HomeMy WebLinkAboutFinal Interagnecy Agreement Amendment 1 between Grant County and Kittitas County Public HealthKittitas County
Review Form
Grants & Contract Agreement
Today's Date
01.21.2015
Fund/Department
116 -Public Health
Contract/Grant Information
Contract /Grant Agency: Interagency
Countv Public Health
Agenda Date
Agreement Amendment 1 Between Grant County and Kittitas
Period Begin Date: January 1, 2015
Total Grant/Contract Amount: $ 40,703.00
Grant/Contract Number:
Contract/Grant Summary:
1 Period End Date: September 29, 2018
The Interagency Agreement Amendment 1 is made and entered into to coordinate the Healthy
Communities Obesity, Diabetes, Heart Disease and Stroke Prevention Program and the Kittitas County
Public Health Department. The agreement will provide a mechanism for collaborative work, completion
of deliverables, and transfer of funds necessary to carry out the health improvement initiatives
associated with the North Central Washington Healthy Communities Obesity, Diabetes, Heart and Stroke
Prevention Program. The amendment increases the total grant amount and extends agreement until
2018.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature:
Administrator Date:
Kittitas County Prosecutor, Auditor, and Board of Health Review and G
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office Date
Signature of Board of Health member Date
Grant/Contract Review Page 1
Financial Information
Total Amount $40,703
State Funds $
Federal Funds $40,703
Percentage County Funds
Matching Funds $
CFDA#93.757
Human Resource
In -Kind $
Explain
Is Equipment being purchased?
Who owns equipment?
New Personnel being hired?
Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑
New Division Created?
Revenue Code
116-612.49.03.333.93.757 - $15,500
116-612.49.04.333.93.757 - $14,500
_T—
d.
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
attach budget form
Prosecutor Review
Has the Prosecutor reviewed this agreement?
Countv Departments Impacted
No ❑x Why not
Included in 2016 budget
Yes L1 No ❑
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource _
Prosecutor's Office _
Who Signed the grant application
Grant/Contract Review Page 2
Auditor
Information Services
Prosecutor
Facilities Maintenance
Human Resource
Treasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource _
Prosecutor's Office _
Who Signed the grant application
Grant/Contract Review Page 2
Reviewer I Date
Grant/Contract Review Page 3
INTERAGENCY AGREEMENT Amendment#1
Between
GRANT COUNTY HEALTH DISTRICT
And
Kittitas County Public Health Department
January 1, 2015 - September 29, 2018
THIS INTERAGENCY AGREEMENT is made and entered into pursuant to Chapter 39.34 RCW, the
Interlocal Cooperation Act, by and between the Grant County Health District, hereinafter referred to as
"GRANT" acting as the Community Lead Organization (CLO) to coordinate the Healthy Communities
Obesity, Diabetes, Heart Disease and Stroke Prevention Program and the Kittitas County Public Health
Department hereinafter referred to as "PARTICIPANT", as funded by the Washington State Department
of Health).
IT IS THE PURPOSE OF THIS AGREEMENT to provide a mechanism for the collaborative work,
completion of deliverables, and transfer of funds necessary to carry out the priority health improvement
initiatives associated with the North Central Washington Healthy Communities Obesity, Diabetes, Heart
Disease and Stroke Prevention Program.
The PARTICIPANT will develop and implement the North Central Washington Healthy Community work
plans that include policy, environmental and system (PSE) strategies that work toward reducing death
and disability due to diabetes, heart disease, and stroke; and reduce the prevalence of obesity among
adult Washington residents with an emphasis on populations that bear a disproportionately high burden
and/or risk for high blood pressure, type 2 diabetes, and obesity.
IT IS, THEREFORE, MUTUALLY AGREED THAT:
Statement of Work
PARTICIPANT shall furnish the necessary personnel and services and otherwise do all things necessary
for or incidental to the performance of the work set forth in Exhibit "A" attached hereto and
incorporated herein. Unless otherwise specified, PARTICIPANT shall be responsible for performing all
fiscal and program responsibilities as set forth in Exhibit "A."
Terms and Conditions
All rights and obligation of the parties to this contract shall be subject to and governed by the special
terms and conditions contained in the text of this agreement.
Period of Performance
Subject to its other provisions, the period of performance of this agreement shall commence on January
1, 2015 and conclude on September 29, 2018 unless continued by written agreement or terminated
sooner as provided herein.
In consideration whereof:
Interagency Agreement — Kittitas Amendment#1
11/20/15
Page 1
Upon receipt of a properly executed A-19 Invoice Voucher and complete billing documentation, GRANT
shall pay to PARTICIPANT the reimbursed sum as agreed upon in Exhibit "A". Parties may mutually
agree to additional sums and deliverables as additional funding is available.
Services and Reporting Requirements
PARTICIPANT will report to GRANT on any services and/or reporting requirements that may be required
under this agreement.
Approved Expenses
Allowable expenses are for reasonable program purposes, including personnel, travel, supplies and
services such as contractual (refer to Omni circular). The primary recipient must perform a substantial
role in carrying out project objectives and not merely serve as a conduit for an award to another party
or provider who may be ineligible. No expenses will be reimbursed for any lobbying efforts of any kind
or for any clinical care. Any type of equipment purchase must be pre -approved by GRANT.
Indirect Costs and Line Item Budget Requirements
Indirect costs are limited to 22 percent of salaries and benefits. PARTICIPANT need not amend the
budget if they anticipate going over in any line item within component 1 or component 2 by less than 10
percent of total direct charges. However, if they anticipate going over by more than 10 percent of total
direct charges for any line item they will be required to amend their budget before being refunded for
costs that exceed 10 percent in respective line items. Component 1 and component 2 budgets must be
tracked separately and funding cannot be moved from one component to the other component.
Monitoring of fund allocation spending
There will be two check-in points (1) mid -year and (2) two months before contract end date:
(1) At mid -year, GRANT will evaluate how much of the PARTICIPANT funds have been spent. If less
than 30% of the funds have been billed, GRANT reserves the right to amend the contract and
reduce the funding allocation.
(2) Two months before the end of the contract, GRANT will evaluate how much PARTICIPANT funds
have been spent. If less than 80% of the funds have been billed and if the PARTICIPANT doesn't
have a reasonable explanation for how they will use the remainder of the funds, GRANT
reserves the right to amend the contract and reduce the funding allocation.
Non -Discrimination
In the performance of this agreement, PARTICIPANT shall not discriminate on the grounds of race, color,
national origin, sex, religion, marital status, age, creed, Vietnam era and disabled veterans status, or the
presence of any sensory, mental, or physical handicap in:
a. Any terms or conditions of employment to include taking affirmative action necessary to
accomplish the objectives of this part; and
Interagency Agreement — Kittitas Amendment#1
11/20/15
Page 2
b. Denying an individual the opportunity to participate in any program provided by this
agreement through the provision of services, or otherwise afforded others.
Records Maintenance
PARTICIPANT and GRANT shall each maintain sufficient records to demonstrate that funds allocated
under this contract have been expended in accordance with the terms and conditions of the Federal
Healthy Communities Obesity, Diabetes, Heart Disease and Stroke Prevention 1422 Program Statement
of Work guidelines and any federal terms and conditions that may apply.
Audit Requirements:
An organization that expends $750,000 or more in a year in Federal awards shall have a single or
program -specific audit conducted for that year in accordance with the provisions of Omni Circular. The
audit must be completed along with a data collection form, and the reporting package shall be
submitted within the earlier of 30 days after receipt of the auditor's report(s), or nine months after the
end of the audit period. The audit report must be sent to Federal Audit Clearing House; Bureau of the
Census; 1201 East 10`h St; Jeffersonville, IN 47132.
All duly authorized auditors or their representatives of the State of Washington and of the CLO, GRANT,
shall have full access and the rights to examine any of these materials during this period, subject to
confidentiality laws and regulations. These records shall be retained for five (5) years.
PARTICIPANT shall adhere to all other Federal Grant requirements.
_Restrictions on Funds (what funds can be used for which activities, not direct payments, etc):
1. Recipients may not use funds for research.
2. Recipients may not use funds for clinical care.
3. Recipients may only expend funds for reasonable program purposes, including personnel, travel,
supplies, and services, such as contractual.
4. Recipients may not generally use HHS/CDC/ATSDR funding for the purchase of furniture or
equipment. However, if equipment purchase is integral to a selected strategy, it will be
considered. Any such proposed spending must be identified in the budget.
5. Recipients may not use funding for construction.
6. The direct and primary recipient in a cooperative agreement program must perform a
substantial role in carrying out project objectives and not merely serve as a conduit for an award
to another party or provider who is ineligible.
7. Reimbursement of pre -award costs is not allowed.
8. Recipients may not use funds for abortions in accordance with Executive Order 13535.
If requesting indirect costs in the budget a copy of the indirect cost rate agreement is required. If the
indirect cost rate is a provisional rate, the agreement should be less than 12 months of age. As per Omni
Circular if participant has never had a negotiated indirect rate they can request 10% de minimis rate.
Agreement Alterations and Amendments
GRANT and PARTICIPANT may mutually amend this agreement. Such amendments shall not by binding
unless they are in writing and signed by personnel authorized to bind PARTICIPANT and GRANT.
Interagency Agreement - Kittitas Amendment#1
11/20/15
Page 3
Indemnification
Each party shall defend, protect and hold harmless the other party from and against all claims, suits
and/or actions arising from any negligent or intentional act or omission of that party's employees,
agency and/or authorized subcontractor (s) while performing this contract.
Termination
Except as otherwise provided in this agreement, either party may terminate this agreement upon 90
days written notification. If this agreement is so terminated, the termination party shall be liable only
for performance in accordance with the terms of this agreement for performance rendered prior to the
effective date of termination.
Administrator
Pursuant to RCW 39.34.030(4)(a), the administrator for this agreement shall be Theresa Adkinson of the
Grant County Health District. Nothing in this agreement shall be deemed to establish a separate legal
entity to conduct the cooperative undertaking described herein.
Property
Unless otherwise specifically agreed by the parties in writing, all property, personal and real, utilized by
the parties hereto in the execution of this Agreement shall remain the property of that party initially
owning it.
Notice
All notices, reports, and correspondence to the respective parties of this Agreement shall be sent to the
following:
To GRANT: Grant County Health District
1038 W. Ivy St.
Moses Lake, WA 98837
Primary Contact: Theresa Adkinson, Administrator
To PARTICIPANT: Kittitas County Public Health Department
507 N Nanum St. # 102
Ellensburg, WA 98926
Primary Contact: Robin Read, Administrator
Savings
Interagency Agreement — Kittitas Amendment#1
11/20/15
Page 4
In the event that funding from state or federal funds is withdrawn, reduced, or limited in any way after
the effective date of this contract and prior to normal completion, GRANT may terminate the contract
under the "termination" clause, or reduce to the new funding limitations and conditions.
Disputes
In the event that a dispute arises under this agreement, it shall be determined in the following manner:
GRANT shall appoint a member to the Dispute board. PARTICIPANT shall appoint a member to the
Dispute board. GRANT and PARTICIPANT shall jointly appoint a member to the Dispute Board. The
Dispute Board shall evaluate the dispute and make a determination of the dispute. The determination
of the Dispute Board shall be final and binding on the parties hereto.
Filin
Pursuant to RCW 39.34.040, this Agreement shall be shall be filed with the county auditor of the parties
hereto or, alternatively, listed by subject on a public agency's web site or other electronically retrievable
public source of the parties hereto.
§200.331 requirements for pass-through entities:
Refer to Exhibit "B".
All Writings contained herein
This agreement contains all the terms and conditions agreed upon by the parties. No other
understandings, oral or otherwise, regarding the subject matter of this agreement shall be deemed to
exist or to bind any of the parties hereto.
IN WITNESS WHEREOF, the parties have executed this agreement.
Kittitas County Public Health Department Grant County Health District
Signature
Robin Read. Administrator
(Print)
Date
Signature
Theresa Adkinson. Administrator
(Print)
Date
Interagency Agreement — Kittitas Amendment#1
11/20/15
Page 5
EXHIBIT "A"
Funding Information:
Chart. of Accounts Program
CFDA It
BARS
Funding Period
Current
Change
Total
Name or Title
Sep 29,
Revenue
(LHJ Use Only)
Consideration
:Increase
Consideration
actual expenditures,
Code
Start End Date
Sep 29,
not to exceed total
following month
2016
Date
Monthly
State and Local Public
93.757
333.93.75
01/01/15
09/29/16
18,500
actual expenditures,
20,203
Health Actions to Prevent
by 8`h of the
Sep 29,
not to exceed total
(Component 41)
following
2016
Obesity, Diabetes, Heart
month
9,500
Disease and Stroke financed
solely by 2014 Prevention
and Public Health Funds
State and Local Public
93.757
333.93.75
09/30/15
09/Z9/1
0
20,500
20,500
Health Actions to Prevent
Obesity, Diabetes, Heart
Disease and Stroke financed
solely by 2014 Prevention
and Public Health Funds
TOTALS
116,500
1 22,203
1 40,703
* Only $10,703 of the $18,500 original consideration was bMed (thus $7,797 expired). Hovvever,
we have budgeted an, additional $9,500 from carry over request which nets to an increase of
$1,703 to year 1 funds.
Billing Information:
All A-19 Invoice billings with original signatures and detailed documentation attached are to be sent to
Grant County Health District 1038 W Ivy Ave Suite 1, Moses Lake WA 98837 attn: Ryan Brimacombe.
Please indicate the costs for each separate component on your A-19.
Billings should be submitted monthly within 30 days after the close of a month. Exception: For the
month after a funding source's expiration date please have the billing submitted within 25 days after the
close of the month.
Statement of Work Information:
Tas
k #
Basle/Activity/l3eseripti®n
Deliverables/
Outrornes
Due
Date/
1lrne
Frame
Payment Information
and/or Amount
Work with a retail or community venue to strengthen healthier
Monthly
Sep 29,
Reimbursement for
1
food access by increasing availability, improved pricing, placement,
progress report
X815
actual expenditures,
and promotion. (Component #1—PS2)
by 8u of the
Sep 29,
not to exceed total
following month
2016
funding consideration
Monthly
Sep 29,
Reimbursement for
Work with up to two worksites to promote physical activity through
progress report
20i5
actual expenditures,
2
signage, worksite policies, and shared use/joint use agreements.
by 8`h of the
Sep 29,
not to exceed total
(Component 41)
following
2016
funding consideration
month
Interagency Agreement — Kittitas Amendment#1
11/20/15
Page 6
Line Item Budgg�a
Kittitas Budget
Description
Comp#1
(yr 1 funds)
Due
Comp#1
(yr 1 funds
no cost
extension)
Tas
Task/Activity/I)escripti®n
Deliverables/
®ate/
Payment Information
k #
Outcomes
Time
and/or Amount
Salaries
Frame
296
1,365
Assist Community Choice, Grant County Health District, and
Monthly
Sep 29,
Reimbursement for
Benefits
Washington State Dept of Health to provide linkages for Comp #2
progress report
7015
actual expenditures,
3
strategies 9-15 by engaging multi -sector community stakeholders,
by 8th of the
Sep 29,
not to exceed total
health systems, existing coalitions and community based resources
following
2016
funding consideration
2,800
to prevent obesity, diabetes, heart disease, and stroke, (Comp #2)
month
404
2,085
Line Item Budgg�a
Kittitas Budget
Description
Comp#1
(yr 1 funds)
Comp#2
(yr 1 funds)
Comp#1
(yr 1 funds
no cost
extension)
Corp#2
(yr 1 funds
no cost
extension)
Comp#1 (yr 2
Bands)
Cone#2 (yr 2
funds)
Total
DIRECT;
Salaries
6,041
296
1,365
4,040
6,415
4,335
22,492
Benefits
2,328
108
520
1,534
2,438
1,649
8,577
Goods & Services (includes
travel & Kittitas Hospital)
200
200
2,200
200
2,800
Total Direct Costs:
8,359
404
2,085
5,774
11,053
6,184
33,869
INDIRECT:
Overhead (22% of Salaries &
Benefits)
1,841
89
415
1,226
1,947
1,316
6,834
Total Funding
10,210
493
2,500
7,000
13,000
7,500
49,793
Funding Source ex irativn
93.757 (Sep 29, 2015)
93.757 (Sep 29, 2016)
93.757 (Sep 29, 2016)
1
42121
Interagency Agreement - Kittitas Amendment#1
11/20/15
Page 7
Form
A19-
7ev
(Rev.
5191)
Agency Use Only
State of Washington
INVOICE VOUCHER Agency No. Locedon Code
AGENCY NAME
Grant County Health District
1038 W Ivy Ave
Moses Lake, WA 98837
VENDOR OR CLAIMANT (Warrant is to be payable to)
Month
Salaries
Benefits
Goods & Services
Indirect Costs
Total
Prepared by
1422 Year 1 Car Over Funds
Comp #2
Comp #1 (YR11) (YR1
Phone # I Date
INSTRUCTIONS TO VENDOR OR CLAIMANT:
Submit this form to claim payment for materials, merchandise or services. Show
complete detail for each item.
Vendor's Certificate: I hereby certify under penalty of perjury that the items and
totals listed herein are proper charges for materials, merchandise or services
furnished to the State of Washington, and that all goods furnished andlor services
rendered have been provided without discrimination because of age, sex, marital
status, race, creed, color, national origin, handicap, religion, or Vietnam era or
disabled veterans status.
(Signature)
By
(Name, Title)
1422 Year 2 Funds
Comp #1 (YR2)
Comp #2 (YR2)
Agency Approval
(Date)
Date
Total
Interagency Agreement - Kittitas Amendment#1
11/20/13
Page 8
Exhibit "B": §200.331 requirements for pass-through entities
-
Is this a subaward?
Yes
i
Federal Award Identification
1U58DP005531-01
ii
Subrecipient Name
Kittitas County Public Health Department
iii
Subrecipient DUNS #
01-020-2547
Iv
Federal Award Identification #
1U58DP005531-01
V
Federal Award Date
9/30/2014
Subaward Period of
January 1, 2015 - September 29, 2016 (includes year 1
Vi (yr1)
Performance Start and End Date
carryover funds)
Amount of Federal Funds
Vii (yr1)
Obligated by this action
$182,643 (includes year 1 carryover funds)
Total Amount of Federal Funds
Viii (yr1)
Obligated to the subrec_i_pient
$20,20? (Includes Year 1 Carry over Funds)
Subaward Period of
Vi (yr2)
Performance Start and End Date
September 30, 2015 - September 29, 2016 (year 2 Funds)
Amount of Federal Funds
Vii (yr2) Obligated by this action _
$182,643 (Year 2 Funds)
Total Amount of Federal Funds
Viii (yr2) Obligated to the subrecipient
$20,500 (Year 2 Funds)
Federal award project
State and Local Public Health Actions to Prevent Obesity,
Ix
description
y y Diabetes, Heart Disease and Stroke financed sole b 2014
Prevention and Public Health Funds
x (a)
Name of Federal awarding
agency
Department of Health and Human Services, CDC
Department of Health
x (b)
Pass-through entity
Contact information for
x (c)
awarding official
CFDA # (note dollar amount
Grant County Health District
awarded for this CFDA# in "vii"
xi
above
93.757
Is the award for R&D (research
xii
I and development)?
No
Indirect Cost Rate for
xiii
Subrecipient Award
22% of salaries & benefits
Interagency Agreement - Kittitas Amendment#1
11/20/15
Page 9