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Consent Agenda
December 5, 2011
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE: UEL' \& '" 1.0 ~ \
SUBJECT: Agenda Item - Consolidated Contract, 2012-2014, Department of
Health; January 1, 2012 - December 31, 2014; $425,359
,r,
STATEMENT OF ISSUE:
Jefferson County Public Health Is requesting Board approval of the Consolidated Contract, 2012-2014,
Department of Health, January 1, 2012- December 31,2014, $425,359.
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
ThIs agreement with the Department of Health is a 3-year agreement containing both State & Federal
Funds. Funding will be provided in the following areas.
. $90,133; Family Planning & Reproductive Health; January 2012 - December 2012
Includes Federallltle X and State Continuation funds to provide Family Planning and Reproductive
Health services (The federal share, $29,730, requires a 10% match which is covered by the state
portion of this funding)
. $28,990; Maternal & Child Health; January 2012 - September 2012, Federal Block Grant to continue
to provide Maternal Child Health services
. $7,500; Office of Drinking Water - Group A; January 2012 - December 2012, Continuation funds to
to provide sanitary surveys
. $9,979; Immunization and Child Profile; January 2012 - December 2012, Continuation funds to
prOVide Federal Vaccine accountability activities
. $66,000; On-Site Sewage System (055) Local Management Plan (LMP), January 2012- June 2013,
continuation funds to implementation of ass LMP for the last 18 months of the 2011-13 Biennium.
. $17,704; Public Health Emergency Preparedness & Response; January 2012 - August 2012,
Continued funding for emergency preparedness activities
. $5,100; Recreational Shellfish Activities, January 2012- June 2013, Continuation funds to provide
shellfish harvesting safety activities
. $1,855; Tobacco Prevention & Control Program, January 2012- June 2012, provIdes funding for
youth tobacco prevention activities includIng retailer education
. $198,098; WIC Nutrition Program; January 2012 - December 2013; Continuation funds to provide
Women, Infant and Children Nutrition Program services
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Consent Agenda
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FISCAL IMPACT/COST BENEFIT J\NALYSIS:
This contract provides $425,359 funding for January 1, 2012-December 31, 2014. State revenue Is:
$135,608. Federal revenue Is $289,751. This funding may change as amendments follow.
RECOMMENDATION:
JCPH management request approval of the Consoildated Contract, January 1, 2012 - December 31, 2014
with the Department of Health; $425,359.
REVIEWED BY:
Iu'?(?
Date
-0
DOH CONTRACT #: C16887
2012 - 2014
WASHINGTON STATE
DEPARTMENT OF HEALTH
CONSOLIDATED CONTRACT
2011-2014 Consolidated Contract
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DOH CONTRACT#: C16887
Table of Contents
purpose ...... ................. ............................................................................................... ..... .... ......3
S+ntements of Work...................................... .................... ............................................. 3
l.Q. ...........
Exhibits ...................................... ......... .............................. .............................................. .........3
Definitions.................... ......................... ....... ....... ..................................... ................................3
Funding and Billing ....................................................................................................... 4
..........
Contract Management ..............................................................................................................5
Access to Records ....................................................................................................................5
All Writings Contained Herein ................................................................................................5
Assignment...............................................................................................................................5
Assurances ................... ............................................................................................................5
Confidential Information............ ......... ................. ........ ............................ ........... .. 5
... ................
Ethics........................................................................................................................................6
Debarment Certification............................ ...................... ....... .................... ......... .... 6
. ................
Disputes........................ ........................................................................................... ..... .... ........6
Equipment purchases ........ ......................................................................... ......... ........... ..... .....6
Funding Contingency ........................................................................................ ................. ......7
Governing Law and Venue ......................................................................................................7
Independent Capacity .......................................................................................................... .....7
Insurance....... ......... ....................... ............ .................. ........... ........ .......................................... 7
Licensing, Accreditation and Registration......... ............................. .........................................7
Maintenance of Records........................................................................................................... 7
ModificationsIW aivers .................................................................................................. ........... 7
No Third-Party Rights Created ................................................ ....................... .........................7
Nondiscrimination....................................................... ..... ...... ....................... ........................... 7
Order of Precedence .............................................................. ... ..................... ............. .... ..... .....8
Ownership of MateriallRights in Data.....................................................................................8
Publications.... ........................... ................................................... ......................................... ...8
Responsibility for Actions ................................................................................... .. 8
..................
Severability ..... ......................... ................................................................................................ 8
Subcontracts............ ..... ......... ................................................................................................... 8
Subrecipient ................................................................. ........................................ ......... ...........9
SuI'Vlvabll1ty............................................................................... . .. 9
.. .........................................
Term ..................................................................... ............... .................... ........ . 9
Termination for Convenience ........................................... ..............................::.::..::... ......... ....9
Termination for Default .................................................................................... ...::..:::::::::::::::: 9
Termination Procedure....... ....................................................................... ...............................9
Standard Federal Certifications and Assurances.................................................................... 1 1
Assurances.. Non-Construction Programs ............................................................................16
2011-2014 Consolidated Contract
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DOH CONTRACT #: C16887
CONSOLIDATED CONTRACT
be1Ween
STATEOFWASBINGTON
DEPARTMENT OF HEALTH
(Referred to as "DOH")
and
JEFFERSON COUNTY PUBLIC HEALTH
(Referred to as "LHJ")
for
THE DELIVERY OF PUBLIC HEALTH SERVICES
FOR THE PERIOD OF
January 1,2012 through December 31, 2014
1. purpose .' '.,
This Contract is created m accordance with RCW 43.70.520 - PublIc Health ServiCes Improvement Plan. The
purpose of this Contract is to d~fine our joint and c?<,perativ~ relationship: It is also the b~is for facilitating the
delivery of public health services to the people m Washmgton State m accordance WIth the Public Health
Improvement Plan. This ContraCt is the result of a cooperative planning effort between the LHJ and DOH. The
parties believe that this Contract accurately reflects their common purpose.
2. Statements of Work
The individual program aqtivities, requirements, and outcomes/deliverables to be achieved by the LHJ under this
Contract are described in Exhibit A, Statements of Work, and are consistent with RCW 43.70.580 requirements for
performance-based contracts.
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
4. Definitions
As used throughout this Contract, the following terms shall have the meanings set forth below:
"American Recovery and Reinvestment Act of 2009 (ARRA or the Recovery Act)": A federal act intended to
create jobs and promote investment and consumer spending during the late-2000s recession. more often called the
Great Recession.
"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 Assi~nce (CFDA)": The unique identirying code assigned to a federal assistance
program which identifies the awardmg agency. .
"Confidential Information": Information protected from disclosure under federal or state law.
2011-2014 Consolidated Contract
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DOH CONTRACT #: C16887
"Contracting Officer": DOH's Contracts Manager and his/her delegates.
"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, coopera~ive agree~e~~, interest subsidies, insurance, or direct appropriations, but does not
include direct federal cash assistance to mdlVlduals.
"Federal Funding Accountability and Transparency Act (FF AT A 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 andlor equipment obtained through donation, gift, purchase, capital
lease, or construction with a service life of more than one year.
"Subcontractor": Any individual or group contracted with the LID to perform all or part of the services included
in this Contract. This term will also apply to situations where an LID'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": An entity that receives federal 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 obligatio!) to comply with federal subrecipient requirements;
andlor used federal funds to carry out DOH's programs.
"Vendor": An entity that provides goods or services to DOH and others. A vendor normally operates its business
in a competitive environment, provides its goods andlor services to many different purchasers during normal
business hours, and does not have the same responsibilities andlor obligations as a subrecipient.
5. Funding and Billing
A. DOH shaH 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 ARRA (the
Recovery Act) or FF A T A (the Transparency Act), the corresponding checkbox on the statement of work will be
checked.
C. Total consideration for this Contract is $425,359, or as amended.
D. 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 at http://www.doh.wa.gov/concon/.
DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable
costs as outlined in the statement of work andlor budget.
E. The LHJ will submit a BARS A financial report by March 15 for the prior calendar year.
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DOH CONTRACT #: Cl6887
6. Contract Management
Unless otherwise specified in the ContraCt, the following individuals are the contacts ("Contract Coordinators") for all
notices required or permitted under this Contract:
LHJ Contract Coordinator: DOH Contract Coordinator:
--
Name: Julia Danskin Name: Brenda Henrikson
- --
Title: Contracts Specialist
Mallin!! Address: MailiDl' Address:
615 Sheridan Street, Port Townsend WA 98368 PO Box 47905, Olympia WA 98504-7905
Phwical Address: Physical Address:
Same as above 101 Israel Rd. SE, TumwaterWA 98501-5570
Phone: 360-385-9400 I Fax: 360-385-9401 Phone: 360-236-3933 I Fax: 360-586-2655
Email Address: Email Address:
jdanskin@co.jefferson.wa.us brenda.henrikson@doh.wa.gov
A party may change its Contract Coordinator from time to time by providing written notice to the other party. DOH
Program Contacts can be found in the Statements of Work in Exhibit A and at: htto://www.doh.wa.gov/conconl.
7. Access to Records
To the extent authorized by applicableJederal 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 authonzed m 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 the
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 and as revised. '
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
11. Confidential Information
The parties agree to comply with all state and federal statutes and regulations relating to Confidential InfOlmation.
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 Contidential Information covered by this Contract must agree to protect the
confidentiality of the information.
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DOH CONTRACT #: CI6887
Either party to this Contract may designate certain Confidential Information as "Confidential InformationJNotice
Requested;" The designation shall be .made by clearly stamping, v.:atermar~ing, or otherwise marking each page of the
Confidential Information. If a third party requestor seeks mformatlOn 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 LID agree to establish or maintain safeguards consistent with state and federal laws, regulations, and
standards 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 LID 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 ~~ 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 wi~ al~ ethics laws applicable to ~eir 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 LID, by siguing this Contract, certifies that the LID 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 . . .
The parties shall use theIr best, good-~alth ~fforts to coopera~lvely resolve disputes and problems that arise in
connection with this Contract. Both partIes WIll make a good faIth effort to continue without delay to carry out their
respective responsibilities under this Contract while attempting to resolve the dispute under this section.
If a dispute arises between.the parties th~t c~nnot be resolved by di~ct negotiat~on, the dispute shall be submitted to a
dispute board for a n~n-bmdmg ~etermmat.'?n. Each party shall.nmely appomt one member to the dispute board.
Those members shall Jomtly appomt an addItIOnal member. The dIspute board shall timely review the facts, Contract
terms and applicable law and rules, and make its determination. Provided that each party and the dispute board act in
a timely manner, the parties agree not to seek legal or equitable relief in the courts until the dispute board renders its
determination. Thereafter, either party may seek legal or equitable relief in the courts.
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 OMS Circular A-I02 or are
included in the federal funding agency's regulations.
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DOH CONTRACT #: Cl6887
16. Funding Contingency . . ., . .
In the event funding from state, federal, or other sources IS WIthdrawn, reduced, or lImIted m any way dunng the tenn
of this Contract, the parties agree to negotiate reasonably and in good faith to amend this Contract to reflect the
changed funding.
17. GnverningLaw 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 LID arising und~r .this .Co~c~ v~mue shall b~ proper only in the county in which the LHJ is located or in
either of the two nearest jUdICial dIstriCts Wlthm the meanmg ofRCW 36.01.050.
18. Independent Capacity . .
The employees or agents of each party who are engaged m the perfonnance 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 ofthe other
party.
19. Insurance .
The LID 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 detennined by the LHJ and/or its risk manager, unless the LHJ and
DOH mutually agree otherwise.
20. Licensing, Accreditation and Registra~on
The LHJ shall comply with all applIcable local, state, and federal licensing, accreditation and registration
requirements/standards, necessary for the perfonnance of this Contract.
21. 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.
22. ModiticationslWaivers
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
shaH 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.
23. 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.
24. Nnndiscrimination
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 ~HJ's noncompliance or refusal to comply with any nondiscrimination
law, regulation or pclicy. this Contract may be rescmded, canceled or terminated in whole or in part. and the LHJ may be
2011-2014 Consolidated Contract
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DOH CONTRACT #: Cl6887
declared ineligible for further contracts with DOH. 111e LID sha1l, 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.
25. 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 f01l0wing 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.
26. Ownership ofMateriallRights 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, modiJY, 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 sha1l exert a1l 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 there~n and of any ~rtion ~fsuch docum~nt which. was not pr~duc:d i? the performance of this
Contract. DOH sha1l receive prompt wntten notice of each notice or claim or copynght mfrmgement received by the
LHJ with respect to any data delivered under this Contract. DOH shall have the right to modiJY 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 a1l liability for doing so.
27. 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 andlor the appropriate federal agencies. Correspondingly, such
documents resulting from information gathered through use of local funds must acknowledge receipt of such local
support.
28. Responsibility for Actions
Each party to this Contract sha1l be solely responsible for the acts and omissions of its own officers, employees, and
agents in the performance of this Contract. N:ither party to this Contract wi1l be responsible for the acts and
omissions of entities or individuals not party to thiS Contract. DOH and the LHJ sha1l cooperate in the defense of tort
lawsuits, when possible.
29. Severability
If any tenn or condition of this Con~ract is held invalid, such invalidity sha1l 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,
cond itions, assurances and certifications. The LHJ agrees it is responsible for assuring adequate perforn1ance 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 severa1ly liable for
personal injury damages arising from any act or omission, then each entity sha1l be responsible for its proportionate
share.
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DOH CONTRACT #: CI6887
31. Subrecipient "..,. .
For those activities designated as subrectplent' on ExhIbIt A, Statements of Work, the LHJ must comply with
applicable federal req';lirements, including but not limited to O:vm Circular A-87, A-I02, A-133.' .and program
specific federal regnlauons. ~fthe L~. expe~ds $50~,00? or ~ore III federal awards from all sources, It IS responsible
for obtaining appropriate audIts. AddItional mformation IS avaIlable at ht\p:/Iwww.doh.wa.gov/concon/.
32. Survivability . .
The terms and conditions contained m thiS Contract which by their sense and context, are intended to survive the
expiration of the Contract sh~ll survive. Su~i~i?g terms inc.lude, but.are not limited to: Access to Records,
Confidential Information, Dlsputes, Responslblhty for ActIOns, Mamtenance 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 from January I, 2012 through December 31, 2014, unless terminated earlier as
provided herein.
34. Termination for Convenience
Either party may terminate this Contract, or any program hereunder, for convenience by providing at least 30 days'
advance written notice to the other party.
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 :vithin that time, the nondefaulting party may then notify the defaulting
party in writing that this Contract IS term mated. 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 the 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 with the
determination of the Contracting Officer that relates to the obligations or amounts due to the LHJ shall be considered
a dispute within the meaning ofthe "Disputes" clause of this Contract.
DOH may withhold from any amounts due the LHJ for such completed work or services such sum as the Contracting
Officer reasonably determines to be necessary to protect DOH against potentia110ss or liability.
The rights and remedies of DOH provide~ in this section shall not be exclusive and are in addition to any other rights
and remedies provided by law or under thIS Contract.
After receipt of a written notice of termination, the LHJ shall:
. Stop work under the Contract on the date and to the extent specified in the notice;
. Place no further orders or subco~tracts for materials, services, or facilities, except as necessmy to complete
such portion of the work not termmated;
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DOH CONTRACT #: CI6887
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Assign to DOH, to the extent reas~nabl~ direct~ by the Contracting Officer and to the extent that the LHJ has
the legal right to do so, alJ of the nght, tItle, and mterest of the LHJ under the orders and subcontracts in which
case DOH has the right, at its reasonable discretion, to settle or pay any or all claims arising out of the
termination of such orders and subcontracts.
Settle all outstanding liabilities and all claims arising out of orders or subcontracts, with the approval or
ratification of the Contracting Officer to the extent he/she may reasonably require, which approval or
ratification shalJ be final for all the purposes ofthis clause;
Transfer title to DOH and deliver, as reasonably directed by the Contracting Officer, any property which, if the
Contract had been completed, would have been required to be furnished to DOH;
Complete performance of such part of the. work nottenninated by the Contracting Officer; and,
Take such action as may be necessary, or as the Contracting Officer may reasonably direct, for the protection
and preservation of the property related to this Contract which is in the possession of the LHJ, or its
subcontractors, and in which DOH has or may acquire an interest.
.
.
.
.
IN WITNESS WHEREOF, the parties have executed this Contract.
State of Washington
Department of Health
Local Health Jurisdiction
Signature
Signature
Title:
Title:
Print Name:
Print Name:
Date:
Date:
APPROVED AS TO FORM ONLY BY THE
OFFICE OF THE ATTORNEY GENERAL
ftIce
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Page 10 of 17
DOH CONTRACT #: C16887
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 Deparbnent 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
accordanC~ 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 agai~~ them f?r
commission of fraud or a cnmmal offense In
connection with obtaining, attempting to
obtain, or perfonning 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)
tenninated 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.
2011-2014 Consolidated 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.
2. CERTIFICATION REGARDING
DRUG-FREE WORKPLACE
REQUIREMENTS
The undersigned (authorized official signing for
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 notirying employees
that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled
substance is prohibited in the grantee's
workplace and specirying the actions that
will be taken against employees for violation
of such prohibition;
b) Establishing an ongoing drug-free awareness
program to infonn employees about
(]) 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 assistaJlce
programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations
occurring in the workp lace;
c) Making it a requirement that each employee
to be engaged in the perfonnance of the
contract be given a copy of the statement
required by paragraph ta) 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-
(I) 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;
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 office: .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;
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).
2011-2014 Consolidated Contract
DOH CONTRACT #: C16887
For purposes of paragraph (e) regarding agency
notification of criminal drug convictions, DOH
has designated the following central point for
receipt of such notices:
Compliance and Internal Control Officer
Office of Grants Management
W A State Department of Health
PO Box 47905
Olympia, WA 98504-7905
3. CERTIFICATION REGARDING
LOBBYING
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 undersigned (authorized official signing for
the contracting organization) certifies, to the best
of his or her knowledge and belief, that:
(I) 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 120fl7
.
.
(2) If any funds other than. Fed~rally
appropriated funds have beenyald or .wIll be
paid to any person for mfluencmg 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 sha~1 ~omplete
and submit Standard Form-LLL, 'DIsclosure
of Lobbying Activities," in accordance with
its instructions. (If needed, Standard Form-
LLL, "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 e~tering into this
transaction imposed by Sectlon 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.
4. CERTIFICATION REGARDING
PROGRAM FRAUD CIVIL REMEDIES
ACT (PFCRA)
The undersigned (authorized official signing for
the contracting organization) ceJ1ifies 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.
201 ]-2014 Consolidated Contract
DOH CONTRACT#: CI6887
5, CERTIFICATION REGARDING
~ONMENTALTOBACCO
SMOKE
Public Law 103-227, also known as the Pro-
Children 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 ofh~th, 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
PageI30rl7
.
."
the physical and mental health of the
American people.
6. CERTIFICATION REGARDING
DEBARMENT. SUSPENSION. AND
OTIIER RESPONSmILITY MATI'ERS
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 shaH 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 ] 2549. You
may contact the person to whom this
2011-2014 Consolidated Contract
DOH CONTRACT #: C 16887
contract is submitted for assistance III
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 telminate
this transaction for cause or default.
Page 140fl7
DOH coNtRACT #: C 16887:
. ~" > ,
-'.
.' . public t:ra/1saCtion; violation' of Federal' ....
or State antitrust ~latateS Or coinmission .
.of tmibezzlemen\ th~ forgerY, bribery,
falsifiCllti(m OT~\1tion of records,
.lIllIking f~ statljments, . or receiving.
~olen property;. " . .'
\l} Areliot' presently indicted' fOJ\ Qr'
. . mherwise "rlrillriaUyor civjlly ~harged
. by jl govemineDtal entity (Fedeial, SUite
. ....6r local) witlrcotlU'llisSion of any of ~
. ..... Qffensesenuin~ .in paragrlIph (l}(b)
. ofthls certification; and . - .
d) Have not withfu it ~year period.
preceding this con~ Iuul one or .more _
. public transaCtIOns -(Federal, Staieor
local) termimrted furcauseor~ef8Jllt.
',--' .
,
.
ASSURANCES - NON CONSTRUCTION PROGRAMS
DOH CONTRACT #: CI6887
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:
I. 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 ~nsure
proper planning, management, and. completion of
the project described in this applicanon,
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 Intergovemmental 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
amended (20 U.S.c. .1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of
2011-2014 Consolidated Contract
the Rehabilitation Act of 1973, as amended (29 V.S.C. 3794),
which prohibits discrimination on the basis of handicaps; (d)
the Age
Discrimination Act of 1975, as amended (42 V.S.C. 33
6101-6107), whicb probibits 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; (I) the Comprehensive Alcohol
Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (P.L. 91-6]6), as amended,
relating to nondiscrimination on the basis of alcohol abuse
or alcoholism; (g) 33 523 and 527 of the Public Health
Service Act of 1912 (42 V.S.C. 33 290 dd-3 and 290 ee 3),
as amended, relating to confidentiality of alcohol and drug
abuse patient records; (h) Title VlII 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 U) the requirements of any
other nondiscrimination statute(s) which may apply to the
application.
7. Will comply, or has already complied, Witll the
requirements of Titles 11 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.
Page 16 of 17
,,,"' ..'
<<
8. Will comply, as applicable, with the provisions of the
Hatch Act (5 U.S.C..150H508 and 1324-1328) which
limit the political activities of employees whose principal
employment activities are fimded in whole or in part with
Federal funds.
9. Will comply, as applicable, with the provisions of the
Davis-Bacon Act (40 U.S.C. ~~276a to 216a-1), the
Copeland Act (40 U.S.C. ~276c and 18 U.S.C. H814) and
the Contract Work Hours and Safety Standards Act (40
U.S.C. ~~ 321-333), regarding labor standards for federaliy
assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1913 (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.
II. Wil1 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
Act of 1972 (16 U.S.C..1451 et seq.); (I) conformity of
Federal actions to State (Clear Air) Implementation Plans
under Section 116(c) of the Clear Air Act of 1955, as
amended (42 U.S.C.. 7401 et seq.); (s) protection of
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
CONTRACTOR SIGNA TliRE REQUIRED
DOH CONTRACT #: C16887
Endangered Species Act of 1973, as amended, (P.L. 93-
205).
12 Will comply with the Wild and Scenic Rivers Act of 1968
(16 U.S.C., 1721 et seq.) related to protecting components
or potantiaJ components of the national wild and scenic
rivers system.
13. Wil1 assi~t the awarding agency in assuring compliance
WIth Section 106 of the National Historic Preservation Act
of 1966, as amended (16 U.S.c. .470). EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of 1914
(16U.S.C..469a-1 etseq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
relatad activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966. (p.L. 89-544, as amended, 7 U.S.C..2131 et seq.)
pertammg to the care, handling, and treatInent of warm
blooded animals held for research, teaching, or other
activities supported by this award of assistance.
16. Will c?mply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C..480l et seq.) which prohibits
the use of leed- based paint in construction or
rehabilitation of residence structures.
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.
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations and policies
governing this program.
SIGNATURE OF AUTIlORIZED CERTIFYING OFFICIAL TITLE
pkase also print or type name:
ORGANIZATION NAME: (if applicable) DATE
2011-2014 Consolidated Contract
^Zrov~ .. to fi~rqp, II
Jeffunlfift Cfi, 1'rosecutor's
Page]7 of 17
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