RFP_F-23-083-MD_1_4.28.23.pdf

AMENDMENT No. 1

DATED: April 28, 2023

Palm Beach County Purchasing Department 50 South Military Trail, Suite 110, West Palm Beach, FL 33415

RFP No. F-23-083/MD Title: Pre-Qualification of Providers for In-Home Services

Request for Proposal Due Date: May 26, 2023

This Amendment is issued to provide additional information and clarification to the RFP document:

A. Proposers are advised of the following changes to the RFP:

1 Appendix A, Price Proposal Pages, has been revised to remove lines ten (10) and eleven (11) on all three (3) tables and all subsequent lines renumbered accordingly. Delete APPENDIX A, PRICE PROPOSAL PAGES, in its entirety and in lieu thereof replace it with the APPENDIX A, REVISED PRICE PROPOSAL PAGES, provided in this Amendment as Attachment No. 1. Proposers shall submit the APPENDIX A, REVISED PRICE PRPOSAL PAGES, in place of the original APPENDIX A, PRICE PROPOSAL PAGES, in your proposal.

2. Appendix C is provided in this Amendment as Attachment No. 2.

All changes addressed in this Amendment No. 1 shall be incorporated into RFP No.

F-23-083/MD and the final contract. AH other terms and conditions of the RFP remain the same and unchanged.

NOTE: Please acknowledge receipt of this Amendment No. 1 by signing below and returning this page with your Proposal Response. Each Amendment to the RFP shall be signed by an authorized agent and submitted with the proposal or the proposal shall be deemed non-responsive.

ACKNOWLEDGMENT:

COMPANY NAME SIGNATURE

DATE

APPENDIX A

REVISED

PRICE PROPOSAL PAGES

RFP NO. F-23-083/MD

Proposer shall provide below the proposed full-burdened hourly rates for providing the Community Services Department with providing personal care, respite care, homemaker service, companionship, chore, enhanced chore, medication management, gerontological counseling, and mental health/screening counseling as described in Requirements/Scope of Work/Services set forth in this RFP document. All rates are “fully burdened”, i.e., includes all overhead costs, general, administrative and profit.

YEAR 1 - LOT #1 – COUNTYWIDE

(EXCLUDING NORTH PALM BEACH COUNTY AND THE GLADES AREA)

ITEM DESCRIPTION

FULLY BURDENED

HOURLY RATE

1. PERSONAL CARE $_____________________

2. PERSONAL CARE WITH RN SUPERVISORY VISIT $_____________________

3. RESPITE CARE $_____________________

4. HOMEMAKER SERVICES $_____________________

5. COMPANIONSHIP $_____________________

6. CHORE $_____________________

7. ENHANCED CHORE $_____________________

8. MEDICATION MANAGEMENT INDIVIDUAL EPISODE $_____________________

9. MEDICATION MANAGEMENT INDIVIDUAL HOURLY $_____________________

10. COUNSELING (Gerontological) $_____________________

11. COUNSELING (Mental Health/Screening) $_____________________

All unit prices bid should be within two (2) decimal points. If vendor’s pricing exceeds two (2) decimal points, Purchasing reserves the right to round up or down accordingly.

YEAR 1 - LOT #2 – GLADES AREA

HOURLY RATE

1. PERSONAL CARE $_____________________

2. PERSONAL CARE WITH RN SUPERVISORY VISIT $_____________________

3. RESPITE CARE $_____________________

4. HOMEMAKER SERVICES $_____________________

5. COMPANIONSHIP $_____________________

6. CHORE $_____________________

7. ENHANCED CHORE $_____________________

8. MEDICATION MANAGEMENT INDIVIDUAL EPISODE $_____________________

9. MEDICATION MANAGEMENT INDIVIDUAL HOURLY $_____________________

All unit prices bid should be within two (2) decimal points. If vendor’s pricing exceeds two (2) decimal

YEAR 1 - LOT #3 – NORTH PALM BEACH COUNTY

HOURLY RATE

1. PERSONAL CARE $_____________________

2. PERSONAL CARE WITH RN SUPERVISORY VISIT $_____________________

3. RESPITE CARE $_____________________

4. HOMEMAKER SERVICES $_____________________

5. COMPANIONSHIP $_____________________

6. CHORE $_____________________

7. ENHANCED CHORE $_____________________

8. MEDICATION MANAGEMENT INDIVIDUAL EPISODE $_____________________

9. MEDICATION MANAGEMENT INDIVIDUAL HOURLY $_____________________

All unit prices bid should be within two (2) decimal points. If vendor’s pricing exceeds two (2) decimal

As noted within Section 1.5 of this RFP, the initial term of the awarded contract is twelve

(12) months, with four (4) subsequent twelve (12) month terms. Palm Beach County acknowledges the fluctuating nature of prices for items and services specified in this RFP, for the renewal period(s). All requests for price adjustments must be submitted in writing to the Director of Purchasing or designee, with substantial documentation, including but not limited to, applicable market indexes for product/service affected, Consumer Price Index (CPI) published by the US department of Labor, and any other documentation supporting the request for price adjustment. The requested price adjustment shall not exceed the published CPI rate or 3%, whichever is less. All price increase(s) and decrease(s) shall become effective only upon approval, in writing, by the Director of Purchasing. Price increases shall not be retroactive. Moreover, if mutually agreed upon, the price adjustment(s) shall be valid for the next contract/renewal term period and are subject to audit as to the validity/accuracy at any time by County personnel.

The Proposer certifies by signature below the following:

a. This pricing is current, accurate complete, and is presented as the Total Pricing, including “out-of-pocket” expenses (if any), for the performance of this Contract in accordance with the Requirements/Scope of Work/Services of this RFP.

b. This Proposal is current, accurate, complete, and is presented to the County for the performance of this Contract in accordance with all the requirements as stated in this

RFP.

c. This Proposal is submitted without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Proposal for the same materials, services, and supplies and is, in all respects, fair and without collusion or fraud.

d. The financial stability to fully perform the terms and conditions as specified herein.

The County reserves the right to request financial information from the proposer at any time during the Solicitation process and in any form deemed necessary by the County.

IMPORTANT: FAILURE TO SUBMIT THESE PAGES, INCLUDING ALL REQUIRED

INFORMATION AND SIGNATURES, WILL BE CAUSE FOR "IMMEDIATE

REJECTION” OF THE ENTIRE PROPOSAL RESPONSE.

NAME (PRINT):

TITLE:

COMPANY:

ADDRESS:

CITY/STATE/ZIP:

TELEPHONE NO.

SIGNATURE:

ATTACHMENT A

SPECIAL CONTRACT PROVISIONS

This Contract includes Federal funding governed by the Florida Department of Elder Affairs, through the Area Agency on Aging of Palm Beach/Treasure Coast, Inc. Therefore, the successful vendor(s) awarded this contract shall adhere to any/all applicable federal/state/local laws, statutes, ordinances, etc., in addition to completing and providing the following:

Incorporation of Documents within the Contract or Agreement

I. Certifications and Assurances provisions (Attachment A)

• Certification Regarding Lobbying (Attachment AA)

• Nondiscrimination & Equal Opportunity Assurance

• Certification Regarding Public Entity Crimes

• Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance

• Scrutinized Companies Lists Certification (Attachment AB)

• Certification Regarding Data Integrity Compliance for Agreements, Grants. Loans & Cooperative Agreements (Attachment AC)

• Verification of Employment Status Certification (Attachment AD)

• Certification Regarding Inspection of Public Records

• Certification Regarding Debarment, Suspension, etc. (Attachment AE)

A. Certification Regarding Lobbying

The undersigned successful vendor certifies, to the best of its knowledge and belief, that:

1. 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.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or employee of a Member of Congress in connection with a Federal contract, grant, loan, or cooperative agreement, the undersigned shall also complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

3. 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 sub-contractors shall certify and disclose accordingly.

4. 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.

B. Nondiscrimination & Equal Opportunity Assurance

As a condition of the Contract, successful vendor 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-financially assisted program or activity.

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RFP No. F-23-083/MD Appendix C

Attachment No. 2 to Amendment No. 1

Nondiscrimination & Equal Opportunity Assurance (cont’d)

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 Department.

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 Department.

4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.

5. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 86), to the endthat, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Department.

6. The American with Disabilities Act of 1990 (Pub. L. 101-336), which prohibits discrimination in all employment practices, including, job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment-related activities. Successful vendor also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to successful vendor’s operation of the WIA Title I-financially assisted program or activity, and to all agreements the successful vendor makes to cany out the WIA Title I - financially assisted program or activity. Successful vendor understands that DOEA and the United States have the right to seek judicial enforcement of the assurance. The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) and that all sub-recipients and sub-contractors shall provide this assurance accordingly.

C. Certification Regarding Public Entity Crimes

Successful vendor hereby certifies that neither it, nor any person or affiliate of successful vendor, has been convicted of a Public Entity Crime as defined in Section 287.133, F.S., nor placed on the Convicted Vendor List. Successful vendor understands and agrees that it is required to inform DOEA immediately upon any change of circumstances regarding this status.

D. Association of Community Organizations for Reform Now (ACORN) Funding Restrictions Assurance

As a condition of the Contract, successful vendor assures that it will comply folly with the federal funding restrictions pertaining to ACORN and its subsidiaries per the Consolidated Appropriations Act, 2010, Division E, Section 511 (Pub. L. 111-117). The Continuing Appropriations Act, 2011, Sections 101 and 103 (Pub. L. 111-242), provides that appropriations made under Pub. L.

111-117 are available under the conditions provided by Pub. L. 111-117.

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 successful vendors shall provide this assurance accordingly.

RFP No. F-23-083/MD

E. Scrutinized Companies Lists Certification

If this Contract is in the amount of $1 million or more, in accordance with the requirements of Section 287.135, F.S., successful vendor 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. Both lists are created pursuant to Section 215.473, F.S.

Successful vendor understands that pursuant to Section 287.135, F.S., the submission of a false certification may subject successful vendor to civil penalties, attorney’s fees, and/or costs. If successful vendor is unable to certify any of the statements in this certification, successful vendor shall attach an explanation to this Contract.

F. Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans & Cooperative Agreements

The successful vendor and any sub-contractors of services under this contract have financial management systems capable of providing certain information, including: (1) 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.

Management Information Systems used by the successful vendor, sub-contractors, or any outside entity on which the successful vendor 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, successful vendors will take immediate action to assure data integrity.

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 successful vendor (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 successful vendor 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.

The successful vendor and any sub-contractors 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.

G. Verification of Employment Status Certification

As a condition of contracting with the Florida Department of Elder Affairs, successful vendor 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 successful vendor during the contract term to perform employment duties pursuant to this contract and that any subcontracts include an express requirement that sub-contractors 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 sub-contractor during the entire contract term.

The successful vendor shall require that the language of this certification be included in all sub-agreements, sub-grants, and other agreements and that all sub-contractors 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 Circulars A-102 and 2 CFR Part 200, and 215 (formerly OMB Circular A-l10).

RFP No. F-23-083/MD

H. Certification Regarding Inspection of Public Records

In addition to the requirements of Sections 10.1, 10.2 of the Standard Contract, and 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, successful vendor 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.

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.

I. Certification Regarding Debarment, Suspension, and Other Responsibility Matters -Primary Covered Transactions

The undersigned Contractor certifies to the best of its knowledge and belief, that it and its principals:

1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal department or agency;

2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or 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.

The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers (including subcontracts, sub-grants and contracts under grants, loans and cooperative agreements) and that all sub recipients and contractors shall provide this certification accordingly.

Additionally, I certify this organization does not provide for institutional memberships.

Successful vendor’s signature below attests that records pertaining to the dues or membership application by the Department are available for inspection as stated above.

By execution of this agreement, successful vendor must include provisions of Attachment “A” (including internal attachments: AA, AB, AC, AD & AE) in all related subcontract agreements (if applicable). By signing below, successful vendor certifies that the representations outlined herein are true and correct.

(Signature and Title of Authorized Representative)

(Vendor/Company) (Date)

(Street Address)

(City, State, ZIP code)

RFP No. F-23-083/MD

ATTACHMENT AA

CERTIFICATION REGARDING LOBBYING

CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND AGREEMENTS

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) 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 any state or federal agency, a member of congress, an officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator, in connection with the awarding 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.

(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all sub- awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all Subcontractors shall certify and disclose 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 section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.

Signature

Name of Authorized Individual

Provider Name

Date

Application or Agreement Number

DOEAForm 103 (Revised Nov 2002)

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RFP No. F-23-083/MD

ATTACHMENT AB

CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS

The undersigned, an authorized representative of the Provider named in the contract or agreement to which this form is an attachment, hereby certifies that:

(1) The Provider understands that pursuant to s. 287.135 F.S., any company at the time of bidding or submitting a bid/proposal for a new contract or renewal of an existing contract, that is on the "Scrutinized Companies with Activities in Sudan List" or the "Scrutinized Companies with Activities in the Iran Petroleum Sector List (collectively , "the Lists") is ineligible for, and may not bid on, submit a proposal for, or enter into or renew a contract or agreement with the Area Agency on Aging of Palm Beach/Treasure Coast, Inc. for goods or services of $1million or more.

(2) The Provider understands that, pursuant to s. 287.135 F.S., any company that submits a false certification to the Agency is subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of false certification.

(3) The Provider understands that the Agreement to which this form is an attachment, may be terminated by the Agency if the Provider submits a false certification or has been placed on the Lists.

This certification, required by Florida law, 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.

Signature (should match Contract signature)

Title

Date

Area Agency on Aging of Palm Beach/Treasure Coast, Inc.

West Palm Beach, FL 33407

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RFP No. F-23-083/MD

ATTACHMENT AC

CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS,

LOANS AND COOPERATIVE AGREEMENTS

The undersigned, an authorized representative of the Provider named in the contract or agreement to which this form is anattachment, hereby certifies that:

(1) The Provider and any Subcontractors of services under this contract have financial management systems capable ofproviding certain information, including: (1) accurate, current, and complete disclosure of the financial results of eachgrant-funded project or program in accordance with the prescribed reporting requirements; (2) the source andapplication of funds for all Agreement supported activities; and (3) the comparison of outlays with budgeted amountsfor each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly,

(2) Management Information Systems used by the Provider, subcontractors, or any outside entity on which the Provideris dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable ofprocessing data accurately, including year-date dependent data. For those systems identified to be non- compliant, Providci's will take immediate action to assure data integrity.

(3) If this Agreement 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 Agency 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 thatimpede 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 Agency, and without interruption to the ongoing business of the Agency, time being of the essence.

(4) The Provider and any subcontractors of services under this Agreement 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.

The Provider shall require that the language of this certification be included in all subagreements, subgrants, and other agreementsand 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-1 02 and 2 CFR Part 215 (formerly 0MB Circular A-1 10).

Signature Title Date

Name of Authorized Signer Provider Name

(Revised June 2008)

RFP No. F-23-083/MD

ATTACHMENT AD

VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION

As a condition of contracting with Palm Beach County Board of County Commissioners for the provision of services to the Division of Senior Services clients, the vendor(s) awarded this contract certifies the use of the US Department of Homeland Security’s E-Verify system to verify the employment eligibility of all new employees hired 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 Contract utilize the E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term.

Signature

Title

Date

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RFP No. F-23-083/MD

ATTACHMENT AE

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND

VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS

(1) The Provider certifies, by signing this certification, neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department agency.

(2) Where the Provider is unable to certify to any of the statements in this certification, such prospective participants shall attach an explanation to this certification.

Signature Date (Certification signature should be same as Contract signature)

Title Agency/Organization

INSTRUCTIONS FOR CERTIFICATION

1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person," "primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, as supplemented by 2 CFR 376.10-376.995). You may contact the Consumer Services Consultant for assistance in obtaining a copy of those regulations.

2. This certification is a material representation of facts upon which reliance was placed when the Parties entered into this transaction. If it is later determined that the Provider knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Agency may pursue available remedies, including suspension and/or debarment.

3. The Provider will provide immediate written notice to the Consumer Services Consultant if at any time the Provider learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The Provider may decide the method and frequency by which it determines the eligibility of its principals. Each participant to a lower tier covered transaction may, but is not required to, check the Excluded Parties List System (EPLS).

4. The Provider will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - lower tier covered transaction" in all its lower tier covered transactions and in all solicitations for lower tier covered transactions.

5. The Provider agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by the federal government.

6. If the Provider knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, the Agency may pursue available remedies, including suspension, and/or debarment.

7. The Provider may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous.

(Revised June2008)

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RFP No. F-23-083/MD

ATTACHMENT B

This Contract includes Federal funding governed by the Florida Department of Elder Affairs, through the Area Agency on Aging of Palm Beach/Treasure Coast, Inc. Therefore, Palm Beach County (hereinafter referred to as “Agency”) requires that all vendors (hereinafter referred to as “Provider”) complete the ADDITIONAL PROVISIONS prior to receiving an award. In performance of this Contract, provider submits the following additional provisions:

II. ADDITIONAL PROVISIONS (ATTACHMENT B)

• Assurances- Non-Construction Programs (Attachment BA)

• Background Screening Affidavit of Compliance - Employer & Employee (Attachment BB)

• Financial and Compliance Audit (Attachment BC)

• Instructions for the Civil Rights Compliance Checklist (Attachment BD)

• Civil Rights Compliance Checklist (Attachment BE)

8 Health Insurance Portability & Accountability Act (HIPPA) of 1996 (Attachment BF)

• Provider’s State Contract List (Attachment BG)

• Management Attestation Letter (Attachment BH)

• PBC- Division of Senior Services Prescription Example (Attachment BI)

• PBC- Division of Senior Services Confidentiality Statement (Attachment BJ)

• PBC- Division of Senior Services Billing Procedures (Attachment BK)

By execution of this agreement, provider must include the Additional Provisions of Attachment “B” (including internal attachments: BA, BB, BC, BD, BE, BF, BG, BH, BI, BJ & BK) in all related subcontract agreements (if applicable). By signing below, successful vendor certifies that the representations outlined herein are true and correct.

(Signature and Title of Authorized Representative)

(Vendor/Company) (Date)

(Street Address)

(City, State, ZIP code)

RFP No. F-23-083/MD

ATTACHMENT BA

ATTACHMENT IV

ASSURANCES—NON-CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated to average forty-five (45) minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND

BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

1. Has the legal authority to apply for federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management, and 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, throughany authorized representative, access toand 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 awardingagency.

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)Sections 523 and 527 ofthe Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), as amended, relating to nondiscrimination in thesale, 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

RFP No. F-23-083/MD 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 inpurchases.

8. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with federal funds.

9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-333), regarding labor standards for federally assisted construction sub-contracts.

10. Will comply, if applicable, with flood insurance purchase requirements of Section102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more.

11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management 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-l 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 2 CFR Part 200.

18. Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

APPLICANT ORGANIZATION DATE SUBMITTED

RFP No. F-23-083/MD

A1TACHMENT BB

Ron DeSantis

BACKGROUNDSCREENING

Attestation of Compliance - Employer

AUTHORITY: This form is required annually of all employers to comply with the attestation requirements set forth in section 435.05(3), Florida Statutes.

> The term "employer” means any person or entity required by law to conduct background screenings, including but not limited to, Area Agencies on Aging/Aging and Disability Resource Centers, Lead Agencies, and Service Providers that contract directly or indirectly with the Department of Elder Affairs (DOEA), and any other person or entity which hires employees or has volunteers in service who meet the definition of a direct service provider. See §§ 435.02, 430.0402, Fla. Stat.

> A direct service provider is "a person 18 years of age or older who, pursuant to a program to provide services to the elderly, has direct, face-to-face contact with a client while providing services to the client and has access to the client’s living area, funds, personal property, or personal identification information as defined in s. 817.568. The term includes coordinators, managers, and supervisors of residential facilities and volunteers.” § 430.0402(1)(b), Fla. Stat.

ATTESTATION:

As the duly authorized representative of

Employer Name located at Street Address City State ZIP code

I, do hereby affirm under penalty of Name of Representative perjury that the above named employer is in compliance with the provisions of Chapter 435 and section 430.0402, Florida Statutes, regarding level 2 background screening.

Signature of Representative Date

DOEA Form 235, Attestation of Compliance - Employer, Effective January 19, 2021 F.S. Form available at: http://elderaffairs.state.fl.us/enqlish/backgroundscreening.php

Section 435.05(3), RFP No. F-23-083/MD

Ron DeSantis GovernorDepartment of

ELDER AFFAIRS

Richard Prudoni

SecretarySTATE OF FLORIDA

BACKGROUND SCREENING

Attestation of Compliance - Candidate

AUTHORITY: This form is required of all candidates who are direct service providers when claiming an exception to Level 2 background screening set forth in sections 430.0402(2) and (3), Florida Statutes, or to comply with the attestation requirements set forth in section 435.05(2), Florida Statutes.

This form is required by all candidates to comply with:

• The attestation requirement of section 435.05(2), Florida Statutes, which states that “every employee required to undergo Level 2 background screening must attest, subjeetto penalty of perjury, to meeting the requirements for qualifying for employment pursuant to this chapter and agreeing to inform the employer immediately if arrested for any of the disqualifying offenses while employed by the employer;” AND

• The proof of screening within the previous 5 years in section 408.809(2), Florida Statutes, which requires proof of compliance with Level 2 screening standards that have been screened through the Care Provider Background Screening Clearinghouse created under section 435.12, Florida Statutes, or screened within the previous 5 years by the Agency, Department of Health, Department of Elder Affairs, the Agency for Persons withDisabilities, Department of Children and Families, or the Department of Financial Services for an applicant for a certificate of authority to operate a continuing care retirement community under Chapter 651, Florida Statutes, if that agency is not currently implemented in the Care Provider Background Screening Clearinghouse.

This form must be maintained in the candidate’s personnel file, if hired, or with the Human Resources Department. If this form is used as proof of screening for an administrator or chief financial officer to satisfy the requirements of an application for a health care provider license eligibility or monitoring purposes, please attach a copy of the screening results and submit the application.

The term "candidate" as used herein refers collectively to all persons required by law to undergo a background screening. This includes, but is not limited to, persons who are determined to be a direct service provider. A direct service provider is a person at least 18 years of age who, pursuant to a program to provide services to the elderly, has direct face-to-face contact with a client while providing services and has access to the client's living areas, funds, personal property, or personal identification information as defined in F.S. 430.0402(1) (b), Florida Statutes. A direct service provider also includes coordinators, managers, and supervisors of residential facilities and volunteers.

DOEA Form 236, Attestation of Compliance - Candidate, Effective January 19, 2021 Section 435.05(2), F.S.

Page1of 6 Form available at: http://elderaffairs.state.fl.us/english/backRroundscreeninR.php

RFP No. F-23-083/MD

Personal identification information defined in F.S. 817.568(l)(f), F.S. means "any name or number that may be used, alone or in conjunction with any other information, to identify a specific individual, including any:

1. Name, postal or electronic mail address, telephone number, social security number, date of birth, mother's maiden name, official state-issued or United States-issued driver's license or identification number, alien registration number, government passport number, employer or taxpayer identification number, Medicaid or food assistance account number, bank account number, credit or debit card number, or personal identification number or code assigned to the holder of a debit card by the issuer to permit authorized electronic use of suchcard;

2. Unique biometric data, such as fingerprint, voice print, retina or iris image, or other unique physical representation;

3. Unique electronic identification number, address, or routingcode;

4. Medical records;

5. Telecommunication identifying information or access device;or

6. Other number or information that can be used to access a person's financial resources." 7.

EMPLOYER: IF A CANDIDATE IS HIRED AND IS DETERMINED TO BE A DIRECT SERVICE PROVIDER, THIS COMPLETED FORM MUST BE RETAINED IN THE EMPLOYEE'S FILE. IF AN EXCEPTION TO BACKGROUND SCREENING IS CLAIMED, A COPY OF THE REQUIRED EVIDENCE MUST BE ATTACHED TO THIS FORM.

STEP ONE: Complete identification information.

Candidate Name Position Applied For

Employer

DOEA Form 236, Attestation of Compliance - Candidate, Effective January 19, 2021 Section 435.05(2), F.S.

Page 2 of 6 Form available at: http://elderaffairs.state.fl.us/english/backgroundscreeninR.php

RFP No. F-23-083/MD

STEP TWO: The candidate must review the following list of disqualifying offenses set forth in Chapters 430 and 435, Florida Statutes.

You must attest to meeting the requirements for employment and you may not have been arrested for and awaiting final disposition of, have…