice shall be delivered by U.S. Postal Service with verification of delivery or any expedited delivery service that
provides verification of delivery or by hand delivery to the Contract Manager or the representative of the Provider
responsible for administration of the contract. The Provider shall not furnish any product after it receives the notice
of termination, except as necessary to complete the continued portion of the contract, if any. The Provider shall not be
entitled to recover any cancellation charges or lost profits. See notes on email regarding this paragraph.
53.2 Termination for Cause. The Alliance may terminate this Contract if the Provider fails to (I) deliver the product within
the time specified in the contract or any extension, (2) maintain adequate progress, thus endangering performance of
the contract, (3) honor any term of the, (4) abide by any statutory requirement, regulatory requirement, licensing
requirement, or Department policy or (5) in the event funds for payment become unavailable for this Contract. The
Alliance will be the final authority as to the availability and adequacy of funds. In the event of termination of this
contract, the Provider will be compensated for any work satisfactorily completed prior to the date of termination. The
Provider shall continue work on any work not terminated. Except for defaults of subcontractors at any tier, the Provider
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 Provider. 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 Provider and the
subcontractor, and without the fault or negligence of either, the Provider shall not be liable for any excess costs for
failure to perform, unless the subcontracted products or services were obtainable from other sources in sufficient time
for the Provider to meet the required delivery schedule. If, after termination, it is determined that the Provider was not
in default, or that the default was excusable, the rights and obligations of the Parties shall be the same as if the
termination had been issued for the convenience of the Alliance. The rights and remedies of the Alliance in this clause
are in addition to any other rights and remedies provided by law or under the Contract.
53.3 Upon expiration or termination of this Contract, the Provider and subcontractors shall transfer all public records in its
possession to the Alliance and destroy any duplicate public records that are exempt or confidential and exempt from
public records, disclosure requirements at no cost to the Alliance. All electronically stored records shall be provided
to the Alliance in a format that is compatible with the Alliance's information technology system(s).
54. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the Provider, subject to the
assignment provisions above.
55. Electronic Records and Signature
55.1 The Alliance authorizes, but does not require, the Provider to create and retain electronic records and to use electronic
signatures to conduct transactions necessary to carry out the terms of this Contract. A Provider that creates and retains
electronic records and uses electronic signatures to conduct transactions shall comply with the requirements contained
in the Uniform Electronic Transaction Act, s. 668.50, Fla. Stat. All electronic records must be fully auditable; are
subject to Florida's Public Records Law, Ch. 119, and Fla. Stat.; must comply with Section 29, Data Integrity and
Safeguarding Information; must maintain all confidentiality, as applicable; and must be retained and maintained by
the Provider to the same extent as non -electronic records are retained and maintained as required by this Contract.
55.2 The Alliance's authorization pursuant to this section does not authorize electronic transactions between the Provider
and the Alliance. The Provider is authorized to conduct electronic transactions with the Alliance only upon further
written consent by the Alliance.
55.3 Upon request by the Alliance, the Provider shall provide the Alliance with non -electronic (paper) copies of records.
Non -electronic (paper) copies provided to the Alliance of any document that was originally in electronic form with an
electronic signature must indicate the person and the person's capacity who electronically signed the document on any
non -electronic copy of the document.
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Contract Number KL 2506
56. Special Provisions
The Provider agrees to the following provisions:
56.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Provider or any subcontractors and referred to a governmental
or investigatory agency must be sent to the Alliance. If the Provider 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 Provider shall notify the contract manager A copy of all documents, reports, notes, or other written
material concerning the investigation, whether in the possession of the Provider or Subcontractors, must be sent to the
Alliance's contract manager with a summary of the investigation and allegations.
56.2 Volunteers:
The Provider 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 Provider shall work in coordination with
organizations that have experience in providing training, placement, and stipends for volunteers or participants (such
as organizations carrying out federal service programs administered by the Corporation for National and Community
Service), in community service settings.
56.3 Enforcement:
The Provider agrees to the following provisions:
56.3.1 The Alliance may, without taking any intermediate measures available to it against the Provider, rescind the
contract, if the Alliance finds that:
56.3.2 An intentional or negligent act of the Provider has materially affected the health, welfare, or safety of clients
served pursuant to this contract, or substantially and negatively affected the operation of services covered
under this contract;
56.3.3 The Provider lacks financial stability sufficient to meet contractual obligations or that contractual funds have
been misappropriated;
56.3.4 The Provider has committed multiple or repeated violations of legal and regulatory standards, regardless of
whether such laws or regulations are enforced by the Alliance, or the Provider has committed or repeated
violations of the Alliance or the Department standards;
56.3.5 The Provider has failed to continue the provision or expansion of services after the declaration of a state of
emergency; and/or
56.3.6 The Provider has failed to adhere to the terms of this contract.
56.3.7 In the alternative, the Alliance may, at its sole discretion, take immediate measures against the Provider,
including: corrective action, unannounced special monitoring, temporary assumption of the operation of one
or more contractual services, placement of the Provider on probationary status, imposing a moratorium on
Provider action, imposing financial penalties for nonperformance, or other administrative action.
56.4 In making any determination under this provision the Alliance may rely upon the findings of another state or federal
agency, or other regulatory body. Any claims for damages for breach of this contract are exempt from administrative
proceedings and shall be brought before the appropriate entity in the venue of Miami -Dade County.
56.5 Use of Service Dollars:
The Provider will optimize the use of contract funds by serving the maximum possible number of individuals with the
services allowed by this contract. The Provider will spend all funds provided by this contract to provide such services.
56.6 Surplus/Deficit Report:
The Provider will submit a consolidated surplus/deficit report in a format provided by the Alliance to the Alliance's
Contract Manager in conjunction with the required monthly billing submission. This report is for this contract between
the Provider and the Alliance. The report will include the following:
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56.6.1 The Provider's detailed plan on how the surplus or deficit spending exceeding the 1% threshold will be resolved;
56.6.2 Number of clients currently on the APCL, that receive a priority ranking score of four (4) or five (5);
56.6.3 Number of clients currently on the APCL designated as Imminent Risk.
56.6.4 Number of clients served and Aging and Disability Resource Center ("ADRC") client contacts,
In accordance with its surplus/deficit management policies, in order to maximize available funding and minimize the
time that potential clients must wait for services, the Alliance in its sole discretion can reduce funding awards if the
Provider is not spending according to monthly plans and is projected to incur a surplus at the end of the year.
56.7 Training:
The Provider will attend all required trainings and meetings schedule by the Alliance.
57. Contract Manager
The Alliance may substitute any Alliance employee to serve as the Contract Manager.
58. Official Payee and Representatives:
The name, address, and telephone number of the representative for the Alliance for this contract is:
Max B. Rothman, JD, LL.M. President and CEO
760 NW 107th Ave, Suite 214
Miami, Florida 33172
(305) 670-6500, Ext. 224
The name, address, and telephone number of the representative of the Provider responsible for administration of the program
under this contract is:
a.
The Provider name, as shown on page 1 of this contract,
and mailing address of the official payee to whom the
Provider info
payment shall be made is:
b.
The name of the contact person and street address
where financial and administrative records are
maintained is:
Provider info
c.
The name, address, and telephone number of the
representative of the Provider responsible for
administration of the program under this contract is:
Provider info
d
The section and location within the AAA where
Requests for Payment and Receipt and Expenditure
forms are to be mailed is:
Vice President for Finance
Alliance for Aging, Inc.
760 NW 107th Avenue, Suite214
Miami, Florida 33172-3155
e.The
name, address, and telephone number of the
Contract Manager for the AAA for this contract is:
Contract Monitor
Alliance for Aging, Inc.
760 NW 107th Avenue, Suite 214
Miami, Florida 33172-3155
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Contract Number KL 2506
In the event different representatives are designated by either party after execution of this contract, notice of the name and
address of the new representative will be rendered in writing to the other party and said notification attached to originals of
this contract.
59. All Terms and Conditions Included:
This contract and its Attachments and any exhibits referenced in said attachments, together with any documents incorporated
by reference, contain all the terms and conditions agreed upon by the Parties. There are no provisions, terms, conditions, or
obligations other than those contained herein, and this contract shall supersede all previous communications, representations
or agreements, either written or verbal between the Parties.
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused contract, to be executed by their undersigned officials as duly
authorized.
Provider: Provider name ALLIANCE FOR AGING, INC.
SIGNED BY:
NAME:
TITLE:
SIGNED BY:
NAME: MAX B. ROTHMAN, JD, LL.M.
TITLE: PRESIDENT AND CEO
DATE: DATE:
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Contract Number KL 2506
INDEX TO ATTACHMENTS
Attachment I
Attachment II
1
STATEMENT OF WORK
CERTIFICATIONS AND ASSURANCES
Attachment III
FINANCIAL AND COMPLIANCE AUDIT
Attachment VI
ASSURANCES — NON -CONSTRUCTION PROGRAMS
Attachment VII
Attachment VIII
_
BUDGET SUMMARY
INVOICE REPORT SCHEDULE
Attachment IX
REQUEST FOR PAYMENT FORM
Attachment X
Attachment A
RECEIPT AND EXPENDITURE REPORT
DOEA HANDBOOK
Attachment B
CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C
BUSINESS ASSOCIATES AGREEMNT
Attachment D
BACKGROUND SCREENING AFFADAVIT OF COMPLIANCE
Attachment F
CERTIFIED MONORITY BUSINESS SUBCONTRACTOR EXPENSDITURES (CMBE FORM)
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Contract Number KL 2506
ATTACHMENT I
LOCAL SERVICES PROGRAM
STATEMENT OF WORK
SECTION I. SERVICES TO BE PROVIDED
A. DEFINITIONS OF TERMS AND ACRONYMS
1. CONTRACT ACRONYMS
ADLs — Activities of Daily Living
AAA — Area Agency on Aging
APCL -Access Priority Consumer List
CAP - Corrective Action Plan
CFR — Code of Federal Regulations
CIRTS - Client Information and Registration Tracking System
DOEA or Department — Florida Department of Elder Affairs
F.A.C. — Florida Administrative Code
F.S. - Florida Statutes
IADLs — Instrumental Activities of Daily Living
LSP - Local Services Program
NOI - Notice of Instruction
PSA - Planning and Service Area
SOPS - Summary of Programs and Services
U.S.C. — United States Code
2. PROGRAM SPECIFIC TERMS
Department of Elder Affairs Programs and Services Handbook (DOEA Handbook): An official document of DOEA.
The 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 Notice of Instruction.
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement.
Notice of Instruction (NOI): The Department's established method to communicate to the Provider the requirement to
perform specific tasks or activities in a particular manner. NOIs are located on the Department's website at
http://elderaffairs. state.fl.us/doe a/nois.php.
Proviso: Language used in a general appropriations bill to qualify or restrict the way in which a specific appropriation
is to be expended.
Program Highlights: Success stories, quotes, testimonials, or human -interest vignettes that are used in the Department's
SOPS, to include information that helps tell the story of 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 Statement
The LSP provides long-term care alternatives enabling elders to maintain an acceptable quality of life in their own homes
and to avoid or delay nursing home placement.
2. Local Services Program (LSP)
The LSP provides community -based services to preserve elders' independence, support caregivers, and target at -risk
persons. Through the provision of meals, transportation, caregiver support, in -home services, expanded respite, adult
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Contract Number KL 2506
day care, or other services authorized by proviso, the LSP assists elders to live in the least restrictive environment that
meets their needs.
3. Authority
The relevant authorities goveming the LSP are:
a. Rule 58C-1, Florida Administrative Code;
b. Sections 430.201 through 430.207, F.S.; and
c. The Catalog of State Financial Assistance (CSFA) Number 65.010
4. Scope of Service
The Provider is responsible for the programmatic, fiscal and operational management of the legislatively funded
project(s). The services shall be provided in a manner consistent with the current DOEA Programs and Services
Handbook and all subsequent amendments and revisions to the Handbook, which are hereby incorporated by reference.
The Provider is responsible for adherence to the4 Area Plan and any amendments to the Area Plan.
5. Major Program Goals
The major goals of the LSP are to ensure that:
a. LSP services are provided to individuals who need long-term care alternatives to maintain an acceptable quality of
life in their own home; and
b. Nursing home placement is delayed or avoided because of the services provided in this program.
C. CLIENTS TO BE SERVED
1. General Description
The LSP provides long-term care alternatives which assist elders in delaying or avoiding nursing home placement.
2. Client Eligibility
Clients eligible to receive services under this contract must:
a. Be sixty (60) years of age or older, unless otherwise specified in the proviso authorizing the service; and
b. Not be enrolled in any Medicaid capitated long-term care program, except consumers in need of Legal Assistance
services and Congregate Nutrition Services, including transportation to and from congregate meal sites, provided
through providers following Older Americans Act (OAA) program guidelines.
3. Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk of
placement in an institution or as otherwise specified in the authorizing proviso.
4. Client Determination
The Department shall have final authority for the determination of client eligibility.
SECTION II. MANNER OF SERVICE PROVISION
A. Service Tasks
To achieve the goals of the LSP, the Provider shall perform, or ensure that its subcontractors perform, the following tasks:
1. Client Eligibility Determination
The Provider 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.
2. Assessment and Prioritization of Service Delivery for New Clients
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Contract Number KL 2506
The Provider shall ensure use of the following criteria to prioritize new clients for service delivery. It is not the intent of
the Department to remove existing clients from services to serve new clients 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 home placement
is likely within one (1) month or very likely within three (3) months.
b. Regardless of referral source, individuals determined through the Department's functional assessment to be at the
higher levels of frailty and risk of nursing home placement shall be given first priority.
3. Program Services
The Provider shall ensure the provision of program services is consistent with the Provider's current Area Plan, as
updated and approved by the Department, and the current DOEA Handbook.
B. Staffmg Requirements
1. Staffmg Levels
The Provider shall dedicate its own staff as necessary to meet the obligations of this contract and ensure that
subcontractors dedicate adequate staff accordingly.
2. Professional Qualifications
The Provider shall ensure that the staff responsible for performing any duties or functions within this contract has the
qualifications as specified in the DOEA Handbook.
3. Service Times
The Provider shall ensure the availability of services listed in this contract at times appropriate to meet client service
needs, at a minimum during normal business hours. Normal business hours are defined as Monday through Friday,
8:00a.m. to 5:00p.m. local time.
4. Use of Subcontractors
If this contract involves the use of a Subcontractor or third party, then the Provider 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 60 days or
more the initiation of the subcontract or the performance of the Subcontractor, the Provider shall notify the Alliance's
Contract Manager in writing of such delay. The Provider shall not permit a Subcontractor to perform services related to
this agreement without having a binding Subcontractor agreement executed. In accordance with Section 23 of this
Contract, the Alliance will not be responsible or liable for any obligations or claims resulting from such action.
a. Copies of Subcontracts:
The Provider shall submit a copy of all subcontracts to the Alliance Contract Manager within thirty (30) days of the
subcontract being executed.
b. Monitoring the Performance of Subcontractors:
The Provider shall programmatically monitor, at least once per year, each of its Subcontractors, Subrecipients,
Vendors, and/or Consultants. The Provider shall perform programmatic monitoring to ensure contractual
compliance, and programmatic performance and compliance with applicable state and federal laws and regulations.
The Provider shall monitor to ensure that time schedules are met; the budget and scope of work are accomplished
within the specified time periods, and other performance goals. The Provider shall also perform fiscal and
administrative monitoring for all subcontractors to ensure fiscal accountability.
c. Copies of Subcontractor Monitoring Reports
The Provider shall ensure the provision of program services is consistent with the Provider's current Area Plan, as
updated and approved by the Department, and the current DOEA Handbook.
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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Contract Number KL 2506
1. Delivery of Service to Eligible Clients:
The Provider shall ensure the provision of services to address the diverse needs of functionally impaired elders. The
Provider shall not provide direct services to clients, unless specifically authorized in proviso. The Provider shall ensure
performance and reporting of the following services per the current DOEA Handbook, and Section II.A.1-3 of this
contract. 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 service unit with calculations that equal the total invoice
amount. The services include the following:
Adult Day Care
Congregate Meals (Screening)
Counseling (Mental Health/Screening)
Home Delivered Meals
Nutrition Counseling
Other
Recreation
Respite (In -Home)
Telephone Reassurance
Congregate Meals
Counseling (Gerontological)
Health Promotion
Homemaker
Nutrition Education
Personal Care
Respite (Facility Based)
Screening/Assessment
Transportation
2. Service Units
The Provider 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 VII lists the services that can be
performed, budget allocation for each service, the number of units of service, and the reimbursement unit rate. Units of
service will be paid pursuant to the rate established in Attachment VII.
3. Administrative Responsibilities
The Provider shall provide management and oversight of LSP Program operations in accordance with the current DOEA
Handbook which include the following:
a. Establish contractual agreements with appropriate and capable subcontractor and vendor agreements, when
applicable.
b. Provide technical assistance to subcontractors and vendors to ensure provision of quality services.
c. Monitor and evaluate subcontractors and vendors for appropriate programmatic and fiscal compliance.
d. Appropriately submit payments to subcontractors.
e. Establish procedures for handling recipient complaints and ensure 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 worker complaints, or any other advice related to
complaints other than termination, suspension or reduction in services that require the grievance process as
described in Appendix D, Department of Elder Affairs Programs and Services Handbook. The complaint procedures
shall include notification to all clients of the complaint procedure and include tracking the date, nature of complaint,
and the determination of each complaint.
f. Ensure compliance with Client Information and Registration Tracking System (eCIRTS) regulations.
g. Monitor outcome measures in accordance with targets set by the Department.
h. Conduct client satisfaction surveys to evaluate and improve service delivery.
D. Reports
The Provider shall respond within five (5) business days to the Alliance's request for routine and/or special requests for
information and ad hoc reports. The Provider must establish due dates for any subcontractors that permit the Provider to meet
the Alliance's reporting requirements.
1. Service Cost Report (SCR):
The Provider shall submit a SCR to the Alliance annually and no later than ninety (90) calendar days after the Provider
Fiscal Year end. The SCR shall reflect the actual costs of providing each service by program for the preceding
contract year. If the Provider desires to renegotiate its reimbursement rates, the Provider shall make a request in
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Contract Number KL 2506
writing to the Alliance with the submission of a Unit Cost Methodology (UCM) and in accordance with the Alliance's
approved Reimbursement Rate Review Policy, which is incorporated by reference.
2. eCIRTS Reports:
The Provider shall ensure timely input of LSP specific data into eCIRTS. The Provider must run monthly eCIRTS reports
to validate the client and service data in eCIRTS is accurate prior to submitting a request for payment invoice. To ensure
eCIRTS data accuracy, the Provider shall adhere to the Alliance's eCIRTS Data Integrity Policy and use eCIRTS-
generated reports which include the following:
a. Client Reports;
b. Monitoring Reports;
c. Service Reports;
d. Miscellaneous Reports;
e. Fiscal Reports; and
f. Outcome Measures Reports.
3. Surplus/Deficit Report:
The Provider will submit a consolidated surplus/deficit report in a format provided by the Alliance to the Alliance's
Contract Manager in conjunction with the required monthly billing submission. The report will include the following:
a. Actual contracted funding utilized each month and YTD
b. Number of active clients compared to the average number of clients funded in the contract
c. Monthly and YTD number of unduplicated clients served
d. Detailed plan on how any projected surplus (or deficit) spending exceeding the Surplus allowance threshold in the
Alliance Policies, incorporated here by referernce,lwill be resolved.
In accordance with Alliance surplus/deficit management policies, in order to maximize available funding and minimize
the time that potential clients must wait for services, the Alliance in its sole discretion can reduce funding awards if the
Provider is not within the Alliance policy surplus allowance.
5. Program Highlights
The Provider shall submit Program Highlights referencing specific events that occurred in the previous fiscal year by
September 15th of the current contract year. The Provider shall provide a new success story, quote, testimonial, or
human -interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms.
For all agencies or organizations that are referenced in the highlight, the Provider shall provide a brief description of
their mission or role. The active tense shall be consistently used in the highlight narrative, in order to identify the specific
individual or entity that performed the activity described in the highlight. The Provider shall review and edit Program
Highlights for clarity, readability, relevance, specificity, human interest, and grammar, prior to submitting them to the
Alliance.
E. Records and Documentation
1. Requests for Payment
The Provider shall maintain documentation to support Requests for Payment that shall be available to the
Alliance, the Department, or other authorized agencies and individuals such as the Florida Department of
Financial Services (DFS), upon request.
2. eCIRTS Data and Maintenance:
The Provider shall ensure, on a monthly basis, collection and maintenance of client and service information in
eCIRTS or any such system designated by the Alliance. Maintenance includes accurate and current data, and valid
exports and backups of all data and systems according to the Alliance and Department standards.
3. Data Integrity and Backup Procedures:
The Provider shall anticipate and prepare for the loss of information processing capabilities. The routine backing
up of all data and software is required to recover from losses or outages of the computer system. Data and
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Contract Number KL 2506
software essential to the continued operation of Provider functions must be backed up. The security controls over
the backup resources shall be as stringent as the protection required of the primary resources. It is recommended
that a copy of the backed up data be stored in a secure, offsite location.
4. Policies and Procedures for Records and Documentation:
The Provider shall maintain written policies and procedures for computer system backup and recovery and shall
have the same requirement of its Subcontractors. These policies and procedures shall be made available to the
Alliance upon request.
5. Policies and Procedures for Records and Documentation:
The Provider shall maintain written policies and procedures for computer system backup and recovery and shall
have the same requirement of its subcontractors. These policies and procedures shall be made available to the
Alliance upon request.
F. Performance Specifications
1. Outcomes
a. Ensure the provision of the services described in this contract are in accordance with the current DOEA
Handbook and Section II.A. and Section II.D. of this contract;
b. The Provider shall timely submit to the Alliance all reports described in Section. II.D of this contract;
b. The Provider shall maintain all information described in Section II.E. of this contract;
d. The Provider shall ensure the prioritization and service provision of clients in accordance with Section II.A.2 of this
contract;
e. The Provider shall timely and accurately submit to the Alliance Attachments IX, X and supporting documentation
in accordance with Attachment VIII of this contract.
2. Criteria
The performance of the Provider in providing the services described in this contract shall be measured by the current
SPA strategies for the following criteria:
a. Percent of APS referrals who are in need of immediate services to prevent further harm who are served within 72
hours;
b. Percent of elders assessed with high or moderate risk environments who improved their environment score;
c. Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
d. Percent of new service recipients whose ADL assessment score has been maintained or improved;
e. Percent of new service recipients whose IADL assessment score has been maintained or improved;
f. Percent of family and family -assisted caregivers who self -report they are likely to provide care;
g. Percent of caregivers whose ability to provide care is maintained or improved after one year of service intervention
(as determined by the caregiver and the assessor);
h. Percent of most frail elders who remain at home or in the community instead of going into a nursing home;
i. Percentage of active clients eating two or more meals per day;
j. After service intervention, the percentage of caregivers who self -report being very confident about their ability to
continue to provide care.
3. The Provider's performance of the measures in F.2. above will be reviewed and documented in the Alliance's Annual
Programmatic Monitoring Report.
4. Monitoring and Evaluation
The Alliance will review and evaluate the performance of the Provider under the terms of this contract. Monitoring shall
be conducted through direct contact with the Provider through telephone, in writing, and/or on -site visit(s). The
Alliance's determination of acceptable performance shall be conclusive. The Provider agrees to cooperate with the
Alliance in monitoring the progress of completion of the service tasks and deliverables. The Alliance may use, but is
not limited to, one or more of the following methods for monitoring:
a. Desk reviews and analytical reviews;
b. Scheduled, unscheduled, and follow-up on -site visits;
c. Client visits;
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Contract Number KL 2506
d. Review of independent auditor's reports;
e. Review of third -party documents and/or evaluation;
f. Review of progress reports;
g. Review of customer satisfaction surveys;
h. Agreed -upon procedures review by an external auditor or consultant;
i. Limited -scope reviews; and
j. Other procedures as deemed necessary.
G. Provider Responsibilities
1. Provider Accountability:
All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility of the Provider,
and for which, by execution of the contract, the Provider agrees to be held accountable.
2. Coordination with Other Providers and/or Entities:
Notwithstanding that services for which the Provider is held accountable involve coordination with other entities in
performing the requirements of the contract, the failure of other entities does not alleviate the Provider from any
accountability for tasks or services that the Provider is obligated to perform pursuant to this contract.
H. Alliance Responsibilities
1. Alliance Obligations:
The Alliance may provide technical support and assistance to the Provider within the resources of the Alliance to assist
the provider in meeting the required tasks in the above Section II.
2. Alliance Determinations:
The Alliance reserves the exclusive right to make certain determinations in the tasks and approaches. The absence of the
Alliance 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 Provider performance. The Alliance will pay the Provider upon satisfactory completion
of the Tasks/Deliverables, as specified in Section II and in accordance with other terms and conditions of the contract.
1. Fixed Fee/Unit Rate
Payment for Fixed Fee/Unit Rates shall not exceed amounts established in Attachment VII, per unit of service.
2. Cost Reimbursement
Payment may be authorized only for allowable expenditures, which are in accordance with the services specified in
Attachment VII. All Cost Reimbursement Requests for Payment must include the Receipt and Expenditure Report
beginning with the first month of the contract.
3. Advance Payments
Non-profit Providers may request a monthly advance for service costs for each of the first two months of the contract
period, based on anticipated cash needs. For the first month's advance request, the Provider shall provide to the Alliance
documentation justifying the need for an advance and describing how the funds will be distributed. If the Provider is
requesting two (2) months of advances, documentation must be provided reflecting the cash needs of the Provider within
the initial two (2) months and should be supported through a cash -flow analysis or other information appropriate to
demonstrate the Provider's financial need for the second month of advances. The Provider must also describe how the
funds will be distributed for the first and second month. If sufficient budget is available, and the Department's Contract
Manager, in his or her sole discretion, has determined that there is justified need for an advance, the Department will
issue approved advance payments after July 1st of the contract year.
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Contract Number KL 2506
All advance payments made to the Provider shall be reimbursed to the Alliance as follows: At least one —tenth of the
advance payment received shall be reported as an advance recoupment on each Request for Payment (Attachment XI),
starting with the invoice submission of the third month activities and billing, in accordance with the Invoice Report
Schedule (Attachment IX).
B. Method of Invoice Payment
Payment shall be made upon the Provider's presentation of an invoice subsequent to the acceptance and approval by the
Alliance of the deliverables shown on the invoice and payment has been received from DOEA. The form and substance of
each invoice submitted by the Provider shall be as follows:
1. Request payment on a monthly basis for the units of services established in this contract, provided in conformance with
the requirements as described in the DOEA Programs and Services Handbook, and at the rates established in Attachment
VII of the contract. 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 service unit with calculations that equal the total invoice
amount. Any change to the total contract amount requires a formal amendment.
2. The Provider shall consolidate all subcontractors' Requests for Payment and Expenditure Reports that support Requests
for Payment and shall submit to the Alliance using forms Request for Payment (Attachment IX), Receipt and Expenditure
Reports (Attachment X) for Case Management and Special Subsidy Services.
3. All Requests for Payment shall be based on the submission of monthly Expenditure Reports beginning with the first
month of the contract. The schedule for submission of advance requests and invoices is Invoice Schedule, Attachment
VIII;
4. In the event that services were not billed during the regular billing cycle, the Provider may request payment for services
no later than 90 days after the month in which the expense was incurred, except that requests cannot be made after the
contract closeout date. Request for payment of services rendered 90 days after the month in which the expense was
incurred will require approval of the contract manager prior to the billing of such incurred expenses. Late service billing
requests will not be paid unless justification is submitted and approved by the contract manager;
5. The Provider shall maintain documentation to support payment requests which shall be available to the Alliance, the
Department, and the Department of Financial Services, or other authorized state and federal personnel upon request; and
6. All payments under the terms of this contract are contingent upon an annual appropriation by the Legislature, and subject
to the availability of funds.
C. Payment Withholding
Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and approval by the
Alliance of all financial and programmatic reports due from the Provider and any adjustments thereto, including any
disallowance not resolved as outlined in this Contract.
D. Final Invoice Instructions
The Provider shall submit the final Request for Payment to the Alliance no later than 30 days after the contract period ends
and as referenced in Attachment VIII. If the contract is terminated prior to the end date of the contract, then the Provider must
submit the final request for payment to the Alliance no more than 30 days after the contract is terminated. If the provider fails
to do so, all right to payment is forfeited, and the Alliance will not honor any requests submitted after the aforesaid time
period.
E. eCIRTS Data Entries for Subcontractors
The Provider must require Subcontractors to enter all required data for clients and services in the eCIRTS database per the
DOEA Programs and Services Handbook and the eCIRTS User Manual - Aging Provider Network users (located in
Documents on the eCIRTS Enterprise Application Services). Subcontractors must enter this data into the eCIRTS prior to
submitting their requests for payment and expenditure reports to the Provider. The Provider shall establish deadlines for
completing eCIRTS data entry and to assure compliance with due dates for the requests for payment and expenditure reports
that Provider must submit to the Alliance.
F. Providers' Monthly eCIRTS Reports
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Contract Number KL 2506
The Provider must run monthly eCIRTS reports and verify client and service data in the eCIRTS is accurate. This report must
be submitted to the Alliance with the monthly request for payment and expenditure report and must be reviewed by the
Alliance before the Provider's request for payment and expenditure reports can be approved by the Alliance.
G. Consequences of Non -Compliance:
Should it be determined that the Provider is found to not be incompliance with any deliverables, aspects or requirements of
this contract, the Alliance may employ any or all of the following consequences:
1. Require a Corrective Action Plan (CAP)
a. If at any time the Provider is notified by the Alliance's Contract Manager that it has failed to correctly, completely,
and/or adequately perform contract deliverables identified in Section II.0 and III.D, or any other contractual
requirements of this contract, the Provider will have ten (10) business days to submit a CAP to the Alliance's Contract
Manager that addresses the deficiencies and states how the deficiencies will be remedied within the time approved
by the Alliance's Contract Manager. The Alliance may assess a Financial Consequence for Non -Compliance on the
Contractor as referenced in Section III.G.2. of this contract for each deficiency identified in the CAP which is not
corrected pursuant to the CAP. The Alliance may also assess a financial consequence for failure to timely submit a
CAP.
b. If the Provider fails to correct an identified deficiency within the approved time specified in the CAP, the Alliance
may deduct a financial consequence established in Section III.G.2. of this contract from the payment for the invoice
of the following month.
c. If the Provider fails to timely submit a CAP, the Alliance shall deduct the amount established in Section III.G.2 of
this contract. The deduction will be made from the payment for the invoice of the following month(s).
d. Failure to submit a CAP may result in contract termination.
2. Financial Consequences
a. Failure to submit a CAP timely may result in a financial penalty up to the lower of $25,000 or 5% of the Provider
Contract amount and may be calculated on the totality of all Alliance funded contracts, depending on the area of non-
compliance.
b. Failure to correct an identified deficiency may result in a financial penalty up to the lower of $25,000 or 5% of the
Provider Contract amount and may be calculated on the totality of all Alliance funded contracts related to the
deficiency, depending on the area of non-compliance.
c. Failure to comply with established assessment and prioritization criteria as per Section ILA and as evidenced by
eCIRTS reports may result in a fmancial penalty of the lower of $25,000 or 5% and may be calculated on the totality
of all related Alliance funded contracts, depending on the area of compliance. A second offense may result in a
financial consequence of the lower of $50,000 or 10% and may be calculated on the totality of related alliance funded
contracts.
d. Failure to provide services in accordance with the current DOEA Handbook, the service tasks described in Section
II.A., and the Budget summary (Attachment XII), and/or failure to submit required documentation may result in a
result in a financial penalty of the lower of $25,000 or 5% and may be calculated on the totality of all related Alliance
funded contracts, depending on the area of compliance. A second offense may result in a financial consequence of
the lower of $50,000 or 10% and may be calculated on the totality of related Alliance funded contracts.
e. Failure to perform management and oversight of the CCE Program operations may result in a financial consequence
of the lower of $50,000 or 10% and may be calculated on the totality of related Alliance funded contracts.
Failure to correct any concerns subsequent to a financial penalty may result in contact termination.
IV. SPECIAL PROVISIONS
A. Provider's Financial Obligations
1. Management and Use of Service Dollars and Continuity of Service:
a. The Provider is expected to spend all funds provided by the Alliance for the purpose specified in this contract. The
Provider must manage the service dollars in such a manner so as to avoid having a surplus of funds at the end of the
contract period.
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Contract Number KL 2506
b. The Provider shall ensure that contract services will be provided until the end of the contract period. In order to enable
the Provider to better manage the services under this contract and to maximize the use of available resources, the
Alliance has established a spending authority as identified in Budget Summary, Attachment VII. The Provider is
responsible for managing the spending authority so that a continuity of service can be maintained for the maximum
number of consumers. The Provider agrees to assume responsibility for any contractual deficit that may be incurred.
2. Budget Summary:
The Alliance has established a spending authority based on services and rate detailed in the Budget Summary, Attachment
VII and any revisions thereto approved by the Alliance. Any changes in the total amounts of the funds identified on the
Budget Summary require a contract amendment.
B. Remedies for Nonconforming Services
1. The Provider shall ensure that all goods and/or services provided under this contract are delivered timely, completely, and
commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible program
participants.
2. If the Provider 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 Provider's signature on the request for payment form certifies
maintenance of supporting documentation and acknowledgement that the Provider shall solely bear the costs associated
with preparing or providing nonconforming goods and/or services. The Alliance requires immediate notice of any significant
and/or systemic infractions that compromise the quality, security or continuity of services to clients.
3. The Alliance will pass through to the provider any financial consequences imposed by the Department on the Alliance
should the provider be at fault and/or cause for the imposed financial consequence. Any passthrough financial consequences
will be withheld by reduction of payment and will levy against the provider for the following:
a. Delivery of services to eligible clients as referenced in Attachment I, Section II of this contract — Failure to comply
with established assessment and prioritization criteria as evidenced by eCRITS reports.
b. Services and units of services as referenced in Attachment I, Section II of this contract — Failure to provider services in
accordance with the current DEOA Handbook
c. Administrative duties as referenced in Attachment I, Section II of this contract — Failure to perform management and
oversight of the program operations.
C. Investigation of Criminal Allegations
Any report that implies criminal intent on the part of the Provider or any Subcontractors and referred to a governmental or
investigatory agency must be sent to the Alliance which will in turn forward the information to the Department. If the Alliance
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 Alliance 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
Provider or Subcontractors, must be sent to the Alliance which will in turn send the material to the Department's Inspector
General with a summary of the investigation and allegations.
D. Volunteers
The Provider 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 Provider shall work in coordination with organizations that have
experience in providing training, placement, and stipends for volunteers or participants (such as organizations carrying out
federal service programs administered by the Corporation for National and Community Service), in community service settings.
E. Use of Service Dollars and Management of Assessed Priority Consumer List
The Provider is expected to spend all federal, state, and other funds provided by the Alliance for the purpose specified in the
contract. The Provider must manage the service dollars in such a manner so as to avoid having a surplus of funds at the end o f
the contract period, for each program managed by the Provider. The Provider understands and agrees to the reallocation of
funding as described in Attachment I, Section II.E.3. of this contract.
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Contract Number KL 2506
ATTACHMENT II
CERTIFICATIONS AND ASSURANCES
The Alliance will not award this contract unless Provider completes the CERTIFICATIONS AND ASSURANCES contained in this
Attachment. In performance of this contract, Provider provides the following certifications and assurances:
A. Debarment and Suspension Certification (29 CFR Part 95 and 2 CFR Part 200)
B. Certification Regarding Lobbying (29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes, section 287.133, F.S.
E. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance (Pub. L.
111-117)
F. Certification Regarding Scrutinized Companies Lists, section 287.135, F.S.
G. Certification Regarding Data Integrity Compliance for Agreements. Grants, Loans And Cooperative
Agreements
H. Verification of Employment Status Certification
I. Certification Regarding Inspection of Public Records
A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS -
PRIMARY COVERED TRANSACTION.
The undersigned Provider certifies to the best of its knowledge and belief, that it and its principals:
I. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered
transactions by a Federal department or agency;
2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them
for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or
receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph A.2. of this certification; and/or
4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,
State, or local) terminated for cause of default.
B. CERTIFICATION REGARDING LOBBYING - Certification for Contracts, Grants, Loans, and Cooperative
Agreements.
The undersigned Provider certifies, to the best of its knowledge and belief, that:
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Contract Number KL 2506
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing
or attempting to influence an officer or employee of Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant,
loan or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an officer or employees of Congress, or employee of a
Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also
complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers
(including subcontracts, sub -grants and contracts under grants, loans and cooperative agreements) and that all sub -recipients and
Providers 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, Provider assures that it will comply fully with the nondiscrimination and equal opportunity
provisions of the following laws:
1. Section 188 of the Workforce Investment Act of 1998 (WIA), (Pub. L. 105-220), which prohibits discrimination against all
individuals in the United States on the basis of race, color, religion, sex national origin, age, disability, political affiliation,
or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to
work in the United States or participation in any WIA Title I-fmancially 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 Alliance.
3. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 84), to the end that, in accordance with
Section 504 of that Act, and the Regulation, no otherwise qualified handicapped individual in the United States shall, solely
by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination
under any program or activity for which the Applicant receives Federal financial assistance from the Alliance.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act
and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from
participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal
financial assistance from the Alliance.
5. Title IX of the Educational Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant
to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the end that, in accordance with
Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the
Applicant receives Federal financial assistance from the Alliance.
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Contract Number KL 2506
6. The American with Disabilities Act of 1990 (Pub. L. 101-336), prohibits discrimination in all employment practices,
including, job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and
privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other
employment -related activities, and;
Provider also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above.
This assurance applies to Provider's operation of the WIA Title I- financially assisted program or activity, and to all
agreements Provider makes to carry out the WIA Title I- financially assisted program or activity. Provider understands that
the Alliance, Department, and the United States have the right to seek judicial enforcement of the assurance.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES, SECTION 287.133, F.S.
Provider hereby certifies that neither it, nor any person or affiliate of Provider, has been convicted of a Public Entity Crime as
defined in section 287.133, F.S., nor placed on the convicted vendor list.
Provider understands and agrees that it is required to inform DOEA immediately upon any change of circumstances regarding
this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE (Pub. L. 111-117).
As a condition of the Contract, Provider assures that it will comply fully with the federal funding restrictions pertaining to
ACORN and its subsidiaries per the Consolidated Appropriations Act, 20 I 0, 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.
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
Providers shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS CERTIFICATION, SECTION 287.135, F.S.
In accordance with s. 287.135, F.S., Provider hereby certifies that it is not participating in a boycott of Israel.
If this Contract is in the amount of $1 million or more, in accordance with the requirements of s. 287.135, F.S., Provider
hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or
Syria.
Provider understands that pursuant to s. 287.135, F.S., the submission of a false certification may result in the Alliance and/or
Department terminating this contract and the submission of a false certification may subject the Provider to civil penalties,
attorney's fees, and/or costs, including costs for investigations that led to the funding of false certification.
If Provider is unable to certify to any of the statements in this certification, Provider shall attach an explanation to this
Contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
1. The Provider and any Subcontractors of services under this contract have financial management systems capable of
providing certain information, including: (I) accurate, current, and complete disclosure of the financial results of each grant -
funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds
for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The
inability to process information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
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Contract Number KL 2506
2. Management Information Systems used by the Provider, Subcontractors, or any outside entity on which the Provider is
dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of
processing data accurately, including year -date dependent data. For those systems identified to be non -compliant, Providers
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
undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of
these products offered by the Provider (represented by the undersigned) and purchased by the state will be verified for
accuracy and integrity of data prior to transfer.
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 Provider agrees to immediately make required corrections to restore
hardware and software programs to the same level of functionality as warranted herein, at no charge to the state, and without
interruption to the ongoing business of the state, time being of the essence.
4. The Provider and any Subcontractors of services under this contract warrant their policies and procedures include a disaster
plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity
compliance issues.
H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Alliance, Provider certifies the use of the U.S. Department of Homeland Security's E-
verify system to verify the employment eligibility of all new employees hired by Provider during the contract term to perform
employment duties pursuant to this contract and that any subcontracts include an express requirement that Subcontractors
performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment
eligibility of all new employees hired by the Subcontractor during the entire contract term.
I. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
1. In addition to the requirements of section 9 of this Contract, and s. 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,
Provider 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 thereunder.
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.
The Provider shall require that the language of this certification be included in all sub agreements, subgrants, and other
agreements and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-
102 and 2 CFR Part 200 (formerly OMB Circular A-110).
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Contract Number KL 2506
By signing below, Provider certifies the representations outlined in parts A through I above are true and correct.
(Signature and Title of Authorized Representative)
Provider Date
(Street Address)
(City, State, Zip code)
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Contract Number KL 2506
ATTACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Alliance for Aging, Inc. to the Provider may be subject to audits and/or monitoring
by the Alliance or the Florida Department of Elder Affairs, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see
"AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the Department of Elder Affairs and
Alliance staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this
agreement, the Provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the
Alliance or the Department of Elder Affairs. In the event the Alliance for Aging, Inc. determines that a limited scope audit of the
Provider is appropriate, the Provider agrees to comply with any additional instructions provided by the Alliance for Aging, Inc. to
the Provider regarding such audit. The Provider 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 Provider is a State or local government or a non-profit organization as defined in OMB Circular A-133,
as revised.
In the event that the Provider expends $1,000,000 or more in federal awards during its fiscal year, the Provider must have a single
or program -specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. EXHIBIT 1 to this
agreement indicates federal resources awarded through the Department of Elder Affairs and the Alliance by this agreement. In
determining the federal awards expended in its fiscal year, the Provider shall consider all sources of federal awards, including federal
resources received from the Alliance or the Department of Elder Affairs. The determination of amounts of federal awards expended
should be in accordance with the guidelines established by OMB Circular A-133, as revised. An audit of the Provider conducted by
the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the Provider shall fulfill the requirements relative to
auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
If the Provider expends less than $1,000,000 in federal awards in its fiscal year, a single or program -specific audit conducted in
accordance with the provisions of OMB Circular A-133, as revised, is not required. In the event that the Provider expends less than
$1,000,000 in federal awards in its fiscal year and elects to have a single or program -specific audit conducted in accordance with the
provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from non-federal resources (i.e., the cost of such
audit must be paid from Provider resources obtained from other than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to agreements with the Alliance for Aging, Inc. shall be based on the agreement's requirements, including any rules,
regulations, or statutes referenced in the agreement. The financial statements shall disclose whether or not the matching requirement
was met for each applicable agreement. All questioned costs and liabilities due to the Alliance for Aging, Inc. shall be fully disclosed
in the audit report with reference to the Alliance for Aging, Inc. agreement involved. If not otherwise disclosed as required by
Section 310(b) (2) of OMB Circular A-133, as revised, the schedule of expenditures of federal awards shall identify expenditures by
agreement number for each agreement with the Alliance for Aging, Inc. in effect during the audit period. Financial reporting
packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after
the end of the Provider's fiscal year end.
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Contract Number KL 2506
PART II: STATE FUNDED
This part is applicable if the Provider is a non -state entity as defined by Section 215.97(2), Florida Statutes.
In the event that the Provider expends a total amount of state financial assistance equal to or in excess of $1,00,000 in any fiscal year
of such Provider (for fiscal years ending September 30, 2004 or thereafter), the Provider must have a State single or project -specific
audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the Department of Financial
Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor
General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance for Aging, Inc. by this
agreement. In determining the state financial assistance expended in its fiscal year, the Provider shall consider all sources of state
financial assistance, including state financial assistance received from the Alliance for Aging, Inc., other state agencies, and other
non -state entities. State financial assistance does not include federal direct or pass -through awards and resources received by a non -
state entity for federal program matching requirements.
In connection with the audit requirements addressed in Part II, paragraph 1; the Provider shall ensure that the audit complies with
the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by
Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit
organizations), Rules of the Auditor General.
If the Provider expends less than $1,000,000 in state financial assistance in its fiscal year (for fiscal years ending September 30, 2004
or thereafter), a single or project -specific audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is
not required. In the event that the Provider expends less than $1,000,000 in state financial assistance in its fiscal year and elects to
have a single or project -specific audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of
the audit must be paid from the non -state entity's resources (i.e., the cost of such an audit must be paid from the Provider resources
obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to agreements with the Alliance for Aging, Inc. shall be based on the agreement's requirements, including any
applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met
for each applicable agreement. All questioned costs and liabilities due to the Alliance for Aging, Inc. shall be fully disclosed in the
audit report with reference to the Alliance for Aging, Inc. agreement involved. If not otherwise disclosed as required by Rule 691-
5.003, Fla. Admin Code, the schedule of expenditures of state fmancial assistance shall identify expenditures by agreement number
for each agreement with the Alliance for Aging, Inc. in effect during the audit period. Financial reporting packages require d under
this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the Provider's fiscal
year end for local governmental entities. Non-profit or for -profit organizations are required to be submitted within 45 days after
delivery of the audit report, but no later than 9 months after the Provider's fiscal year end. Notwithstanding the applicability of this
portion, the Alliance and the Department of Elder Affairs retain all right and obligation to monitor and oversee the performance of
this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of
this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the
Provider directly to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107th Ave. Suite 214
Miami, FL. 33172-3155
The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by Sections .320 (d)
(1) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following address:
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Contract Number KL 2506
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
Other federal agencies and pass -through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as revised.
Pursuant to Sections .320(f), OMB Circular A-133, as revised, the Provider shall submit a copy of the reporting package described
in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the Alliance for Aging, Inc.
at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107th Ave. Suite 214
Miami, FL. 33172-31550
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of the
Provider directly to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NW 107th Ave. Suite 214
Miami, FL. 33172-3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Alliance for Aging, Inc. pursuant to this
agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes, and Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General, as applicable.
Providers, when submitting financial reporting packages to the Alliance for Aging, Inc. for audits done in accordance with OMB
Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the
Auditor General, should indicate the date that the reporting package was delivered to the Provider in correspondence accompanying
the reporting package.
PART IV: RECORD RETENTION
The Provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years
from the date the audit report is issued, and shall allow the Alliance for Aging, Inc. or its designee, the CFO or Auditor General
Access to such records upon request. The Provider shall ensure that audit working papers are made available to the Alliance for
Aging, Inc., or its designee, the Department or its designee, CFO, or Auditor General upon request for a period of six years from the
date the audit report is issued, unless extended in writing by the Alliance for Aging, Inc.
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Contract Number KL 2506
ATTACHMENT III
EXIIIBIT I
FINANCIAL, AND COMPLIANCE AUDIT ATTACHMENT
PART 1: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR Part 200, and/or s.
215.97, Fla. Stat. Providers 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 I is met or
as allowed in 2 CFR.200.425.c. Providers who have been determined to be vendors are not subject to the requirements of 2 CFR
Part §200.38, and/or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, Providers who have been
determined to be recipients or subrecipients 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 691-5.006, FAC, Provider has been determined to be:
Vendor not subject to 2 CFR Part §200.38 and/or s. 215.97, F.S.
X Recipient/subrecipient subject to 2 CFR Part §200.86 and §200.93 and/or s. 215.97, F.S. OR subject to 2CFR §200.425.c.
Exempt organization not subject to 2 CFR Part §200 and/or s. 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 Provider is determined to be a recipient/subrecipient of federal and or state financial assistance and has been
approved by the Alliance to subcontract, they must comply with s. 215.97(7), F.S., and Rule 69I-5.006, FAC [state financial
assistance] and 2 CFR Part §200.330 [federal awards].
PART II: FISCAL COMPLIANCE
REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal
awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a
subrecipient must comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part §200.416-§200.417 — Special Considerations for States, Local Governments and Indian Tribes
2 CFR Part §200.201- Administrative Requirements**
2 CFR Part §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:
2CFRPart §200.400-.411-Cost Principles*
2 CFR Part §200.100 -Administrative Requirements
2 CFR Part §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 Part §200.418- §200.419 Special Considerations for Institutions of Higher Education*
2 CFR Part §200.100- Administrative Requirements
2 CFR Part §200 Subpart F -Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
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Contract Nurnber KL 2506
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted inthe 2 CFR Part
§200.400(5) (c).
**For funding passed through U.S. Health and Human Services, 45 CFR P art 92; for funding passed through U.S.
Department of Education, 34 CFR 80.
STATE FINANCIAL ASSISTANCE. Provider s who receive state financial assistance and who are determined to be
a recipient/subrecipient must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 69I-5, Fla. Admin Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
THE REAMINDER OF THIS PAGE LEFT INTENTIONALLY BLANK
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Contract Number KL 2506
ATTACHMENT III
EXIIIBIT 2
FINANCIAL, AND COMPLIANCE AUDIT ATTACHMENT
FUNDING SUMMARY
Note: Title 2 CFR & 2 CFR Part 200, As Revised, and s. 215.97(5), Florida Statutes, Require That Information About Federal Programs
and State Projects Be Provided to the Recipient and Are Stated in the Financial and Compliance Audit Attachment and Exhibit 1.
Financial and Compliance Audit Attachment, Exhibit 2-Funding Summary Provides Information Regarding the Funding Sources
Applicable to This Contract, Contained Herein, Is APrediction of Funding Sources and Related Amounts Based on the Contract Budget.
1. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF
THE FOLLOWING:
MATCHING RESOUCES FOR FEDERAL PROGRAMS
PROGRAM TITLE
FUNDING
SOURCE
CFDA
AMOUNT
TOTAL STATE AWARD
STATE FINANCIAL ASSITANCE SUBJECT TO sec. 215.97, F.S.
PROGRAM TITLE
FUNDING
SOURCE
CFDA
AMOUNT
Local Service Program — Non -Recurring
General Revenue
65.009
$1,000,000.00
TOTAL AWARD
$1,000,000.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSI STANCE:
Section 215.97, F.S., Chapter 69I-5, FL Admin Code, State Projects Compliance supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations.
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Contract Number KL 2506
ATTACHMENT VI
ASSURANCES —NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the
collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-
0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact
the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including
funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and completion of the
project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any
authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and
will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. ❑ ❑4728-4763) relating to prescribed standards for
merit systems for programs funded under one of 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 Civil
Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. ❑ ❑ 1681-1683, and 1685-1686), which prohibits discrimination on the
basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. ❑ 794), which prohibits discrimination
on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. ❑ ❑ 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
(g) ❑ ❑ 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. ❑ ❑ 290 dd-3 and 290 see 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.
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
Page 40 of 58
Contract Number KL 2506
labor standards for federally assisted construction sub -agreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act
of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental
quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514;
(b) notification of violating facilities pursuant to EO 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 Act of 1972 (16 U.S.C. ❑ ❑ 1451 et seq.); (f) conformity
of federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended
(42 U.S.C. ❑ ❑ 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of
1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as
amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. ❑ ❑ 1721 et seq.) related to protecting components or
potential components 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 assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. ❑ ❑2131 et seq.) pertaining
to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this
award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. ❑ ❑4801 et seq.), which prohibits the use of lead -
based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments
of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non -Profit Organizations.
18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
APPLICANT ORGANIZATION
Provider name
DATE SUBMITTED
Page 41 of 58
Contract Number KL 2506
ATTACHMENT VII
LOCAL SERVICES PROGRAM
BUDGET SUMMARY
The Alliance shall make payment to the provider for provision of services up to a maximum number of units of service
and at the rate(s) stated below:
Services to be Provided
Service Unit
Rate
Maximum
Units of
Service
Maximum
Dollars
Congregate Meals
$ 6.46
119,365
$ 771,100.00
Emergency Congreate Meals
$ 6.46
464
$ 3,000.00
Congregate Meals Screening
$ 40.00
225
$ 9,000.00
Nutrition Counseling
$ 77.32
65
$ 5,000.00
Nutrition Education
$ 6.63
1,795
$ 11,900.00
Recreation
$ 66.58
3,004
$ 200,000.00
Total
$ 1,000,000.00
Page 42 of 58
Contract Number KL 2506
ATTACHMENT VIII
LOCAL SERVICES PROGRAM
INVOICE REPORT SCHEDULE
Report Number Based On Submit to Alliance on
this Date
1 July Advance* July 5
2 August Advance* July 5
3 July Expenditure Report August 5
4 August Expenditure Report September 5
5 September Expenditure Report + 1/10 advance reconciliation October 5
6 October Expenditure Report + 1/10 advance reconciliation November 5
7 November Expenditure Report + 1/10 advance reconciliation December 5
8 December Expenditure Report + 1/10 advance reconciliation January 5
9 January Expenditure Report + 1/10 advance reconciliation February 5
10 February Expenditure Report + 1/10 advance reconciliation March 5
11 March Expenditure Report + 1/10 advance reconciliation April 5
12 April Expenditure Report + 1/10 advance reconciliation May 5
13 May Expenditure Report + 1/10 advance reconciliation June 5
14 June Expenditure Report+ 1/10 advance reconciliation July 5
15 Final Expenditure and closeout July 31
Legend: * Advance based on projected cash need.
Note 1: All advance payments made to the Provider shall be returned to the Alliance as follows:
One -tenth of the advance payment received shall be reported as an advance recoupment on each
Request for Payment, starting with report #5. The adjustment shall be recorded in Part C, Line
1 of the report (Attachment IX).
Note 2: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Alliance, payment is to accompany the report.
Page 43 of 58
Contract Number KL 2506
ATTACHMENT IX
REQUEST FOR PAYMENT
Form 106
CCE
Provider Name,
Provider:
Address:
Telephone:
Address, Phone#
Type Of Report
Contract #:
Advance
Contract Period:
Reimbursement
Report Period
REPORT#:
CERTIFICATION:
Prepared
I hereby certify that this request or refund conforms with the terms of the above contract.
By: Date Approved By: Date:
BUDGET SUMMARY
CCE
TOTAL
Approved Contract Amount
► 0.00
► 0.00
Previous Month YTD Billed
r
0.00
r 0.00
Prior Month Ending Contract Balance
►
0.00
►
0.00
m
Current Month Amount Billed
► 0.00
►
0.00
Less Curretn Month Adv Payback
0.00
0.00
Contracted Funds Requested for Month
0.00
0.00
CO -PAYMENTS CURRENT MONTH CONTRACT YTD
1. Number of persons assessed Co -payments
2. Number of persons treminated for non-payment
-
3. Number of persons waived from termin. for non-payment
4. Number of persons waived from assessment
5. Number of persons exempt from co -pay
-
6. Total amount of co -pay assessed
$ -
7.Total Amount ofCo-pay collected
$ -
8.Total amouhntofco-pay expended
$ -
PSA#11 CCE Forms, Revised December 2020
Page 44 of 58
Prior Mo. YTD
Contract Number KL 2506
ATTACHMENT X
RECEIPTS & UNIT COST REPORT
Form 105
CCE
PROVIDER NAME ADDRESS PHONE#
FUNDING SOURCE
THIS REPORT PERIOD:
0
0
0
0
CCE
Contract #: 10
Contract Perioci0
Report Period 10
REPORT#: 10
CERTIFICATION: Icertifyto the best of my knowledge and belief that this eport is complete and correct and all outlays herein are for purposes set forth in
the contract. Further, I certifythat the attached monthly and YTD service units/unduplicated clients' report is correct
Prepared by: Date: Approved by: Date:
INCOME/RECEIPTS
State Funds
Program Income
Cash Match
SUBTOTAL: Cash Receipts
Local In -Kind match
TOTAL RECEIPTS
A. Approved Budget
B. Actual Total Billing
for this report
C. Total Billing
Year to Date
D. % of Approved
Budget
r #DIV/0!
c #DIV/0!
$ -
$ -
$ -
$ -
$ -
$ -
P$
$0.00
$ -
$0.00
$ -
$ -
' #DIV/0!
Billable Unit Cost Report
(A) (B) (C) (D) (E) (F) (G)
Services Contract Billable Unit Rate Amount Earned Y-T-D Y-T-D
Amount Units This Period Billable Billable
Units Cost
Unduplicated Clients Served
(A) (B)
Current Month Y-T-D
Undup Clients Undup Clients
Served Served
$ _
_
$
$ _
_
$
$ _
_
$
$ _
_
$
$ _
_
$
$ _
_
$
$ _
_
$
$ _
_
$
$ _
_
$
$ -
$
MATE
Cost Reimb
$ -
$ -
HOIM
Cost Reimb
$ -
$ -
SCSM
Cost Reimb
$ -
-
$ -
Total $ - $ - $ -
PSA #11 CCE Forms, Revised October 2019
Page 45 of 58
Prior Mo. Receipts YTD
Prior YID units
Prior YID $
Contract Number KL 2506
ATTACHMENT A
Title: Department of Elder Affairs Programs & Services Handbook
http://www.allianceforaging.org/providers/program-documents/2012-doea-programs-service s-handbook
Page 46 of 58
Contract Number KL 2506
ATTACHMENT B
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
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:
2. POPULATION OF AREA SERVED. Source of data:
Total #
% White
% Black
% Hispanic
% Other
% Female
3. STAFF CURRENTLY EMPLOYED. Effective date:
Total #
% White
% Black
% Hispanic
% Other
% Female
% Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total #
% White
% Black
% Hispanic
% Other
% Female
% Disabled
% Over 40
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total #
% White
% Black
% Hispanic
% Other
% Female
% Disabled
PART H: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? If N/A or NO, explain.
7. Compare the staff composition to the population. Is staff representative of the population?
If N/A or NO, explain.
N/A YES NO
N/A YES NO
8. Compare the client composition to the population. Are race and sex characteristics representative of the
population? If N/A or NO, explain. N/A YES NO
9. Are eligibility requirements for services applied to clients and applicants without regard to race, color,
national origin, sex, age, religion or disability? If N/A or NO, explain. N/A YES NO
10. Are all benefits, services and facilities available to applicants and participants in an equally effective
manner regardless of race, sex, color, age, national origin, religion or disability? If N/A or NO, explain. N/A YES NO
11. For in -patient services, are room assignments made without regard to race, color, national origin
or disability? If N/A or NO, explain. N/A YES NO
12. Is the program/facility accessible to non-English speaking clients? If N/A or NO, explain. N/A YES NO
❑ ❑ ❑
Page 47 of 58
Contract Number KL 2506
13. Are employees, applicants and participants informed of their protection against discrimination? If
YES, how? Verbal ❑ Written ❑ Poster ❑ If N/A or NO, explain. N/A YES NO
14. Give the number and current status of any discrimination complaints regarding services or
employment filed against the program/facility.
N/A NUMBER
15. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? If N/A
or NO, explain. N/A YES NO
PART III: THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES.
16. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make
any necessary modifications? If NO, explain. YES NO
❑ ❑
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints?
If NO, explain.
YES NO
❑ ❑
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES NO
❑ ❑
19. Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination on the basis of disability? If NO, explain. YES NO
❑ ❑
20. Are auxiliary aids available to assure accessibility of services to hearing and sight -impaired individuals?
If NO, explain. YES NO
❑ ❑
PART IV: FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000.00 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES NO
❑ ❑
ALLIANCE 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 / /
Revised August 2010, Page 2 of 2
Page 48 of 58
Contract Number KL 2506
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county, city or other locality. If the program/facility serves a
specific target population such as adolescents, describe the target population. Also, define the type of service provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the geographical
area for which services are provided such as a city, county or other regional area. Population statistics can be obtained
from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population
statistics. Include the source of your population statistics. ("Other" races include Asian/Pacific Islanders and American
Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your
summary
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their
percent by race, sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory
or governing board, leave this section blank
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract
language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population
is Hispanic, is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race, sex or ethnic composition 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, 45 CFR 80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment?
Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record
analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and 45 CFR 80.1 (b) (2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical
and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age
or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and
without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas,
restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b).
11. For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or
disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different
race, color, national origin, or disability, 45 CFR 80.3 (a).
12. The program/facility and all services must be accessible to participants and applicants, including those persons who may
not speak English In geographic areas where a significant population of non-English speaking people live, program
accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for
service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of
services, 45 CFR 80.3 (a).
13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint
of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS. The information
Page 49 of 58
Contract Number KL 2506
may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity
policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed,
sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination,
etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local,
state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable
cause found, failure to conciliate, failure to cooperate, under review, etc.
15. The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated
parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone,
restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic
areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for
accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for
light, heat, ventilation, fire alarms, and other essentials should be installed at an appropriate height for mobility impaired
individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self -
evaluation to identify any accessibility barriers. Self -evaluation is a four step process:
a. With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply
with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been
followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due
process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by
Section 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply
with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination
on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate
written communication, 45 CFR 84.8 (a).
20. Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired
sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for
hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally
effective services, 45 CFR 84.52 (d).
21. Programs/facilities with 50 or more employees and $50,000.00 in federal contracts must develop, implement and maintain
a written affirmative action compliance program in accordance with Executive Order 11246, 41 CFR 60 and Title VI of
the Civil Rights Act of 1964, as amended.
DOEA Form 101-B, Revised August 2010
Page 50 of 58
Contract Number KL 2506
ATTACHMENT C
Alliance for Aging, Inc.
Business Associate Agreement
This Business Associate Agreement is dated , by the Alliance for Aging, Inc. ("Covered Entity") and
Provider name, ("Business Associate"), a not -for -profit Florida corporation.
1.0 Background.
1.1 Covered Entity has entered into one or more contracts or agreements with Business Associate that involves the use of
Protected Health Information (PHI).
1.2 Covered Entity recognizes the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
and has indicated its intent to comply in the County's Policies and Procedures.
1.3 HIPAA regulations establish specific conditions on when and how covered entities may share information with Providers
who perform functions for the Covered Entity.
1.4 HIPAA requires the Covered Entity and the Business Associate to enter into a contract or agreement containing specific
requirements to protect the confidentiality and security of patients' PHI, as set forth in, but not limited to the Code of
Federal Regulations (C.F.R.), specifically 45 C.F.R. §§ 164.502(e), 164.504(e), 164.308(b), and 164.314(a-b)(2010) (as
may apply) and contained in this agreement.
1.5 The Health Information Technology for Economic and Clinical Health Act (2009), the American Recovery and
Reinvestment Act (2009) and Part I — Improved Privacy Provisions and Security provisions located at 42 United States
Code (U.S.C.) §§ 17931 and 17934 (2010) require business associates of covered entities to comply with the HIPAA
Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 164.308, 164.310, 164.312, and 164.316 (2009) and such
sections shall apply to a business associate of a covered entity in the same manner that such sections apply to the covered
entity.
The parties therefore agree as follows:
2.0 Definitions. For purposes of this agreement, the following definitions apply:
2.1 Access. The ability or the means necessary to read, write, modify, or communicate data/information or otherwise use any
system resource.
2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to manage the selection,
development, implementation, and maintenance of security measures to protect electronic Protected Health Information
(ePHI) and to manage the conduct of the covered entity's workforce in relation to the protection of that information.
2.3 ARRA. The American Recovery and Reinvestment Act (2009)
2.4 Authentication. The corroboration that a person is the one claimed.
2.5 Availability. The property that data or information is accessible and useable upon demand by an authorized person.
2.6 Breach. The unauthorized acquisition, access, use, or disclosure of PHI which compromises the security or privacy of
such information.
2.7 Compromises the Security. Posing a significant risk of financial, reputational, or other harm to individuals.
2.8 Confidentiality. The property that data or information is not made available or disclosed to unauthorized persons or
processes.
Page 51 of 58
Contract Number KL 2506
2.9 Electronic Protected Health Information (ePHI). Health information as specified in 45 CFR §160.103(1)(i) or
(1)(ii), limited to the information created or received by Business Associate from or on behalf of Covered Entity.
2.10 HITECH. The Health Information Technology for Economic and Clinical Health Act (2009)
2.11 Information System. An interconnected set of information resources under the same direct management control that
shares common functionality. A system normally includes hardware, software, information, data, applications,
communications, and people.
2.12 Integrity. The property that data or information have not been altered or destroyed in an unauthorized manner.
2.13 Malicious software. Software, for example, a virus, designed to damage or disrupts a system.
2.14 Part I. Part I — Improved Privacy Provisions and Security provisions located at 42 United States Code (U.S.C.) §§
17931 and 17934 (2010).
2.15 Password. Confidential authentication information composed of a string of characters.
2.16 Physical Safeguards. The physical measures, policies, and procedures to protect a covered entity's electronic
information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized
intrusion.
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part
164, subparts A and E.
2.18 Protected Health Information (PHI). Health information as defined in 45 CFR § 160.103, limited to the information
created or received by Business Associate from or on behalf of Covered Entity.
2.19 Required By Law. Has the same meaning as the term "required by law" in 45 CFR § 164.103.
2.20 Secretary. The Secretary of the Department of Health and Human Services or his or her designee.
2.21 Security incident. The attempted or successful unauthorized access, use, disclosure, modification, or destruction of
information or interference with system operations in an information system.
2.22 Security or Security measures. All of the administrative, physical, and technical safeguards in an information system.
2.23 Security Rule. The Security Standards for the protection of Electronic Protected Health Information at 45 CFR part
164, subpart C, and amendments thereto.
2.24 Technical Safeguards. The technology and the policy and procedures for its use that protect electronic protected health
information and control access to it.
2.25 Unsecured PHI. Protected health information that is not secured through the use of technology or methodology
specified by the Secretary in guidance issued under 42 U.S.C. section 17932(h)(2).
2.26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in the
Privacy Rule.
3.0. Obligations and Activities of Business Associate.
3.1 Business Associate agrees to not use or disclose PHI other than as permitted or required by this agreement or as
Required by Law.
3.2 Business Associate agrees to:
Page 52 of 58
Contract Number KL 2506
(a) Implement policies and procedures to prevent, detect, contain and correct Security violations in accordance with 45
CFR § 164.306;
(b) Prevent use or disclosure of the PHI other than as provided for by this Agreement or as required by law;
(c) Reasonably and appropriately protect the confidentiality, integrity, and availability of the ePHI that the Business
Associate creates, receives, maintains, or transmits on behalf of the Covered Entity; and
(d) Comply with the Security Rule requirements including the Administrative Safeguards, Physical Safeguards,
Technical Safeguards, and policies and procedures and documentation requirements set forth in 45 CFR §§
164.308, 164.310, 164.312, and 164.316.
3.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate
of a use or disclosure of PHI by Business Associate in violation of the requirements of this Agreement.
3.4 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI not provided for by
this Agreement of which it becomes aware. This includes any requests for inspection, copying or amendment of such
information and including any security incident involving PHI.
3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security breach pertaining to -
(a) Identification of any individual whose unsecured PHI has been, or is reasonably believed by the Business Associate
to have been, accessed, acquired, or disclosed during such security breach; and
(b) All information required for the Notice to the Secretary of HHS of Breach of Unsecured Protected Health
Information.
3.6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from,
or created or received by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions
that apply through this Agreement to Business Associate with respect to such information.
3.7 If Business Associate has PHI in a Designated Record Set:
(a) Business Associate agrees to provide access, at the request of Covered Entity during regular business hours, to PHI
in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to an individual in order to meet
the requirements under 45 CFR § 164.524; and
(b) Business Associate agrees to make any amendment(s) to PHI in a Designated Record Set that the Covered Entity
directs or agrees to pursuant to 45 CFR § 164.526 at the request of Covered Entity or an Individual within 10
business days of receiving the request.
3.8 Business Associate agrees to make internal practices, books, and records, including policies and procedures and PHI,
relating to the use and disclosure of PHI received from, or created or received by Business Associate on behalf of
Covered Entity, available to the Covered Entity or to the Secretary upon request of either party for purposes of
determining Covered Entity's compliance with the Privacy Rule.
3.9 Business Associate agrees to document such disclosures of PHI and information related to such disclosures as would be
required for Covered Entity to respond to a request by an individual for an accounting of disclosures of PHI in
accordance with 45 CFR § 164.528.
3.10 Business Associate agrees to provide to Covered Entity or an individual, upon request, information collected to permit
Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45
CFR § 164.528 and ARRA § 13404.
3.11 Business Associate specifically agrees to use security measures that reasonably and appropriately protect the
confidentiality, integrity, and availability of PHI in electronic or any other form, that it creates, receives, maintains, or
transmits on behalf of the Covered Entity.
3.12 Business Associate agrees to implement security measures to secure passwords used to access ePHI that it accesses,
maintains, or transmits as part of this Agreement from malicious software and other man-made and natural
vulnerabilities to assure the availability, integrity, and confidentiality of such information.
Page 53 of 58
Contract Number KL 2506
3.13 Business Associate agrees to implement security measures to safeguard ePHI that it accesses, maintains, or transmits as
part of this agreement from malicious software and other man-made and natural vulnerabilities to assure the
availability, integrity, and confidentiality of such information.
3.14 Business Associate agrees to comply with:
(a) ARRA § 13404 (Application of Knowledge Elements Associated with Contracts);
(b) ARRA § 13405 (Restrictions on Certain Disclosures and Sales of Health Information); and
(c) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Care Operations).
4.0 Permitted Uses and Disclosures by Business Associate. Except as otherwise limited in this Agreement or any related
agreement, Business Associate may use or disclose PHI to perform functions, activities, or services for, or on behalf of,
Covered Entity as specified in any and all contracts with Covered Entity provided that such use or disclosure would not violate
the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement, Business Associate may use PHI for the proper
management and administration of the Business Associate or to carry out the legal responsibilities of the Business
Associate.
5.2 Except as otherwise limited in this agreement or any related agreement, Business Associate may disclose PHI for the
proper management and administration of the Business Associate, provided that disclosures are Required By Law, or
Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will
remain confidential and used or further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which
the confidentiality of the information has been breached.
5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as permitted by 45 CFR
§ 164.504(e)(2)(i)(B), only when specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State authorities, consistent with
45 CFR §164.502(j)(1).
6.0 Obligations of Covered Entity.
6.1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of Covered Entity
in accordance with 45 CFR § 164.520, to the extent that such limitation may affect Business Associate's use or
disclosure of PHI, by providing a copy of the most current Notice of Privacy Practices (NPP) to Business Associate.
Future Notices and/or modifications to the NPP shall be posted on Covered Entity's website at
www.allianceforaging.org.
6.2 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has
agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Business Associate's use
or disclosure of PHI.
7.0 Permissible Requests by Covered Entity. Except for data aggregation or management and administrative activities of
Business Associate, Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not
be permissible under the Privacy Rule if done by Covered Entity.
8.0 Effective Date and Termination.
8.1 The Parties hereby agree that this agreement amends, restates and replaces any other Business Associate Agreement
currently in effect between Covered Entity and Business Associate and that the provisions of this agreement shall be
effective as follows:
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Contract Number KL 2506
(a) These Business Associate Agreement provisions, with the exception of the electronic security provisions and the
provisions mandated by ARRA, HITECH and Part I shall be effective upon the later of April 14, 2003, or the
effective date of the earliest contract entered into between Business Associate and Covered Entity that involves the
use of PHI;
(b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or the effective date of the
earliest contract entered into between Business Associate and Covered Entity that involves the use of PHI; and
(c) Provisions hereof mandated by ARRA, HITECH and/or Part I shall be effective the later of February 17, 2010 or
the effective date of the earliest contract entered into between covered entity and business associate that involves
the use of PHI or ePHI.
8.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered
Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this agreement
if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity;
(b) Immediately terminate this agreement if Business Associate has breached a material term of this Agreement and cure
is not possible; or
(c) If neither termination nor cure is feasible, Covered Entity shall report the violation to the Secretary.
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section, upon termination of this agreement, for
any reason, Business Associate shall return all PHI and ePHI received from Covered Entity or created or received by
Business Associate on behalf of Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or agents of Business
Associate. Business Associate shall retain no copies of the PHI and ePHI.
(b) In the event that Business Associate or Covered Entity determines that returning the PHI or ePHI is infeasible,
notification of the conditions that make return of PHI or ePHI infeasible shall be provided to the other party.
Business Associate shall extend the protections of this Agreement to such retained PHI and ePHI and limit further
uses and disclosures of such retained PHI and ePHI, for a minimum of six years and so long as Business Associate
maintains such PHI and ePHI, but no less than six (6) years after the termination of this agreement.
9.0 Regulatory References. A reference in this agreement to a section in the Privacy Rule or Security Rule means the section
then in effect or as may be amended in the future.
10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement from time to time as is
necessary for Covered Entity to comply with the requirements of the Privacy Rule, the Security Rule and the Health
Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.
11.0 Survival. Any term, condition, covenant or obligation which requires performance by either party hereto subsequent to the
termination of this agreement shall remain enforceable against such party subsequent to such termination.
12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to comply with the Privacy
Rule and Security Rule.
13.0 Incorporation by reference. Any future new requirement(s), changes or deletion(s) enacted in federal law which create
new or different obligations with respect to HIPAA privacy and/or security, shall be automatically incorporated by reference
to this Business Associate Agreement on the respective effective date(s).
14.0 Notices. All notices and communications required, necessary or desired to be given pursuant to this agreement, including a
change of address for purposes of such notices and communications, shall be in writing and delivered personally to the other
party or sent by express 24-hour guaranteed courier or delivery service, or by certified mail of the United States Postal
Service, postage prepaid and return receipt requested, addressed to the other party as follows (or to such other place as any
party may by notice to the others specify):
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Contract Number KL 2506
To Covered Entity:
To Business Associate:
Alliance for Aging, Inc.
Attention: Max Rothman
760 NW 107 Avenue
Miami, Florida 33172
Provider name
Provider address
Miami, FL 33181
Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery thereof is refused,
delivery will be deemed to have occurred on the date such delivery was attempted.
15.0 Governing Law. The laws of the State of Florida, without giving effect to principles of conflict of laws, govern all matters
arising under this agreement.
16.0 Severability. If any provision in this agreement is unenforceable to any extent, the remainder of this agreement, or
application of that provision to any persons or circumstances other than those as to which it is held unenforceable, will not
be affected by that unenforceability and will be enforceable to the fullest extent permitted by law.
17.0 Successors. Any successor to Business Associate (whether by direct or indirect or by purchase, merger, consolidation, or
otherwise) is required to assume Business Associate's obligations under this agreement and agree to perform them in the
same manner and to the same extent that Business Associate would have been required to if that succession had not taken
place. This assumption by the successor of the Business Associate's obligations shall be by written agreement satisfactory
to Covered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement of the parties relating to the subject matter of this
agreement and supersedes all other oral or written agreements or policies relating thereto, except that this agreement does
not limit the amendment of this agreement in accordance with section 10.0 of this agreement.
Covered Entity: Alliance for Aging, Inc.
By: Date:
(signature)
Business Associate: Provider name
By: Date:
(signature)
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Contract Number KL 2506
ATTACHMENT D
DEPAVI11 ENT OF ELDER AFFAIRS
BACKGROUND D SCREENING
ATTESTATION OF COMPLIANCE CE - EMPLOYER
AUTHORJT'i • ALL I3 LFLOlERS are required to annually submit this farm attesting to
compliance with the pra'isons of chapter 435 and section 430.0-K02 of the Florida Statutes.
The term 'employer -means any person or ,ninny required by law to conduct backp+nmd Lereerin . ,, including
but not limited to, Area Agencies on Aging/Aging and Disability Resource Cis, Lead Aeencies. and Snr i e
Providers that contract directly oar indirectly with the Department of Elder Affairs (DOEA„); and any ether person
or entity which hires employees ix has volunteers in service who meet the definition of ,a direct service praxider.
See §§ 435.02, 43L_01442, Fla. Stan
A direct service provider is 'a person 18 years of age or older who, prrs-aaa t to a program to provide sismicie to
the elderly, has direct face-to-face Calibd with a client wink, providing sertiogs to the client and has access to
the client's living areas, fields,; personal property, or personal identification information as defined in s. 817.565_
The term also includes, bat is n Gt limited to; the adm nis rator or a similarly titled person laic is responscble Ens
the day -today operations of the provider, the financial officer or similarly titled person who is responsible for the
f',manrial operations of the prnidec coordinators, manages, and i oas of r idential facilities, and
volunteers, and any other person seeking employment with a praviderwho is expected to.; or whose respoaisihalms
may rewire him or her to, provide personal care or seniees directly to dient or have aeons to chest funds
financial matters, legal matters, personal property, or lining areas." § 430.()402(1xb), Fla- .Stall. (2023).
As the duns authorized representative oft
Located at
ATTESTATION
(Name of Frployer)
Street address City State Zip Code
Under penalty ofperjury: I,
{Name of Representative)
hereby swear or affirm that the above -named employer is in compliance with the provisions of chapter
435 and sect on430.0402 of the Florida Statutes, regarding level 2 background screenins.
Signature of Representative Date
DOEA Foam 235, Attestetoa of rnirgslia ye - Employer, Eliediva a October 20123, Fa
Farm available at.htipse' elderaffai=orb aboat-us,°krackgrvaild-sere•backeza>md na_cle ringlio., aming-
accessnng-ttie-c]eari gb M1se
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Contract Number KL 2506
ATTACHMENT F
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES (CMBE FORM)
CMBE FORM MUST ACCOMPANY INVOICES SUBMITTED TO ALLIANCE
PROVIDER:
CONTRACT NUMBER:
*REPORTING PERIOD -FROM: TO:
*(DATE RANGE OF RENDERED SERVICES, MUST MATCH INVOICE SUBMITTED)
REPORT ALL EXPENDITURES MADE TO CERTIFIED MINORITY BUSINESS SUBCONTRACTORS
CONTACT DOER CMBE COORDINATOR FOR ANY QUESTIONS, AT 850-414-2153.
SUBCONTRACTOR NAME
SUBCONTRACTOR'S
CMBE
EXPENDITURES
FEID
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.
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.
https://osd.dms.myflorida.com/directories
INSTRUCTIONS
(A) Enter the Provider name as it appears on your Alliance contract.
(B) Enter the Alliance 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 covered by the invoice:
1. Enter certified minority business name.
2 Enter the certified minority business FEID number.
3. Enter the certified minority business CMBE number.
4. Enter the amount expended with the certified minority business for the time period covered by the invoice.
(E) CMBE be form must accompany invoice submitted to the Alliance for processing.
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