Agenda - Thurston County

Transcription

Board of County Commissioners
Cathy Wolfe , District 1  Sandra Romero , District 2  Bud Blake , District 3
Agenda for Meeting Date:
Tuesday, January 6, 2015
Summary of Timed Items
2:00 p.m.)
Call Meeting to Order
2:05 p.m.)
Election of 2015 BoCC and BOH Officers
2:00 p.m.) Call Meeting to Order

Pledge of Allegiance to be led by Commissioner Wolfe

Approval of the Tuesday, January 6, 2015 Agenda

Approval of the Board Meeting Minutes from: December 16, 2014
2:05 p.m.) Commissioners Item
Dept: Commissioners
Description: Election of Officers for 2015
Contact: Cliff Moore, County Manager
File Attachment
Action: Election of 2015 officers for the Board of County
Commissioners.
1)
Opportunity for the Public to Address the Board
2)
County Manager's Update
a)
Item Description: Follow-up on citizen issues
b)
Item Description: Other current issues
Thurston County - Board of County Commissioners Agenda
Page 1 of 5
3)
Consent Item(s) "a" through "h"
a)
Dept: Public Works
Description: A resolution increasing the full time
equivalency of position 34R01002 in the
Thurston County Pay and Classification Pay
Plan.
Contact: Ramiro Chavez, Director
BoCC-AIS-2015-01-06HumanResourcesNadineSordahl-1619.pdf
Adobe Acrobat Document
71.0 KB
Action: Move to approve the resolution increasing the
full time equivalency of position 34R01002
Education and Outreach Specialist I from 0.75
FTE to 1.0 FTE in the Thurston County Pay and
Classification Pay Plan.
b)
Dept: Emergency Services
Description: Resolution for Disposal of Excess County
Equipment (medic vehicles)
Contact: Fay Flanery, Administrative Assistant II
Action: Move to approve a resolution declaring a 2004
Ford E-450 and a 2007 Ford E-450
Ambulances as excess County property, and to
dispose of same to City of Olympia
and Thurston County Fire District 17 (Bald
Hills), respectively.
c)
Dept: Commissioners
Description: Contract Amendments for Foster Pepper, Bond
Counsel and The PFM Group, Financial Advisor,
assignee of SDM Ad visors.
Contact: Robin Campbell, Assistant County Manager
Action: Move to approve and authorize extending the
term of the contracts for Foster Pepper, Bond
Counsel and PFM Group, Financial
Advisor, assignee of SDM Advisors, ending
December 31, 2015.
d)
Dept: Public Health and Social Services
Description: Approval of Program Agreement #1163-27329
Amendment #10 with the State of Washington
Department of Social and Health Services
Contact: Diana Cockrell, Social Services Program
Specialist I
Action: Move to approve Amendment #10 to Contract
No.1163-27329 with State of Washington
Department of Social and Health Services,
decreasing the contract by $60,000, for a
revised total maximum contract amount of
$11,631,503 for the amended period of
November 1, 2014 through June 30, 2015
and authorize the Director of Public Health and
Social Services to sign the amendment.
BoCC-AIS-2015-01-06EmergencyServicesFayFlanery-1507.pdf
93.3 KB
BoCC-AIS-2015-01-06CommissionersTawniSharp-0854.pdf
186 KB
BoCC-AIS-2015-01-06PublicHealthandSocialServ
ices-TinaGehrig-1407.pdf
323 KB
Page 2 of 5
e)
Dept: Commissioners
Description: Reappointment to the Agriculture Advisory
Committee
Contact: LaBonita Bowmar, Administrative Assistant II
Action: Move to reappoint Robert McIntosh to the
Agriculture Advisory Committee, farmer
member, for the term beginning September
30, 2014 and ending September 30, 2016.
f)
Dept: Commissioners
Description: Reappointment to the Thurston County Historic
Commission
Contact: LaBonita Bowmar, Administrative Assistant II
Action: Move to reappoint Daniel Shaw, district 1
member, to the Thurston County Historic
Commission for the term beginning January
31, 2015 and ending January 31, 2019.
g)
BoCC-AIS-2015-01-06CommissionersDanielleWestbrook1027.pdf
49.2 KB
BoCC-AIS-2015-01-06CommissionersDanielleWestbrook1323.pdf
49.5 KB
Dept: Public Health and Social Services
Description: Approval of the State of Washington
Department of Social and Health Services
contract No.1363-90047 Amendment No.2
Contact: Diana Cockrell, Social Services Program
Specialist I
BoCC-AIS-2015-01-06PublicHealthandSocialServ
ices-TinaGehrig-1104.pdf
361 KB
Action: Move to approve Contract #1363-90047
Amendment No.2 with State of Washington
Department of Social and Health Services for
an additional amount of $4,820 for a revised
total maximum contract amount of $199,949
for the amended period of December 1, 2014
through June 30, 2015. Further move to
approve and authorize the Director of Public
Health and Social Services to sign related
subcontracts with TOGETHER! and Mason
County Public Health.
h)
Dept: Auditor - Financial Services
Description: Approval of the Voucher List
File Attachment
Contact: Darren Bennett, Financial Services Division
Manager
Action: Move to approve the voucher list for the weeks
of December 23 and 30, 2014 and January 6,
2015.
Page 3 of 5
Department Items
4)
Public Health and Social Services
a)
b)
Description: Approval of a Interfaith Works - Sidewalk
Program Housing contract amendment
Contact: Gary Aden, Social Services Program Specialist
III
Action: Move to approve an amendment to Interfaith
Works Sidewalk Program Housing Contract to
provide additional $15,000 to support rapid
rehousing for single homeless adults for a
revised total maximum contract amount of
$185,000 for the contract duration of
September 1, 2014 through August 31, 2015.
Description: Approval of Washington State Department of
Health 2015-2017 Consolidated Contract
#C17129
Contact: Don Sloma, Director
Action: Move to approve the State of Washington
Department of Health 2015 – 2017
Consolidated Contract #C17129 for a
maximum consideration not to exceed
$379,736 for the duration of January 1, 2015
through December 31, 2017 and authorize the
Director of Public Health and Social Services to
sign the contract.
5)
BoCC-AIS-2015-01 -06PublicHealthandSocialServ
ices-LydiaHodgkinson1445.pdf
214 KB
File Attachment
BoCC-AIS-2015-01 -06PublicHealthandSocialServ
ices-LydiaHodgkinson0947.pdf
1.12 MB
Commissioners' and County Manager Items
a)
Description: 2015 South Sound Military and Communities
Partnership Memorandum of Agreement
Contact: Cliff Moore, County Manager
Action: Move to approve the 2015 South Sound
Military and Communities Partnership
Memorandum of Agreement and authorize the
county manager to execute the agreement.
BoCC-AIS-2015-01 -13CommissionersCliffMoore-0852.pdf
309 KB
Page 4 of 5
b)
Item Description:
Commissioners will report on board work sessions and assigned committee meetings
providing updates on actions taken as well as upcoming issues.
c)
Item Description:
The County Manager will review the Board of County Commissioners schedule for the
week of January 06, 2015 .
d)
Item Description:
Adjournment - Motion: Move to adjourn the Board of County Commissioners meeting of
January 06, 2015 .
Page 5 of 5
AGENDA ITEM SUMMARY
Date Created: 12/17/2014
Agenda Date: 01/06/2015
Created by:
Presenter:
Agenda Item #: 3a
Nadine Sordahl, Human Resources Specialist - Human Resources - 786-5451
Ramiro Chavez, Director - Public Works - 867-2271
Item Title:
Public Works - A resolution increasing the full time equivalency of position 34R01002 in
the Thurston County Pay and Classification Pay Plan.
Action Needed: Pass Resolution
Class of Item: Consent
List of Exhibits
Resolution -PW Increase
FTE EOS I.doc
Microsoft Word 97 2003 Document
34.0 KB
c PAO
d
e
f
g
g Budget Office
c
d
e
f
Notes:
c FinSvcs
d
e
f
g
b HR
c
d
e
f
g
c CAO
d
e
f
g
c Other
d
e
f
g
Recommended Action:
Move to approve the resolution increasing the full time equivalency of position 34R01002 Education
and Outreach Specialist I from 0.75 FTE to 1.0 FTE in the Thurston County Pay and Classification Pay
Plan.
Item Description:
Public Works Solid Waste Division is requesting to change a 0.75 Full Time Equivalency (FTE) Education
and Outreach Specialist I position to a 1.0 FTE position. Since the incep tion of this position as 0.75 FTE
the work load has transitioned and expanded considerably. This position is the primary steward of the
Food 2 Flowers school organics programs throughout the county. Each year, additional schools are
seeking assistance from county waste reduction staff for the purpose of reducing compostables and
other recyclables from their disposal waste stream in the manner of setting up cafeteria food waste
collection programs, providing classroom presentations, evaluating waste streams through waste sorts,
and identifying alternative methods of waste reduction. The additional staffing time will enhance the
ability of the Solid Waste staff to effectively communicate and implement waste reduction programs in
the schools. This position is currently funded by solid waste utility p ublic tipping fees and is funded as
a .75 FTE in the 2015 budget. If approved, a budget amendment will be necessary to fund the
additional 0.25 FTE.
The salary range for the Education and Outreach Specialist I (FTE 0.75) is $3,077 - $4,093 per month
and the salary range for the Education and Outreach Specialist I (FTE 1.0) is $4,102 - $5,457 per
month. The difference between the classifications top salaries is $1,364 or a 33% increase. This
position is funded by solid waste utility public tipping fees.
Date Submitted: 12/18/2014
RESOLUTION NO. ______
A RESOLUTION increasing the full time equivalency of position 34R01002 from 0.75 FTE to 1.0 FTE
in the Thurston County Pay and Classification Pay Plan.
WHEREAS, it has been brought to the attention of the Thurston County Commissioners that the
full time equivalency of position 34R01002, Education and Outreach Specialist I should be increased,
and;
WHEREAS, it has been brought to the attention of the Thurston County Commissioners that the
Thurston County Pay and Classification Pay Plan should be amended as follows;
NOW, THEREFORE, the Board of County Commissioners of Thurston County, State of
Washington, does resolve as follows:
Section 1. The Thurston County Pay and Classification Pay Plan should be amended as follows:
Office/Department: Public Works
Previous Position
Position No.:
Classification:
Spec. No.:
FTE:
Range:
34R01002
Education & Outreach Specialist I
1351
0.75
12
New Position
Position No.:
Classification:
Spec. No.:
FTE:
Range:
34R01002
Education & Outreach Specialist I
1351
1.0
12
ADOPTED: ____________________________
ATTEST:
BOARD OF COUNTY COMMISSIONERS
Thurston County, Washington
Clerk of the Board
Chair
APPROVED AS TO FORM:
Vice-Chair
Lauren Spurgeon
Interim Human Resources Director
Commissioner
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 3b
Fay Flanery, Administrative Assistant II - Emergency Services - 704-2784
Fay Flanery, Administrative Assistant II - Emergency Services - 70 4-2784
Item Title:
Resolution for Disposal of Excess County Equipment (medic vehicles)
Action Needed: Pass Resolution
List of Exhibits
Surplus resolution
excess vehicles.pdf
28.1 KB
g PAO
b
c
d
e
f
c Budget Office
d
e
f
g
Notes:
g FinSvcs
c
d
e
f
g HR
c
d
e
f
c CAO
d
e
f
g
c Other
d
e
f
g
Recommended Action:
Move to approve a resolution declaring a 2004 Ford E-450 and a 2007 Ford E-450 Ambulances as
excess County property, and to dispose of same to City of Olympia and Thurston County Fire District
17 (Bald Hills), respectively.
Item Description:
Medic One is requesting the Board of County Commissioners to declare a 2004 Ford E-450 and a 2004
Ford E-450 Ambulances (emerg ency medical response vehicles) as unnecessary to the needs of the
County. These vehicles, issued new to a Thurston County Advanced Life Support (ALS) contract agency,
have been utilized as both primary and secondary paramedic vehicles d uring their ALS life span. These
vehicles have exceeded their useful economical and reliable life as paramedic vehicles. As it has been
determined to be more economically feasible to replace rather than remount the vehicle, replacement
ALS vehicles have been purchased and are now in service.
During their 2014 ‘disposal process’, the EMS Council's Operations Committee reviewed, evaluated and
prioritized applications from interested Thurston County fire agencies, for medic vehicles anticipated to
be declared as excess property. At their meeting of July 16, 2014, the EMS Council accepted the
recommendation of the Operations Committee for ap proval of disposal of excess medic vehicles to: City
of Olympia and Thurston County Fire District 17 (Bald Hills).
Surplus of these vehicles are in accordance with Medic One’s ALS vehicle equipment repair and
replacement schedule. By utilizing these vehicles as a transport capable aid vehicles, the citizens of
Thurston County will continue to realize a substantial benefit from the Medic One System.
RESOLUTION NO. _______________
A RESOLUTION relating to the disposal of a 2004 and a 2007 Ford Ambulances (medic units), to City of Olympia and
Thurston County Fire District 17 (Bald Hills), respectively:
WHEREAS, it has come to the attention of the Board of County Commissioners of Thurston County that property described
herein below is unnecessary to the needs of the County and should be disposed of to City of Olympia and Thurston County
Fire District 17 (Bald Hills), respectively; and
WHEREAS, pursuant to RCW 36.34.130, the Board of County Commissioners may dispose of county property to another
governmental agency; and
WHEREAS, the Emergency Medical Services Operations Committee solicited applications from all fire agencies within
Thurston County for the vehicles; and
WHEREAS, the EMS Council and the Operations Committee reviewed the applications, taking into consideration amongst
other criteria, the availability and condition of the applicant's current equipment, and the EMS run volume in the applicant's
service area; and
WHEREAS, it was determined by the EMS Council and Operations Committee that the emergency medical needs of the
citizens of Thurston County would best be served by disposing of the vehicle to City of Olympia and Thurston County Fire
District 17 (Bald Hills), respectively; and
WHEREAS, the Board of County Commissioners of Thurston County have determined that delivery of emergency medical
services will be improved by disposing of the vehicles to City of Olympia and Thurston County Fire District 17 (Bald Hills),
respectively;
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF THURSTON COUNTY, STATE OF
WASHINGTON, as follows:
The following described property belonging to Thurston County is hereby disposed of, as designated:
CITY OF OLYMPIA 2004 FORD AMBULANCE
(MEDIC VEHICLE)
THURSTON COUNTY FIRE DISTRICT 17 (BALD HILLS) 2007 FORD AMBULANCE
(MEDIC VEHICLE)
VIN NO. 1FDXE45F93HB08297
VIN NO. 1FDXE45P37DA64397
LICENSE NO. 70244C
LICENSE NO. 84385C
ADOPTED:________________________________
ATTEST:
________________________________
Clerk of the Board
_______________________________________
Chair
APPROVED AS TO FORM:
JON TUNHEIM
_______________________________________
PROSECUTING ATTORNEY
Commissioner
________________________________________
By:
Rick Peters
Deputy Prosecuting Attorney
_______________________________________
Commissioner
RESOLUTION
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 3c
Tawni Sharp , Senior Management Analyst - Commissioners - 754-3355, ext. 6219
Robin Campbell, County Manager, Assistant - Commissioners - 709-3063
Item Title:
Contract Amendments for Foster Pepper, Bond Counsel and The PFM Group, Financial
Advisor, assignee of SDM Advisors.
Action Needed: Pass Motion
List of Exhibits
Contract amendment
Foster Pepper 2014.doc
32.0 KB
Contract amendment
SDM Advisors4 to PFM
2014.doc
33.5 KB
Recommended Action:
Move to approve and authorize extending the term of the contracts for Foster Pepper, Bond Counsel
and PFM Group, Financial Advisor, assignee of SDM Ad visors, ending December 31, 2015.
Item Description:
On May 28, 2009 staff presented the Board with contracts for services provided by Foster Pepper, Bond
Counsel, and PFM Group, Financial Advisor, assignee of SDM Advisors for the 2009 debt issuance. Both
contracts end December 31, 2014. Provided that the parties mutually agree to extend the term of the
contracts on a year to year basis until December 31, 2015, they may do so by attaching an amendment
to the original contract. Staff would like to continue to work with both contractors for legal and financial
advice related to past and future bond sales.
PROFESSIONAL SERVICES CONTRACT
THURSTON COUNTY / NANCY NERAAS c/o FOSTER PEPPER PLLC
AMENDMENT NO. 4
This CONTRACT AMENDMENT is made and entered into between THURSTON
COUNTY, a municipal corporation, with its principal offices at 2000 Lakeridge Drive S.W.,
Olympia, Washington 98502, hereinafter “COUNTY,” and NANCY NERAAS c/o FOSTER
PEPPER PLLC, a private corporation, with its principal offices at 1111 Third Avenue Suite
3400, Seattle, WA 98101-3299, hereinafter “CONTRACTOR.”
In consideration of the mutual benefits and covenants contained herein, the parties
agree that their Contract, numbered as Contract No. 50963586.1, executed on May 28, 2009,
shall be amended as follows:
1.
DURATION OF CONTRACT shall be amended to read: The term of this Contract
shall be extended until December 31, 2015.
2.
CONTRACT REPRESENTATIVES shall be amended to read:
b. For COUNTY:
Name of Representative: Robin Campbell
Title: Budget & Fiscal Manager
Mailing Address: 2000 Lakeridge Drive SW
City, State & Zip Code: Olympia, WA 98502-6045
Telephone Number: 360-709-3063
Fax Number: 360-754-4104
E-mail Address: [email protected]
3.
Contract No.
10/29/13
Except as expressly provided in this Contract Amendment, all other terms and
conditions of the original Contract remain in full force and effect.
Executed in duplicate originals this 6th day of January 2015.
CONTRACTOR:
For
Firm: FOSTER PEPPER PLLC
By: NANCY NERAAS
By:
Signature:
(Authorized Representative)
Title: Commissioner, Chair
Title:
Address: 1111 Third Avenue Suite 3400
Seattle, WA 98101-3299
Approved As To Form:
JON TUNHEIM
BY:
Contract No.
10/29/13
PROFESSIONAL SERVICES CONTRACT
THURSTON COUNTY / PUBLIC FINANCIAL MANAGEMENT, INC. (PFM)
AMENDMENT NO. 4
This CONTRACT AMENDMENT is made and entered into between THURSTON
COUNTY, a municipal corporation, with its principal offices at 2000 Lakeridge Drive S.W.,
Olympia, Washington 98502, hereinafter “COUNTY,” and PFM GROUP, assignee of SDM
ADVISORS, a private corporation, with its principal offices at 1200 Fifth Avenue, Suite 1220,
Seattle, WA 98101, hereinafter “CONTRACTOR.”
In consideration of the mutual benefits and covenants contained herein, the parties
agree that their Contract, numbered as Contract No. 1, executed on October 28, 2008.
1.
DURATION OF CONTRACT shall be amended to read: The term of this Contract
shall be extended until December 31, 2015.
2.
CONTRACT REPRESENTATIVES shall be amended to read:
a. For CONTRACTOR:
Name of Representative: Susan Musselman
Mailing Address: PFM Group
1200 Fifth Avenue, Suite 1220
City, State & Zip Code:
Seattle, WA 98101
b. For COUNTY:
Name of Representative: Robin Campbell
Title: Budget & Fiscal Manager
Mailing Address: 2000 Lakeridge Drive SW
City, State & Zip Code: Olympia, WA 98502-6045
Fax Number: 360-754-4104
Contract No.
10/29/13
3. Except as expressly provided in this Contract Amendment, all other terms and
conditions of the original Contract remain in full force and effect.
Executed in duplicate originals this 6th day of January, 2015.
CONTRACTOR:
For
Firm: PFM Group
By: SUSAN MUSSELMAN
By:
Signature:
(Authorized Representative)
Title: Commissioners, Chair
Title: Director
Address: 1200 Fifth Avenue, Suite 1220
Seattle, WA 98101
Approved As To Form:
JON TUNHEIM
BY:
Contract No.
10/29/13
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 3d
Tina Gehrig, Social Services Program Assistant - Public Health and Social Services 867-2509
Diana Cockrell, Social Services Program Specialist I - Pu blic Health and
Social Services - 867-2511
Item Title:
Approval of Program Agreement #1163-27329 Amendment #10 with the State of
Washington Department of Social and Health Services
List of Exhibits
Amendment #10
DBHR.pdf
222 KB
Org Chart DBHR #10 16-15.pdf
34.1 KB
File Attachment
File Attachment
g PAO
b
c
d
e
f
c Budget Office
d
e
f
g
Notes:
g FinSvcs
c
d
e
f
g HR
c
d
e
f
c CAO
d
e
f
g
c Other
d
e
f
g
Recommended Action:
Move to approve Amendment #10 to Contract No.1163 -27329 with State of Washington Department
of Social and Health Services for a revised total maximum contract amount of $11,631,503 for the
amended period of November 1, 2014 through June 30, 2015 and authorize the Director of Public
Health and Social Services to sign the amendment.
Item Description:
This request is for approval of Amendment #10 to Contract No.1163 -27329 with the State of
Washington Department of Social and Health Services (DSHS) for a decrease of $60,000 for a revised
total maximum contract amount of $11,631,503 for the amended period November 1, 2014 through
June 30, 2015. This red uction in Thurston/Mason County's funding reflects actual exp enditures of
federal funding for the period July 1, 2013 -June 30, 2014.
The services connected to this amendment impact the Thurston Thrives Clinical Care goals of
increasing access to behavioral health services. The money was unspent and returned to the State
after subcontractors were unable to use it due to contracting challenges for childcare and the closure
of a critical service.
2014 Budgeted Revenue
1 State Contracts
$2.5m
2 Federal Contracts
$781k
3 Excise Tax
$32k
4 Treatment Sales Tax
(County) $483k
5 Dedicated Millage
$105k
6 Other
$60k
Thurston Mason
Chemical Dependency Program
$3.9m
Administration
$334K – 3.4 FTE’s
(1,4,5)
Treatment Services
$2.9m
Alternatives
Professional
Counseling
(1)
Outpatient
Jail
Behavioral
Health
Resources
(1,4)
Women’s
Outpatient
Crisis Clinic
(1,2)
Educational
Service
District 113
(1,4,)
Youth
Outpatient
Evergreen
Treatment
Services
(1,2)
Methadone
Northwest
Resources
(1,2,3,4)
Adult
Outpatient
St. Peter
Hospital
(1,2,4)
Adult and
Youth
Outpatient
Sea Mar
(1)
Adult
Outpatient
Syringe
Exchange
Professional
Services
Additional
Expenses
$95k (5,6)
$41k (1)
$501k (1,2)
Continuing
Education
Prevention
Training
Family
Education
and Support
Mason Co
Public
Health
TOGETHER!
Mason Co
Drug Court
Intensive
Case
Management
Budgeted expenditures, actual subcontract amounts may vary
Involuntary
Treatment
Act
Juvenile Drug
Court
Thurston Co
Superior
Court
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 3e
Danielle Westbrook, Commissioner's Assistant - Commissioners - 786-5414
LaBonita Bowmar, Administrative Assistant II - Commission ers - 75 4-3355,
x 6308
Item Title:
Reappointment to the Agriculture Advisory Committee
Action Needed: Other
List of Exhibits
File Attachment
Recommended Action:
Move to reappoint Robert McIntosh to the Agriculture Advisory Committee, farmer member, for the
term beginning September 30, 2014 and ending September 30, 2016.
Item Description:
Because of staff transition in Resource Stewardship, Robert McIntosh's reappointment request was
never formally made. This agenda item backdates his reappointment.
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 3f
Danielle Westbrook, Commissioner's Assistant - Commissioners - 786-5414
LaBonita Bowmar, Administrative Assistant II - Commission ers - 75 4-3355,
x 6308
Item Title:
Reappointment to the Thurston County Historic Commission
Action Needed: Other
List of Exhibits
File Attachment
Recommended Action:
Move to reappoint Daniel Shaw, district 1 member, to the Thurston County Historic Commission for
the term beginning January 31, 2015 and ending January 31, 2019.
Item Description:
Daniel Shaw is requesting reap pointment to the Thurston County Historic Commission.
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 3g
Tina Gehrig, Social Services Program Assistant - Public Health and Social Services 867-2509
Diana Cockrell, Social Services Program Specialist I - Pu blic Health and
Social Services - 867-2511
Item Title:
Approval of the State of Washington Department of Social and Health Services contract
No.1363-90047 Amendment No.2
List of Exhibits
Amendment #2 DBHR
Partnership.pdf
260 KB
Org Chart DBHR #2
partnership 1-6-15.pdf
33.9 KB
b PAO
c
d
e
f
g
g Budget Office
c
d
e
f
Notes:
c FinSvcs
d
e
f
g
c HR
d
e
f
g
c CAO
d
e
f
g
c Other
d
e
f
g
Recommended Action:
Move to approve Contract #1363-90047 Amendment No.2 with State of Washington Department of
Social and Health Services for an additional amount of $4,820.00 for a revised total maximum
contract amount of $199,949 for the amended period of December 1, 2014 through June 30,
2015. Further move to approve and authorize the Director of Public Health and Social Services to
sign related subcontracts with TOGETHER! and Mason County Public Health.
Item Description:
This amendment provides funding for the Shelton Community Prevention and Wellness Initiative (CPWI)
to implement a Secure Medicine Take-b ack Project as part of year 2 funding from the federal
Partnership for Success grant award for substance abuse prevention programs.
The certified prevention professional incentive is reward for a specific TOGETHER! Rainier Cares
Coalition staff who pursued their Substance Use Prevention specialist certification. This portion of the
project is aimed at increasing workforce development, and is for Community Prevention and Wellness
Initiative (CPWI) substance use prevention selected community staff.
The Thurston County portion of this amendment aligns with the Thurston Thrives Child and Youth
Resilience action team strategies to increase protective factors in the communities of Tenino and
Rainier with evidence based prevention programs and professionals to reduce risk factors and problem
behavior in individuals and families so that children are raised in a healthy, safe environment by
strengthening the local prevention workforce.
Contract # 1363-90047
1 State Contracts
$2.5m
2 Federal Contracts
$781k
3 Excise Tax
$32k
(County) $483k
5 Dedicated Millage
$105k
6 Other
$60k
Thurston Mason
Chemical Dependency Program
$3.9m
Administration
$334K – 3.4 FTE’s
(1,4,5)
Treatment Services
$2.9m
Alternatives
Professional
Counseling
(1)
Outpatient
Jail
Behavioral
Health
Resources
(1,4)
Women’s
Outpatient
Crisis Clinic
(1,2)
Educational
Service
District 113
(1,4,)
Youth
Outpatient
Evergreen
Treatment
Services
(1,2)
Methadone
Northwest
Resources
(1,2,3,4)
Adult
Outpatient
St. Peter
Hospital
(1,2,4)
Adult and
Youth
Outpatient
Sea Mar
(1)
Adult
Outpatient
Syringe
Exchange
Professional
Services
Additional
Expenses
$95k (5,6)
$41k (1)
$501k (1,2)
Continuing
Education
Prevention
Training
Family
Education
and Support
Mason Co
Public
Health
TOGETHER!
Mason Co
Drug Court
Intensive
Case
Management
Involuntary
Treatment
Act
Juvenile Drug
Court
Thurston Co
Superior
Court
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 4a
Lydia Hodgkinson, Administrative Assistant II - Public Health and Social Services - 8672503
Gary Aden, Social Services Program Specialist III - Public Health and Social
Services - 867-2532
Item Title:
Approval of a Interfaith Works - Sidewalk Program Housing contract amendment
Class of Item: Department
List of Exhibits
2014 Housing Interfaith
Works Sidewalk
Program contract amend
010615.pdf
169 KB
Recommended Action:
Move to approve an amendment to Interfaith Works Sidewalk Program Housing Contract to provide
additional rapid rehousing funding for single homeless adults for a revised total maximum contract
amount of $185,000. for the contract d uration of September 1, 2014 through August 31, 2015.
Item Description:
The Home Consortium, at their December 2014 meeting approved a request from Interfaith Works Sidewalk Program to provide ad ditional rapid rehousing funding for single homeless adults. This
additional funding will provide additional housing for approximately 10 to 12 homeless adults in
permanent housing.
This is a request to amend Interfaith Works original contract for an additional funding of $15,000 for a
revised total maximum contract amount of $185,000. The funding for this action comes from the
Homeless Housing (2163) contingency fund. The contract duration remains Sep tember 1, 2014 through
August 31, 2015.
Thurston Thrives Housing Strategies ad dressed in this contract include the creation of a cohesive crisis
response system to serve those who are homeless.
2 State
Contracts
$1.1m
1 HUD
(HOME/CDBG)
$2.5m
3 Fees (2060/2163)
$1.7m
4 County/HHSC/Misc
$340k
Housing and Community Renewal
$5.6m
Administration
$503k – 4.0 FTE’s
(1,2,3,4)
Construction
$1.7m
(1,2,3)
O&M
Coordinated Entry
Homeless Coordinater
$526k
Rapid Rehousing
Rental Assistance
$2.3m
Support Services
Shelter
$370k
Social Services
HHSC
$234k
(2,3)
(2,3)
(4)
InterfaithWorks
SideWalk
Family Support Center
Community Action
Council
Community Youth Services
N.W. Resources
Point-InTime
(City of Olympia)
The Salvation Army
Interfaith Works
Overnight Shelter
Community Action
Council
(3)
PANZA
City of Tenino
City of Yelm
Town of Bucoda
HomesFirst!
Habitat for Humanity
Yelm Community Services
Community Action Council
Foundation for the
Challenged
Housing Authority of
Thurston County
Catholic Community
Services
SideWalk
Theresa Slusher
Catholic Community
Services
Yelm Community Services
Housing Authority of
Thurston County
InterfaithWorks
Out of the Woods
PANZA
SafePlace
The Salvation Army
Behavioral Health
Resources
Catholic Community
Services
CHOICE Regional Health
Network
Crisis Clinic
Olympia Free Clinic
SafePlace
Senior Services
Thurston County Food
Bank
YWCA
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #: 4b
Lydia Hodgkinson, Administrative Assistant II - Public Health and Social Services - 8672503
Don Sloma, Director - Public Health and Social Services - 867-2502
Item Title:
Approval of Washington State Department of Health 2015-2017 Consolidated Contract
#C17129
Class of Item: Department
List of Exhibits
2015-2017 DOH ConCon
C17129 Main
Contract.pdf
866 KB
ConCon C17129
Program info and
funding allocation
spreadsheet - original
contract.pdf
113 KB
2014 C17129 main
contract all programs
010615.pdf
116 KB
b PAO
c
d
e
f
g
c Budget Office
d
e
f
g
Notes:
c FinSvcs
d
e
f
g
c HR
d
e
f
g
c CAO
d
e
f
g
c Other
d
e
f
g
Recommended Action:
Move to approve the State of Washington Department of Health 2015 – 2017 Consolidated Contract
#C17129 for a maximum consideration not to exceed $379,736 for the duration of January 1, 2015
through December 31, 2017 and authorize the Director of Public Health and Social Services to sign
the contract.
Item Description:
The Washington State Department of Health (DOH) Consolidated Contract is the mechanism used to
transmit federal and state funding for public health services to the county where the services are
delivered. The current Consolidated Contract #C16904 expired December 31, 2014. This Consolidated
Contract #C17129 is for the duration of January 1, 2015 through December 31, 2017 for a maximum
consideration not to exceed $379,736. As stated in Exhibit B this funding allocation is for the year
2015. Forthcoming contract amendments will provide additional funding allocations for the remaining
years of the contract.
This Contract provides Statements of Work for the following programs: Emergency Preparedness
response; Healthy Eating Active Living - Reducing Sodium for Health Project; Tuberculosis elimination;
Office of Immunization and Child Profile; Maternal Child Health Block Grant; Infectious Disease
Prevention - Adult Viral Hepatitis Prevention; all of which advance the Thurston Thrives Clinical and
Emergency Care action strategies and work towards the County Strategic Plan Goal to promote
conditions in the community that support the health and well-being of individuals and families. This
Contract also provides Statements of Work for the On-site Sewage System Local Management Plan
Implementation; Recreational Shellfish/Biotoxin; and Drinking Water Group A all of which advance the
Thurston Thrives Environment - Clean Water action strateg ies and promote the County Strategic Plan
Goal to preserve and enhance our physical environment and natural resources.
For your information we have attached two documents: 1) an excel spreadsheet providing
funded programs, their descriptions and 2015 funding allocations; and 2) Financial organization charts
with the programs circled in red that are funded by this contract. Please note: dollar amounts on the
organizational charts are for 2014 and are currently being revised with the 2015 allocation amounts.
DOH CONTRACT #: C17129
2015 - 2017
WASHINGTON STATE
DEPARTMENT OF HEALTH
CONSOLIDATED CONTRACT
Page 1 of 17
Table of Contents
1.
Purpose .................................................................................................................................... 3
2.
Statements of Work ................................................................................................................. 3
3.
Exhibits .................................................................................................................................... 3
4.
Definitions ............................................................................................................................... 3
5.
Funding and Billing ................................................................................................................. 4
6.
Contract Management ............................................................................................................. 5
7.
Access to Records ................................................................................................................... 5
8.
All Writings Contained Herein................................................................................................ 5
9.
Assignment .............................................................................................................................. 5
10. Assurances ............................................................................................................................... 5
11. Confidential Information ......................................................................................................... 6
12. Ethics ....................................................................................................................................... 6
13. Debarment Certification .......................................................................................................... 6
14. Disputes ................................................................................................................................... 6
15. Equipment Purchases .............................................................................................................. 6
16. Governing Law and Venue...................................................................................................... 7
17. Independent Capacity .............................................................................................................. 7
18. Insurance ................................................................................................................................. 7
19. Licensing, Accreditation and Registration .............................................................................. 7
20. Maintenance of Records .......................................................................................................... 7
21. Modifications and Waivers ..................................................................................................... 7
22. No Third-Party Rights Created................................................................................................ 7
23. Nondiscrimination ................................................................................................................... 7
24. Order of Precedence ................................................................................................................ 8
25. Ownership of Material/Rights in Data .................................................................................... 8
26. Publications ............................................................................................................................. 8
27. Responsibility for Actions ....................................................................................................... 8
28. Loss or Reduction of Funding ................................................................................................. 8
29. Severability .............................................................................................................................. 8
30. Subcontracts ............................................................................................................................ 8
31. Subrecipient ............................................................................................................................. 9
32. Survivability ............................................................................................................................ 9
33. Term ........................................................................................................................................ 9
34. Termination for Convenience .................................................................................................. 9
35. Termination for Default........................................................................................................... 9
36. Termination Procedure ............................................................................................................ 9
Standard Federal Certifications and Assurances.............................................................................. 11
Assurances – Non Construction Programs ...................................................................................... 16
2015-2017 Consolidated Contract
Page 2 of 17
CONSOLIDATED CONTRACT
between
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
(Referred to as “DOH”)
and
THURSTON COUNTY PUBLIC HEALTH & SOCIAL SERVICES DEPARTMENT
(Referred to as “LHJ”)
for
THE DELIVERY OF PUBLIC HEALTH SERVICES
FOR THE PERIOD OF
January 1, 2015 through December 31, 2017
1. Purpose
This Contract is entered into in accordance with RCW 43.70.520, RCW 43.70.580, the general statutory powers of the
Secretary of the Department of Health, including at RCW 43.70.040, the general statutory powers of local health
jurisdictions, including at RCW 70.05.060, RCW 70.08.020, and RCW 70.46.060, and the authority for joint or
cooperative action provided for under chapter 39.34 RCW. The purpose of this Contract is to define the parties’ joint
and cooperative relationship. The contract and all statements of work adopted under its provisions are intended to
implement applicable objectives under the Public Health Improvement Plan and to facilitate the delivery of public
health services to the people in Washington State. This Contract is the result of cooperative planning efforts between
the LHJ and DOH.
2. Statements of Work
The individual program activities, requirements, and outcomes/deliverables to be achieved by the parties under this
Contract are described in Exhibit A, Statements of Work. Each statement of work shall comply with the performancebased criteria under RCW 43.70.580(2)(b).
The LHJ shall furnish the necessary personnel, equipment, material and/or services and otherwise do all things
necessary for or incidental to the performance of the work as set forth in Exhibit A, Statements of Work.
3. Exhibits
This Contract incorporates by reference the following Exhibits:
 Exhibit A - Statements of Work
 Exhibit B – Allocations
 Exhibit C – Schedule of Federal Awards
4. Definitions
As used throughout this Contract and unless amended for a particular Statement of Work, the following terms shall
have the meanings set forth below:
“Budget, Accounting, and Reporting System (BARS)”: The system designed by the State Auditor's office for
collecting, consolidating, and reporting financial budgeting and accounting information from all local
governmental units.
“Client”: An agency, firm, organization, individual or other entity applying for or receiving services provided by
the LHJ under this Contract.
“Catalog of Federal Domestic Assistance (CFDA)”: The unique identifying code assigned to a federal assistance
program which identifies the awarding agency.
“Confidential Information”: Information protected from disclosure under federal or state law.
Page 3 of 17
“Contract Coordinator”: Each party’s designated contact for all notices required or permitted under this Contract.
“Contracting Officer”: Individual(s) of the Contracts Office of DOH and his/her delegates within that office
authorized to execute this agreement on behalf of DOH.
“Contractor”: An entity that provides goods or services to DOH and others. A contractor normally operates its
business in a competitive environment, provides its goods and/or services to many different purchasers during
normal business hours, and is not subject to the compliance requirements of the federal program.
“Equipment”: When used in this Contract is defined as an article of non-expendable, tangible property other than
land, buildings, or fixtures which is used in operations and having a useful life of more than one year and an
acquisition cost of $5,000 or more or as otherwise provided in the Statements of Work, Exhibit A.
“Federal Assistance”: Assistance provided by a federal agency in the form of grants, contracts, loans, loan
guarantees, property, cooperative agreements, interest subsidies, insurance, or direct appropriations, but does not
include direct federal cash assistance to individuals.
“Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act)”: A federal act to
make information available online so the public can see how federal funds are spent.
“Fixed Assets”: Fixed assets are property and/or equipment obtained through donation, gift, purchase, capital
lease, or construction with a service life of more than one year.
“Program Contact”: Each party’s designated contact for those purposes identified in the Statements of Work,
Exhibit A.
“Subcontractor”: Any individual or group contracted with the LHJ to perform all or part of the services included
in this Contract. This term will also apply to situations where an LHJ’s subcontractor contracts with another
individual or group to perform all or part of the services included in its agreement with the LHJ.
“Subrecipient” or “Subgrantee”: A non-federal entity that receives a subaward of federal grant money or goods
directly or indirectly from DOH and makes decisions regarding who can receive what federal assistance; has its
performance measured against the objectives contained in the DOH agreement with the federal government;
makes decisions on how to operate the program to accomplish the program goals; has the obligation to comply
with federal subrecipient requirements; and/or use federal funds to carry out a program for the public purpose
specified in the authorizing statute.
5. Funding and Billing
A. DOH shall pay the LHJ for services as set forth in the Statements of Work, Exhibit A, not to exceed funding
amounts as detailed in the Contract Allocations, Exhibit B, for those services provided herein.
The LHJ will advise the Program Contact identified in the applicable Statement of Work in writing 90 calendar
days prior to the end of the funded period, or as soon as practicable thereafter, if the LHJ anticipates not using all
Contract funding.
B. If the Exhibit A, Statement of Work, is supported by federal funds that require compliance with FFATA (the
Transparency Act), the corresponding checkbox on the statement of work will be checked.
C. Total consideration for this Contract is $379,736, or as amended.
The LHJ will submit accurate and timely billings which, for clarity and consistency, will be prepared using the
form provided and following the instructions located on the DOH website, www.doh.wa.gov
DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable
costs as outlined in the statement of work and/or budget.
Page 4 of 17
D. The LHJ will submit a BARS A financial report by March 15 for the prior calendar year.
6. Contract Management
Unless otherwise specified in the Contract, the following individuals are each party’s designated contact (“Contract
Coordinator”) for all notices required or permitted under this Contract.
LHJ Contract Coordinators:
DOH Contract Coordinator:
Name: Lydia Hodgkinson
Name: Brenda Henrikson
Title:
Contracts Specialist
Mailing Address:
Mailing Address:
412 Lilly Road NE, Olympia WA 98506-5132
PO Box 47905, Olympia WA 98504-7905
Physical Address:
Physical Address:
Same as above
101 Israel Rd. SE, Tumwater WA 98501-5570
Phone: 360-867-2503
Email Address:
Fax: 360-867-2601
[email protected]
Phone: 360-236-3933
Email Address:
Fax: 360-586-2655
[email protected]
A party may change its Contract Coordinator or its Program Contact by providing written notice to the other party.
DOH Program Contacts can be found in the Statements of Work, Exhibit A, and on the DOH website,
www.doh.wa.gov.
7. Access to Records
To the extent authorized by applicable federal and state law, the parties shall provide access to records relevant to this
Contract to each other, the Joint Legislative Audit and Review Committee, the State Auditor, and authorized federal
officials, at no additional cost. Inspections shall occur at reasonable times and upon reasonable notice.
8. All Writings Contained Herein
This Contract contains all the terms and conditions agreed upon by the parties. No other understandings, oral or
otherwise, regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. The
individuals signing this Contract certify by their signatures that they are authorized to sign this Contract on behalf of
their respective entity.
9. Assignment
Except for subcontracting as authorized in this Contract, the LHJ shall not assign or delegate, in whole or in part, this
Contract or any of its rights, duties, obligations, or responsibilities, without the prior written consent of DOH’s
Contracting Officer, which consent shall not be unreasonably withheld.
10. Assurances
The parties agree that all activity pursuant to this Contract shall be in accordance with all applicable current federal,
state and local laws, rules, and regulations.
The LHJ acknowledges its agreement to comply with federal certifications and assurances by signing and returning
the following:
1. Standard Federal Certifications
2. Standard Federal Assurances for Non-Construction Programs
Page 5 of 17
11. Confidential Information
The parties agree to comply with all state and federal statutes and regulations relating to Confidential Information.
DOH and LHJ will limit access to the Confidential Information to the fewest number of people necessary to complete
the work. Everyone having access to Confidential Information covered by this Contract must agree to protect the
confidentiality of the information.
Either party to this Contract may designate certain Confidential Information as “Confidential Information/Notice
Requested.” The designation shall be made by clearly stamping, watermarking, or otherwise marking each page of the
Confidential Information. If a third party requestor seeks information that has been marked “Confidential
Information/Notice Requested,” notice shall be given to the marking party prior to release of the information. Such
notice shall be provided to the program contact no less than five business days prior to the date of disclosure, to allow
the party objecting to disclosure to seek a protective order from the proper tribunal.
DOH and LHJ agree to establish, document and maintain security practices and safeguards consistent with state and
federal laws, regulations, standards, and guidelines to prevent unauthorized access, use, or disclosure of Confidential
Information in any form. In accordance with federal and state contracting requirements, DOH may monitor, audit, or
investigate LHJ management of Confidential Information relating to this Contract. Working together, the LHJ and
DOH may use any and all tools available to track Contract related Confidential Information.
If one of the parties becomes aware of an actual or suspected breach of confidentiality, that party will promptly notify
the Contract Coordinator for the other party of the facts. The parties will work within their respective organizations to
take any steps necessary to determine the scope of the breach and to restore reasonable security to the Confidential
Information. Both parties agree to mitigate any known harmful effects of a breach in confidentiality, including
notifying affected individuals to the extent required by law. The parties will also reasonably cooperate with law
enforcement as appropriate.
12. Ethics
Both parties and their officers shall comply with all ethics laws applicable to their activities under this Contract,
including Chapters 42.23 and 42.52 RCW. If a violation occurs and is not cured within a reasonable time after notice,
the other party shall have the right to terminate this Contract. This section is expressly subject to the Disputes section
of this Contract.
13. Debarment Certification
The LHJ, by signing this Contract, certifies that the LHJ is not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any federal department
or agency. The LHJ also agrees to include the above requirement in all subcontracts into which it enters. The LHJ
will notify DOH of any such events that may occur during the term of the Contract.
14. Disputes
Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot be resolved by
direct negotiation, the parties agree to participate in good faith in non-binding mediation. The mediator shall be
chosen by agreement of the parties. If the parties cannot agree on a mediator, the parties shall use a mediation service
located in Washington State that selects a qualified mediator for the parties. Each party shall bear its own costs for
mediation and each party shall contribute equally to the mediator’s fee, if any. The parties agree that mediation shall
precede any action in a judicial tribunal.
Nothing in this contract shall be construed to limit the parties’ choice of a mutually acceptable alternate dispute
resolution method in addition to the dispute resolution procedure outlined above.
15. Equipment Purchases
Equipment purchased by the LHJ for use by the LHJ or its subcontractors during the term of this Contract using
federal funds, in whole or in part, shall be the property of the LHJ. The use, management and disposal of the
equipment must comply with federal requirements. These requirements are found in the OMB Circular A-102 or are
included in the federal funding agency’s regulations.
Page 6 of 17
16. Governing Law and Venue
The laws of the state of Washington govern this Contract. In the event of a lawsuit by the LHJ against DOH arising
under this Contract, venue shall be proper only in Thurston County, Washington. In the event of a lawsuit by DOH
against the LHJ arising under this Contract, venue shall be proper only in the county in which the LHJ is located or in
either of the two nearest judicial districts within the meaning of RCW 36.01.050.
17. Independent Capacity
The employees or agents of each party who are engaged in the performance of this Contract shall continue to be
employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other
party.
18. Insurance
The LHJ certifies that it is self-insured, is a member of a risk pool, or maintains insurance coverage as required by this
Contract. Each party shall pay for losses for which it is found liable. The LHJ agrees to require all subcontractors to
maintain insurance in types and with limits as may be determined by the LHJ and/or its risk manager, unless the LHJ and
DOH agree otherwise.
19. Licensing, Accreditation and Registration
The LHJ shall comply with all applicable local, state, and federal licensing, accreditation and registration
requirements and standards, necessary for the performance of this Contract.
20. Maintenance of Records
Each party to this Contract shall maintain books, records, documents and other evidence that sufficiently and properly
reflect all direct and indirect costs expended by it. All books, records, documents, and other material relevant to this
Contract will be retained for six years after expiration. If any litigation, claim or audit is started before the expiration
of the six (6) year period, the records shall be retained until all litigation, claims, or audit findings involving the
records have been resolved.
Each party will use reasonable security procedures and protections to assure that records and documents provided by
the other party are not erroneously disclosed to third parties. Both parties agree to continue protecting records until
such time as the information is destroyed in accordance with applicable state and federal records retention laws.
21. Modifications and Waivers
This Contract, or any term or condition, may be modified only by a written amendment signed by the DOH
Contracting Officer and the authorized representative for the LHJ. Either party may propose an amendment.
Failure or delay on the part of either party to exercise any right, power, privilege or remedy provided under this Contract
shall not constitute a waiver. No provision of this Contract may be waived by either party except in a writing signed by the
DOH Contracting Officer or the authorized representative of the LHJ.
22. No Third-Party Rights Created
This Contract, or any program hereunder, is entered into solely for the benefit of the two parties thereto and shall not
be construed as giving rise to any right, remedy or expectancy of any kind or nature on the part of any third party.
23. Nondiscrimination
During the performance of this Contract, the LHJ and DOH shall comply with all federal and state nondiscrimination
laws, regulations and policies. In the event of the LHJ’s noncompliance or refusal to comply with any nondiscrimination
law, regulation or policy, this Contract may be rescinded, canceled or terminated in whole or in part, and the LHJ may be
declared ineligible for further contracts with DOH. The LHJ shall, however, be given a reasonable time in which to cure
this noncompliance. Any dispute may be resolved in accordance with the “Disputes” procedure set forth herein.
Page 7 of 17
24. Order of Precedence
In the event of an inconsistency in the terms of this Contract, or between its terms and any applicable statute or rule,
the inconsistency shall be resolved by giving precedence in the following order:




Applicable state and federal statutes, and local laws, rules and regulations.
Terms and conditions of this Contract.
Statements of Work.
Any other provisions of this Contract, including other materials incorporated by reference.
25. Ownership of Material/Rights in Data
Records and other documents relevant to this Contract, in any medium, furnished by one party to this Contract to the
other party, will remain the property of the furnishing party, unless otherwise agreed. Data which is delivered under
the Contract shall be transferred to DOH with a nonexclusive, royalty-free, perpetual, irrevocable license to publish,
translate, reproduce, modify, deliver, perform, dispose of, and to authorize others to do so; provided that such license
shall be limited to the extent which the LHJ has a right to grant such a license. The LHJ shall exert all reasonable
effort to advise DOH, at the time of delivery of data furnished under this Contract, of all known or potential invasions
of privacy contained therein and of any portion of such document which was not produced in the performance of this
Contract. DOH shall receive prompt written notice of each notice or claim or copyright infringement received by the
LHJ with respect to any data delivered under this Contract. DOH shall have the right to modify or remove any
restrictive markings placed upon the data by the LHJ, provided that if DOH modifies or removes such markings
without the LHJ’s approval, it assumes all liability for doing so.
26. Publications
Any program reports, articles, and publications that result from information gathered through use of state and federal
funds must acknowledge receiving support from DOH and/or the appropriate federal agencies. Correspondingly, such
documents resulting from information gathered through use of local funds must acknowledge receipt of such local
support.
27. Responsibility for Actions
Each party to this Contract shall be solely responsible for the acts and omissions of its own officers, employees, and
agents in the performance of this Contract. Neither party to this Contract will be responsible for the acts and
omissions of entities or individuals not party to this Contract. DOH and the LHJ shall cooperate in the defense of tort
lawsuits, when possible.
28. Loss or Reduction of Funding
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way after the
effective date of this contract and prior to normal completion, DOH may elect to suspend or terminate the contract, in
whole or in part, under the "Termination for Convenience" clause with a ten (10) business day notice to LHJ, to the
extent possible, subject to renegotiation at DOH’s discretion under those new funding limitations and conditions.
29. Severability
If any term or condition of this Contract is held invalid, such invalidity shall not affect the validity of the other terms
or conditions of this Contract, provided, however, that the remaining terms and conditions can still fairly be given
effect.
30. Subcontracts
The LHJ may subcontract any or all of the services or other obligations specified in this Contract. The LHJ will
require the subcontractor to comply with all the applicable terms and conditions of this Contract, including all terms,
conditions, assurances and certifications. The LHJ agrees it is responsible for assuring adequate performance on the
part of the subcontractor.
The parties agree that all subcontractors must be responsible for any liabilities created by their actions or omissions.
In the event DOH, LHJ, and subcontractor are found by a jury or trier of fact to be jointly and severally liable for
Page 8 of 17
personal injury damages arising from any act or omission, then each entity shall be responsible for its proportionate
share.
31. Subrecipient
For those activities designated as “subrecipient” on Exhibit A, Statements of Work, the LHJ must comply with
applicable federal requirements, including but not limited to OMB Circular A-87, A-102, A-133, and program
specific federal regulations. If the LHJ expends $500,000 or more in federal awards from all sources, it is responsible
for obtaining appropriate audits. For fiscal years starting after December 26, 2014, if the LHJ expends $750,000 or
more in federal grants or awards from all sources, it is responsible for obtaining the required single audit.
32. Survivability
The terms and conditions contained in this Contract which by their sense and context, are intended to survive the
expiration of the Contract shall survive. Surviving terms include, but are not limited to: Access to Records,
Confidential Information, Disputes, Responsibility for Actions, Maintenance of Records, Ownership of
Material/Rights in Data, Subcontracts, Termination for Convenience, Termination for Default, and Termination
Procedure.
33. Term
This Contract will be in effect following execution by the parties from January 1, 2015 through December 31, 2017,
unless terminated earlier as provided herein.
34. Termination for Convenience
Except as otherwise provided in this Contract, either party may terminate or suspend this Contract, or any program
hereunder, for convenience by providing at least 30 days’ advance written notice to the other party.
If DOH elects to suspend the Contract, in whole or in part, LHJ shall stop work as of the effective date of DOH’s
written notice of suspension. During suspension, each Party will reasonably notify the other of any conditions that
may affect resumption of performance. Upon DOH’s written notice to resume performance, LHJ shall resume work
unless the LHJ provides notice to DOH that services cannot be resumed. If LHJ cannot resume performance, the
Contract or affected Exhibit A Statement of Work will be deemed terminated upon the date the LHJ received notice to
suspend performance.
35. Termination for Default
(a) In the event of a default by either party under this Contract, the nondefaulting party may give written notice to the
defaulting party that it intends to terminate this Contract, or any program hereunder, if the default is not cured
within 30 days of the date of the notice, or such longer period of time as may be reasonable under the
circumstances. If the default is not cured within that time, the nondefaulting party may then notify the defaulting
party in writing that this Contract is terminated. In the event of such termination, the nondefaulting party shall
have all rights and remedies available to it under general law.
(b) A disputed termination for default is expressly subject to the Disputes section of this Contract.
36. Termination Procedure
Upon termination DOH may require the LHJ to deliver to DOH any non-LHJ-owned equipment, data, or other
property specifically produced or acquired for the performance of such part of this Contract as has been terminated.
DOH shall pay to the LHJ the agreed upon price, if separately stated, for completed work and services accepted by
DOH. In addition DOH shall pay the amount determined by DOH’s Contracting Officer for (a) completed work and
services for which no separate price is stated, (b) partially completed work and services, (c) other property or services
which are accepted by DOH, and (d) the protection and preservation of the property. Disagreement by the LHJ with
the determination of DOH’s Contracting Officer that relates to the obligations or amounts due to the LHJ shall be
considered a dispute within the meaning of the “Disputes” clause of this Contract.
Page 9 of 17
Standard Federal Certifications and Assurances
Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded (in
whole or in part) agreements administered by the Washington State Department of Health.
CERTIFICATIONS
1. CERTIFICATION REGARDING
DEBARMENT AND SUSPENSION
The undersigned (authorized official signing for
the contracting organization) certifies to the best
of his or her knowledge and belief, that the
contractor, defined as the primary participant in
accordance with 45 CFR Part 76, and its
principals:
a) are not presently debarred, suspended,
proposed for debarment, declared ineligible,
or voluntarily excluded from covered
transactions by any Federal Department or
agency;
b) have not within a 3-year period preceding
this contract been convicted of 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;
c) are not presently indicted or otherwise
criminally or civilly charged by a
governmental entity (Federal, State, or local)
with commission of any of the offenses
enumerated in paragraph (b) of this
certification; and
d) have not within a 3-year period preceding
this contract had one or more public
transactions (Federal, State, or local)
terminated for cause or default.
Should the contractor not be able to provide this
certification, an explanation as to why should be
placed after the assurances page in the contract.
The contractor agrees by signing this contract
that it will include, without modification, the
clause
titled
"Certification
Regarding
Debarment, Suspension, In eligibility, and
Voluntary Exclusion--Lower Tier Covered
Transactions" in all lower tier covered
transactions (i.e., transactions with sub- grantees
and/or contractors) and in all solicitations for
lower tier covered transactions in accordance
with 45 CFR Part 76.
DRUG-FREE WORKPLACE
REQUIREMENTS
the contracting organization) certifies that the
contractor will, or will continue to, provide a
drug-free workplace in accordance with 45 CFR
Part 76 by:
a) Publishing a statement notifying employees
that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled
substance is prohibited in the grantee’s
workplace and specifying the actions that
will be taken against employees for violation
of such prohibition;
b) Establishing an ongoing drug-free awareness
program to inform employees about
(1) The dangers of drug abuse in the
workplace;
(2) The contractor’s policy of maintaining a
drug-free workplace;
(3) Any available drug counseling,
rehabilitation, and employee assistance
programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations
occurring in the workplace;
c) Making it a requirement that each employee
to be engaged in the performance of the
contract be given a copy of the statement
required by paragraph (a) above;
Page 11 of 17
d) Notifying the employee in the statement
required by paragraph (a), above, that, as a
condition of employment under the contract,
the employee will—
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or
her conviction for a violation of a criminal
drug statute occurring in the workplace no
later than five calendar days after such
conviction;
For purposes of paragraph (e) regarding agency
notification of criminal drug convictions, DOH
has designated the following central point for
receipt of such notices:
e) Notifying the agency in writing within ten
calendar days after receiving notice under
paragraph (d)(2) from an employee or
otherwise receiving actual notice of such
conviction. Employers of convicted
employees must provide notice, including
position title, to every contract officer or
other designee on whose contract activity
the convicted employee was working, unless
the Federal agency has designated a central
point for the receipt of such notices. Notice
shall include the identification number(s) of
each affected grant;
LOBBYING
f) Taking one of the following actions, within
30 calendar days of receiving notice under
paragraph (d) (2), with respect to any
employee who is so convicted—
(1) Taking appropriate personnel action
against such an employee, up to and
including termination, consistent with the
requirements of the Rehabilitation Act of
1973, as amended; or
(2) Requiring such employee to participate
satisfactorily in a drug abuse assistance
or rehabilitation program approved for
such purposes by a Federal, State, or
local health, law enforcement, or other
appropriate agency;
g) Making a good faith effort to continue to
maintain a drug-free workplace through
implementation of paragraphs (a), (b), (c),
(d), (e), and (f).
Compliance and Internal Control Officer
Office of Grants Management
WA State Department of Health
PO Box 47905
Olympia, WA 98504-7905
Title 31, United States Code, Section 1352,
entitled "Limitation on use of appropriated funds
to influence certain Federal contracting and
financial transactions," generally prohibits
recipients of Federal grants and cooperative
agreements from using Federal (appropriated)
funds for lobbying the Executive or Legislative
Branches of the Federal Government in
connection with a SPECIFIC grant or
cooperative agreement. Section 1352 also
requires that each person who requests or
receives a Federal grant or cooperative
agreement must disclose lobbying undertaken
with non-Federal (nonappropriated) funds.
These requirements apply to grants and
cooperative agreements EXCEEDING $100,000
in total costs (45 CFR Part 93).
the contracting organization) 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 agency, a Member of
Congress, 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.
Page 12 of 17
(2) If any funds other than Federally
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
of Lobbying Activities," in accordance with
its instructions. (If needed, Standard FormLLL, "Disclosure of Lobbying Activities,"
its instructions, and continuation sheet are
included at the end of this application form.)
(3) The undersigned shall require that the
language of this certification be included in
the award documents for all subcontracts at
all
tiers
(including
subcontracts,
subcontracts, and contracts under grants,
loans and cooperative agreements) and that
all subrecipients 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, 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 and not more than $100,000 for each
such failure.
PROGRAM FRAUD CIVIL REMEDIES
ACT (PFCRA)
the contracting organization) certifies that the
statements herein are true, complete, and
accurate to the best of his or her knowledge, and
that he or she is aware that any false, fictitious,
or fraudulent statements or claims may subject
him or her to criminal, civil, or administrative
penalties. The undersigned agrees that the
contracting organization will comply with the
Public Health Service terms and conditions of
award if a contract is awarded.
ENVIRONMENTAL TOBACCO
SMOKE
Public Law 103-227, also known as the ProChildren Act of 1994 (Act), requires that
smoking not be permitted in any portion of any
indoor facility owned or leased or contracted for
by an entity and used routinely or regularly for
the provision of health, day care, early childhood
development services, education or library
services to children under the age of 18, if the
services are funded by Federal programs either
directly or through State or local governments,
by Federal grant, contract, loan, or loan
guarantee. The law also applies to children’s
services that are provided in indoor facilities that
are constructed, operated, or maintained with
such Federal funds. The law does not apply to
children’s services provided in private residence,
portions of facilities used for inpatient drug or
alcohol treatment, service providers whose sole
source of applicable Federal funds is Medicare
or Medicaid, or facilities where WIC coupons
are redeemed.
Failure to comply with the provisions of the law
may result in the imposition of a civil monetary
penalty of up to $1,000 for each violation and/or
the imposition of an administrative compliance
order on the responsible entity.
By signing the certification, the undersigned
certifies that the contracting organization will
comply with the requirements of the Act and
will not allow smoking within any portion of
any indoor facility used for the provision of
services for children as defined by the Act.
The contracting organization agrees that it will
require that the language of this certification be
included in any subcontracts which contain
provisions for children’s services and that all
subrecipients shall certify accordingly.
The Public Health Services strongly encourages
all recipients to provide a smoke-free workplace
and promote the non-use of tobacco products.
This is consistent with the PHS mission to
protect and advance the physical and mental
health of the American people.
Page 13 of 17
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS
INSTRUCTIONS FOR
CERTIFICATION
1) By signing and submitting this proposal, the
prospective contractor is providing the
certification set out below.
2) The inability of a person to provide the
certification required below will not
necessarily result in denial of participation
in this covered transaction. The prospective
contractor shall submit an explanation of
why it cannot provide the certification set
out below. The certification or explanation
will be considered in connection with the
department or agency's determination
whether to enter into this transaction.
However, failure of the prospective
contractor to furnish a certification or an
explanation shall disqualify such person
from participation in this transaction.
3) The certification in this clause is a material
representation of fact upon which reliance
was placed when the department or agency
determined to enter into this transaction. If it
is later determined that the prospective
contractor knowingly rendered an erroneous
certification, in addition to other remedies
available to the Federal Government, the
department or agency may terminate this
transaction for cause of default.
4) The prospective contractor shall provide
immediate written notice to the department
or agency to whom this contract is submitted
if at any time the prospective contractor
learns that its certification was erroneous
when submitted or has become erroneous by
reason of changed circumstances.
5) The terms covered transaction, debarred,
suspended, ineligible, lower tier covered
transaction, participant, person, primary
covered transaction, principal, proposal, and
voluntarily excluded, as used in this clause,
have the meanings set out in the Definitions
and Coverage sections of the rules
implementing Executive Order 12549. You
may contact the person to whom this
contract is submitted for assistance in
obtaining a copy of those regulations.
6) The prospective contractor agrees by
submitting this contract that, should the
proposed covered transaction be entered
into, it shall not knowingly enter into any
lower tier covered transaction with a person
who is debarred, suspended, declared
ineligible, or voluntarily excluded from
participation in this covered transaction,
unless authorized by DOH.
7) The prospective contractor further agrees by
submitting this contract that it will include
the clause titled ``Certification Regarding
Debarment, Suspension, Ineligibility and
Voluntary Exclusion -- Lower Tier Covered
Transaction,'' provided by HHS, without
modification, in all lower tier covered
transactions and in all solicitations for lower
tier covered transactions.
8) A participant in a covered transaction 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. A participant may decide the
method and frequency by which it
determines the eligibility of its principals.
Each participant may, but is not required to,
check the Nonprocurement List (of excluded
parties).
9) Nothing contained in the foregoing shall be
construed to require establishment of a
system of records in order to render in good
faith the certification required by this clause.
The knowledge and information of a
participant is not required to exceed that
which is normally possessed by a prudent
person in the ordinary course of business
dealings.
10) Except for transactions authorized under
paragraph 6 of these instructions, if a
participant in a covered transaction
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, DOH may terminate
this transaction for cause or default.
Page 14 of 17
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;
c) Are not presently indicted for or
otherwise criminally or civilly charged
by a governmental entity (Federal, State
or local) with commission of any of the
offenses enumerated in paragraph (1)(b)
of this certification; and
d) Have not within a three-year period
preceding this contract had one or more
public transactions (Federal, State or
local) terminated for cause or default.
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS
-- PRIMARY COVERED
TRANSACTIONS
1) The prospective contractor certifies to the
best of its knowledge and belief, that it and
its principals:
a) Are not presently debarred, suspended,
proposed for debarment, declared
ineligible, or voluntarily excluded from
covered transactions by any Federal
department or agency;
b) Have not within a three-year period
preceding this contract been convicted
of 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
2) Where the prospective contractor is unable
to certify to any of the statements in this
certification, such prospective contractor
shall attach an explanation to this proposal.
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Please also print or type name:
ORGANIZATION NAME: (if applicable)
DATE
Page 15 of 17
Assurances – Non Construction Programs
Public reporting burden for this collection of information is estimated to average 15 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 (0348-0040), 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.
As the duly authorized representative of the contractor, I certify that the contractor:
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, through any
authorized representative, access to and 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 awarding agency.
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
-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)  523 and 527 of the 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 the sale, 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 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 in purchases.
8.
Will comply, as applicable, with the provisions of the
Hatch Act (5
-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.
Page 16 of 17
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 subagreements.
12 Will comply with the Wild and Scenic Rivers Act of 1968
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
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(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 or
more.
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of 1974
-1 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.
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
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89pertaining to the care, handling, and treatment of warm
blooded animals held for research, teaching, or other
activities supported by this award of assistance.
Federal actions to State (Clear Air) Implementation Plans
under Section 176(c) of the Clear Air Act of 1955, as
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act
Amendments of 1996 and OMB Circular No. A-133,
Audits of States, Local Governments, and Non-Profit
Organizations.
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. 93205).
16. Will comply with the Lead-Based Paint Poisoning
prohibits the use of lead- based paint in construction or
rehabilitation of residence structures.
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies
governing this program.
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Please also print or type name:
ORGANIZATION NAME: (if applicable)
DATE
Page 17 of 17
THURSTON COUNTY PUBLIC HEALTH & SOCIAL SERVICES DEPARTMENT
2015-2017 CONSOLIDATED CONTRACT #C17129
EXHIBIT A - STATEMENTS OF WORK
TABLE OF CONTENTS
DOH Program Name or Title:
Exhibit A, Statements of Work
Emergency Preparedness & Response - Effective January 1, 2015 ................................................................................................... 2
Healthy Eating Active Living-Reducing Sodium for Health Project - Effective January 1, 2015 ..................................................... 6
Infectious Disease Prevention Section (IDPS) - Effective January 1, 2015 ....................................................................................... 9
Maternal & Child Health Block Grant - Effective January 1, 2015 ................................................................................................. 13
Office of Drinking Water Group A Program - Effective January 1,2015 ........................................................................................ 17
Office of Immunization & Child Profile - Effective January 1, 2015 .............................................................................................. 22
OSS LMP Implementation - Effective January 1, 2015 ................................................................................................................... 28
Recreational Shellfish Activities - Effective January 1, 2015 .......................................................................................................... 31
TB Program - Effective January 1, 2015 .......................................................................................................................................... 33
Page 1 of 35
Contract Number C17129
Exhibit A
Statement of Work
Contract Term: 2015-2017
DOH Program Name or Title: Emergency Preparedness & Response Effective January 1, 2015
SOW Type: Original
Local Health Jurisdiction Name: Thurston County Public Health
& Social Services Department
Contract Number: C17129
Revision # (for this SOW)
Funding Source
Federal Subrecipient
State
Other
Period of Performance: January 1, 2015 through June 30, 2015
Federal Compliance
(check if applicable)
FFATA (Transparency Act)
Research & Development
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to establish the funding and tasks for the Public Health Emergency Preparedness and Response program for
the 2015 grant period through June 30, 2015.
Revision Purpose: N/A
Chart of Accounts Program Name or Title
FFY14 EPR LHJ FUNDING
FFY14 EPR HPP BP3-PREP
CFDA #
93.069
93.889
BARS
Revenue
Code
333.93.06
333.93.88
Master
Index
Code
18101630
18101640
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 06/30/15
01/01/15 06/30/15
Current
Change
Consideration
Increase (+)
TOTALS
Task
Number
Admin 1
Task/Activity/Description
*May Support PHAB
Standards/Measures
Deliverables/Outcomes
Submit completed templates.
As required
Submit end-of-year reporting
template.
June 30, 2015
template.
June 30, 2015
1.2
Participate in Thurston County Disaster
Assistance Meetings.
template.
June 30, 2015
3.1
Review and annually update the Emergency
Operations/Response Plan.
template.
June 30, 2015
3.2
Provide training and educational opportunities
for public health staff and community partners as
needed.
template.
June 30, 2015
Admin 2
1.1
Page 2 of 35
0
0
32,967
14,000
32,967
14,000
0
46,967
46,967
Due Date/Time Frame
Complete reporting templates to comply with
federal grant requirements (e.g., performance
measures, gap analysis, etc.)
Attend emergency preparedness events (monthly
program update calls, quarterly workshops, etc.)
hosted by DOH.
Conduct Medical Reserves Corps (MRC)
Leadership Team Meetings.
Total
Consideration
Payment Information
and/or Amount
Reimbursement for costs,
not to exceed total funding
consideration amount.
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time Frame
3.3
Confirm department Incident Management Team
(IMT) 4 staff assignments by position.
template.
June 30, 2015
3.4
Conduct Continuity of Operations Plan (COOP)
table top exercise (TTX).
template.
June 30, 2015
3.5
Attend state wide Regional Emergency Response
(RERC) meetings as Region 3 RERC. Support
Region 3 as RERC Lead.
Conduct two 24/7 Drills.
template.
June 30, 2015
template.
June 30, 2015
4.1
Update communications plan to include
(WASecure).
template.
June 30, 2015
4.2
Provide National Incident Management System
(NIMS) training opportunities to staff.
template.
June 30, 2015
4.3
Conduct WASecure communication drill.
template.
June 30, 2015
5.1
Convene a Thurston County Emergency Support
Function 8 (ESF-8) meeting with stakeholders.
template.
June 30, 2015
7.1
Meet with stakeholders in mass care operations.
Partners would include Emergency Support
Function 6 (ESF-6), ESF-11, and emergency
management.
Develop and Implement Medical Reserve Corp
(MRC) Resource Response Teams Training.
template.
June 30, 2015
template.
June 30, 2015
Conduct a tabletop or more complex exercise
testing an element from the emergency response
plan. Mass Dispensing and Point of Distribution
(POD) Operations.
Complete the Centers for Disease Control and
Prevention (CDC) Operational Readiness Review
(ORR) self-assessment tool.
Maintain Emergency Response Warehouse for
storage and handling of emergency
pharmaceuticals.
Participate in the Region 3 Healthcare Coalition
Meetings.
template.
June 30, 2015
Submit ORR
May 15, 2015
template.
June 30, 2015
template.
June 30, 2015
Participate in Thurston County Emergency
Management Council meetings.
template.
June 30, 2015
3.6
7.2
8.2
8/9
9.2
10.1
10.2
Page 3 of 35
Payment Information
and/or Amount
Task
Number
10.3
13.1
13.2
14.1
14.2
15.1
15.2
15.3
*May Support PHAB
Standards/Measures
Due Date/Time Frame
Meet with stakeholders in local health and
medical operations. Partners would include
Emergency Support Function 8 (ESF-8) and
emergency management.
Conduct investigations of disease, injury or
exposure in response to natural or man-made
threats or incidents and ensure coordination of
investigation when illegal activity is suspected.
Partners may include law enforcement,
environmental health practitioners, public health
nurses, maternal and child health, and other
regulatory agencies.
Provide epidemiological and environmental
public health consultation, technical assistance,
and information to local health departments
regarding disease, injury, or exposure and
methods of surveillance, investigation, and
response.
Develop and conduct an annual Health and
Safety training for emergency responders
including staff and volunteers.
Develop debrief standards and post deployment
follow up/surveillance procedures.
template.
June 30, 2015
template.
June 30, 2015
template.
June 30, 2015
template.
June 30, 2015
template.
June 30, 2015
Develop and implement annual volunteer
verifications process to include credentialing,
fitness, readiness, and training refresher.
Recruit target volunteers based on specialized
team and POD job actions sheets.
template.
June 30, 2015
template.
June 30, 2015
Develop and Implement an annual MRC training
and exercise schedule.
template.
June 30, 2015
Complete reporting templates to comply with
federal grant requirements. (Examples:
Performance Measures, Gap Analysis,
Healthcare Coalition Membership, etc.)
Develop Work Plan for the 2015/2016 grant
period.
Submit completed templates.
As required
2014-15 Work Plan
March 15, 2015
Attend emergency preparedness events (monthly
program update calls, quarterly workshops, etc.)
template.
June 30, 2015
Payment Information
and/or Amount
FFY14 PHEPR HC SYSTEMS – PREP (HPP)
1
2
3
Page 4 of 35
Reimbursement for costs,
not to exceed total funding
consideration amount.
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time Frame
Payment Information
and/or Amount
hosted by DOH.
4
5
6
7
Participate in the refinement of the regional
training and exercise plan to include a proposed
schedule, the demonstrated participation by
healthcare coalitions & participating hospitals to
include the participating organizations and
anticipated capabilities to be tested.
Continue Mass Fatality response activities under
the ESF-8 guidelines with an emphasis on
cultural sensitivity within local plans.
Develop & implement health & safety training
for emergency responders.
template.
June 30, 2015
template.
June 30, 2015
template.
June 30, 2015
Conduct a tabletop or more complex exercises
testing an element from the emergency response
plan.
template.
June 30, 2015
*For Information Only:
Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a
Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at:
http://www.phaboard.org/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf
Program Specific Requirements/Narrative
Federal Funding Accountability and Transparency Act (FFATA)
This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent.
To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number.
Information about the LHJ and this statement of work will be made available on http://USASpending.gov by DOH as required by P.L. 109-282.
Special Requirements
For purchases of individual equipment in which the aggregate unit price of the equipment (including shipping, handling and associated costs) is $5,000 or more, the LHJ shall
obtain written prior approval from the Washington State Department of Health and adhere to all federal requirements as referenced in OMB Circular A-87 (State, Local and Indian
Tribal governments) at: http://www.whitehouse.gov/omb/circulars_a087_2004/
DOH Program Contact
Rachel McKinlay, Contract & Finance Specialist
Department of Health
PO Box 47960, Olympia, WA 98504-7960
360-236-4056
[email protected]
PHEPR Deliverable Submission: [email protected]
Page 5 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: Healthy Eating Active Living-Reducing Sodium for
Health Project - Effective January 1, 2015
SOW Type: Original
Funding Source
State
Other
Period of Performance: January 1, 2015 through September 29, 2015
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to provide funding for improving food environments in non-chain restaurants and large worksites by
implementing sodium reduction interventions.
FFY14 CDC Sodium Reduction in Comm YR2
CFDA #
93.082
BARS
Revenue
Code
333.93.08
Master
Index
Code
7874024K
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 09/29/15
Current
Change
Consideration
Increase (+)
TOTALS
Task
Number
1A
*May Support PHAB
Standards/Measures
0
43,875
43,875
0
43,875
43,875
Due Date/Time
Frame
Administration
Conference Calls
Participation is required by at least one (1)
member of the Reducing Sodium for Health
Project (RSHP) team in monthly conference
calls, as scheduled by DOH.
Participate in Centers for Disease Control and
Prevention (CDC)-organized all-awardee
networking calls.
Attendance at all DOH-scheduled
conference calls. Substitutions
allowed.
March 31, 2015
June 30, 2015
September 29, 2015
Attendance by at least one (1) team
member.
As scheduled by
CDC
3A
Coordinate and participate in one (1) DOH site
visit per year. Attendance of RSHP team in site
visit.
Site visit agenda and summary.
September 29, 2015
5A
Annual Report
Submit documentation to DOH for Sodium
Reduction in Communities Project (SRCP)
competitive grant submission and annual report,
including an updated work plan.
Copy of materials requested by
DOH
May 30, 2015
2A
Page 6 of 35
Total
Consideration
Payment Information
and/or Amount
Reimbursement of costs,
not to exceed total
funding consideration. See
Program Specific
Requirements.
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time
Frame
6A
Trainings
Participation of a minimum of one (1) Sodium
Reduction in Communities (SRC)
training/conference if offered by the CDC.
Debrief of conference via regularly
scheduled phone call.
As scheduled by
CDC
7A
Subcontracts
Submit and obtain approval for all subcontracts
from DOH prior to execution.
Subcontracts must ensure that use of funds is
aligned with the RSHP work plan.
Subcontracts approved by DOH
prior to execution.
September 29, 2015
8A
Budget and Billing
Plan yearly budget and submit A19-1A invoices
and reports quarterly.
Implementation of Work Plan
Report activities and outcomes of work plan
using DOH provided template.
A19-1A invoices and reports
submitted at minimum quarterly.
February 15, 2015
May 15, 2015
August 15, 2015
March 31, 2015
June 30, 2015
September 29, 2015
1C
Performance Monitoring and Evaluation
Participation of evaluation coordinator in
evaluation calls scheduled with DOH to
establish and coordinate activities related to the
program’s evaluation.
Attendance at all DOH-scheduled
evaluation conference calls.
Substitutions allowed.
March 31, 2015
June 30, 2015
September 29, 2015
2C
Implement evaluation plan as specified in the
CDC-approved evaluation plan and work plan.
Summary of evaluation results.
March 31, 2015
June 30, 2015
September 29, 2015
1B
Submit completed Milestones
Reporting Form/Quarterly Report.
Payment Information
and/or Amount
Page 7 of 35
Restrictions on Funds (what funds can be used for which activities, not direct payments, etc)
a) No part of any appropriated funds used under this cooperative agreement shall be used other than for normal and recognized executive legislative relationships, for publicity or
propaganda purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet, publication, radio, television, or video presentation designed to support or defeat
legislation pending or proposed before the Congress or any State or local legislature, including city councils or ballot initiatives except in presentation to the Congress or any
State or local legislature, including city councils, itself.
b) No part of any appropriated funds used under this cooperative agreement shall be used to pay the salary or expenses of any grant or contract recipient, or agent acting for such
recipient, related to any activity designed to influence legislation or appropriations pending or proposed before the Congress or any State or local legislature or city council.
c) Recipients may not use funds for research.
d) Recipients may not use funds for clinical care.
e) Recipients may only expend funds for reasonable program purposes, including personnel, travel, supplies, and services, such as contractual.
f) 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.
g) Recipients may not use funding for construction.
h) 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.
i) Reimbursement of pre-award costs is not allowed.
j) Recipients may not use funds for abortions in accordance with Executive Order 13535.
k) 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. The indirect cost rate agreement should be uploaded as a PDF file with Other Attachment Forms when submitting via Grants.gov.
Follow guidelines from DOH and the Centers for Disease Control and Prevention (CDC) related to Section 503 of Division F, Title V, of the FY 12 Consolidated Appropriations
Act (P.L. 112-74) passed by Congress in December 2011. This section reinforces and expands restrictions on lobbying activities. The expanded language restricts: lobbying local
governments and officials, lobbying for or against executive or administrative actions by federal and state agencies, and lobbying activities related to the Prevention and Public
Health Fund of the Affordable Care Act.
DOH Program Contact
Colleen Arceneaux
Office of Healthy Communities – Community Based Prevention
Washington State Department of Health
Street Address: 310 Israel Rd. SE, Tumwater, WA, 98501
Mailing Address: PO Box 47848
Phone: 360-236-3722
Email: [email protected]
Page 8 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: Infectious Disease Prevention Section (IDPS) Effective January 1, 2015
SOW Type: Original
Funding Source
Federal <Select One>
State
Other
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to provide infectious disease (HIV, STD, and Adult Viral Hepatitis) prevention services.
ADULT VIRAL HEPATITIS PREV
CFDA #
N/A
BARS
Revenue
Code
334.04.91
Master
Index
Code
12407100
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 06/30/15
Current
Change
Consideration
Increase (+)
TOTALS
Task
Number
1.
Complete and submit a detailed budget and
budget justification prior to invoicing DOH for
any program activities.
2.
Provide comprehensive syringe services
programming to approximately 900 duplicated
clients.
a.
Exchange 150,000 syringes with IDU.
b.
Provide approximately 1,500 condoms
through outreach to injection drug users
(IDU).
c.
Provide and document referrals for IDU
who need and request human
immunodeficiency virus (HIV)/sexually
transmitted disease (STD) testing,
*May Support PHAB
Standards/Measures
Standard 1.2
Standard 3.1
Standard 4.2
Standard 7.2
Standard 10.1
Total
Consideration
0
23,750
23,750
0
23,750
23,750
Due Date/Time
Frame
Payment Information
and/or Amount
Budget and justification
submitted and approved.
January 1, 2015
Invoices will not be paid
until a detailed budget and
justification are submitted
by the LHJ and approved
by DOH.
Complete and report actual
deliverables in the appropriate
data reporting system. See
General Requirements, 2 below.
Deliverables will be
completed by the
end of the period of
performance.
Reimbursement for actual
costs incurred, not to
exceed total funding
consideration.
See General
Requirements, 17.
Payment below.
Page 9 of 35
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time
Frame
Payment Information
and/or Amount
HIV/STD care and treatment, medical case
management, and viral hepatitis prevention
services.
d.
3.
In collaboration with DOH, build capacity
to routinely offer hepatitis C virus (HCV)
rapid testing as part of syringe exchange
services.
The LHJ shall also perform tasks as required by
DOH that enhance, support, or are deemed as
necessary for the success of the programs listed
within this contract. Additional tasks not
described in this statement of work will be
delivered to the LHJ in writing and within a
reasonable time frame.
Standard 1.2
Standard 3.1
Standard 4.2
Standard 7.2
Standard 10.1
General Requirements
1. Subcontracting for services by the LHJ is prohibited by this Agreement unless approved in advance by DOH. If DOH grants approval, subcontractors are required to meet all
requirements set forth in this contract. In such cases, the LHJ is responsible for ensuring that all requirements are met by their subcontractors.
2.
All activities carried out in the performance of this statement of work must be documented in the appropriate DOH data system. LHJ must use Evaluation Web to report HIV
testing activity. Negative test result data is due no later than ten (10) days after testing services are provided. For confirmed HIV positive results, additional testing
information must be entered in Evaluation Web within ninety (90) days. LHJ must use the SHARE system for other program activity reporting. An LHJ needing assistance
with developing or filing plans in SHARE should contact DOH. LHJ is required to use other data reporting systems that may become available during the contract period.
DOH will provide training and technical assistance as needed to enable LHJ to comply with this requirement.
3.
All activities carried out in the performance of this statement of work must conform to an approved budget. Changes to the Statement of Work incorporated in this contract
require an amendment to the contract. Changes to the approved budget must be approved by DOH prior to taking effect.
4.
The LHJ is required to participate in annual contract monitoring and quality improvement activities performed by DOH. DOH will inform the LHJ of applicable contract
monitoring and quality improvement activities in advance to enable the LHJ to gather and retain appropriate information. The outcomes of contract monitoring and quality
improvement activities carried out by DOH will be shared with the LHJ to support collaborative efforts to increase efficiency and quality of all programs funded by DOH.
DOH will offer technical assistance to LHJ upon request. Technical assistance may be provided by DOH directly or in conjunction with CDC-contracted training and capacity
building providers.
Page 10 of 35
5.
The LHJ is required to participate in collaborative efforts with public health and community health and social service agencies, a wide variety of community partners and the
population(s) they serve to generate input from the community regarding the needs of the population(s) served and the most appropriate strategies to meet identified needs.
LHJ’s and their partners may use a variety of methods to generate community input such as client satisfaction surveys, focus groups, population or community surveys, key
informant surveys, community forums, online input methods or other approaches to meet this requirement. LHJ must document its community input methods as well as the
information generated and make it available to its communities and DOH.
6.
HIV CTR (Counseling, Testing, and Referral) services must follow Washington State and CDC guidance for HIV CTR.
7.
Partner services (PS) must follow current CDC guidelines for HIV PS and the Washington state Department of Health HIV Partner Services Standards. LHJ staff that
provides PS must have completed CDC approved HIV Partner Services training available from a National Prevention Training Center prior to beginning work.
8.
Any funds generated from charging clients for HIV testing will be used to support or enhance HIV prevention activities.
9.
HIV CTR must be performed by personnel who have attended the two-day Washington State HIV Prevention Counseling course conducted by instructors trained by DOH or
CDC (or an equivalent training as approved by DOH).
10. Persons performing HIV testing must be authorized by a licensed provider whose scope of practice includes ordering of diagnostic tests. This can be achieved with
memorandum of understanding / agreement (MOU/A) between agencies if there is no licensed provider directly accountable to the contracted agency.
11. Persons performing HIV rapid testing must be trained in how to store, perform, and read the results of the rapid test and rapid test controls. The rapid testing training must be
provided by the DOH or CDC (or an equivalent training as approved by DOH). Contractors performing HIV rapid testing must have written quality assurance (QA) plan in
place and make the plan available to DOH upon request.
12. DOH will conduct quality assurance activities with agencies implementing HIV CTR. The quality assurance activities will be used to assess and, when necessary, improve the
quality of services being provided. HIV testing programs will participate and conduct client satisfaction surveys. Documentation of the surveys will be sent to the DOH
Testing Coordinator by April 30, 2015.
13. LHJ prevention workers, testers and case managers involved in linkage to care activities are required to attend the appropriate Anti-Retroviral Treatment and Access to
Services (ARTAS) course provided by DOH or CDC.
14. Contracted sites involved in linkage to care activities must have MOU’s in place with partnering agencies and medical providers to assure continuity of services to clients.
15. Material Review and Website Disclaimer Notice:
In accordance with all federal guidance, an LHJ receiving federal funds will:
a)
Submit all proposed written materials including, but not limited to, pictorials, audiovisuals, questionnaires, survey instruments, agendas for conferences, plans for
educational sessions and client satisfaction surveys purchased, produced or used by staff funded with CDC funds to the State HIV/AIDS Review Panel for approval prior
to being used. This includes World Wide Web pages.
b)
Assure prominent display of disclaimer notice on all websites containing HIV/AIDS education information (including sub-contractors). Such notice must consist of
language similar to the following:
“This site contains HIV prevention messages that may not be appropriate for all audiences. Since HIV infection is spread primarily through sexual practices or by sharing
needles, prevention messages and programs may address these topics. If you are not seeking such information or may be offended by such materials, please exit this website.”
16. Youth and Peer Outreach Workers:
For purposes of this agreement, the term “youth” applies to persons under the age of 18. All programs, including subcontractors, using youth (either paid or volunteer) in
program activities will use caution and judgment in the venues / situations where youth workers are placed. Agencies will give careful consideration to the age
appropriateness of the activity or venue; will ensure that youth comply with all relevant laws and regulations regarding entrance into adult establishments and environments;
and will implement appropriate safety protocols that include clear explanation of the appropriate laws and curfews and clearly delineate safe and appropriate participation of
youth in program outreach activities. Programs using youth in program activities will submit protocols and other relevant materials to DOH by February 15, 2015.
Page 11 of 35
17. Payment:
Payment under the statement of work shall not exceed the amounts contained in the contract budget period and will be based on actual costs with back-up documentation
retained by the LHJ.
Maximum payment shall not exceed the total consideration. Payment will be made upon receipt and acceptance of the deliverables and receipt of properly executed A19-1A
invoice voucher. Receipt of the deliverables must be documented in the appropriate DOH data system prior to payment of invoices. Grantee must submit the following with
each monthly invoice for reimbursement:
a.
b.
c.
A summary of personnel costs charged to this statement of work during the billing month.
A summary of goods or materials charged to this statement of work during the billing month.
A summary of any other expenses charged to this statement of work during the billing month.
The LHJ is required to gather and retain the following information and provide it to DOH upon request:
a. Documentation of all salaries and benefits charged to this statement of work, by individual and program activity.
b. Documentation of all goods or materials charged to this statement of work by program activity.
c. Documentation of all other expenses charged to this statement of work, including administrative expenses.
DOH Program Contact
Abby Gilliland
Disease Control and Health Statistics
Infectious Disease Prevention Section
PO Box 47840, Olympia, WA 98504-7840
360.236.3351/Fax 360.236.3400
[email protected]
Page 12 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: Maternal & Child Health Block Grant Effective January 1, 2015
SOW Type: Original
Funding Source
State
Other
Period of Performance: January 1, 2015 through September 30, 2015
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to support local interventions that impact the target population of the Maternal and Child Health Block
Grant.
FFY15 MCHBG CBP ConCon
CFDA #
93.994
BARS
Revenue
Code
333.93.99
Master
Index
Code
78734250
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 09/30/15
TOTALS
Task
Number
*May Support PHAB
Standards/Measures
Current
Change
Consideration
Increase (+)
Total
Consideration
0
127,937
127,937
0
127,937
127,937
Due Date/Time Frame
Payment
Information and/or
Amount
Maternal and Child Health Block Grant (MCHBG) Administration
1a
1b
1c
1d
Participate in calls, at a minimum of every other
month, with DOH contract manager. Dates and
time for calls are mutually agreed upon between
DOH and LHJ.
Participate in DOH sponsored MCHBG-related
quarterly conference calls and/or webinars,
including up to two (2) in-person meetings.
Complete 2015-2016 MCHBG Budget Workbook
for October 1, 2015 through September 30, 2016
Report actual expenditures for October 1, 2014 –
December 31, 2014.
Designated LHJ staff will
participate in contract
management calls.
September 30, 2015
Designated LHJ staff will
participate in calls, webinars, and
meetings.
Submit completed MCHBG
Budget Workbook to DOH
contract manager.
Submit actual expenditures using
the MCHBG Budget Workbook
(Sections A and B only) to
contract manager.
September 30, 2015
Page 13 of 35
September 4, 2015
February 18, 2015
Reimbursement for
actual costs, not to
consideration. Action
Plan and Progress
Reports must only
reflect activities paid
for with funds
provided in this
statement of work for
the specified funding
period.
See Program Specific
Requirements and
Special Billing
Requirements.
Task
Number
*May Support PHAB
Standards/Measures
Payment
Information and/or
Amount
Due Date/Time Frame
MCHBG Assessment and Evaluation
2a
2b
Participate in statewide capacity and needs
assessment activities in preparation for next
statewide 5 year plan, as requested.
Participate in project evaluation activities
developed and coordinated by DOH, as
requested.
Documentation using report
template provided by DOH.
May 1, 2015
Reimbursement for
consideration.
Requirements and
Special Billing
Requirements.
Documentation using report
template provided by DOH.
September 30, 2015
Submit MCHBG Action Plan to
DOH contract manager.
Draft - August 21, 2015
Final - September 4, 2015
Submit Action Plan quarterly
reports to DOH contract manager.
January 15, 2015
April 15, 2015
July 15, 2015
MCHBG Implementation
3a
3b
Develop 2015-2016 MCHBG Action Plan for
October 1, 2015 through September 30, 2016
Report activities and outcomes of 2014-2015
MCHBG Action Plan using DOH provided
template.
If LHJ chooses to bill on a
monthly basis, reports are
due on or before the 15th
of the following month.
Reimbursement for
Plan and Progress
Reports must only
for with funds
provided in this
period.
Requirements and
Special Billing
Requirements.
Children with Special Health Care Needs (CSHCN)
4a
4b
Complete Child Health Intake Form (CHIF) using
the CHIF Automated System on all infants and
children served by the CSHCN Program as
referenced in CSHCN Program Manual.
Administer allocated DOH Diagnostic and
Treatment funds for infants and children per
CSHCN Program Manual when funds are used.
Submit CHIF data into Secure
File Transport (SFT) website:
https://sft.wa.gov
January 15, 2015
April 15, 2015
July 15, 2015
Submit completed Health
Services Authorization forms and
Central Treatment Fund requests
directly to the CSHCN Program
as needed.
30 days after forms are
completed.
Page 14 of 35
Reimbursement for
Plan and Progress
Reports must only
for with funds
provided in this
Task
Number
4c
Participate in the CSHCN Regional System and
quarterly meetings as described in the CSHCN
Program Manual.
*May Support PHAB
Standards/Measures
Submit Action Plan quarterly
reports including number of
regional meetings attended to the
DOH contract manager.
Due Date/Time Frame
January 15, 2015
April 15, 2015
July 15, 2015
Payment
Information and/or
Amount
period.
Requirements and
Special Billing
Requirements.
Program Manual, Handbook, Policy References
Children with Special Health Care Needs Manual - http://www.doh.wa.gov/Portals/1/Documents/Pubs/970-209-CSHCN-Manual.pdf
Staffing Requirements
1. At least 30% of federal Title V funds must be used for preventive and primary care services for children and at least 30% must be used services for children with
special health care needs. [Social Security Law, Sec. 505(a)(3)].
2.
Funds may not be used for:
a. Inpatient services, other than inpatient services for children with special health care needs or high risk pregnant women and infants, and other patient services approved by
Health Resources and Services Administration (HRSA).
b. Cash payments to intended recipients of health services.
c. The purchase or improvement of land, the purchase, construction, or permanent improvement of any building or other facility, or the purchase of major medical
equipment.
d. Meeting other federal matching funds requirements.
e. Providing funds for research or training to any entity other than a public or nonprofit private entity.
f. payment for any services furnished by a provider or entity who has been excluded under Title XVIII (Medicare), Title XIX (Medicaid), or Title XX (social services block
grant).[Social Security Law, Sec 504(b)].
Page 15 of 35
3.
If any charges are imposed for the provision of health services using Title V (MCH Block Grant) funds, such charges will be pursuant to a public schedule of charges; will not
be imposed with respect to services provided to low income mothers or children; and will be adjusted to reflect the income, resources, and family size of the individual
provided the services. [Social Security Law, Sec. 505 (1)(D)].
Monitoring Visits (frequency, type)
Telephone calls with contract manager at least one every other month.
Special Billing Requirements
Payment is contingent upon DOH receipt and approval of all deliverables and an acceptable A19-1A invoice voucher. Payment to completely expend the “Total Consideration”
for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices must be submitted at least quarterly and must be based on
actual allowable program costs. Billing for services on a monthly or quarterly fraction of the “Total Consideration” will not be accepted or approved. Monthly invoices on actual
allowable program costs will be accepted but an updated Action Plan Progress Report must also be submitted.
DOH Program Contact
Marilyn Dold
Healthy Communities Consultant
Office of Healthy Communities
Street Address: 310 Israel Rd SE, Tumwater, WA 98501
Mailing Address: PO Box 47848, Olympia, WA 98504
Telephone: 360-236-3747/ Fax: 360-236-3646
Email: [email protected]
Page 16 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: Office of Drinking Water Group A Program Effective January 1,2015
SOW Type: Original
Local Health Jurisdiction Name: Thurston County Public Health & Social
Services Department
Funding Source
Federal Contractor
State
Other
Period of Performance: January 1, 2015 through December 31, 2017
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to provide funding to the LHJ for conducting sanitary surveys and providing technical assistance to small
community and non-community Group A water systems.
Drinking Water Group A - SS
Drinking Water Group A - TA
CFDA #
N/A
N/A
BARS
Revenue
Code
346.26.64
346.26.66
Master
Index
Code
2421921C
2421921D
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 12/31/15
01/01/15 12/31/15
TOTALS
Task
Number
1
Trained LHJ staff will conduct sanitary
surveys of small community and noncommunity Group A water systems
identified by the DOH Office of Drinking
Water (ODW) Regional Office.
See Special Instructions for task activity.
*May Support PHAB
Standards/Measures
Current
Change
Consideration
Increase (+)
Total
Consideration
0
0
17,750
6,000
17,750
6,000
0
23,750
23,750
Due Date/Time Frame
Provide Final* Sanitary Survey
Reports to ODW Regional Office.
Complete Sanitary Survey Reports
shall include:
1. Cover letter identifying
significant deficiencies,
significant findings,
observations, recommendations,
and referrals for further ODW
follow-up.
2. Completed Small Water System
checklist.
3. Updated Water Facilities
Inventory (WFI).
4. Photos of water system with text
identifying features
5. Any other supporting
documents.
Page 17 of 35
Final Sanitary Survey
Reports must be received
by the ODW Regional
Office within 30 calendar
days of conducting the
sanitary survey.
Payment Information
and/or Amount
Upon ODW acceptance
of the Final Sanitary
Survey Report, the LHJ
shall be paid $250 for
each sanitary survey of a
non-community system
with three or fewer
connections.
Upon ODW acceptance
of the Final Sanitary
Survey Report, the LHJ
shall be paid $500 for
each sanitary survey of a
non-community system
with four or more
connections and each
community system.
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time Frame
*Final Reports have been reviewed
and accepted by the ODW Regional
Office.
Payment Information
and/or Amount
Payment is inclusive of
all associated costs such
as travel, lodging, per
diem.
Payment is authorized
upon receipt and
acceptance of the Final
Sanitary Survey Report
within the 30 day
deadline.
Late or incomplete
reports may not be
accepted for payment.
2
Trained LHJ staff will conduct Special
Purpose Investigations (SPI) of small
community and non-community Group A
water systems identified by the ODW
Regional Office.
Provide completed SPI Report and
any supporting documents and
photos to ODW Regional Office.
Completed SPI Reports
must be received by the
ODW Regional Office
within 2 working days of
the service request.
Upon acceptance of the
completed SPI Report,
the LHJ shall be paid
$800 for each SPI.
as travel, lodging, per
diem.
upon receipt and
acceptance of completed
SPI Report within the 2
working day deadline.
3
Trained LHJ staff will provide direct
technical assistance (TA) to small
community and non-community Group A
water systems identified by the ODW
Regional Office.
Provide completed TA Report and
any supporting documents and
photos to ODW Regional Office.
Page 18 of 35
Completed TA Report
must be received by the
ODW Regional Office
within 30 calendar days of
providing technical
assistance.
Late or incomplete
reports may not be
Upon acceptance of the
completed TA Report,
the LHJ shall be paid for
each technical assistance
activity as follows:
 Up to 3 hours of work:
$250
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time Frame
Payment Information
and/or Amount
 3-6 hours of work:
$500
 More than 6 hours of
work: $750
as consulting fee, travel,
lodging, per diem.
upon receipt and
acceptance of completed
TA Report within the 30day deadline.
4
LHJ staff performing the activities under
tasks 1, 2 and 3 must have completed the
mandatory Sanitary Survey Training.
Prior to attending the training, submit
an “Authorization for Travel (NonEmployee)” DOH Form 710-013 to
the ODW Program Contact below for
approval (to ensure that enough
funds are available).
Annually
Late or incomplete
reports may not be
LHJ shall be paid
mileage, per diem, and
lodging costs in
accordance with the
current rates listed on the
OFM Website
http://www.ofm.wa.gov/r
esources/travel.asp
Special References (RCWs, WACs, etc)
Chapter 246-290 WAC is the set of rules that regulate Group A water systems. By this statement of work, ODW contracts with the LHJ to conduct sanitary surveys (and SPIs, and
provide technical assistance) for small community and non-community water systems with groundwater sources. ODW retains responsibility for conducting sanitary surveys (and
SPIs, and provide technical assistance) for small community and non-community water systems with surface water sources, large water systems, and systems with complex
treatment.
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. See special instructions under Task 4, below.
Page 19 of 35
Special Billing Requirements
The LHJ shall submit quarterly invoices within 30 days following the end of the quarter in which work was completed, noting on the invoice the quarter and year being billed for.
Payment cannot exceed a maximum accumulative fee of $17,750 for Task 1, and $6,000 for Task 2, Task 3 and Task 4 combined during the contracting period, to be paid at the
rates specified in the Payment Method/Amount section above.
When invoicing for Task 4, submit receipts and the signed pre-authorization form for non-employee travel to the ODW Program Contact below and a signed A19-1A Invoice
Voucher to the DOH Consolidated Contracts Office, billing to BARS Revenue Code 346.26.66 under Technical Assistance (TA).
Special Instructions
Task 1
Trained LHJ staff will evaluate the water system for physical and operational deficiencies and prepare a Final Sanitary Survey Report which has been accepted by ODW. Detailed
guidance is provided in the Field Guide for Sanitary Surveys, Special Purpose Investigations and Technical Assistance (Field Guide). The sanitary survey will include an
evaluation of the following eight elements: source; treatment; distribution system; finished water storage; pumps, pump facilities and controls; monitoring, reporting and data
verification; system management and operation; and certified operator compliance. If a system is more complex than anticipated or other significant issues arise, the LHJ may
request ODW assistance.
 No more than 11 surveys of non-community systems with three or fewer connections to be completed between January 1, 2015 and December 31, 2015.
 No more than 30 surveys of non-community systems with four or more connections and all community systems to be completed between January 1, 2015 and
December 31, 2015.
The process for assignment of surveys to the LHJ, notification of the water system, and ODW follow-up with unresponsive water systems; and other roles and responsibilities of
the LHJ are described in the Field Guide.
Task 2
Trained LHJ staff will perform Special Purpose Investigations (SPI) as assigned by ODW. SPIs are inspections to determine the cause of positive coliform samples or the cause of
other emergency conditions. SPIs may also include sanitary surveys of newly discovered Group A water systems. Additional detail about conducting SPIs is described in the Field
Guide. The ODW Regional Office must authorize in advance any SPI conducted by LHJ staff.
Task 3
Trained LHJ staff will conduct Technical assistance as assigned by ODW. Technical Assistance includes assisting water system personnel in completing work or verifying work
has been addressed as required, requested, or advised by the ODW to meet applicable drinking water regulations. Examples of technical assistance activities are described in the
Field Guide. The ODW Regional Office must authorize in advance any technical assistance provided by the LHJ to a water system.
Task 4
LHJ staff assigned to perform activities under tasks 1, 2, and 3 must be trained and approved by ODW prior to performing work. LHJ staff performing the activities under tasks 1,
2 and 3 must have completed, with a passing score, the ODW Online Sanitary Survey Training and the ODW Sanitary Survey Field Training. LHJ staff performing activities under
tasks 1, 2, and 3 must attend the Annual ODW Sanitary Survey Workshop, and are expected to attend the Regional ODW LHJ Drinking Water Meetings.
If required trainings, workshops or meetings are not available, not scheduled, or if the LHJ staff person is unable to attend these activities prior to conducting assigned tasks, the
LHJ staff person may, with ODW approval, substitute other training activities to be determined by ODW. Such substitute activities may include one-on-one training with ODW
staff, co-surveys with ODW staff, or other activities as arranged and pre-approved by ODW. LHJ staff may not perform the activities under tasks 1, 2, and 3 without completing
the training that has been arranged and approved by ODW.
Page 20 of 35
http://www.doh.wa.gov/Portals/1/Documents/Pubs/331-486.pdf
DOH Program Contact
Denise Miles
DOH Office of Drinking Water
243 Israel Rd SE
Tumwater, WA 98501
[email protected]
(360) 236-3028
Page 21 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: Office of Immunization & Child Profile Effective January 1, 2015
SOW Type: Original
Services Department
Funding Source
State
Other
Period of Performance: January 1, 2015 through December 31, 2015
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to define required immunization tasks, deliverables, and funding.
FFY15 VFC Ops
FFY15 VFC Ordering
FFY15 317 Ops
FFY15 AFIX
CFDA #
93.268
93.268
93.268
93.268
BARS
Revenue
Code
333.93.26
333.93.26
333.93.26
333.93.26
Master
Index
Code
74203250
74204250
74201250
74205250
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 12/31/15
01/01/15 12/31/15
01/01/15 12/31/15
01/01/15 12/31/15
TOTALS
Current
Change
Consideration
Increase (+)
Total
Consideration
0
0
0
0
8,088
8,268
10,669
36,863
8,088
8,268
10,669
36,863
0
63,888
63,888
Payment
Information and/or
Amount
Perform accountability activities in accordance with state and federal requirements for the Vaccines for Children (VFC) Program as outlined in the Centers for Disease Control and
Prevention (CDC) VFC Operations Guide and as directed by the state administrators of the VFC program. Accountability requirements include, but are not limited to: provider
education, provider site visits and required corrective action, quality assurance activities, VFC screening, satisfaction survey, outside provider agreements, new provider enrollment
visits, fraud and abuse reporting, monthly accountability reports, and private provider report of vaccine usage.
1
Facilitate annual renewal of the Provider
Provider Agreements for Receipt
Annually, per Annual
Reimbursement for
Agreement for Receipt of State Supplied
of State Supplied Vaccine received VFC Provider Agreement actual costs incurred,
Vaccine for all health care providers receiving
online via the Washington
Update Schedule
not to exceed total
state-supplied childhood vaccines, per
Immunization Information System.
funding consideration
instructions at this link
amount.
Task
Number
*May Support PHAB
Standards/Measures
Due Date/Time Frame
Funds available for
this task*:
FFY15 AFIX,
74205250
Page 22 of 35
Task
Number
2
Enroll new providers. Conduct an enrollment
site visit to all new providers, and gather
information needed to complete Program
enrollment, per instructions at this link
*May Support PHAB
Standards/Measures
a)
Provider Agreement for
Receipt of State Supplied
Vaccine with original
signature (NOTE: a photocopy
will not be accepted)
Within ten (10) days after
the date of the provider
enrollment visit
Funds available for
this task*:
c)
FFY15 AFIX,
74205250
e)
Use and facilitate provider use of the
Washington Immunization Information System
to place and approve provider vaccine orders.
Monitor provider orders for appropriateness
(including: accuracy of shipping information,
order frequency, timing, quantity and type) and
approve vaccine order online after assuring the
appropriateness of the order.
Reimbursement for
actual costs incurred,
not to exceed total
amount.
b) Provider Agreement
(DOH 348-022)
IIS Information Sharing
Agreement
d) Account Application
3
Payment
Information and/or
Amount
*See Restrictions on
Funds below
Due Date/Time Frame
Funds below
User Account Worksheet
Electronic submission of provider
vaccine orders via the Washington
Immunization Information System
Based on provider order
schedules
Reimbursement for
not to exceed total
amount.
Funds available for
this task*:
FFY15 VFC Vaccine
Ordering
74204250
FFY15 VFC Ops
74203250
FFY 317 Ops
74201250
Funds below
Page 23 of 35
Task
Number
4
5
Monitor and assure electronic or paper
submission of vaccine accountability reports for
compliance with Provider Agreement related to
vaccine management (ordering, inventory
management, reconciliation, compliance with
storage and handling, and reporting of all
vaccine incidents and returns).
Provide communication, technical assistance,
consultation, and education to providers about
vaccine quality assurance, accountability,
program participation and vaccine management.
*May Support PHAB
Standards/Measures
a)
Monthly Vaccine
Accountability Report
(DOH 348-006), submitted by
e-mail or online in the IIS
a)
By the 15th of each
month
b) Inclusion in the online
ordering system of doses used
in the last month and
inventory on hand.
b) based on provider
order schedules
c)
c)
Report of Vaccine Storage
Incidents (DOH 348-154)
complete with reason and
corrective action as needed.
Payment
Information and/or
Amount
Reimbursement for
not to exceed total
amount.
Due Date/Time Frame
Funds available for
this task*:
within seven (7) days
of the incident
FFY15 AFIX,
74205250
Funds below
d) Report all cases (or suspected
cases) of vaccine fraud or
abuse.
d) within seven (7) days
of the incident
Summary of LHJ Technical
Assistance Form (DOH 348-257)
December 31st
Reimbursement for
not to exceed total
amount.
Funds available for
this task*:
FFY15 VFC Ops
74203250
FFY 317 Ops
74201250
Funds below
6
Conduct VFC site visits at sixteen (16) private
provider site(s) within your jurisdiction. Site
visits should address all requirements outlined in
the Provider Agreement, the CDC Vaccines for
Children (VFC) Operations Guide, and as
directed by the state administrators of the
Vaccines for Children program. All VFC site
a)
VFC Site Visit Selection
Planning tool (will be supplied
by DOH)
Page 24 of 35
a)
January 15th
Reimbursement for
not to exceed total
amount.
Task
Number
visits must be conducted by September 30th.
Conduct VFC Compliance Site Visit Follow-Up
to assure providers resolve all corrective actions
identified during the initial VFC compliance site
visit. Follow-up may include another physical
site visit or verification by email, phone, fax, or
mail that corrective actions were completed.
Documentation that all VFC Site Visit corrective
actions have been completed must be available
to DOH upon request.
Participate in all DOH/CDC trainings required
for site visit reviewers and supervisors (a list of
required trainings will be provided by DOH).
7
a)
Conduct AFIX (Assessment, Feedback,
Incentive, and Exchange) visits with six (6)
provider sites in your jurisdiction per
instructions at this link. Visits can be
conducted in-person, by telephone, or by
webinar. All AFIX visits must be conducted
by September 30th.
b) Conduct AFIX follow-up visits with
provider sites that choose to implement
quality improvement strategies during their
initial AFIX visit. Continue following up
with provider sites until they fully
implement their selected quality
improvement activities. Follow-up visits
can be conducted in-person, by telephone,
or by webinar.
8
a) In coordination with hospitals, health care
providers, and health plans (if applicable),
conduct activities to prevent perinatal hepatitis B
infection in accordance with the Perinatal
Hepatitis B Prevention Program Guidelines,
including the following:
*May Support PHAB
Standards/Measures
Due Date/Time Frame
b) Enter responses from the VFC
Provider Compliance Site
Visit questionnaire into the
VFC Provider Education,
Assessment, and Reporting
(VFC-PEAR) on-line system
for each provider site visit.
Follow all corrective action
and follow-up guidance
provided by VFC-PEAR for
each incorrect response.
b) At the time of the
VFC Compliance
Site Visit or within
ten (10) business
days of the site visit.
c)
c)
upon completion of
each training
a)
At the time of the
AFIX visit or within
ten (10) business
days of the AFIX
visit.
Submit copy of signed
Acknowledgement of Receipt
d) Document completion of each
required training
a) Enter the following data in the
AFIX Online Tool:
 General Site Visit
Information.
 Questionnaire responses.
 Coverage assessment results
(from CoCASA reports).
 Feedback visit information.
b) Enter the following data in the
Exchange tab of the AFIX
Online Tool for follow-up
visits:
 Clinic progress on
implementing quality
improvement strategies.
 Follow-up coverage
assessment results (from
CoCASA reports).
Enter information for each case
identified into the Perinatal
Hepatitis B module of the WA
Immunization Information System
Page 25 of 35
Payment
Information and/or
Amount
Funds available for
this task*:
FFY15 AFIX,
74205250
Funds below
Reimbursement for
not to exceed total
amount.
b) At the time of the
AFIX follow-up visit
or within ten (10)
business days of the
AFIX follow-up visit
Funds available for
this task*:
FFY15 AFIX,
74205250
Funds below
By the 15th of each
month
Reimbursement for
not to exceed total
amount.
Task
Number
1) identification of HBsAg-positive
pregnant women, and pregnant women with
unknown HBsAg status
2) reporting of HBsAg-positive women and
their infants
3) case management for infants born to
HBsAg-positive women to ensure
administration of HBIG and hepatitis B
vaccine within 12 hours of birth, the
completion of the 3-dose hepatitis B vaccine
series, and post-vaccination serologic
testing.
*May Support PHAB
Standards/Measures
Annual Perinatal Hepatitis B
Outreach Summary
(DOH 348 268)
Due Date/Time Frame
December 15th
Payment
Information and/or
Amount
Funds available for
this task*:
FFY 317 Ops
74201250
Funds below
b) Provide technical assistance to birthing
hospitals to encourage administration of the
hepatitis B birth dose to all newborns within 12
hours of birth, in accordance with ACIP
recommendations.
c). Report all perinatal hepatitis B investigations,
including HBsAg-positive infants, in the
Perinatal Hepatitis B Module of the Washington
State Immunization Information System.
 All LHJ staff who conducts VFC Compliance Site Visits and AFIX visits must participate in an annual VFC and AFIX training, conducted by DOH Office of Immunization
and Child Profile (OICP) staff or their designee.
 All new LHJ site visit reviewers are required to have at least one (1) observational visit conducted by DOH OICP staff or their designee. DOH OICP staff (or designee) will
periodically conduct observational VFC/AFIX site visits with all other LHJ reviewers who conduct VFC Compliance Site Visits.
 LHJ staff who conducts VFC Compliance Site Visits must participate in at least one (1) joint (observational) VFC compliance visit with DOH staff every other year. The
observational visit will occur during a regularly scheduled site visit conducted by the LHJ reviewer. DOH will determine the Observational visit.
 Tasks in this statement of work may not be subcontracted without prior written approval from DOH OICP.
Page 26 of 35
Office of Immunization and Child Profile References and Resources for vaccine management, VFC compliance site visits, AFIX visits, and Perinatal Hepatitis B activities can be
found at this link to our website.
VFC Operations Guide - A copy will be provided by the Office of Immunization and Child Profile. (Note: All site visit reviewers are required to have access to the most current
CDC VFC Operations Guide at every VFC compliance site visit).
Staffing Requirements
Provide notification via email to [email protected] within fifteen (15) days of any changes to staffing for those who conduct work outlined in this statement of work.
Allowable expenses with 317 and VFC FA Operations Funds (dated September 7, 2011) document is posted on the DOH Consolidated Contract website at this link. In addition to
the funding listed in the Payment Information and/or Amount column for each task, FFY13 317 Ops funding may be used for any activity in this statement of work, per funding
availability.
These federal funds may not be used for expenses related to travel or attendance at any CDC-sponsored conference, training, or event without prior written approval from the
Office of Immunization and Child Profile.
DOH Program Contact
Tawney Harper, MPA
Budget and Operations Manager
Office of Immunization and Child Profile
Department of Health
[email protected], 360-236-3525
Deliverables may be sent electronically via email at [email protected],
by fax to 360-236-3590, or by mail to PO Box 47843, Olympia WA 98504-7843
DOH Fiscal Contact
Sheri Spezze
Budget Coordinator
Office of Immunization and Child Profile
[email protected], 360-236-3495
Page 27 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: OSS LMP Implementation - Effective January 1, 2015
SOW Type: Original
Funding Source
State
Other
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to fund implementation of the on-site sewage system (OSS) local management plan (LMP) for the last 6
months of the 2013-2015 biennium.
Puget Sound OSS LMP Implementation
CFDA #
N/A
BARS
Revenue
Code
334.04.93
Master
Index
Code
2670000C
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 06/30/15
TOTALS
Task
Number
1
2
*May Support PHAB
Standards/Measures
Project Administration & Management
A progress report will be submitted to the DOH
at the end of the period of performance and
include statistics as required in the progress
report form and the data reporting requirements.
Electronic copy of progress report
Electronic files for mapping data
Henderson Inlet On-Site Sewage Systems
(OSS) Program Implementation
 Additional staffing (~0.58 FTE) will be
provided over the life of the contract to ensure
full implementation of all elements of the
Henderson Watershed area of special concern,
which established rigorous septic system
operation and maintenance requirements for
100% of the systems.
 Operational Certificate notices will be sent to
owners whose OSS certificates due for
 Number of properties served by
OSS within the Henderson
marine recovery area (MRA).
 Number of OSS with current
Operational Certificates.
 Number of OSS in
nonconforming status.
 Number of nonconforming
OSS brought back into
compliance.
 Number of failing OSS
Current
Change
Consideration
Increase (+)
Total
Consideration
0
36,500
36,500
0
36,500
36,500
Due Date/Time Frame
Report due date:
June 30, 2015
Payment
Information and/or
Amount
$1,500
Task is ongoing throughout
the project period.
Page 28 of 35
Report due date:
June 30, 2015
$35,000
Task is ongoing throughout
the project period.
Task
Number
*May Support PHAB
Standards/Measures
renewal. Operational Certificates will be
issued for those OSS complying with the
inspection and code requirements.
 Staff will follow up on OSS owners who do
not respond to the notices or do not do the
necessary repairs or maintenance indicated by
the inspections.
 Dye tests of high risk systems will be
completed for systems due.
 Quality assurance inspections will be
conducted on approximately 10% of OSS
inspections received.
Due Date/Time Frame
Payment
Information and/or
Amount
identified.
 Number of Notices of Violation
sent.
 Number of OSS repaired.
 Number and type of minor
repairs made.
 Number of quality assurance
inspections completed.
 Number of septic workshops
held for MRA OSS owners
 Number of workshop
attendees.
 Map inspection status of OSS
in Henderson MRA, as
specified in DOH instructions.
Thurston County On-site Sewage System Management Plan – Adopted January 7, 2008.
WAC 246-272A and RCW 70.118A
State funds from the Aquatic Lands Enhancement Account must be used to implement elements and activities of the local on-site sewage management plans that do not conflict
with and are consistent with the goals, strategies, objectives, and actions of the Puget Sound Action Agenda.
These funds can NOT be used for local match to federal grants.
Definitions
Failure: A condition of an on-site sewage system or component that threatens the public health by inadequately treating sewage or by creating a potential for direct or indirect
contact between sewage and the public. Examples of failure include: (a) Sewage on the surface of the ground; (b) Sewage backing up into a structure caused by slow soil
absorption of septic tank effluent; (c) Sewage leaking from a sewage tank or collection system; (d) Cesspools or seepage pits where evidence of ground water or surface water
quality degradation exists; (e) Inadequately treated effluent contaminating ground water or surface water; or (f) Noncompliance with standards stipulated on the permit.
Page 29 of 35
Maintenance and Monitoring: The actions necessary to keep the on-site sewage system components functioning as designed. Periodic or continuous checking of an on-site sewage
system, which is performed by observations and measurements, to determine if the system is functioning as intended and if system maintenance is needed. Monitoring also
includes maintaining accurate records that document monitoring activities.
Progress reports, including marine recovery area (MRA) mapping data, are due to DOH via email to [email protected] and [email protected] on June 30, 2015.
The progress report format and data reporting requirements will be provided by DOH.
DOH Program Contact: Laura Homan, Office of Shellfish and Water Protection, PO Box 47824, Olympia WA 98504-7824; 360.236.3380; [email protected]
DOH Fiscal Contact: Connie Dunn, Environmental Public Health, PO Box 47820, Olympia WA 98504-7820, 360-236-3013, [email protected]
Page 30 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: Recreational Shellfish Activities Effective January 1, 2015
SOW Type: Original
Services Department
Funding Source
State
Other
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is to provide funds for shellfish harvesting safety for the last six months of the 2013-2015 biennium.
Rec Shellfish / Biotoxin (PSAA)
CFDA #
N/A
BARS
Revenue
Code
334.04.93
Master
Index
Code
26403600
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 06/30/15
TOTALS
Task
Number
1
Biotoxin Monitoring
 Collect samples on schedule according to
Department of Health (DOH) Biotoxin
Monitoring Plan, coordinate deviations from
the schedule with DOH, notify DOH in
advance if samples cannot be collected.
 Post / remove recreational shellfish warning
and / or classification signs on beaches and
restock cages as needed.
 This may also include recruiting, training, and
coordination of volunteers, and fuel
reimbursement funds for volunteer biotoxin
monitoring.
*May Support PHAB
Standards/Measures
Submit report on DOH approved
format of activities for the year,
including the number and names
of beaches posted for
classification.
Current
Change
Consideration
Increase (+)
Total
Consideration
0
500
500
0
500
500
Due Date/Time Frame
Email Report to DOH by:
02/20/2015
Payment
Information and/or
Amount
$500
Page 31 of 35
Department of Health’s Biotoxin Monitoring Plan
Chapter 246-280 WAC
http://www.doh.wa.gov/CommunityandEnvironment/Shellfish/RecreationalShellfish.aspx
http://www.doh.wa.gov/AboutUs/ProgramsandServices/EnvironmentalPublicHealth/ShellfishandWaterProtection/ShellfishProgram/Biotoxins.aspx
Report for work done the previous year must be submitted via email to Liz Maier by February 20, 2015.
The report format will be provided by DOH and may be modified throughout the contract period via email announcement.
DOH Program Contact (Name, Program Title, Mailing Address, Email Address, Phone & Fax Number)
Liz Maier, Office of Shellfish and Water Protection, PO Box 47824, Olympia WA 98504-7824; 360.236.3308; [email protected]
Page 32 of 35
Exhibit A
Statement of Work
DOH Program Name or Title: TB Program - Effective January 1, 2015
SOW Type: Original
Funding Source
State
Other
Period of Performance: January 1, 2015 through November 30, 2015
Federal Compliance
Type of Payment
Reimbursement
Fixed Price
Statement of Work Purpose: The purpose of this statement of work is tuberculosis (TB) prevention and control.
FFY15 TB Elimination
CFDA #
93.116
BARS
Revenue
Code
333.93.11
Master
Index
Code
12708215
Funding Period
(LHJ Use Only)
Start Date End Date
01/01/15 11/30/15
Current
Change
Consideration
Increase (+)
TOTALS
Task
Number
1
2
Provide Directly Observed Therapy (DOT) for
Tuberculosis per local protocol and procedure.
DOT is defined as a direct, face-to-face contact,
including videophone contact, in any location
between an individual with TB and a health care
worker who is trained to observe patients with TB
take each dose of medication and to remove
barriers to completion of treatment.
Endeavor to assure completion of curative TB
therapy within 12 months of initiation.
*May Support PHAB
Standards/Measures
0
12,569
12,569
0
12,569
12,569
Due Date/Time Frame
Payment
Information and/or
Amount
Reimbursement for
actual costs.
6.4 S, 6.4 L, 6.5 S
Written summary of 2014
activities.
March 2015, August 2015
for 2014 DOT activities
6.4 S, 6.4 L, 6.5 S
Completion of case in Public
Health Information Management
System (PHIMS) TB
Completion of case on TB
worksheet in Electronic Disease
Notification (EDN) Database
Aggregate Reports for TB
Program Evaluation - Contacts
Ongoing
Reimbursement for
actual costs.
Ongoing
Reimbursement for
actual costs.
July 1, 2015 for a) final
screening data for 2013
and b) preliminary
Reimbursement for
actual costs.
3
Appropriately evaluate immigrants and refugees
designated as Class A, B1, and B2.
7.2 L, 7.2 S
4
Management of TB contacts: the LHJ shall
medically evaluate persons who are identified as
TB contacts and initiate appropriate procedures
and treatment in accordance with current Centers
4.4 S, 4.6 S,
4.7 S, 4.9 S,
4.12 S, 8.1 S,
8.2 S, 8.3 S,
Total
Consideration
Page 33 of 35
Task
Number
*May Support PHAB
Standards/Measures
for Disease Control and Prevention
(CDC)/American Thoracic Society (ATS)
recommendations. The state and national
objective is to evaluate 95% of close contacts to
infectious cases of TB. Ongoing contact data will
be periodically supplied by the LHJ to DOH-TB
Program. These data will be used by DOH-TB
Program to complete the Aggregate Reports for
Tuberculosis Program Evaluation – Follow Up
and Treatment For Contacts of Tuberculosis
Cases. This report is required by the CDC.
8.7 S, 8.8 S,
8.10 S
5
Maintain a system to collect and evaluate current
and future data regarding activities associated
with identification and treatment of persons with
latent TB infection who are at high risk for active
TB (See MMWR "Targeted Tuberculin Testing
and Treatment of Latent Tuberculosis Infection",
June 9, 2000/Vol. 49/No. RR-6). Screening data
will be reported to DOH-TB in the Aggregate
Reports for Tuberculosis Program Evaluation Targeted Testing and Treatment of Latent
Tuberculosis Infection on an annual basis.
6.4 S, 6.4 L,
6.5 S, 7.2 L,
7.2 S
6
Provide computer and records support, interpreter
services, transportation support, and other
associated TB outreach activities as provided for
in the current CDC TB Elimination Cooperative
Agreement.
7.2 L
Payment
Information and/or
Amount
Due Date/Time Frame
Aggregate Reports for TB
Program Evaluation – Targeted
Testing
July 1, 2015 for a) final
and b) preliminary
Reimbursement for
actual costs.
CDC annual report summary and
cooperative agreement
application
March 2015, August 2015
Reimbursement for
actual costs.
Special Requirements (if applicable)
Page 34 of 35
TB Guidelines Manual (http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Tuberculosis/ProviderMaterials/TBServicesManual.aspx)
Restrictions on funds
1. Emphasis must be given to directing the majority of funds to core TB control activities.
2. Funds may not be used:
 To supplant State or LHJ funds;
 For inpatient care or construction or renovation of facilities;
 To purchase treatment medications.
Special References
TB Laws and Regulations (http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Tuberculosis/LawsGuidelines.aspx)
DOH Program Contact Name, Address, Email Address, Phone Number
Sheanne Allen
TB Controller/ Program Manager
P.O. Box 47837, Olympia, WA 98504-7837
[email protected]
(360) 236-3423
Page 35 of 35
EXHIBIT B
ALLOCATIONS
Thurston County Public Health
BARS
Revenue
Federal Award
Chart of Accounts Program Title
Identification Number
Amend #
CFDA*
Code*
Statement of Work
Funding Period
Contract Number:
Date:
C17129
October 17, 2014
Funding
Period
Chart of
Accounts
Amount
Sub Total
Total
DOH Use Only
Chart of Accounts
Funding Period
Start Date End Date Start Date End Date
FFY14 EPR LHJ Funding
U90TP000559
N/A
93.069
333.93.06
01/01/15
06/30/15
07/01/14
06/30/15
$32,967
$32,967
$32,967
FFY14 CDC Sodium Reduction in Comm YR2
U58DP004928
N/A
93.082
333.93.08
01/01/15
09/29/15
09/30/14
09/29/15
$43,875
$43,875
$43,875
FFY15 TB Elimination
NGA Not Received
N/A
93.116
333.93.11
01/01/15
11/30/15
01/01/15
12/31/15
$12,569
$12,569
$12,569
FFY15 317 Ops
NGA Not Received
N/A
93.268
333.93.26
01/01/15
12/31/15
01/01/15
12/31/15
$10,669
$10,669
$10,669
FFY15 AFIX
NGA Not Received
N/A
93.268
333.93.26
01/01/15
12/31/15
01/01/15
12/31/15
$36,863
$36,863
$36,863
FFY15 VFC Ops
NGA Not Received
N/A
93.268
333.93.26
01/01/15
12/31/15
01/01/15
12/31/15
$8,088
$8,088
$8,088
FFY15 VFC Ordering
NGA Not Received
N/A
93.268
333.93.26
01/01/15
12/31/15
01/01/15
12/31/15
$8,268
$8,268
$8,268
FFY14 EPR HPP BP3-Prep
U90TP000559
N/A
93.889
333.93.88
01/01/15
06/30/15
07/01/13
06/30/15
$14,000
$14,000
$14,000
FFY15 MCHBG CBP ConCon
B04MC28134
N/A
93.994
333.93.99
01/01/15
09/30/15
10/01/14
09/30/15
$127,937
$127,937
$127,937
Adult Viral Hepatitis Prev
N/A
N/A
334.04.91
01/01/15
06/30/15
07/01/13
06/30/15
$23,750
$23,750
$23,750
Puget Sound LMP Implementation
N/A
N/A
334.04.93
01/01/15
06/30/15
07/01/13
06/30/15
$36,500
$36,500
$36,500
Rec Shellfish / Biotoxin (PSAA)
N/A
N/A
334.04.93
01/01/15
06/30/15
07/01/13
06/30/15
$500
$500
$500
N/A
N/A
346.26.64
01/01/15
12/31/15
07/01/13
12/31/15
$17,750
$17,750
$17,750
N/A
N/A
346.26.66
01/01/15
12/31/15
07/01/13
12/31/15
$6,000
$6,000
$6,000
$379,736
$379,736
TOTAL
Total consideration:
$379,736
GRAND TOTAL
$379,736
GRAND TOTAL
$379,736
Total Fed
Total State
$295,236
$84,500
*Catalog of Federal Domestic Assistance
**Federal revenue codes begin with "333". State revenue codes begin with "334".
Page 1 of 1
Exhibit C Schedule of Federal Awards
Date: October 17, 2014
THURSTON CO PUB HEALTH & SOC SER-SWV0007436-08
CONTRACT C17129-Thurston County Public Health & Social Services Department
CONTRACT PERIOD 1/1/2015-12/31/2017
Chart of Accounts Program Title
BARS
DOH
Federal
Award Date
Total Amt
Federal
Award
Allocation Period
Start
End
Date
Date
Contract Amt
CFDA
CFDA Program Title
Federal Agency Name
Federal Award
Identification Number
Federal Grant Award Name
FFY14 EPR LHJ FUNDING
333.93.06
06/30/14
$12,663,227
01/01/15
06/30/15
$32,967
93.069
Public Health Emergency
Preparedness
Department of Health and Human
Services Centers for Disease
Control and Prevention
U90TP000559
TP12-1201 HPP AND PHEP
COOPERATIVE AGREEMENTS
FFY14 CDC SODIUM REDUCTION IN COMM
333.93.08
07/24/14
$350,000
01/01/15
09/29/15
$43,875
93.082
Sodium Reduction in
Communities
U58DP004928
WASHINGTON STATE REDUCING
SODIUM FOR HEALTH PROJECT
FFY15 TB ELIMINATION
333.93.11
NGA Not
Received
NGA Not
Received
01/01/15
11/30/15
$12,569
93.116
Project Grants and Cooperative
Agreements for Tuberculosis
Control Program
NGA Not Received
NGA Not Received
FFY15 317 OPS
333.93.26
NGA Not
Received
NGA Not
Received
01/01/15 12/31/15
$10,669
93.268
Immunization Cooperative
Agreements
NGA Not Received
NGA Not Received
FFY15 AFIX
333.93.26
NGA Not
Received
NGA Not
Received
01/01/15 12/31/15
$36,863
93.268
Agreements
NGA Not Received
NGA Not Received
FFY14 VFC OPS
333.93.26
NGA Not
Received
NGA Not
Received
01/01/15 12/31/15
$8,088
93.268
Agreements
NGA Not Received
NGA Not Received
FFY15 VFC ORDERING
333.93.26
NGA Not
Received
NGA Not
Received
01/01/15 12/31/15
$8,268
93.268
Agreements
NGA Not Received
NGA Not Received
FFY14 EPR HPP BP3-PREP
333.93.88
06/30/14
$12,663,227
01/01/15
06/30/15
$14,000
93.889
Public Health Emergency
Preparedness
U90TP000559
TP12-1201 HPP AND PHEP
COOPERATIVE AGREEMENTS
FFY15 MCHBG CBP CONCON
333.93.99
10/21/14
$1,734,378
01/01/15
09/30/15
$127,937
93.994
Maternal and Child Health
Services Block Grant to the
States
Services Health Resources and
Services Administration
B04MC28134
MATERNAL AND CHILD HEALTH
SERVICES
TOTAL
$295,236
Page 1 of 1
DOH Consolidated Contract C17129
2015 - 2017 Program Funding Information
Original Contract Amount
Program title
Emerergency Preparedness &
Response EPR LHJ
Healthy Eating Active Living Reducing Sodium for Health Project
CDC Sodium Reduction in Comm
YR2
Thurston
Thrives*
Program Purpose
Establish funding and
tasks for Public Health
Emergewncy
Clinical &
Preparedness and
Emergency Care
Response Program for
2015 grant period
through 6/30/15
Food
Amend # Start Date
Office of Immunization & Child
Profile 317 Ops
Profile - AFIX
Amend Amount
Program Amount
What services does this funding
actually provide?
Public Health emergency preparedness and
response activities - planning, training,
communication, collaboration and response
original
1/1/2015
6/30/2015
$
32,967.00
$
32,967.00
Provide funding for
improving food
environments in nonchain restaurants and
large worksites by
implemeneting sodium
reduction interventions
Provide technical assistance, including
nutrition analysis, by our Public Health
Nutritionist to support partner food
business menu item and promotion changes to
increase the access to and availability of lowsodium foods at 2 worksite cafeterias and at
least one restaurant.
original
Tuberculosis (TB) Elimination
End Date
$379,736
1/1/2015
9/29/2015 $
43,875.00
$
43,875.00
Clinical &
TB prevention and
Emergency Care control
original
1/1/2015
Clinical &
Define required
Emergency Care immunization tasks,
deliverables and funding.
original
Clinical &
Define required
Emergency Care immunization tasks,
original
11/1/3015 $
12,569.00
$
12,569.00
1/1/2015 12/31/2015 $
10,669.00 $
10,669.00
1/1/2015 12/31/2015 $
36,863.00 $
TB prevention and control which includes
providing Directly Observed Therapy (DOT)
for individuals with TB.
These three budget lines fund the three parts
36,863.00 of our immunizations contract -- quality
improvement visits (AFIX), perinatal hepatitis
B, and the Vacines for Children Program
(VFC) site visits.
O:\Admin_Team\Contracts\CONSOLIDATED CONTRACT\2015-2017 DOH ConCon C17129\ConCon C17129 Program info and funding allocation spreadsheet - original contract
Page 1
Program title
Office of Immunizations & Child
Profile VFC Ops
Profile VFC Ordering
Emerergency Preparedness &
Response HPP BP3-PREP
Maternal & Child health Block Grant
(MCHBG)
CBP ConCon
Infectious Disesae Prevention
Section (IDPS)
Adult Viral Hepatitis Prev
Thurston
Thrives*
Program Purpose
Amend # Start Date
End Date
Amend Amount
Define required
Clinical &
immunization tasks,
Emergency Care
original
1/1/2015 12/31/2015 $
8,088.00
$
8,088.00
original
1/1/2015 12/31/2015 $
8,268.00 $
8,268.00
Define required
Clinical &
immunization tasks,
Emergency Care
Establish funding and
tasks for Public Health
Emergewncy
Clinical &
Preparedness and
Emergency Care
Response Program for
2015 grant period
through 6/30/15
Support local
Clinical &
interventions that impact
Emergency Care the target population of
the MCHBG
Clinical &
Provide infectious
Emergency Care
disease (HIV, STD, Adult
Viral Hepatitis)
prevention services
Whatbudget
services
does
thisthe
funding
These three
lines
fund
three parts
actually
provide?
Program Amount of our immunizations
contract -- quality
improvement visits (AFIX), perinatal hepatitis
B, and the Vacines for Children Program
(VFC) site visits.
Public Health emergency preparedness and
response activities - planning, training,
communication, collaboration and response
original
1/1/2015
6/30/2015
$
14,000.00
$
14,000.00
Preventive and primary care services for
children and services for children with special
health care needs.
original
original
1/1/2015
1/1/2015
9/30/2015 $
6/30/2015 $
127,937.00
23,750.00
$
$
127,937.00
1 for 1 Syringe exchange services, outreach
services including Substance Use Disorder
treatment referrals, Hep C, HIV, onsite
substance use disorder professionals when
available, syringe disposal, community
outreach and education for blood borne
23,750.00 pathogen prevention., and sharps safety.
Page 2
Program title
On-site Sewage System (OSS) Local
Management Plan (LMP)
Implementation - Puget Sound
Thurston
Thrives*
Environment Clean Water
Program Purpose
Amend # Start Date
EnvironmentClean Water
Program Amount
1/1/2015
6/30/2015 $
36,500.00 $
36,500.00
Provide funds for
shellfish harvesting
safety for the last six
months of the 20132015 biennium.
Provide funding to the
LHJ for conducting
sanitary surveys and
providing technical
assistanfce to small
community and noncommunity Group A
water systems
Provide funding to the
LHJ for conducting
sanitary surveys and
providing technical
assistanfce to small
community and noncommunity Group A
water systems
What services does this funding
actually provide?
Provides staff resources to fully implement the
Henderson Inlet septic system O&M program.
Addition resources focus on compliance, dye
tracing and quality assurance.
Collect shellfish samples for DoH to test to
determine if biotoxins are present at
dangerous levels. Post beaches if toxin is
present at high levels.
original
Amend Amount
Fund implementation of
the OSS LMP for the last
6 motnhs of the 20132015 biennium
original
Recreational Shellfish/Biotoxin
(PSAA)
End Date
1/1/2015
6/30/2015 $
500.00 $
500.00
Inspect Group A systems ( they serve 15 +
homes, restaurant, church or school) to
confirm proper construction and operation.
operators.
original
1/1/2015 12/31/2015 $
17,750.00
$
17,750.00
Provide technical assistance (help problem
solve/follow up on previous inspections) for
owners and operators of Group A systems.
original
1/1/2015 12/31/2015 $
6,000.00
GRAND TOTAL
$
$
6,000.00
379,736.00
Page 3
1 State Treasury
$143k
2 County
$337k
3 Federal Contracts
$166k
4 Fees
$92k
5 Intergov/
Interfunds $98k
Evidence Based Leadership
$792k
*Administration
$110k
5554
(1,2,3,4,5)
Health Officer
(1, 2, 5)
$188k
.60 FTE Thurston
.20 FTE Lewis
Epidemiology
(1, 2)
$92k
1.0 FTE
Vital Records
(1, 2, 4)
$102k
1.0 FTE
Emergency
Preparedness
(1, 2, 3)
$184k
1.85 FTE
Thurston
Thrives
(1, 2)
$116k
.50 FTE
Infectious Disease
Control
Data Support
Assessment
Registers, certifies and
issues certificates for
births and deaths
Public Health
emergency
infrastructure
Regional Health
Improvement
Collaborative
Community Public
Health Assessment
Evaluation
Disease Surveillance
Child Death Review
support
Coordinate Medical
Reserve Corps
Performance Measures
*Administration = allocated share of Director, Personnel/Systems, Fiscal
1 State Treasury
$764k
2 County
$431k
3 State Contracts
4 Federal Contracts
$111k
$574k
5 Medicaid Match
$47k
$252k
Disease Control & Prevention Division
$2.2m
*Administration
$165k
(1,2,3,6)
Infectious Disease
Control
(1, 2, 3, 5, 7)
$657k
5.0 FTE
Maternal
Child Health
(1, 2, 3, 4, 5, 6, 7)
$955k
6.9 FTE
Chronic Disease
Prevention
(1, 2, 3, 4)
$442k
1.75 FTE
Notifiable Conditions
Investigation and
Follow-up
Nurse – Family
Partnership
Tobacco-Free
Living
Vaccine for Children
Program
Children with Special
Health Care Needs
Healthy
Eating
Active
Living
Girls
Circle
*Administration = allocated share of Director, Personnel/Systems, Fiscal
7 Fees
$30k
1 State Treasury
$140k
2 County
$124k
3 State Contracts
$785k
4 Federal Contracts
$287k
5 Permit Fees
$2.6m
6 Interfund/Other Fees
$1.5m
Environmental Health Division
$5.4m
*Administration
$433k
(1,2,3,4,5)
Drinking Water/Land
Use/On-Site
(1, 3, 5)
$1.2m
8.0 FTE
Water
Quality
(1, 2, 3, 4, 5, 6)
$1.3m
9.5 FTE
Drinking
Water
Ground/Surface
Water Monitoring
Septic
System (On-site
Sewage)
Septic System
Operation and
Maintenance
Land Use
Review
Laboratory
(1, 2, 3, 4, 5, 6)
$204k
1.5 FTE
Drinking
Water/Surface Water
Testing
Food and
Environmental
Services
(1, 2, 5)
$1.1m
7.9 FTE
Food
Safety
Schools
Health and Safety
Public Swimming
Pools and Spas
Noise and
Smoking
Compliance
*Administration = Allocated share Director, Personnel/Systems, Fiscal
Rabies, WNV, and
other bug and critter
related illnesses.
Education
and Outreach
(2, 3, 6)
$350,000
3.3 FTE
Sewage Systems
Healthy Homes
Toxics
Scatter Creek
Solid and Hazardous
Waste
(1, 2, 3, 5, 6)
$744k
6.1 FTE
Solid
Waste
Hazardous
Waste
Complaints
and
Permitting
Notifiable Conditions
Investigation &
Follow-up
AGENDA ITEM SUMMARY
Created by:
Presenter:
Agenda Item #:
Cliff Moore, County Manager - Commissioners - 754-2960
Cliff Moore, County Manager - Commissioners - 754-2960
Item Title:
2015 South Sound Military and Communities Partnership Memorandum of Agreement
Class of Item: Commissioners and Manager's Items
List of Exhibits
2014 SSMCP MOA.pdf
258 KB
Recommended Action:
Move to approve the 2015 South Sound Military and Communities Partnership Memorandum of
Agreement and authorize the county manager to execute the agreement.
Item Description:
Thurston County continues to be a Steering Committee member of the South Sound Military and
Communities Partnership. The Partnership provides a framework for collaboration between local
governments, military installations and State and Federal agencies to better coordinate efforts in areas
including: military relations; transportation and land use planning; environmental protection;
emergency preparedness; data coordination; funding requests (e.g., grant applications); health care
coordination; population forecasting; workforce development; education; housing; community
development; economic development; and other issues that may arise. The Partnership provides
actionable recommendations to regional leaders on initiatives, programs, and topics that strengthen the
role that Joint Base Lewis-McChord (JBLM), the National Guard, and Reserves play in America's defense
strategy and the economic health and vitality of the region and the State of Washington.
The 2015 Steering Committee membership fee of $6,500 was approved and is included in the adopted
2015 county budget. The MOA has been reviewed and approved by the Prosecuting Attorney's Office.
MEMORANDUM OF AGREEMENT
This agreement is made between the undersigned parties and hereto it is agreed as follows:
I. Establishment:
This Memorandum of Agreement (MOA) establishes the structure, roles and responsibilities of the
South Sound Military & Communities Partnership (SSMCP, or the Partnership). This MOA supersedes
previous SSMCP MOAs.
II. Purpose:
The Partnership provides a framework for collaboration in the south Puget Sound region between
local governments, military installations, State agencies, and Federal agencies to better coordinate
efforts in areas such as: military relations; transportation and land use planning; environmental
protection; emergency preparedness; data coordination; funding requests (e.g., grant applications);
health care coordination; population forecasting; workforce development; education; housing;
community development; economic development; and other issues that may arise. The Partnership
provides actionable recommendations to regional leaders on initiatives, programs, and topics that
strengthen the role that Joint Base Lewis-McChord (JBLM), the National Guard, and Reserves play in
America's defense strategy and the economic health and vitality of the region and the State of
Washington. The Partnership:
a. Focuses on the intersection of issues between local governments and the military community,
engaging the support of the business, healthcare, education, workforce development, and
social services communities;
b. Assists in the coordination of governmental efforts so that all citizens of the community can
receive the full benefits of the economic, civil, commercial, cultural, and educational
opportunities presented to them, and so that the impact of the military community will be
fairly shared;
c. Promotes the general welfare of the region;
d. Acts on behalf of the members as the regional organization recognized by the Federal
government for applying for community assistance and grants related to mission changes
and/or growth at JBLM and Camp Murray;
e. Coordinates state and federal legislative educational and advocacy efforts by members and
SSMCP staff related to the promotion of common interests as approved by the Steering
Committee; and
f. Acts as the regional representative of the member governments to coordinate with JBLM and
Camp Murray regarding the ability of each installation to accomplish its current and future
projected mission.
III. Objectives:
1. Work collaboratively to create, expand, and improve opportunities to collect and disseminate
information and best practices that address the challenges of the local communities, residents,
121014 SSMCP MOA per 120514 EOC approval.doc
Page 1 of 8
2.
3.
4.
5.
6.
businesses, and military installations in our region to succeed in meeting their own needs without
preventing the others from meeting their needs, both now and in the future. Specifically:
a. Coordinate and provide recommendations to the region’s leaders to remedy and protect JBLM
and Camp Murray from encroachment or other initiatives that could result in degradation of
or restriction to military operations on or based out of JBLM and Camp Murray.
b. Notify the local military installations of development proposals or other projects in the
surrounding communities that may impact military operations.
Coordinate with commanders, communities, and State and Federal agencies on affairs that affect
the installation and may require State coordination and assistance.
Serve as a “single point of contact” to ensure that communities, the military, Washington State’s
congressional delegation, and other Federal agencies, as appropriate, are fully aware of activities
likely to result in impacts or benefits to the region.
Support efforts by agencies and service providers in the region to implement the
recommendations and strategies of the 2010 JBLM Growth Coordination Plan (GCP) and more
recently idenitified SSMCP priorities, which include:
a. A sound infrastructure system, adequate housing and education, and transition support into
Pierce and Thurston county workforces for military members and their families, military
retirees, and veterans;
b. Support for economic development organizations and initiatives that focus on leveraging the
military and related business opportunities to help create jobs and expand defense and
homeland security related economic development activity in the South Sound.
Adopt processes, similar to those already in place for artillery firing notices, to ensure that the
military installations provide timely advance notification of operations which are likely to impact
other partner members, and that other partner members provide the same courtesy to the
military installations.
Discuss and potentially act upon other issues or matters that the SSMCP deems essential to
fulfilling its purpose.
IV. Responsibilities:
1. Maintain a vision, organizational structure, brand, and a Work Plan for the Partnership consistent
with the recommendations and strategies identified in the GCP and subsequent documents as
well as other SSMCP priorities.
2. Form Working Groups (WGs) that support the Partnership and the implementation of the
recommendations in the GCP. Consider stakeholders involved in the ten Expert Panels of the GCP
effort for these working groups, but also be open to new stakeholders.
3. Develop and commit to a schedule of regular meetings for the Partnership and the WGs.
4. Hold an annual public forum that includes speakers from JBLM, regional stakeholders, and/or any
other relevamt organizations to share news; report on major changes at JBLM, Camp Murray, and
in local jurisdictions; discuss progress on GCP strategies, SSMCP priorities and other plans;
network among current and seek new SSMCP members; recognize outstanding service; and
celebrate new partnerships and programs.
5. Hold one or more member-exclusive events (in person, via social media, etc.) annually during
which data concerning progress and information about JBLM, Camp Murray, and SSMCP priorities
would be shared (including, for instance, actual and projected military-connected (active duty,
civilian employee, and military family( population and employment changes, construction
projects, funding changes, mobilization and deployment, etc.)
Page 2 of 8
6. Formalize a method for data sharing between JBLM and Camp Murray and the surrounding
communities which would include the most recent military related population changes, including
incoming personnel, deployments, Department of Defense (DoD) civilian operations, and
construction projects.
7. Develop periodic memoranda, schedules or press releases to share with members regarding
expansion/contraction of JBLM personnel, mobilization, and deployment.
8. Support information-sharing and appropriate advocacy with state and federal legislative bodies.
9. Accept an active role to ensure that GCP-related recommendations and other SSMCP priorities
are funded and sustained through the foreseeable future.
V. Membership:
To ensure efforts of the Partnership are planned, coordinated, and implemented with a focus on
outcomes, the structure of the SSMCP is as follows:
1. General Members.
Role: The primary role of the general membership is to provide expertise, perspective and
guidance to the Steering Committee on specific topics that promote the objectives of the SSMCP.
Members will gather at least annually (more often, if necessary) to share best practices and
receive information on changes at JBLM and Camp Murray, and in adjacent communities. They
will also be encouraged to share their insights on existing conditions and growth trends; assist in
the development of the GCP and other SSMCP priority implementation; and to review any
studies, products, and other information developed by staff. Working Groups (WGs) will be
established based on the strategies outlined in the GCP and on other topics of interest within the
SSMCP membership. Each WG will select a spokesperson/chair that will serve on the Steering
Committee to represent their strategy area/topic of interest. WG chairs will be expected to
report on GCP strategy and SSMCP priority progress, and may also take new initiatives to the
Steering Committee for consideration as part of the Partnership’s annual work plan. The WGs
already established include Transportation & Infrastructure (TI), Business & Development (BD),
Social Services (SS), and Healthcare (HC).
Participants: The Partnership is open to any person, association, group, or organization having an
interest in the purpose and objectives of the SSMCP, and such will be considered a member upon
payment of the annual dues established by the Steering Committee. The Partnership is intended
to be as inclusive as necessary to address the numerous topical areas covered in the GCP and
other SSMCP priorities.
Benefits:
a. Participate on one or more Working Groups of the member’s choice;
b. Participate in member-exclusive events and information sharing opportunities.
2. Executive Leadership Team.
Role: The Executive Leadership Team (ELT) is operational in nature, overseeing the day-to-day
work of Partnership staff, activities and budget and serving as a sounding board for staff on
emerging issues, problems, and initiatives that may occur during the interval between meetings
of the full Steering Committee. The ELT is structured to promote timely and manageable
communication and coordination between leadership and staff.
Page 3 of 8
Participants: The Executive Leadership Team (ELT) is open to any person, association, group, or
organization having an interest in the purpose and objectives of the SSMCP, and such will be
considered a member upon payment of the annual dues established by the Steering Committee.
3. Steering Committee.
Role: The Steering Committee (SC) is the foundation of the Partnership and the members are
committed to remaining actively involved in the Partnership moving forward. The SC provides
broad oversight to the implementation of the recommendations, strategies and action items
outlined in the GCP and subsequent documents and identified as other SSMCP priorities. The SC
coordinates the work of assigned staff with members of the Partnership, helps develop an annual
work plan to implement GCP strategies and other SSMCP priorities, approves the annual work
plan, authorizes the annual budget, and is committed to ensuring that the SSMCP remains
sustainable and has high value for the region. Finally, the SC is responsible for authorizing the
creation of Working Groups (WGs) that reflect the needs, opportunities and intersection of
military and community issues. Regular members will typically represent the local military
installations, local and state governments, and affected service districts in the region. The SC shall
meet as necessary, but not less than quarterly, in order to coordinate the activities of assigned
staff and clarify issues, formulate strategies, and propose action plans.
Participants: The Steering Committee (SC) is open to any person, association, group, or
organization having an interest in the purpose and objectives of the SSMCP, and such will be
considered a member upon payment of the annual dues established by the Steering Committee.
4. Elected Officials Council.
Role: The current Elected Officials Council (EOC) role and structure will be maintained to continue
advocating for military issues of mutual concern in the south Puget Sound region.
Participants: All elected leaders within Pierce and Thurston Counties, the surrounding cities and
legislative districts are invited to attend EOC meetings, but a single representative from each
governmental body is requested to represent their interests on the EOC. The EOC is convened by
the Mayor of Lakewood, the Pierce County Executive, and the Chair of the Thurston County
Commissioners 2-3 times annually to receive updates on military and community issues, review
the annual work plan, coordinate legislative strategies, and suggest outreach efforts to maintain a
high level of visibility for these priorities. EOC meetings will conform to the Open Public Meetings
Act of the State of Washington, 42.30 RCW.
VI. Funding:
There is a financial commitment required to participate in the Partnership. To ensure smooth and
continuous operations over time, it is desirable to structure for maximum financial stability. To that
end, the dues for Executive Leadership team (ELT) and Steering Committee (SC) members are set
based on the funds needed for pay, benefits, and program overhead for two full-time SSMCP staff
members to focus on the work plan priorities established by the SC. Costs are also expected to
include operations and administration, consultant efforts, and the commissioning of special studies as
well as other activities as approved by the Steering Committee. Each year, in conjunction with
preparation of the Annual Work Plan and Budget, dues will be calculated based on a methodology
Page 4 of 8
agreed to by a majority of the combined ELT and SC members. This commitment is outlined in
Appendix A of this Agreement.
VII. Formation of Subcommittees:
The Partnership may be supported by technical experts, advisors, and community staff and leadership
in various agency, jurisdictional, non-profit, and institutional capacities. Subcommittees will be
formed by action of the SC as necessary to carry out the specific recommendations and strategies of
the GCP or other SSMCP priorities.
VIII. Review/Changes:
The signatories (or their successors) will review this MOA periodically, but no less than annually.
Proposed changes to this MOA will be in writing and shall be subject to approval in any event by the
signatories or their successors.
IX. Effective Date and Termination:
This Agreement is effective when signed and shall remain in effect until terminated by a majority of
the Steering Committee members in good standing. Any member partner may terminate its
membership in the Partnership by providing no less than 30 days written notice to the Partnership of
the desired termination date.
X. Indemnification:
Each Party shall defend, indemnify and hold each other harmless from any and all claims, demands,
suits, actions, judgments, recoveries, liabilities, penalties, costs and expenses, including, but not
limited to reasonable attorneys’ fees, resulting from damage or bodily injury, including death, to the
extent caused by a Party’s breach of this Agreement or the negligent actions or omissions of that
Party, or its employees, agents, or officers, elected or appointed. The foregoing indemnity specially
covers actions brought by the Party’s own employees, and each Party agrees that the foregoing
indemnity is specifically and expressly intended to constitute a waiver of immunity under
Washington’s Industrial Insurance Act, RCW Title 51, but only as to the Party entitled to indemnity
and only to the extent necessary to provide a full and complete indemnity as required under this
Section. The indemnification obligation provided in this section shall survive the expiration or earlier
termination of this Agreement for the duration of any applicable statute of limitations.
XI. Effect of Agreement:
This MOA is an internal agreement and does not confer any rights upon any individual or other entity.
This MOA sets forth mutual goals and approaches. This MOA is not intended to create any rights,
benefits, or other responsibilities, either substantive or procedural, nor is it enforceable as law or
equity by a party against the U.S., its agencies, its officers, or any other person.
Nothing in this MOA shall obligate members to expend other monies or enter into any contract or
other obligation. Nothing in the MOA shall be interpreted as limiting, superseding, or otherwise
affecting the Parties’ normal operations or decisions in carrying out their statutory or regulatory
duties. This MOA does not limit or restrict members from participating in similar activities or
arrangements with other agencies.
Page 5 of 8
Signed, dated and acknowledged:
Pierce County
City of DuPont
City of Lacey
City of Lakewood
Town of Steilacoom
City of Tacoma
City of University Place
Thurston Regional Planning Council
Thurston County
City of Yelm
Nisqually Indian Tribe
Washington Military Department, Camp Murray
Washington State Department of Transportation
Tacoma-Pierce County Chamber of Commerce
United Way Pierce County
Joint Base Headquarters, Joint Base Lewis-McChord
Tacoma Pierce Co. Department of Health
Page 6 of 8
EXHIBIT A
Membership and Annual Financial Commitment
The Executive Leadership Team (ELT) will be comprised of the following members:
1. City of Lacey
2. City of Lakewood
3. Pierce County
4. Joint Base Lewis-McChord Headquarters (advisory only)
The chief appointed official from each of the local governments will represent their jurisdiction on the
ELT. JBLM will be represented by the Joint Base Commander (JBC) and/or his Chief of Staff. ELT
members will also be members of the Steering Committee, and on an annual rotating basis (or other
arrangement) each member of the ELT will serve as chair of the Steering Committee at the regular
monthly meeting.
The Steering Committee (SC) will be comprised of regular members and Working Group (WG) Chairs.
Regular members will consist of government representatives from the following:
1. City of DuPont
2. City of Tacoma
3. City of University Place
4. City of Yelm
5. Nisqually Tribe
6. Joint Base Lewis-McChord Headquarters
7. Thurston County
8. Thurston Regional Planning Council
9. Town of Steilacoom
10. Washington Military Department (Camp Murray)
The chief appointed official from each of the local governments will represent their jurisdiction on the
SC.
Working Groups (WG) consist of the numerous public and private sector interests in our region that
interact with JBLM and Camp Murray. WG Chairs will be the chief appointed officials or their
designees from the following:
1. Tacoma-Pierce County Chamber (as Chair of the Business and Development WG)
2. United Way of Pierce County (as Chair of the Health and Social Services WG)
3. Washington State Department of Transportation (as Chair of the Transportation WG).
4. If needed, other WGs will be formed at the request of the SC, and Chairs will be appointed
accordingly.
Financial Commitments
Financial commitments are tiered based on level of involvement, as follows:
1. Executive Leadership Team (ELT): City of Lacey $20,000, City of Lakewood $50,000, Pierce
County $50,000.
2. Steering Committee: $6,500 annually unless this amount is prohibited by law, regulation, or
local policy.
3. Working Group (WG) Chairs: $2,500 annually for as long as they actively chair a WG.
4. General Members: $500 annually.
Page 7 of 8
Membership costs may be reduced through in-kind donations with advance approval of the majority
of SC members in good standing. An example of an acceptable in-kind donation is staff time
dedicated to SC Work Plan priorities that is significantly above and beyond that expected of all SC
members in their role on the SC.
The City of Lakewood will act as the fiduciary agent for the SSMCP and will be responsible for
invoicing the members pursuant to this agreement.
Invoicing
After signature, members will be invoiced for annual membership fees. Invoicing will begin in
October of the preceding year. Membership fee payment that is not received by February 1will be
considered late and will suspend the member’s meeting attendance and voting privileges. A
member’s good standing will be reinstated upon receipt of the full membership fee.
Annual fees shall be prorated on a monthly basis during the first year for members who join after
January 1 of that year; such members will pay full fees in subsequent years.
Page 8 of 8

Agenda - Thurston County

Transcription

Similar documents

Ongoing PPP Projects in Health

saltaire market redevelopment project

HI-5 : Kalusugang Tuloy-Tuloy Para sa Pamilyang Pinoy

Carpenter, Angela

Weekly pertussis update for Washington State

New Surespan Brochure 64960

Dietitian/Nutritionist Certification Application Packet Contents:

Directions to GeoData - Thurston GeoData Center

Medical Assistant-Phlebotomist Certification Application Packet Contents: