HomeMy WebLinkAboutInteragency Agreement GC and KCPHD.pdf (Updated)Kittitas County
Review Form
Grants & Contract Agreement
Today's Date Agenda Date 'J 5\ \lJJ
Fund/Department
116-Public Health
Contract/Grant Information
Contract /Grant Agency: Interagency Agreement Amendment 1 between Grant County and KCPHD
Period Begin Date: January 1, 2015 I I Period End Date: September 30,2017
Total Grant/Contract Amount : 18,728.00
Grant/Contract Number:
Contract/Grant Summary:
The Interagency agreement between Grant County Health District and Kittitas County Public Health
Department 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 tobacco
prevention and control in Central Washington.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature: -,-________ -', Administrator Date: \ flu 1 / V)
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
ice
Date
Signature of Board of Health member Date
Financial Information
Total Amount $7000.00 State Funds $4000.00 Federal Funds $3000.00
Percentage County Funds Matching Funds $ CFDA# 93.758
93.305
Grant/Contract Review Page 1
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? YesD attach budget form No []I Why not
New Division Created? Included in 2016 Budget
Revenue Code
116-612.44.03.333.93.758 -$1000.00
116-612.44.03.333.93.305 -$2000.00
116-612.44.03.334.04.93 -$4000.00
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review
[ Has the Prosecutor reviewed this agreement? [ YesD No D
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Department:
! Date: I Signature:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2
BOARD OF COUNTY COMMISSIONERS
COUNTY OF KITTITAS
STATE OF WASHINGTON
RESOLUTION TO AUTHORIZE THE EXECUTION OF AN AMENDMENT TO AN
INTERAGENCY AGREEMENT BETWEEN THE KITTITAS COUNTY PUBLIC HEALTH
DEPARTMENT AND THE GRANT COUNTY HEALTH DISTRICT
RESOLUTION No. 20 ' -COS
WHEREAS, RCW 39.34, the Interlocal Cooperation Act, provides the capability for public
agencies to cooperate for mutual advantage; and
WHEREAS, Kittitas County, through the Kittitas County Public Health Department, is charged
with the preservation, promotion, and improvement of health in the County; and
WHEREAS, the Kittitas County Public Health Department and the Grant County Health District
previously executed an Interagency Agreement for the purpose of collaborating on priority health
improvement initiatives associated with tobacco prevention and control in Central Washington; and
WHEREAS, the terms and conditions of said Interagency Agreement provided that the parties
may mutually amend the agreement in writing; and
WHEREAS, the Kittitas County Public Health Department and the Grant County Health District
are agreeable to such amendment under the terms and conditions of the amended Interagency Agreement
attached hereto, which shall replace the original Interagency Agreement in its entirety; and
WHEREAS, the Board of County Commissioners of Kittitas County authorized the execution of
this amended Interagency Agreement by action taken at a regular meeting; and
NOW THEREFORE, BE IT HEREBY RESOLVED that the Board of County Commissioners
of Kittitas County, Washington authorizes the Director of the Kittitas County Public Health Department to
execute the amended Interagency Agreement with the Grant County Health District that is attached hereto
and incorporated herein by this reference.
ADOPTEDthis 5f1"daYOf~ 2015.
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY, WASHINGTON !LH-
Ob· . n, ~Chairman
slOner
INTERAGENCY AGREEMENT Amendment #1
Between
GRANT COUNTY HEALTH DISTRICT
And
Kittitas County Public Health Department
January 1, 2015 -September 30,2017
THIS INTERAGENCY AGREEMENT is made and entered into pursuant to Chapter 39.34 RCW, the Inter
local 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 tobacco prevention and control in Central Washington.
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 30, 2017 unless continued by written agreement or terminated
sooner as provided herein.
In consideration whereof:
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.
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
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,JAN 2 6 2016 ~
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 the organization's approved overhead rate. PARTICIPANT need not amend
the budget if they anticipate going over in any line item within 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.
Monitoring of fund allocation spending
There will be two check-in points (1) mid-year and (2) two months before statement of work 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 statement of work deliverables, 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
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 Program Statement of
Work guidelines and any federal terms and conditions that may apply.
Audit Requirements:
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
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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 10th 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 .
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
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
11/6/15 Page 3
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.
All notices, reports, and correspondence to the respective parties of this Agreement shall be sent to the
following address:
To GRANT :
Primary Contact:
To PARTICIPANT:
Primary Contact:
Savings
Grant County Health District
1038 W. Ivy St.
Moses Lake, WA 98837
Theresa Adkinson , Administrator
Kittitas County Public Health Department
507 N Nanum St. # 102
Ellensburg, WA 98926
Robin Read, Administrator
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
ofthe Dispute Board shall be final and binding on the parties hereto.
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
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Pursuant to RCW 39 .34 .040, this Agreement 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
~1hJ\ 11 0 1 10k-,,Ae\\l , ~Ch )
--st{nature Signature
Robin Read. Administrator Theresa Adkinson . Administrator
(Print) \.
l _~IHP
(Print)
Date
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
11/6/15 Page 5
EXHIBIT "A"
Funding Information :
Chart of CFDA# BARS Funding Period Current Change Total
Accounts Revenue (LHJ Use Only) Consideration Increase Consideration
Program Name Code Start Date End Date (+)
or Title
Youth Tobacco N/A 334 .04 .93 01/01/15 06/30/15 5,750 (1 ,294) 4,456
Prevention
FFY14 PHBG 93 .758 333.93 .75 01/01/15 09/30/15 11,750 (4,478) 7,272
CBP Tobacco-
PPHF
FFY15 PHBG 93 .758 333.93 .75 10/01/15 12/30/15 0 1,000 1,000
CBP Tobacco-
PPHF
FFY15 CDC 93 .305 333 .93 .30 03/29/15 03/28/16 0 2,000 2,000
Tobacco
Prevention
Youth Tobacco N/A 334 .04 .93 07/01/15 06/30/16 0 4,000 4,000
Prevention
TOTALS 17,500 1,228 18,728
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.
Line Item Budget:
Kittitas Budget (Oct 1, 2015 -Jun 30, 2016)
Description Budget
DIRECT:
Salaries $2,522
Benefits $963
Goods & Services $2 ,500
Total Direct Costs: $5,985
INDIRECT:
Overhead $1,015
Total Funding $7,000
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
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Statement of Work Information:
Task
Number Task/Activity/Description Deliverables/Outcomes
Goal PREVENT YOUTH FROM INITIATING TOBACCO AND NICOTINE USE
1 Objective 1.1-Enhance community participation
in youth tobacco prevention and control
Participate in quarterly regional partner conference Attendance at meetings and
conference calls . GCHD will calls to discuss work plan progress and network maintain attendance document. with regional partners.
Partner with school districts and local public health
to address tobacco and e-cigarette usage .
-Work with school district teachers, staff
and administration on tobacco Documentation us i ng reporting
education, e-cigarettes/vaping and template provided by GCHD .
current trends , in order to include
electronic cigarettes into school policy
Coordinate CANS assessments with LHJs and
prevention coalitions in at least four communities.
Determine if CANS were done in the
past, send data to the GCH D
-Train youth to conduct CANS assessment
using adult guides and the "How-to"
PowerPoint
Complete 20-30 new CANS Assessments
and return data to GCHD . . Work with 1-2 tobacco retailers to :
0 Reduce the number of tobacco
advertisements displayed in the
business .
0 Have a "purchaser birth date" sign
displayed at the cash register . . Assist the youth to:
0 Share CANS findings with at least
1-2 City Council, Board of Health or
other group of elected officials.
0 Recognize outstanding tobacco
retailers and share CANS find ings
through media releases and/or
social media.
1 Objective 1.2-Strengthen school and campus
tobacco-free policies
Provide smoke-free and vape-free col lege campus
technical assistance to regional college and
workplace campuses. Documentation using reporting Work with three local employers to
implement tobacco free poliCies on their template provided by GCHD.
campus .
Partner with the City of Ellensburg Parks and
Recreation to enhance current tobacco free parks
to include vaping and electronic cigarettes .
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
11/6/15
Due Payment
Date/Time Information and/or
Frame Amount
6/30/2016
Reimbursement for
actual expenditures,
6/30/2016 not to exceed total
funding
consideration .
9,l29,l2G15
6/30/2016
9,l29,l2m5
6/30/2016
6/30/2016
Page 7
Form
A19-1A
(Rev . 5191)
State of Washington
INVOICE VOUCHER
AGENCY NAME
Grant County Health District
1038 W Ivy Ave
Moses Lake, WA 98837
VENDOR OR CLAIMANT (Warrant is to be payable to)
Month:
Decription Amount
Contract
Goods & Services
Indirect Costs
Total
Prepared by Date
Agency Use Only
Agency Location Code
No.
INSTRUCTIONS TO VENDOR OR CLAIMANT:
P.R. or
Auth. No.
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 and/or services rendered have been provided without
discrimination because of age, sex, marital status, race, creed, color,
national or igin, handicap, religion, or Vietnam era or disabled veterans
status.
(Signature)
By
(Title) (Date)
I Agency Approval I Date
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
11/6/15 Page 8
-
i
ii
iii
iv
v
vi
vii
viii
ix
x (a)
x (b)
x (c)
xi
xii
xiii
Exhibit "B"· §200 331 reauirements for Dass-throul!h entities
Is this a subaward? Yes Yes
Federal Award Identification #'s B010T009058 B010T009058
Subrecipient Name Kittitas County Public Health
Subrecipient DUNS # 01 -0202547
Federal Award Identification # B010T009058 B010T009058
Federal Award Date 7/2/2014 3/23/2015
Subaward Period of January 1, 2015 -September October 1, 2015 -December
Performance Start and End Date 30,2015 30,2015
Amount of Federal Funds $11,250
Obligated by this action $45,000
Total Amount of Federal Funds $1,000
Obligated to the subrecipient $7,272
Federal award project FFY15 PHBG CBP Tobacco-
description FFYl4 PHBG CBP Tobacco-PPHF PPHF
Name of Federal awarding Department of Health and Department of Health and
agency Human Services, CDC Human Services, CDC
Pass-through entity Department of Health Department of Health
Contact information for Grant County Health District
awarding official Grant County Health District
CFDA # (note dollar amount 93 .758
awarded for this CFDA# in "vii"
above 93.758
Is the award for R&D (research No
and development)? No
Indirect Cost Rate for 40 .25% of salaries
Subrecipient Award
Youth Tobacco Interagency Agreement -Kittitas Amendment#l
11/6/15
Yes
U58DP006004
U58DP006004
3/23/15
March 29, 2015 -March 28,
2016
$25,000
$2,000
FFY15 CDC Tobacco Prevention
Department of Health and
Human Services, CDC
Department of Health
Grant County Health District
93.305
No
Page 9