The URL can be used to link to this page

Home My WebLink AboutInteragency YMPEP 16-81. r' Y• yi.\ Kittitas County Review Form 1--- -- -_ Grants & Contract Agreement Today's Date 05/18/2016 Fund/Department 116 -Public Health Contract/Grant Information Agenda Date Contract /Grant Agency: Interagency Agreement #16-81 for Youth Marijuana Prevention Education Program Period Begin Date: May 10, 2016 Total Grant/Contract Amount: Maximum of $5000.00 Grant/Contract Number: 16-81 Contract/Grant Summary: Period End Date: June 30, 2016 The Interagency Agreement is entered into between Walla Walla County Department of community Health and Kittitas County that provides a mechanism for the completion of deliverables and transfer of funds necessary to complete a needs assessment for Kittitas County. 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 Comment: APPROVED AS TO FORM: Signature of Prosecutor's Office Date Signature of Auditor's Office Date Signature of Board of Health member Date Financial Information Total Amount $5000.00 Percentage County Funds State Funds $5000.00 Matching Funds $ Federal Funds $ CFDA# Grant/Contract Review Page 1 In -Kind $ 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? New Division Created? Revenue Code 116-612.91.334.06.902 - $5000 Yes ❑x attach budget form No ❑ Why not Will enter in budget center Pass Through Information Agency to Pass Through Amount to Pass Through $ Sub -Contract Approved Date: Prosecutor Review Has the Prosecutor reviewed this agreement? County Departments Impacted_ Auditor _ Information Services Prosecutor Submitted Signature: Department: Assignment of Tra Auditor's Office Human Resource Prosecutor's Office Who Signed the Pranl Information application Yes ❑ No ❑ Facilities Maintenance Human Resource Treasurer Reviewer Date Grant/Contract Review Page 2 Interagency Agreement #16-81 for Youth Marijuana Prevention Education Program May 10, 2016 — June 30, 2016 THIS INTERAGENCY AGREEMENT is made and entered into by and between WALLA WALLA COUNTY DEPARTMENT OF COMMUNITY HEALTH, herein after referred to as "WWCDCH" and KITTITAS COUNTY herein after referred to as KITTITAS COUNTY. WHEREAS, ESD 105 is the fiscal agent for the Youth Marijuana Prevention Education Program (YMPEP) funded through a State grant from the Washington State Department of Health, WWCDCH is contracted with ESD 105 to provide a needs assessment for the ten counties within the Greater Columbia Accountable Communities of Health (GCACH). It is the purpose of this agreement to provide a mechanism for the completion of deliverables and transfer of funds necessary to complete a needs assessment for each county within the Greater Columbia Accountable communities of Health as required by YMPEP. WWCDCH and the KITTITAS COUNTY HEALTH DEPARTMENT HEREBY AGREE to the following terms and conditions: 1.0 KITTITAS COUNTY HEALTH DEPARTMENT RESPONSIBILITIES KITTITAS COUNTY HEALTH DEPARTMENT agrees to: • Complete a needs assessment tetnplate, provided by WWCDCH specific to KITTITAS COUNTY HEALTH DEPARTMENT which will include: o 2014 Healthy Youth Survey 10"' Grade School District data. Additional data may include but not limited to the following local sources: o law enforcement o state and local poison control o hospital emergency room o EMT o pediatricians/primary health providers o local substance abuse coalitions • Implement an electronic survey provided by WWCDCH to universities, community colleges, trade schools and employers who serve the 18-20 year old population within KITTITAS COUNTY. • Return the completed needs assessment template to WWCDCH by date requested KITTITAS COUNTY HEALTH DEPARTMENT is responsible for the implementation and monitoring of the project. KITTITAS COUNTY HEALTH DEPARTMENT agrees to follow all applicable statutes and regulations. #16-81 Kittitas County Health Department YMPEP Page 1 of 4 KITTITAS COUNTY HEALTH DEPARTMENT agrees to hold WWCDCH 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 fiords. 2.0 BILLING AND PAYMENT The KITTITAS COUNTY HEALTH DEPARTMENT agrees to submit required deliverables as detailed in item 1.0. WWCDCH will reimburse the actual approved expense of the KITTITAS COUNTY HEALTH DEPARTMENT up to a MAXIMUM OF $5000. Allowable expenses are for reasonable program purposes, including personnel, travel and supplies. 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 June 10, 2016. WWCDCH shall not be responsible for any Invoices received after July 11, 2016. 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 KITTITAS COUNTY HEALTH DEPARTMENT and KITTITAS COUNTY HEALTH DEPARTMENT's employees and agents shall perform all duties pursuant to this Contract as an independent contractor. WWCDCH shall not control or supervise the manner in which this Contract is performed nor withhold or pay any taxes on behalf of the KITTITAS COUNTY HEALTH DEPARTMENT or the KITTITAS COUNTY HEALTH DEPARTMENT's employees or agents. #16-81 Kittitas County Health Department YMPEP Page 2 of 4 5.0 INDEMNIFICATION Any and all claims which hereafter arise on the part of any and all persons as a direct or indirect result of the KITTITAS COUNTY HEALTH DEPARTMENT or the KITTITAS COUNTY HEALTH DEPARTMENT's employees or agents performance or failure to perform duties pursuant to this Contract, shall be the KITTITAS COUNTY HEALTH DEPARTMENT's sole obligation, and the KITTITAS COUNTY HEALTH DEPARTMENT shall indemnify and hold harmless WWCDCH. 6.0 SUSPENSION AND DEBARMENT The KITTITAS COUNTY HEALTH DEPARTMENT 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 WWCDCH for the purposes of this agreement are not made available to the WWCDCH for any reason whatsoever. Either party may terminate this agreement with written notice to the other party prior to June 10, 2016. 8.0 VERBAL AGREEMENTS This written Contract constitutes the mutual agreement of the KITTITAS COUNTY HEALTH DEPARTMENT and WWCDCH 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 benefits of, or be otherwise subjected to discrimination under activities performed pursuant to this Contract. #16-81 Kittitas County Health Department YMPEP Page 3 of 4 11.0 EFFECTIVE DATE - DURATION This Contract shall commence on the 12"' day of May 2016, and shall terminate at midnight on the 30`x' day of June 2016, regardless of the date of execution. Section 5.0 (Indemnification) which shall continue to bind the parties their heirs and successors after June 30, 2016. IN WITNESS WHEREOF, WWCDCH and KITTITAS COUNTY HEALTH DEPARTMENT have executed this Contract consisting of four pages and attachments. WALLA COUNTY DEPARTMENT OF COMMUNITY HEALTH COUNTY COMMISSIONER TITLE DATE Who certifies he/she is a person duly qualified and authorized to bind the WWCDCH so identified in the foregoing Contract. KITTITAS COUNTY HEALTH DEPARTMENT BY: ROBIN READ ADMINISTRATOR TITLE DATE #16-81 Kittitas County Health Department YMPEP Page 4 of 4 Expenditure Report Form (ERF) INSTRUCTIONS TO VENDOR OR CLAIMANT: STATEMENT FOR SERVICES - Claim payment for materials, merchandise or services. Show complete detail for each Ilam, Vendor's Certificate. I hereby certify under penalty of perjury that Submit this form to Contractor: the items and totals listed herein are proper charges for materials, merchandise or County of Walla Walla, Washington services furnished to the County of Walla Walla and that all goods furnished and/or services rendered have been provided without discrimination because of age, sex, marital status, race, creed, color, national origin, handicap, religion, or Vietnam era Department of Community Health or disabled veterans status and the claim is Just, due and unpaid obligation against the PID Box 1753 Countyof Walla Walla and that I am authorized to authenticate and certify to said claim. Walla Walla, WA 99362 CLWIIIIANT.; ; - BY: Kittitas County Health Department (SIGN IN INK) 507 N. Nanum St. Suite 102 (TITLE) toAte} Ellensburg WA 98926 Program: YMPEP Agreement Number: #16.81 Claim Period: DATE _ _ - _ DESCRIPTION OF SERVICES AMOUNT $2,000.00 Completed needs assessment template provided by WWCDCH with 10th grade 2014 data Implemented electronic survey provided by WWCDCH to institutions of higher learning who serve the 18-20 year old population $1,500.00 Return completed needs assessment template to WWCDCH $1,500.00 _ -_ -- -- _ _ - - -- = TOTALPAYMENTREQUESTED WITH THIS ERF; $5000.00 PREPARED BY TELEPHONE NUMBER DATE FOR COUNTY FINANCE USE ONLY BOE NUMBER UFfI NUMdEk FUND Code Distribution .............. .... ACCOUNTING APPROVAL FOR PAYMENT iOATE WARRANT TOTAL $5,000.00 WARRANTNUMSER rrur►r]