HomeMy WebLinkAboutWalla Walla County and KCPHDKittitas County
Review Form
Grants & Contract Agreement
Today's Date
10/23/2017
Fund/Department
116 -Public Health
Contract/Grant Information
Contract /Grant Agency: Walla Walla Count,
Period Begin Date: 07/01/2017
Total Grant/Contract Amount: $3000.00
Grant/Contract Number:
Contract/Grant Summary:
LAgencla Date
and KCPHD
1 Period End Date: 06/30/2018
10i ri I 'IN Cul ."I Y
The agreement is entered into, by, and between Walla Walla County and Kittitas County Public Health
Department for engagement and participation in the Greater Columbia Accountable Community of
Health Youth Marijuana Prevention and Education Program Planning Team.
Recommendation for Board of Health and Board of Health Review on
F_
Department Head Signature:
Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office
Signature of Board of Health member
Financial Information
Date
Date
Total Amount $3000.00
State Funds $3000.00
Federal Funds $
Percentage County Funds
Matching Funds $
CFDA#
In -Kind $
Explain
Grant/Contract Review Page 1
Is Equipment being purchased? TWho owns equipment?
New Personnel being hired? I Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form
New Division Created?
Revenue Code
116-612.91.334.06.902 - $3000.00
Pass Through Information
(to Pass Through
Amount to Pass Through 1 $
quo-wnLract r+ppruveu i uate:
Prosecutor Review
Nox❑ Why not
Not an increase in bottom line, shifting of
revenues
Has the Prosecutor reviewed this agreement?.1 Yes❑ No ❑
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer I Date
Grant/Contract Review Page 2
Service Agreement #
between
WALLA WALLA COUNTY
and
KITTITAS COUNTY PUBLIC HEALTH
The Agreement is entered into by and between Walla Walla County, hereinafter "County," and
Kittitas County Public Health, hereinafter "Contractor," for engagement and participation in the
Greater Columbia Accountable Community of Health Youth Marijuana Prevention and
Education Program Planning Team, as outlined in the attached Statement of Work. The rights
and obligations of both parties are governed by the General Terms and Conditions, and the
following Exhibits, copies of which are attached hereto and incorporated herein by this reference
as fully as if set forth herein:
Exhibit A — Statement of Work
Exhibit B — Budget
Exhibit C — Expenditure Report Form
Exhibit D — Participation Report Form
Performance Period: The terms of this Agreement shall commence on July 1 st, 2017 and shall,
unless terminated or renewed as provided elsewhere in the Agreement,
terminate on June 30, 2018.
Compensation: Payment to Contractor for services rendered under this Agreement shall be
as set forth in Exhibit B — Budget. The allocation of funding is currently
awarded for Fiscal Year 2017: 7/1/2017 to 6/30/2018. The amount of
payment for the performance period of this Agreement shall not exceed
$3,000.
CFDA# (if applicable): UBI#:
State Industrial Account ID # (if applicable):
1.0 CONTRACTOR RESPONSIBILITIES:
CONTRACTOR agrees to:
• Participate in a minimum of six (6) monthly meetings of the regional planning
group for Marijuana Prevention and Education per Statement of Work, Exhibit A
CONTRACTOR is responsible for the selection of the CONTRACTOR's participant in
the regional planning meetings per Statement of Work, Exhibit A
CONTRACTOR agrees to follow all applicable statutes and regulations.
CONTRACTOR agrees to hold COUNTY harmless from all liabilities resulting from the
above-described activities and further assumes responsibility for any future audit
exceptions due to the use of these funds.
2.0 BILLING AND PAYMENT
11Page
The CONTRACTOR agrees to submit required deliverables as detailed in Exhibit B,
Budget.
COUNTY will reimburse the actual approved expense of the KITTITAS COUNTY
PUBLIC HEALTH up to a MAXIMUM OF $3000. See Exhibit B
Allowable expenses are for reasonable program purposes, including personnel and travel
submitted on Expenditure Report form (ERF), Exhibit C per Participation Report Form,
Exhibit D. No expenses will be reimbursed for any lobbying efforts of any kind or for
any clinical care.
Indirect costs are limited to the organization's approved overhead rate.
After approval of the billing invoices, payment will be made on the next scheduled Walla
Walla County voucher run.
All items shall be received and services rendered by midnight April 30, 2018.
COUNTY shall not be responsible for any Invoices received after June 15, 2018.
3.0 PROHIBITION AGAINST ASSIGNMENT
Neither this contract nor any interest therein may be assigned by either party without first
obtaining the consent of the other party.
4.0 INDEPENDENT CONTRACTOR STATUS OF HEALTH DEPARTMENT
The CONTRACTOR and CONTRACTOR's employees and agents shall perform all
duties pursuant to this Contract as an independent contractor. COUNTY shall not
control or supervise the manner in which this Contract is performed nor withhold or pay
any taxes on behalf of the CONTRACTOR or the CONTRACTOR's employees or
agents.
2 1 P a g e
5.0 INDEMNIFICATION AND INSURANCE
Any and all claims which hereafter arise on the part of any and all persons as a direct or
indirect result of the CONTRACTOR or the CONTRACTOR's employees or agents
performance or failure to perform duties pursuant to this Contract, shall be the
CONTRACTOR's sole obligation, and the CONTRACTOR shall indemnify and hold
harmless COUNTY.
Insurance. CONTRACTOR is a member of the Washington Counties Risk Pool.
CONTRACTOR shall notify COUNTY forty-five (45) days before cancellation or
reduction in CONTRACTOR's insurance coverage.
6.0 SUSPENSION AND DEBARMENT
The CONTRACTOR certifies that persons responsible for this agreement are not
presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this program by any federal department or
agency.
7.0 TERMINATION
This agreement shall terminate and be null and void to the extent funds anticipated to be
made available to the COUNTY for the purposes of this agreement are not made
available to the COUNTY for any reason whatsoever.
Either party may terminate this agreement with written notice to the other party prior to
June 10, 2018.
8.0 VERBAL AGREEMENTS
This written Contract constitutes the mutual agreement of the CONTRACTOR and
COUNTY in whole. No alteration or variation of the terms of this Contract and no oral
understandings or agreements not incorporated herein, unless made in writing between
the parties hereto, shall be binding.
9.0 APPLICABLE LAW
This Contract shall be governed by the laws of the State of Washington.
10.0 NONDISCRIMINATION
No person shall, on the grounds of race, creed, color, national origin, sex, sexual
orientation or handicapping condition be excluded from participation in, be denied the
3 1 P a g e
benefits of, or be otherwise subjected to discrimination under activities performed
pursuant to this Contract.
11.0 EFFECTIVE DATE - DURATION
This Contract shall commence on the 1st Day of July 2017, and shall terminate at
midnight on the 30a' day of June 2018, regardless of the date of execution. Section 5.0
(Indemnification) which shall continue to bind the parties their heirs and successors after
June 30, 2018.
IN WITNESS WHEREOF, COUNTY and CONTRACTOR have executed this Contract
consisting of four pages and attachments.
By their signatures below, the parties agree to the terms and conditions of this Agreement and all
documents incorporated by reference. The parties signing below certify that they are authorized
to sign this Agreement.
IN WITNESS WHEREOF, the parties hereto have signed this Agreement.
COUNTY: CONTRACTOR:
Meghan DeBolt, MBA/MPH Date
Director
Department of Community Health
314 W. Main
P.O. Box 1753
Walla Walla, WA 99362
Phone: (509) 524-2650 Fax: (509) 524-2642
Telephone Number / Email Address:
Mailing Address (Street address required in addition to PO Box.):
Authorized By Date
Print Name & Title of Person Signing
Social Security or Business Tax ID#:
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Exhibit A
STATEMENT OF WORK
Grantee Name: Kittitas County Public Health
Agreement Number: Contract Period: July 1, 2017 — June 30, 2018
# SOW Page 1 of 1
Due
Payment
Task
Task/Activity/
Deliverables/Outcomes
Date/Time
Information
Number
Description
and/or
Frame
Amount
1
Participate in
Participation and attendance to
Monthly —
Invoiced
Monthly YMPEP
monthly YMPEP Planning Team
October
monthly
Planning Team
meetings
2017
meetings.
through
March 2018
# SOW Page 1 of 1
Exhibit B
BUDGET
Grantee Name: Kittitas County Public Health
Agreement Number: Contract Period: October 1, 2017 - June 31,
2018
This Agreement includes / X does not include, in the SPECIFIC TERMS AND
CONDITIONS, requirements to which payment of budgeted funds is contingent.
Line Item/Description Amount
Personnel Costs: Time and Effort $2000
Travel to and From YMPEP Planning Team Meetings, $0.54/mile 1 $1000
TOTAL: 1 $3,000
Funded By:
WA State Department of Health Youth Marijuana Prevention and Education Program
#BUDGET Page 1 of 1
Expenditure Report Form (ERF)
INSTRUCTIONS TO VENDOR OR CLAIMANT:
STATEMENT FOR SERVICES - Claim payment for materials, merchandise or services. Show complete detail for each item.
Vendor's Certificate. I hereby certify under penalty of perjury that
§WbMit this formContractor: the items and totals listed herein are proper charges for materials, merchandise
County of Walla Walla, Washington or services furnished to the County of Walla Walla and that all goods furnished
and/or services rendered have been provided without discrimination because of
Department of Community Health age, sex, marital status, race, creed, color, national origin, handicap, religion, or
Vietnam era or disabled veterans status and the claim is just, due and unpaid
PO Box 1753 obligation against the County of Walla Walla and that I am authorized to I
Walla Walla WA 99362
Email to: DCF1CantraClcL3iflitlg[+�1cc5.,ualia-walia.wa.us
CLAIMANT BY:
(SIGN IN INK)
(TITLE) ;DATE}
Program:
Agreement Number:
Claim Period:
DATE
DESCRIPTION OF SERVICES
AMOUNT
TOTAL PAYMENT REQUESTED WITH THIS ERF:
$0.40
PREPARED BYTELEPHONE
NUMBER
JDATE
FOR COUNTY FINANCE USE ONLY
VENDOR NUMBER T
I J131 NUMB EA
FUND Code Distribution
ACCO4NFNYG APPROVAL FOR PAYMENT OAFL•
WARRANT TOTAL
'NARRAt+T NUMBER