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HomeMy WebLinkAbout040113_ca03Consent Agenda W o-SON COL JEFFERSON COUNTY PUBLIC HEALTH Qgs~2t 615 Sheridan Street o Port Townsend o Washington o 98368 www.jeffe rso ncou ntypu blichealth. o rg March S1, 2013 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Jean Baldwin, Director DATE: /~ -~ r ~ l I I ~--~ 13 SUBJECT: Agenda Item -Interlocal Agreement with Whatcom County Health Department for supporting Healthy Communities work, Amendment #1; July 1, 2012 -June 30, 2013; language change only STATEMENT OF ISSUE: Jefferson County Public Health, requests Board approval of Interlocal Agreement with Whatcom County Health Department for supporting Healthy Communities work, Amendment #1; July 1, 2012 - June 30, 2013; language change only ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S: In 2011 Washington State Department of Health was awarded a Federal Centers for Disease Control and Prevention, Community Transformation Grant (CTG). The CTG program supports community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes. By promoting healthy lifestyles, especially among population groups experiencing the greatest burden of chronic disease, these grants will help improve health, reduce health disparities, and control health care spending. The focus is on four priority areas; Healthy Eating, Active Living, Preventive Healthcare Services, and Tobacco-Free Living. Whatcom County Health Department was selected to serve as the Hub for the Northwest Healthy Communities Region and is working with Jefferson County Public Health to help build capacity with Jefferson County to achieve a policy, environmental or system change, using an integrated approach toward Tobacco Free Living, Healthy Eating and Active Living. FISCAL IMPACT/COST BENEFIT ANALYSIS: This amendment reflects an administrative/accounting language change. This amendment adds an additional CFDA number, 93.548, in order to utilize allowable funds before the deadline. i'bMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES WATER QUALITY MAIN: (360) 385-9400 ALWAYS WDRNING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Consent Agenda RECOMMENDATION: JCPH management request approval of the Interlocal Agreement with Whatcom County Health Department for supporting Healthy Communities work, Amendment #1; July 1, 2012 -June 30, 2013; language change only R ED BY: ~ i ip Morl unty ator ~~ l~ Date VVHATCDM CC)UNTY HEAL'T'H DFPATtT~'IE~1T IN'I`ERLfQC~rL CU(7I'EItATIVE A[RREF.MEh~T - ANTENDIVIEI~T #1. PARTIES: W11~tC0I1'1 C[)Llil~' Wlzatcoarn Ca~~ty Courthouse 311. Grand ~1.-=enue I3ellit~gham, ~A 98225 ANII C[)1~"I'RACT1Jlt: ,Ieffer~ara C'aunty 615 Sheri~lar~ St. Part T©wnsend, WA 9$36$ ANTEIVT)IVTENT' ~iLJsVTI3EI~c 1 CQI~TRACT PERT[IDS: C)riginal: 0711}112012 - 0613012013 Amendment ~ 0110] 121f 13 - 06130/201 TIIE +CC?~1TRACT IDF~iVTTFIED HEIZEI~C, I~iCI.UDT~iG ANY PREVIQIJS AME~1DMEhTS THERETQ, IS HEIxESY AIVTEI~DED AS S'ET' FC1RT1"I TN THE DESC1~tIPTT®N [)F THE AME;VDVIFNT DEI~,HW B~' ~'ILFTUAL CQIVSEhT OF AI~I~ PARTIES HERETCI DES£~ItIPTIC?N QF AME1~TlMENT. 1. Amsend paragraph 6. II~AtVNER E3F 1='I~tiANC~~IG by addincd ""and C~'l~A 53.548" to the end cif the first sentence. 2, Amend Exhibit 1~, Sl~i3-RECIP9EIVT AC~REE~EIVT ~iET~V1IEEN WhiATCOM GQUIVTY AfJ^ JEFEE'~SC)~1 Cc3L~I~TY by replacing the secand taaragraph v~ith the fa~lawir~g: "This is a stria-grant of US i~epartment of Human Services, Centers fcar Disease Ccrntroi and' Preventir~n, investigations and Technics! Assistance, CFDA~ 93.83 and Nutritican, Physical Activity and ©t:esity Program, CFDA~# 93.548. `~ 3. The effective date Q# the amendment is January 1, 2tJ13. FCL_X14113_Jeffersan_Couaty_i~eaithy_Comrnu~rlities_R,rraendmeni#1 Page 1 a# 2 ALL (7TI3ER 'TERMS AND C[?NDITIQNS QF THE ORIGINAL CQNTRACT AIV~D ANY T'I2EVIfl[JS AMENDI'VIENTS T)CIEI2ETt] REl-vIAIN IN FULL FARCE AND ET`FECT. ALL PARTIES II]ENTIFIED AS A~'FEC`I'ED I3Y THIS AIVtENDMENT HERESY ACKNOWLEDGE AND ACCEPT THE TERMS AND CONDITIONS OF THIS AMENDMENT.. Sig~tature is required 73elor~v. Al?d'ROVAL AS TC] PRC3GttANt: Astrid Newel, Manager Cnm~~trnity Healtl3 Pres~ram Date DEPAIZrG'NYl~NT HEAD Al?PFtDVAL. _ Regina A, Delahurtt, WCIID 1[~irectar Date FQIt ,IEFFERS[]N Cf3i~N'TY. Co~traetmr Signature ~ Print Name and ~"itle ~ hate ~~~pr~v~t1 ~~ ~ ft3~ DD~~~ ~~. l~ 1r~f~i~~r~rt ~'~?. 1"'r+nseut~t~r's ffiCe HL_01D113_.~effe~sc~~_Co~nty~Heaiihy_C~am~r~ar~wties~Arneadrrreni#1 Page 2 of 2 VNTERLOCAL. CQ~7'PEF~ATIVF AGR'~~M1wNT '~'~T'E~N Wh1ATCa~~JI COUNTY ANL3 JEFFERSON COUNTY TH15 ,A,GREEMENT is mane and entered into by and between 1Nhatcom County ~"Whstcam"'} and Jefferson County ~"`Jefferson"}; both counties in the s#ate of V~lashington pursuant to the authority granted by Chapter 39.34 RCW, INTERLOCAL COOPERATION ,ACT. BACKGROUND: Since October 2011, the Vltashington State Department of Health ~~Of-ly has begun implerr~enting a regions! snadel far supporting Healthy Comrrtunities work in counties across the state. The goal of this work is to improve the health of communities, reduce chronic diseases and reduce health disparities through policy, systems, environmental and infrastructure change strategies. Funds are allocated from aDH to regions! Hubs that in turn work with other counties in t}~eir region. 1Nhatcorn County Health Qepartrnent ~Whatcorrf} was selected to serve as the Hub for the Northwest Hesithy Communities Region ~1Nhatcam, Skagit„ Island, San Jusn, lCitssp, Clallam, and Jefferson}. Three counties (Kitsap, Skagit, and 1~Ihstcarr~} are designated ss Community Transfarmstion Grant priority counties due to size and chronic disease risk factors. Four counties tlsland, San Juan, Clailsm and Jefferson} are designated as non-CTG counties. In July 2012, pOH allocated funds to support Healthy Communities work in non-CTG counties. 2. PURpOCE: The purpose of this contrac# is to build capacity within Jefferson County to achieve a policy, environmentaB, ar systerrr change, using an integrated approach toward Tobacco Free Living, Healthy Eating and Active Living. This statement of work is governed by W'l~atcorr's contract with (SOH for Healthy Cornrr~unities work and wi~11 be subject to change if llVhatcom"s contract with DOH changes. Any changes occurring duo to a contract amendment with t~OH will be communicated to Jefferson County without a further amendment to this agreement unless the change results in alteration of the reimbursement arr~ount of this agreement. Use of ''lands must align with the I~C~H Healthy Carnr~unities priorities and be suppodive of focal, regional, or state-levee policy, environment„ programmatic, and infrastructure changes. 3. R!ESI~ONSVF3ILITl'ES: Whatcom will: 1. Provide technical assistance and support to Jefferson County in carrying out their Healthy Communities work. 2, Incfude Jefferson County staff in regional Healthy Communities corr~munication, trsinings, and meetings. 3. Share state and regional Healthy Communities resources with designated Jefferson County staff. HL C17~1~2_Je'f~sf~!~_~ountyfG~rG_,Ac~reement Page i ~. Candt~ct at least one annual site visit at a mutually agreeable time to discuss program progress and contract oversight. Jefferson wi4i: 1, Designate a primary staff personJcontact for Healthy Communities work. Primary stafF will ensure Jefferson County I~HJ administrator is kept informed of local progress and activities and is invited to attend meetings ar events as appropriate. ~. Deuelop and submit a local budget and wank plan far appraual by [7ecemkaer 31, ~~~ ~ outlining specific tasks and deliverables to address the following approved area: a. Completion of an action plan andfor taking significant steps towards implementation of action plan elements that address a policy, systems, andlor environmental change to promote healthy eating, active living and~or reduce tobacco Use in Jefferson County lJy .fr~ne 3fl, 201. The action plan should involve partners outside the health department, such as schools, YIVICAs, transportation, housing„ ar other local partners. 3. Identify and facilitate participation of local argarfiizationsfindividUals in a Regional Healthy Communities Coaiitian. 4. Have at least one staff person ~preferabiy mare} attend twice yearly Regional Coalition meetings. ~. Participate in conference calls, trainings, and in-person meetings as available 6. lViaintain accurate records of staff tune dedicated to Healthy CammUni#ies activities. ~. Provide monthly reports of program activities and staff effort to Hub 6~egional Caardinatar for inclusion In DOH Catalyst reporting. Due dates will be no later than the 7"' day of each month. g. Jefferson County wil! perform a!l work necessary within the limits of the available resources tram this agreement to implement the strategies, action steps, and deliverahles agreed to with regional partners and approved by DCH. g. Jefferson County will comply with all applicable Federal and State requirements that govern this agreement and will cooperate with 1~Nhatcom. County on at Eeast one annual site visit at a mutually agreeable time to discuss Jefferson County program progress and contract oversight ~ TFRMM ®~ AGRE~fi~1FNT: The start date for this grant funded pra~ect is July 1, 20'12 therefore the start date of this contract llas been established as of that date, regardless of the tune of signing and shall be in effect through June fig, 2C}13. ~. ~}CTivNSIQN: The duration of this Agreement may be extended by mutual written consent of the parties; for a period of up to one year, and far a total of no longer than five years. HL p7Q112_Jefferson_County_CTG_.~greernent Page 2 6. MANNER ~F FINANCYNC~ ~"he source of funding far this agreement is the consolidated contract Pram 1Nashington State DepartrnerZt of 4"Yealth, CFL7A# ~~_~~$. :leffersan County wily be rein^sbursed far casts associated with rr~eeting the requirements estabYYs~~=d in "R'esp°nsYbities" shave in an arr~aurat not to exceed. ~~ a,~~~}. In~Qicira 1. All reimbursed casts must be allowable as defined in Q411113 Circular A-87, Cast Prrnci~les far State, Lacaf acrd ft~dian Tribe! Gavernrraer~ts. ~. 4r~direct Costs: Eligible program casts include direct program casts and indirect cost reimbursement. Wifh the first invoice claiming indirect costs, Jefferson County will submit a espy ^f their Cast Allocation Agreement. The rate or rates specified in the agreement will be established following applicable Federal cast princip4es. The indirect rate used far this contract w444 not exceed the rate specified in the submitted Cast Aflocatian Agreement. 3. Jefferson County shall su4~mit itemized invoices an a quarterly basis in a format approved by +,,~hatcom. Invoices submitted for payment must include sufficient documentation to prove the validity of all casts claimed. A general ledger report of casts clair~ned toward this project will be sufficient far invoicsng this agreement. Whatcom reserves the rig4-St to request further back-up dacumentatian far any casts claimed far reimbursement. 4- unallowable costs: Recipients may not use funds for the fallowing:. a, Recipients may not use funds far research b. Recipients may not use funds far' clinical care. c. Recipients may only expend funds far reasonable program purpases, including personnel, travel, supplies; and services such as contractual. d. Recipients may not generally use I~HSTCDC1Al~SDR funding for the prurchase of furniture ar equipment. Y-lowever, if equiprrsent purchase is integral to a solected strategy, it will be considered. Any such proposed spending must be identified in the budget- s. Recipients may not use funding far construction.. f. The direct and primary recipssnt in a cooperative agreement prograrrt must perform a substantial role in carrying out project objectives and not merely serve as a conduit for an award to another party ar provider who is ineligible. g Reirrsburser~ent of pre-award costs is not allowed. h. Recipients may not use funds far abortions in accordance with Executive Order 13535. i. if requestirog indirect costs in tY~e budget, a copy of the indirect cast rate agreement is required. if the indirect cost rate is a previsional rate, the acJreerrsent should be less than ~Z months of age. 5. Jefferson County shall submit invoices to (incfta~e F'C~ }: Attention: Eusiness Office t+'~hatcam County 1-Yealth Depar4rnsnt Ht_ 0?~~12_Jeffersas~_Cnursty_~TG_F+greernent rage 3 5D9 Girard Street Bellingham, V'VA 9$~2a ~. Payment by the Gounty v~rili }~e considered t@rneiy if it is made within 3t7 days of the receipt and acceptance of billing information from. Contractor. The Gounty may withho}d payment of an invoice if the Contractor submits it rraore than 3t~ days after the expiration of this contract. ~. Invoices must include the fol@owing statement., with an author'szed signature and date: y certify that ti-te m2rterials have been furnished, the services rendered, or the labor ~erfarrr~ed as described on this invoice.. g. Du. licatic~n of gilled Costs or Pa meats for Service; Jefferson Gounty shall not bill ~lV`hatcom for ser'v'ices ~ ,~effersoGounty has beentor wild be paid bdy any other sourice~t pay Jefferson County, including grants, for those casts used to perform or provide the services in this contract. Jefferson Gounty is responsible for any audit. exceptions or disallowed amounts paid as a result of this contract. 9. p,pMlNi~TRATIQ~N: The fole~ ntati~es ~sdhall berredseol~s bEe~or adrninis~ratioEn of thishe respective parties. The rep p Agreement and for coordinating and monit©ring performance under this Agreement. In the event such representatives are changed, the party making the change sha@@ notify the other pady g ~ Vv'hatcom Gounty"s representative shall be: Astrid Newell, Go Health Deeartmentnager Whatcor~s Courxt~ p 15gt1 North State Street Bellingham, 'V11A 38225 ~iinwh~tcomcoun~y.us ~: 36p-616-45'93 5C18f32 ~: 36{x_676-6729 9.2 Jefferson County's representafive shall be: Julia Dansl4in, Public Health Supervisor Jefferson Gounty Public Health 61.5 Sheridan Street Port To~uvnsenri, ~A ~J8~68 jdanskin~a co.je'~erson.wa.us P: 366.385.34Q6 16. TI~BATNt'~NT GF ASSNS ANI~ PI~CPE~RTY: N~o fixed assets or personal or real property ~nrilV be jointly or cooperatively, acc}uired, held, used;. or disposed of pursuant to this Agreement. Page 4 }~L_Q7{X112_Jeffersar~_~c~rjtY_~TG_Agrees~ent 1 ~ ~ 1q~p~M1~4lF1CA,TIQ~: 1~ach party agrees to be responsible and assume liability for Its own wrongful and]or negligent acts or omissions or those of their officia9s, officers, agents, or ernpioyees to the fullest extent required by law, and further agrees to save, indemnify, defend, anal hold the other party harmless from any sa~ch liability. It is further provided that rro liability shall atided he ~ natcorn County by reason of entering into Ellis contract except as expressly prov 1~. TERIVIINATICIV: AnY party hereto may terminate this Agreement upon thirty ~3Q} days notice in writing either personally delivered or mailed postage-prepaid by certified mail, return receipt requested, to the party's last known address for the purposes of giving notice under this paragraph if this Agreement is so terminated, the parties shall be liable on9y for performance rendered or costs incurred in accordance with the terms of this Agreement prior to the effective date of termination. 3. CHANCES, ~,rypi~IFICATIQNS, AMI~DMI~NTS AFL WAIVRRS; The Agreement may be changed,. modified, amended or waived only by written agreement executed by the parties hereto. Waiver or breach of any term or condition of this Agreement shal9 not be considered a waiver of any prior or subsequent breaoh. ~}~. S~VERA931LIT~; In the event any term or condition of this Agreement or application thereof to any person or circumstances is held. invalid„ such invalidity shall not affect other terrxrs, conditions or applications of this Agreement which can be given effect without the invalid term, condition, or application. To tlrlis end the terms and conditions of this Agreement are declared severable. ~} ~. I=NTIR~ ACR~~~"~~~T: This Agreement ct~ntains all the terrras and conditions agreed upon by the parties. All items incorporated herein by reference are attached. No other understandings, oral or ot}~erwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. 16_ ~}TNFR Ply©VISI~NS: Jeffersan County will comply with all applicable Federal and State requirements that govern this agreement. The following exhibits include additional contract requirements. ti~xhibit A, Sub-recipient Agreement exhibit S, Required Assurances From Washington State Department of i~lealth Contract # C'16gg? Rage 5 H~ b i rJ112_Jefferson_Coursky~C7G_Agreerraent WHA`~C'~"NI CQUN~Y PRQC~RA~M A!~~'~~VAL, ,;~~~ a~ta~er Date Astrid ~etinrel~, CH HEALTH DE~'ARTM~~T ApF'RC7VAL °.~'~-- Date ~® Red . Defah~rit, Director ,A~'PRQVE'D NS TO !FC7RM: ', r ... ~ ~ ttorr~ey_ _ Date pep~ty prosecut~_ ~'~ge 6 HL Q70112TJeffersar_Gnuntv_GTGTAgr~~rner~t ~o~ ~r~~F~r~sor~ couN~~ DATED this ~~~ i , Char Commissioners Jefferson oard Qf Courtly =`~~~'~~~~ ~s ~=r~ ~c~~ o~~~r~ q~ a~°~~ 1 ~~- t~~~~~~~~a~k ~~'~ ~j~~~~~~ttt~ ~ ~~g~ 7 Hl. ~7fl112^.~effe~son_~~~nty_CT~_Ar~~rr~ent EXHYY3YT "A" SUB-REC~PYtPNT AGREENCYrNT 13ET'NEEN ~~'HA7CG~1 CE~UNTY AND .~~o's=ARSON ca~NT~ THIS SUB-REClP1ENT AGREEMENT is made and entered into by and bet~aeen Whatcom County, herein after referr~4 to as the "VVhatcam", and Jefferson ~ounfy, here'!n after referred fa as the ".Yeffersan." This is a suhgrant of INSERT FUN7YNG SOURCE, FEDERAL PDflGRAN1 NAI>JIE, CC~NTI~ACT NUl4tBER, TER(k~b QF FEt7ERAL t=4JhlUlNG, A1gB CFA Y~t9YVIBED, 1F CFDA NYJMBY=R 15 N©T }tN~G~VI`~, REFEY~ TC3 HTTP'.f1~rNW'J~l.CFt7A.CCJVI. The purpase of this sut~award is as stated in this agreement. 9eNerson agrees to comph'~l~'the following General ~em~s and Csndi~ons and lalncorporale the terms and condslic~ns inclaadeo herei:r is? any and all s~bcontraeting, agreemenls enlered lnlo pursuant. to thrs agreement. GENERAL TERMS ANL? CGND1TiQNs Administrative Requirements: Jefferson sY~aii comply with all requirements within pMB Circular A-8i, Cost principles for State, Local, and Vndian Tribal Governments or CMB CircuYar A-~ 22, Cost Printlples far Nan-Profit Grganizatians; Gf~~E3 Circular A-1 G2, Administratfue Requirements far Grants and Cooperative Agreements with State and Local Gavernrr~ents or t~MB Circular A-11 U, Administrative Requirements far Non-Profit C~rganiaations; and ~7fJ1B Circular A-133, Audits of States, Local Governments, and Non-Profit C}rgani~atians, as are applicable. Jeffersan shaYY amply with all federal and state laws and regulations, including aYi nondiscriminaflon la~,~vs, but not limited ta, Title'+Jll of the CiuiY Rights Act, ~~ taSC 121171 et seq., the Americans ~,M1/it1F f?isa~;ilities At;t (ADA~y; and Chapter 4g.6[t RCW. 2, Single A:adit Deporting.: Non-federa4 entities receiving financiaY assistance of $~(3{t,(7ga or more in federal funds from aYY sources, direct and indirect, are rer~uiretl to have a singYe or a program-specific audit conducted in accordance with the Office of NYanagement and Y3udget [C7YV1B} CireuYar A-133, Audits of States, Local Governments, and Non-Pr©fif t3rganizatians, Circular A-133 is available an the CC~B Y-tome Page at f~ti ~?I~~n~~~r~.ornb o,. Yf Ibis is applicable Jefferson has the responsibility of notifyir7g the State Auditor's Office and requesting are audit. Nan-federal erltlties that spend Yess than $Sg~,QOg a year sn federal a~varo's are exempt from federal audit requirerrlents for that y^ear, except as noted in C~fvtB CircularA-i33. Jetfers©r! County sha11 maintain retards and accounts sa as to faciYitate the audit requirement and aY~ove audit el~ularerynenbcon~r~Ytoubcantra fsntain auditabie records. CIaYYum shall Include the ,Yefferson is responsible far any audit exceptions incurred by its o~~,~n arganizatian or that of its subcontractors. Fiespcnses to any unresolved management findings and disaiiewed or questioned casts shall be included with the audit report, Jefferson must respond to'~'Vha'ca~n's requests far infarrnation or correcti~ye action concerning audit issues wwithin 30 days of the date of request. '~J'sJhatcem reserves the right to recover from Jefferson all disallowed costs resulting `;ram the audit. and a §etter s~a~ingdt~ere were no firldingst~r kff the e weretfindi~gs~ all set 4{ tf~e ~irld ~glsto ~^Jhatcam Page ~ }~L_g7011 ~_Je'ferson~County_CTG_Agreement 3. CertificafiorD regarding ~3e~arment, Suspension, ineligibility, and Voluntary ~xclusian _ Lower-Tier hovered Transactions: that neither it nor its principals is ,iefterson certifies, by subrrtission at this proposal or caniraet, presently debarred, suspended,. proposed #or debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. Je#ferson #urther agrees that it shall not knawingly enter into any iov~er-tier covered transactions iia transaction ~setween ,~efferson and any o3her person} with a person who is proposed for debarmen#, debarred, suspended, declared ineligible, or voluntarily excluded frarn participation in this covered transaction, anal .ie##erson agrees to include tYtis clause tithed "Certiticatian~ Regarding Uebarrr+ent, Suspension, lnefigibility, and Voluntary ~xclusior, ~- Laver Tior Covered Transaction" without madi#koation, in all lower-tier covered transactions and it aH solicitations for lower tier transactions. The "general Service Administration List of Parties Excluded #rorn Federal #'rocuremen# or t~ion- procurementPrograms" is available to research this information at nttp:~lvrr~vw.e ls.rtavT. CTG_~+ reament Page 9 µL_o7~3112_.7efterson_Caunty~ 9 exhibit B Required Assurances From Washington State p,apartment of F~eaZth Contract # C1G9a7 STANt]~RD FEII~RAL CERTtFICATi(J~NS ANI) ASSL^TLAN~ES Fallowing are the Assurariees, Gerti.~catio~~s, and Special Conditions that apply to all federally funded (ire ~~,}3~,te or in part) agreements administered 'by the `Washing#on State Department ~f He.a9th. +CERTIFICATl~IVS 1. bEBARMEfsfT~AN~ES SKEINS DN The undersigned (authorized official signing. for the contracting Organization} certifies to the best of his or her know9edge and belief, that the cQ nr~ccordanc^e with 45 CFpR fart participant 7~, and itsprincipals: a) b} are not presently debarred, suspended, proposed for debarment, declared ineiigihle, or voluntarily e~~n ~edederal covered transactions. by Y Departrr7ent Or agency; have not vvithin a 3-year period preceding this contract been convicted of or had a vivid ~udgrnent rendered against them for comrraissiOn of fraud Or a Cflrrdinai Offense ire Cto n ®bta n wtlaf obtaining, at{ernpting performing a public (Federal, State, or local} transaction or contract under a public transaction; violation of federal or ;tote antitrust statutes ofor oemrni ~{9be Of embezzlement, theft, g ry, '~', falsification or destruction of records, making false statements, or receiving stolen property; c} are not presently indicted or Otherwise cram+natly or civwd9y Charged by a gQVernmentad entity (Federal, State, or local} with Commission araara h fbt Of offenses enumerated in p g " p ( 3 this certification; and d} have not Within a 3-year period preceding this contract had ogle or more public transactions (Federal, State, or local} terminated for cause or default. Shou9d the contra~f~o exolanatione aos ftoowhy this certification, p HL Q7!~"~ 12_Jeiterson_Coun#v_CTG_Agreement 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, do eligibi9ity, and Voluntary Exclusion--Lower TEer Covered Transactions" in al9 lower tier covered transactions (i.e., transactions with sub- grantees andlor contractors} and in ad9 solicitations for dower tier covered transactions in accordance with 45 CFR Part 76. Z. CERTIFtCATIOIV REGARt71N'G DRUG- FREE WC)RKPLACE REQUIREMENTS The undersigned (authorized official signing for the oontracfing organization} certifies that the contractor v,+ill, or will continue to, provide a drug-free workplace inn accordance with 45 CFR Part 7~ by: a} Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,. possession i7r uSe Of a contfolled substance is prohibited ire 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 a~varcness pr®grarr~ to inform employees about (1 } The dangers at drug abuse in the workplace; (2} The contractor's policy of maintaining adrug-free workplace; (~} Any availab9e drug Counseling, rehabi9itation, and employee assistance programs; and Page iii (4} The penalties ghat may be imposed upon employees for drug abuse violations occurring in the workplace; c} Baking it a requirement that each employee to tae engaged in the perfor ofn the f s~ temen acrequirged nby copy paragraph Via} above; d) Notifying the employee in the statement required by paragraph (a), above, that, as a condition of employment under the contract, the employee vviil~ ~1 ~ Abide by the terms of the statement; and to er in writing of his ~~} Notify tt~e emp Y 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)[~3 from an en-,pluyee or ather~vise receiving actual notice of such conviction. lwmployers of convicted ernpioyees must provide notice, including position title, to every contract officer or other designee on whose contract activity the convicted employee was Working: unless the Federa9 agency has designated a central paint. for the receipt of such notices. Notice shai9of each affected identification nurnber~s} grant; fy Taking. one of the following actions, within 30 calendar days of receiving notice ender paragraph (d} (2), with respect to any employee who is so convictedv ~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 ~~~ Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes t3y a Federal, State, or local health, law enforcement, ar other appropriate agency; Hu {}7112_,fefferson_Caunty_CTG_Agreement g) Malting a good faith effort to continue to maintain adrug-free workplace through implementation of paragraphs (a}. (ta), ~c}, (d}, (e}, and (f}. For purposes of paragraph (e) regarding agency notification of criminal dray convictions, DON has designated the following central point for receipt of such notices: Compliance and Internal Control Office r Office of Grants Manayernent WA State Department of 1°iealth PO f3ox 479{}5 Olympia, VVA 985t~4-7905 3. C'I=RTIFiCATIC]N REGARDING LOBE3`(ING Title 31, united States Code, Section 1052, entitled "Limifation 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 t_egislative 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 Federa9 grant or cooperative agreement must disclose lobbying undertaken with non-Fetteral {nonappropnated} funds. These requirements apply to grants and cooperative agreements EXCI°EDING S1OO,DO{} in total costs X45 CFR Marl 93}. The undersigned (authorized official signing for the contracting organization} certifies, to the best of his or her knowledge and belief, that: 41 } No Federal appropriated funds have }assn paid ar will be paid, by or on behalf Pale 11 Qf the undersigned, to any person tar influencing or atternPting to influence sn officer ar empltayee of any agency, s {Member ®f congress, an Officer or employee of Congress, car an ertaplayee a# a iVler~tber pf Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Faders{ 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. (~} if any funds other than i=ederally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or ernpiayee of any agency,. a Member of Congress, an office~o'oere tat alMernher Congress, or an amp y of Congress in coon ~cnt n loan thor Federal. contract, g cooperative agreement, the undersigned shall complete and submit Standard Faun-Lt-t-t '~~isclc~sure of Lobbying Activities.," in accordance with its instructicans. (If needed, Standard Form- LLL, ^"L]isclosure of Lobbying Activities,°' its instructions, and contiendtioofs th s are included at the application. form.} ~~} The undersigned shall require that the language of this certification be included in the award documents #or all subcontracts at subcon recta inclu a@nd subcontracts, confracts 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 cr entered into. Submission of this certi#ication is a prerequisite far making or entering into this transaction impos edso ywho fails 132, U.S. Cede. Any p to file the required certification shall be HL. (}7~t 12_Jefferson~~~unty_GTG_Agreer~lent subject tQ a civil penally of not less than 1~,QOf3 aria not more than ~~dQ,C~DC~ far each such failure. 4. CERT{FICA7IC7N F2EGARDING PR{3GRAM ~'RAt9D C{V{L REMEf~lES AC`T ~PFCRA} The undersigned ~suthorized cafficial signing far the contracting organization} certifies. #hat the statements herein are true, complete, and accurate to the best of his or her knowledge, and that he or she is aWVare that any false, fictitious,. or fraudulent statements or claims rosy subject hire or her to criminal, t:ivil, or adrriinistrative penalties. The undersigned agrees that the contracting organization will. comply with the Public I-lesith Service terms and conditions of award if a contract is awarded. 5. CERTII/{CATIC3N REGAR[711~C ENVIR(]iVMEIVTAL TC}E3ACC0 SML K1` Public Law 1 g3-227, also known as the Pra- Children Act of 1984 Act}, requires that smoking not be permitted in any pcartion of any indoor facility owned or Ceased ar contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood deveioprnent 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 governr~tents, by Federal grant; contract, loan, or loan guarantee. The law else applies to children's services that are provided in indoor facilities that are constructed, operated, car maintained e,vith such Federal funds. The IaNr does not apply to children's services provided in private residence, portions of facilities used tar 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. Failuee to comfy sas4@y the {reavrsroers urt@re la;w r;iay cesa@t rn the rmpastian are civi@ saaaneta€y pent@ty of ~p ao $1 •GilU Fps each wio@atia;, and,'or the irnposman nran administrative cor~rp!lance ceder an the responsi6@e ent~ay~ By signing the certification, the undersigned certifies that the contracting organization ~r~rill t;omply with the regtairernents of the Act and will not alloGV snloking~ within any porno@7 of F?age t 2 any iCesofor chi d ~n as~d ~rrled by the Act.of sere The contracting organization agrees that it will rezxt~ire that the lang+~age of this certification be included in any subcontracts which contain previsions for children's services acrd t f at all subrecipients shad certify according Y The Public Health Services strrsn~ly cncflurago~ ail rocip'sents sa provide a smoke-free workplace and prom°€~ the non-use of tahacco products. This is ~°sira9 and mene 1 Pearlh or€he to prase~t arad advance she p Y ~merscan people fi. CERTIFBGATIQ~N RE~~1RDlNt~ ~}`~13AR1V~ENT, SUSF''~NSIC]N, ANL C]Ti HER Ft~S~'t?NSlgklrfTY M,~TTI=RS 11s1STRUGTIC)1VS FC]R CER`fIFCCAT"lQN `~ 'ay signing and submitting.. this proposal, the prospective contractor is providing. the certification set out below. Tl~e inability of a person to provide the cordfication 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 cent below- The Uertification or explanation will be considered. in connection w~~tl~ the department or agency"s determination w~;trether to enter into this transaction. Ho~,vever, failure of the prospective contractor to furnish a certification or an explanation shall disqualify such person from participation in this transaction. ~} 'f'he certification in this clause: is a material representation crf fact upon evhich reliance ~w"as placed when the department or agency. deter i~~ined to enter into this transaction, if it is later determined that tl~e prospective contractor knowingly rendered an erroneous certification, in addition to other remedies available to the federal Cc'~'ornrrient, the department or agiancy Inay terminate this transaction far cause rsf default. ,~} The prospective contractor shall pror^ide in~med'iate ~~"ritten notice to the department or a;;ency to ~~'horn this contract is submitted if at any time the prospective contractor learns that its certihcatiorr was erroneous ~hegl 5L9biTlittcd ar has become erroneous by reasr~n of cflaslged circumstances. ~~ -~ hc: Leir71S COVered tra]~Silctl(3n, deharred, suspended, iile]igible, lover tier covered HL 47U112rJeftersan~Coun6y~CTG_Agreement transaction, participant, persor7, primary covered transaction, principal, proposal, and voluntarily excluded, as used in ttris clause, have fihe rneanir~gs set out in the f?e#initions and Coverage sections of the rules implementing Executive Larder 1254. You may contact the person to whom this contract is subrcritted for assistance in obtaining. a copy of those regulations. b} The prospective contractor agrees by submitting this contract that, sl~oterld the proposed covered transaction be c:a~rtered into, it shall not knowingly enter into any lotiver tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from. participation in tl'ris covered transaction., unless authorized ley L7C)ll. 7} "t`he prospective cornractor f>brr~ther agrees by submitting this coritraet that it will include the clause titled "Certification regarding l~ebar-rnent, suspension, lnefigibiiit}' and Voluntary Excleision -- l~oti~er Tier Covered "f°rar~saction," provider) by Hl-fS, wvithotrt modification, in all lower tier covered transactir>rts and in ail sol'icitatioras for lt~wer tier covered trar7sactions. 8} A participant. in a ceavered transaction rrtay rely upon a certification of a prosp~r~ctive participant in a lower tier covercd transaction that it is riot deLar-i~ed, suspended, ineligible, or voluntarily excluded Encino the covered transaction, ~rnle>ss it knows that the certification is ern7neaus. A participant may decide the method and frequency ley w'hicl~ it determines the eligibility of its principals. Eaci~ participant rnay, lout is not required tC), check the Norrpi'oeureinent List (of excluded parties). 9} Nothing contained in the foregoing shall be constrt.red to require estabiisl~ment of` a system of records in ordc;r to rer~der~ in stood faith tl~e certification retlLrir~ed by this clat.ise. l"he. ka~re~wledt~e at~d ii~forrnatian of a pti~ticipant is trot regtrirr~d tt~ exceed that ~vhsch is narrrraliy possessed by a prudent person in the ordinary course of business dealings. lD} Except for transactie~ns authorized ur7der paragraph b of these instructions, if a participant in a covered tra~nsact~iorr knowingly eaters. into a la3wei~ tier covered transaction tivitlr a person ~~~ha is strsper:dccl, debarred, ineligible, or voluntarily excluded from participation irr this transaction, in F~age 13 edies availab bl ~ ~e~n a p n e~inaie addition to Other rem rnment,. >~GH may tract un cier a sact o 14ca1) tra f F d Federal Gove use or default. e eral public transaction; uialatiorr o this trartsaGtion for ca or State antitrust statutes or cnrnmission afembezzlerrrent, theft, forgery, bribery, A~~®~ ~tEGAR>W]INC falsification or destruction of records, 7. CERT~~9C EBA'R~E~~> SUSPENSIa'N, ANI~ ` making false statements, or receiving t l D IVIATi ZERS - SI'ONSIBILI~`s en proper y; sto C)7HER !RE G~VERE#~ IMARY c} Are not presently indicted for or h i ill d - ~I~ y c arge v otheravise criminally or c ~RA~SACTIC~'~S by a governmental entity ~f'ederal, State G4rltractpr Gertlfl:°S 44 'tile OT local) '4vrth CQ3Y1rrr15Sr4rr Df any of the rL?S eGtrve 1) Thep P rledge arld belref, t'flat it aIlCl .~ ~ ~rc'.uTra~}~r ~ t~{}y) l C , fje5t of rt5 ~no e3rlL~ ei-trfl atrQr Qf thrs its pnnGlpals: esently debarred, suspended, d) Flave not within a three.-year pericld a) ~,re not pr r debarrnerlt, declared f preceding this Gorltract hail one or mol e o ra used .r p p exclu~ed trorn tuntar'r1y public transactions (Federal, State or ineligible,. 4r vo sactions by any Federal local) terminated f'4r cause or defaralt. covered tran department or agency; within a ttrree~year per'IOd ~) 11~~here the }~rospeutive contractor is unable ~) l~iave not t}lis contract been convicted to c~:rtif}f to arr}~ cf tltie stag€~~ents in this precediT}g 1'~dgment rendered d a civil h certification, such prospective Gar~tr`<rctor a . of or ?r GO]'91T7i1~~9®rl Uf ~r~I1C~ flr' f shall attaC~l aId eXp~hE3dtlOn tC) 1~t3$ pr[1pQSal. L agalr"1ST t11erT1 Crrllllnal {7ffer15GG in GCnneGtl4}n With a ()btalnrTlg, atternptina t0 CllJtaln, 4r cnrur~~cro~ srGnrarur:?~ r~~QVr~~D --~ sf~~,aYU~ar u~~at~i~~~ c~r~% ~~rcca~,~ ri~r~.~ "~ ~ F'_ ~=- ~" N~fr' ~~ !sa priest ar type name. PVeasc ~>~ ~~ r--1 ~.y [?ATE (]f~GANh~7ffl?J NA~1E: {if applica~ley ~ ~ ~ t ,'~ ! c~ ~~ . _ r r ~ ~t 1t,~~1C_ i-1~~ L`I ~ GAG^A reenient P~ye 34 H~~OiQ112_~etfer'sorr_Gount'Y_ ~ ~ss~,~~c.~s - ~a~v c~~rsr~r~c~rc~~ ~~~~~rs Public reporting burden far this collection of informatiar~ is estimated to average 1 ~ minutes per response, including time far reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and car~pleting and reviewing the cnliectiort of information. Send camrr~errts regarding the burden estir~tate car any ether aspect of this collection of infarmafinn, estions for reducing this burden., to the Office of 1Vlanagernent and i3udget, F'aperwnrk Including Bugg ~1~1a5h6n tors, ~C 2{15x3 Reduction Prnyect i~0348-6a~~1}, g PLEASE. DG NC3T I~~TUR~! YC~ClR CC3M~'LETED FARM TC? THE ©FF1GE C]F MANAGEIV~ENT AND ~3UDGET. SENQ 4T TO T'HE A'DC~~tESS PRL7WIflED EY Tf~E SPQNStJR1NG AGENCY. ~~#~; Certain of these assurannes may not be applicable to your project or pragrarn. It you have questions, please contact the awarding agency. Further, certain Faders! awarding agencies may require applicants to certify to additional assurances. 1f such is the case, you will be r~ atifi ed . As the duly authari~ed representative of the contractor, 9 certify that the contractor: Has the 1egaV authority to appky for 1=ederaf assistance, and the institutiona9, rnanageriaV arrd financial capability (inclui3i€sg f~rnds ~utficierst to paY the Wort-1=eiieraV share of project cast} to ensure proper planning. rnariag~'rT7ent, antj carnpketlon of Ilia project ~escribeti in th!s appVication. 2. IflJiil give the awarding agency, the Comptroller General of the Unthrou litany authnrdized appropriate, the state, g representative, access to and the right to examine all records, !books, papers, or d>ccurrlerrots related to the award; and. will establish a proper accounting system in accordance with generally accepted accounting standards nr agency directives. 3. 'Wi11 establish safeg theirs posntion ~rforiba employees from using resents the purpose that constitutes or p appearance of personal or organi2atinnal contVRet 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. UVill comply with the Intergovernmental Personnel Act of 1970 {42 U.S.C. 3~4728- rt763} relating to prescribed standards for merit systems for programs funded under ane of the 19 statutes or regulations specified in HL p7{3112_Jefferson,Cauny_CTG_Agreernerrof Appendix A of OPl'Jt's Standards for a Merit System of Personnel Administration ~~ C.F.F. 90[1, subpart F}. ~. Will comply with all Federal statutes relating to nnndiscriminattan. These include but are not limited to (a} Title 1II of the Civil {fights Act of 196~d ~P. L. 8~-352} which prohibits discrimination on the basis of raoe, Dolor nr national origin; fib} Title iX of the l=duration Amendments of 1972, as amended X20 U.S.G. 1681-1683, and 1685-1686j, which prohibits discrimination on the bases of sex; (c} Section 50~ of the Rehabilitation Act of 1973, as amended t29 U.S.C. X794}, which prohibits discrimination on the basis of handicaps; ~d} the Age discrimination Act of 1975, as amended (~32 U.S.C. ~3 61[}1-61(77}, which prohibits discrimination an the basis of age; (e) the drug Abuse Office and Treatment Act of 1972 (R.iL. 92-255}, as amended, relating to nondiscrimination on the basis of drug abuse; (f} the Ccamprehensive Alcohol Abuse and Alcoholism Prevention,. Treatment and Rehabilitation Act of 1970 P.L. 91-610}, as amended, relating to nondiscrimination nn the basis of alcohol abuse or alcoholism; ig) 3~ 523 and 527 cal Page i 5 the Public Health Service Act oaf 1912 (42 U.S.C. ~~ 29D dd-~ and 290 ee 3}, as amended, relating to cc~nfidentialhty of alcohol and drug abuse patient records; (h} Title Vil1 of the Civil bights Act of 1968 (42 U.S.C. ~ 36(]1 et seq.}, as amended, relating tc~ nondiscriminat%on in the sale, rental ar financing of housing.;. (i) any ether nondiscrimination previsions ~n l~catio~eCfor statutes} under which app Federal assistance is being made,; and ~9) the requirer>~ents of which ama r nondiscrimination statute(s7 Y apply to the application. 7, Will comply, ar has already complied, with the requirements of Titles 11 and 111 of the urtiiforrn Relocation Assistance and Real Props=rty Acq'~isitiar~ Policies Act of 197fl P.L. 91-640} which provide for fair and equitable treatment of persons displaced ar whose property is acquired as a result of Federal or federally IsSto adll interests n These requirements app y ro act ur oses real praper#y acquired for p artici titian in regardless of Federal p p purchases. 8. W iii carr~ply, as applicable, with the provisions of the Hatch Aot ~5 U.S.C., 1501- 1508 and 7324-7328} which limit the political activities of employees whose principal employment activities are funded in whole ar in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis-Bacon Act {40 U.S.C. ~3276a to 276a-7}, the Copeland Act X40 U.S.C. ~276c and 18 U.S.G. 33874} and the Contract ~40~ U~S.C~ sand 2 7333} Standards Act ~ regarding labor standardrseements~derally assisted can5trLlction sL~bag 10. Will comply, if applicable, with flood ;nsurance purchase requirements of Section 102~a} of the pload f~isaster Protection Act Qf 1973 ~P-I-. 93-234} which requires recipients in a special flood hazard area to ~!~ 07a1~2_JeEfersdn_C~ur+tp_CTG_Agre~ment participate in the program and to purchase flood insurance if the fate! coast of insurable construction and acquisition is 1Q,C~O~J or mare. 11.Wili comply with environmental standards which. may be prescribed pursuant to the fallt~wing~ (a} institution of environmental quality central measures under the National Environmental Policy Act of 1969 ~P. L. 91 a 190) and Executive Order ~E4} 1'1514; (b} notification of violating facilities pursuant to EC 11 T38; ~c) pratectiDn of wetlands pursuant to EC7 11990; ~d} evaluation of flood. hazards in floodplans in accordance with EC3 11988; te} assurance of project consistency with the approved State management pragram days@oped under the Coastal Zane Management Act of 1972 ~1 ~ U.S.C. , 14'51 et seq.}, (f} cant®rmity of Federal actions to State [Clear Air) Implementation Plans under Section 176{c} of the Clear Air Act of 1955, as arraended (42 U.S.C., 7401 et seq.}; (g} protection of underground sources of drinking water under the Safe Drinking 1Nater Act of 1974, as amended; (P.L. 93-523}; and (h} protection of endangered species under tree Endangered Species Act of 1'973, as amended, {P.t-. 93-205}. 12 lNill comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C., 1721 et sag,} related to 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 1ational Historic Preservation Act of 1966, as amended X16 I.S.C. .470}, EC? 11593 identification and protection of historic properties}, and the Archaeological and 'Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seg.). 14.Vllill comply with P.~. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this av4rard of assistance. F~ag~ 1~ 1.5. Wi44 cartilply with the Tabora 89-5 ~nimaal Welfare Act of '196 (~' ~ ~- arnended, 7 !U.S-C.. x.131 et seq~) Pertaining tQ the care, handling, and treatrrtent of warms blaoded anirnals held far res~'arthistaward of or ether activities supported by assistance- 16.Wi61 camply with the t..ead~Based Paint Poisoning prevention ,~,ct ~~~ 'U_S.C.. X801 et seq.} which prohibits the toss of 9ead~ based paint in construction or rehabilitatiars of residence structLSres. ~a~Y~~~Tau ~t~rua~r~rt~ ~~Qt~~R~v SIGNATUi~E OF AU INU 1ZR E ~ GE~tTiFYkNG f~3FFlt,9AL Please also rint or typ~~a""° OF~GANi7a'+TIUN NyAP~tE; (if applicak7l~} 17. V~lill cause to lie Perfarmed the required financial and compliance audits in accordance with the Single Audit Act Arnendrnents at 199E and OMS Circular No. A~133, Audits of States, ~,acal Gt~vernmonts, ar'Id Nan-Profit Organizations. 18. Will cornpiy with all applicable requirements of a9l ether Federal laws, executive orders, regu4atians and Policies governing this program. TITLE L1 l f~=_ ~ C_~ i L; i Ui-~Ti= C7 ~ ~-:"~ ~ I C r'~ A (~.F.'n"lerlt ~e°3(~e ~1, HL Q7~112_JefiersanwCoun[y_~-1 G_ 9