HomeMy WebLinkAbout021014_ca03��,son coLA
JEFFERSON COUNTY PUBLIC HEALTH
Q,s 615 Sheridan Street o Port Townsend o Washington o 98368
www.jeffersoncountypublichealth.org
Consent Agenda
January 13, 2014
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE: rcf. trcr
SUBJECT: Agenda Item — Interlocal Agreement with Whatcom County Health
Department for Supporting Healthy Communities work;
October 1, 2013 — September 29, 2014; $25,000
STATEMENT OF ISSUE:
Jefferson County Public Health, Community Health, requests Board approval of the Interlocal Agreement
with Whatcom County Health Department for Supporting Healthy Communities work; October 1, 2013 —
September 29, 2014; $25,000
ANALYSIS /STRATEGIC GOALS /PRO'S and CON'S:
This is the second year performing work under the Health Communities Grant. This contract 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, work funded by this contract 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. This year JCPH will be involved with the adoption and
implementation of specific policies related to smoke free venues, school district wellness, and safe routes to
school. JCPH will work with local partners to implement a smoke -free policy at all JC Farmers Market
venues, collaborate with community and PTSD partners to implement a district wide wellness policy that
meets state /federal physical activity recommendations, and work together with the community and
Chimacum School District to implement a campus -wide Safe Routes to School policy for the Chimacum
Elementary, Middle and High School campus.
Whatcom County Health Department serves as the Hub (lead) for the Northwest Healthy Communities
Region. Whatcom County Health Department will work 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.
COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH
DEVELOPMENTAL DISABILITIES WATER QUALITY
MAIN: (360) 385 -9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385 -9444
FAX: (360) 385 -9401 HEALTHIER COMMUNITY FAX: (360) 379 -4487
Consent Agenda
FISCAL IMPACT /COST BENEFIT ANALYSIS:
These funds represent both State and Federal money awarded to Whatcom County Health Department
through the WA State Department of Health Consolidated Contract. Whatcom County will reimburse
Jefferson County for work performed under this contract.
RECOMMENDATION:
JCPH management request approval of the Interlocal Agreement with Whatcom County Health Department
for Supporting Healthy Communities work; October 1, 2013 — September 29, 2014; $25,000
REVIEWED BY:
ilip Morl ounty Arlminicr or
(Routed to all Public Health Managers)
/ /5oe
Date
Whatcom County
Contract No.
WHATCOM COUNTY CONTRACT
INFORMATION SHEET
Originating Department:
Health
Contract or Grant Administrator:
Katie Hicks
Contractor's / Agency Name:
Jefferson County
Is this a New Contract? If not, is this an Amendment or Renewal to an Existing Contract? Yes _ No _
Yes X No If Amendment or Renewal, Original Contract #
Does contract require Council Approval? Yes X No _
Is this a grant agreement?
Yes _ No X If yes, grantor agency contract number(s) CFDA #
Is this contract grant funded?
Yes X No _ If yes, associated Whatcom County grant contract number(s) 201112012
Is this contract the result of a RFP or Bid process? Contract
Yes _ No X If yes, RFP and Bid number(s) Cost Center: 677530
Is this agreement excluded from E- Verify? No Yes X If no, include Attachment D Contractor Declaration
If yes, indicate exclusion(s) below:
❑ Professional services agreement for certified/licensed professional ❑ Contract work is for less than 120 days
❑Contract less than $100,000. ❑Contract for Commercial off the shelf items (COTS)
❑Contract work is all performed outside U.S. ❑Work related subcontract less than $25,000.
0 Interlocal Agreement (between Govt's) ❑ Public Works - Local Agency/Federally Funded FHWA
Contract Amount:(sum of original contract amount and
Contracts that require Council Approval (incl. agenda bill & memo)
any prior amendments)
Professional Services Agreement above $20,000.
$ 25 000
Bid is more than $40,000.
This Amendment Amount:
• Amendments that have either an increase greater than 10% or
$
provide a $10,000 increase in amount (whichever is greater)
Total Amended Amount:
$
RENEWALS: Council approval is not required when exercising an
option to renew that is provided in the original contract.
Summary of Scope:
The purpose of this agreement is to fund the adoption and implementation of specific
policies related to smoke free venues, school district wellness, and safe routes to school.
Term of Contract: I Year
Expiration Date: 09/29/2014
Contract Routing Steps & Signoff [sign or initial] [indicate date transmitted)
1. Prepared by: pi Date 12/19/13 [electronic]
2. Attorney reviewed: Date [electronic]
3. AS Finance reviewed:mdc Date-1/7/14 [electronic]
4. IT reviewed if IT related Date [electronic]
5. Corrections made: Date [electronic] hard copy printed
6. Attorney signoff:
7. Contractor signed:
8. Submitted to Exec Office
hardcopies]
9. Council approved (if necessary)
10. Executive signed:
11. Contractor Original Returned to dept;
12. County Original to Council
Date
Date
[summary via electronic;
Whatcom County Contract No.
CONTRACT FOR SERVICES AGREEMENT
Healthy Communities Grant Funded Work
Jefferson County, hereinafter called Contractor, and Whatcom County, hereinafter referred to as County, agree and contract as
set forth in this Agreement, including:
General Conditions, pp. 3 to 8
Exhibit A (Scope of Work), pp. 9 to 10
Exhibit B (Compensation), pp. 11 to 13
Exhibit C (Certificate of Insurance), p. 14
Exhibit D (Sub- Recipient Agreement), pp. 15 to 16
Exhibit E (Standard Federal Certifications and Assurances), pp. 17 to 23 .
Copies of these items are attached hereto and incorporated herein by this reference as if fully set forth herein
The term of this Agreement shall commence on the 1st day of October, 2013, and shall, unless terminated or renewed as
elsewhere provided in the Agreement, terminate on the 29th day of September, 2014.
The general purpose or objective of this Agreement is to improve the health of communities, reduce chronic diseases and
reduce health disparities in Jefferson County, as more fully and definitively described in Exhibit A hereto. The language of
Exhibit A controls in case of any conflict between it and that provided here.
The maximum considerafion for the initial term of this agreement or for any renewal term shall not exceed
$ 25,000. The Contract Number, set forth above, shall be included on all billings or correspondence in connection therewith.
Contractor acknowledges and by signing this contract agrees that the Indemnification provisions set forth in Paragraphs 11.1,
21.1, 30.1, 31.2, 32.1, 34.2, and 34.3, if included, are totally and fully part of this contract and have been mutually negotiated by
the parties.
IN WITNESS WHEREOF, the parties have executed this Agreement this _ day of
FOR JEFFERSON COUNTY:
royal s to
Jefferson County Prosecutor' Office
John Austin, Chair
Jefferson Board of County Commissioners
STATE OF WASHINGTON )
ss.
COUNTY OF )
20
On this _ day of 20 _, before me personally appeared to me known to be
the (title) of Jefferson County and who executed the above instrument and who acknowledged to me the act
of signing and sealing thereof.
NOTARY PUBLIC in and for the State of Washington, residing at
. My commission expires
HL-100113—Jefferson—County Healthy_Communities_Work
WHATCOM COUNTY:
Recommended for Approval:
Astrid Newell, Community Health Mgr. Date
Regina A. Delahunt, Dept. Director Date
Approved as to form:
Prosecuting Attorney Date
Approved:
Accepted for Whatcom County:
RV
Jack Louws, Whatcom County Executive
STATE OF WASHINGTON )
) ss
COUNTY OF WHATCOM )
On this _ day of , 20 _, before me personally appeared Jack Louws, to me known to be the Executive of
Whatcom County, who executed the above instrument and who acknowledged to me the act of signing and sealing thereof.
NOTARY PUBLIC in and for the State of Washington, residing at
My commission expires
CONTRACTOR INFORMATION:
Julia Danskin, Public Health Supervisor
Jefferson County public Health
615 Sheridan St.
Port Townsend, WA 98268
Email: idanskin(o)co.lefferson.wa.us
Phone: 350-385-9400
HL 100113 Jefferson County_Healthy_Communities_Work
GENERAL CONDITIONS
Series 00 -09: Provisions Related to Scope and Nature of Services
0.1 Scope of Services:
The Contractor agrees to provide to the County services and any materials as set forth in the project narrative identified
as Exhibit "A ", during the agreement period. No material, labor, or facilities will be furnished by the County, unless
otherwise provided for in the Agreement.
Series 10 -19: Provisions Related to Term and Termination
10.1 Term:
Services provided by Contractor prior to or after the term of this contract shall be performed at the expense of Contractor
and are not compensable under this contract unless both parties hereto agree to such provision in writing.
10.2 Extension:
The duration of this Agreement may be extended by mutual written consent of the parties, for a period of up to one year,
and for a total of no longer than three years.
11.1 Termination for Default:
If the Contractor defaults by failing to perform any of the obligations of the contract or becomes insolvent or is declared
bankrupt or commits any act of bankruptcy or insolvency or makes an assignment for the benefit of creditors, the County
may, by depositing written notice to the Contractor in the U.S. mail, first class postage prepaid, terminate the contract,
and at the County's option, obtain performance of the work elsewhere. Termination shall be effective upon Contractor's
receipt of the written notice, or within three (3) days of the mailing of the notice, whichever occurs first. If the contract is
terminated for default, the Contractor shall not be entitled to receive any further payments under the contract until all
work called for has been fully performed. Any extra cost or damage to the County resulting from such default(s) shall be
deducted from any money due or coming due to the Contractor. The Contractor shall bear any extra expenses incurred
by the County in completing the work, including all increased costs for completing the work, and all damage sustained,
or which may be sustained by the County by reason of such default.
11.2 Termination for Reduction in Funding:
In the event that funding from State, Federal or other sources is withdrawn, reduced, or limited in any way after the
effective date of this Agreement, and prior to its normal completion, the County may summarily terminate this Agreement
as to the funds withdrawn, reduced, or limited, notwithstanding any other termination provisions of this Agreement. If the
level of funding withdrawn, reduced or limited is so great that the County deems that the continuation of the programs
covered by this Agreement is no longer in the best interest of the County, the County may summarily terminate this
Agreement in whole, notwithstanding any other termination provisions of this Agreement. Termination under this section
shalt be effective upon receipt of written notice as specified herein, or within three days of the mailing of the notice,
whichever occurs first.
113 Termination for Public Convenience:
The County may terminate the Agreement in whole or in part whenever the County determines, in its sole discretion, that
such termination is in the interests of the County. Whenever the Agreement is terminated in accordance with this
paragraph, the Contractor shall be entitled to payment for actual work performed at unit contract prices for completed
items of work. An equitable adjustment in the contract price for partially completed items of work will be made, but such
adjustment shall not include provision for loss of anticipated profit on deleted or uncompleted work. Termination of this
Agreement by the County at any time during the term, whether for default or convenience, shall not constitute breach of
contract by the County.
Series 10.19: Provisions Related to Consideration and Payments
20.1 Accounting and Payment for Contractor Services:
Payment to the Contractor for services rendered under this Agreement shall be as set forth in Exhibit "B:' Where Exhibit
"B" requires payments by the County, payment shall be based upon written claims supported, unless otherwise provided
in Exhibit "B;' by documentation of units of work actually performed and amounts earned, including, where appropriate,
HL 100113 Jefferson County_Healthy_Communities_Work
the actual number of days worked each month, total number of hours for the month, and the total dollar payment
requested, so as to comply with municipal auditing requirements.
Unless specifically stated in Exhibit "B" or approved in writing in advance by the official executing this Agreement for the
County or his designee (hereinafter referred to as the "Administrative Officer ") the County will not reimburse the
Contractor for any costs or expenses incurred by the Contractor in the performance of this contract. Where required, the
County shall, upon receipt of appropriate documentation, compensate the Contractor, no more often than monthly, in
accordance with the County's customary procedures, pursuant to the fee schedule set forth in Exhibit "B."
21.1 Taxes:
The Contractor understands and acknowledges that the County will not withhold Federal or State income taxes. Where
required by State or Federal law, the Contractor authorizes the County to withhold for any taxes other than income taxes
(i.e., Medicare). All compensation received by the Contractor will be reported to the Internal Revenue Service at the end
of the calendar year in accordance with the applicable IRS regulations. It is the responsibility of the Contractor to make
the necessary estimated tax payments throughout the year, if any, and the Contractor is solely liable for any tax
obligation arising from the Contractor's performance of this Agreement. The Contractor hereby agrees to indemnify the
County against any demand to pay taxes arising from the Contractors failure to pay taxes on compensation earned
pursuant to this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired hereunder as required by law. The
Contractor must pay all other taxes, including, but not limited to, Business and Occupation Tax, taxes based on the
Contractor's gross or net income, or personal property to which the County does not hold title. The County is exempt
from Federal Excise Tax.
22.1 Withholding Payment:
In the event the County's Administrative Officer determines that the Contractor has failed to perform any obligation under
this Agreement within the times set forth in this Agreement, then the County may withhold from amounts otherwise due
and payable to Contractor the amount determined by the County as necessary to cure the default, until the
Administrative Officer determines that such failure to perform has been cured. Withholding under this clause shall not be
deemed a breach entitling Contractor to termination or damages, provided that the County promptly gives notice in
writing to the Contractor of the nature of the default or failure to perform, and in no case more than 10 days after it
determines to withhold amounts otherwise due. A determination of the Administrative Officer set forth in a notice to the
Contractor of the action required and/or the amount required to cure any alleged failure to perform shall be deemed
conclusive, except to the extent that the Contractor acts within the times and in strict accord with the provisions of the
Disputes clause of this Agreement. The County may act in accordance with any determination of the Administrative
Officer which has become conclusive under this clause, without prejudice to any other remedy under the Agreement, to
take all or any of the following actions: (1) cure any failure or default, (2) to pay any amount so required to be paid and to
charge the same to the account of the Contractor, (3) to set off any amount so paid or incurred from amounts due or to
become due the Contractor. In the event the Contractor obtains relief upon a claim under the Disputes clause, no
penalty or damages shall accrue to Contractor by reason of good faith withholding by the County under this clause.
23.1 Labor Standards:
The Contractor agrees to comply with all applicable state and federal requirements, including but not limited to those
pertaining to payment of wages and working conditions, in accordance with RCW 39.12.040, the Prevailing Wage Act,
the Americans with Disabilities Act of 1990; the Davis -Bacon Act; and the Contract Work Hours and Safety Standards
Act providing for weekly payment of prevailing wages, minimum overtime pay, and providing that no laborer or mechanic
shall be required to work in surroundings or under conditions which are unsanitary, hazardous, or dangerous to health
and safety as determined by regulations promulgated by the Federal Secretary of Labor and the State of Washington.
Series 30.39: Provisions Related to Administration of Agreement
30.1 Independent Contractor:
The Contractor's services shall be furnished by the Contractor as an independent contractor, and nothing herein
contained shall be construed to create a relationship of employer - employee or master - servant, but all payments made
hereunder and all services performed shall be made and performed pursuant to this Agreement by the Contractor as an
independent contractor.
The Contractor acknowledges that the entire compensation for this Agreement is specified in Exhibit "B" and the
Contractor is not entitled to any benefits including, but not limited to: vacation pay, holiday pay, sick leave pay, medical,
dental, or other insurance benefits, or any other rights or privileges afforded to employees of the County. The Contractor
HL-100113—Jefferson County_ Healthy_Communities_Work
represents that helshelit maintains a separate place of business, serves clients other than the County, will report all
income and expense accrued under this contract to the Internal Revenue Service, and has a tax account with the State
of Washington Department of Revenue for payment of all sales and use and Business and Occupation taxes collected
by the State of Washington.
Contractor will defend, indemnify and hold harmless the County, its officers, agents or employees from any loss or
expense, including, but not limited to, settlements, judgments, setoffs, attorneys' fees or costs incurred by reason of
claims or demands because of breach of the provisions of this paragraph.
30.2 Assignment and Subcontracting:
The performance of all activities contemplated by this agreement shall be accomplished by the Contractor. No portion of
this contract may be assigned or subcontracted to any other individual, firm or entity without the express and prior written
approval of the County.
303 No Guarantee of Employment:
The performance of all or part of this contract by the Contractor shall not operate to vest any employment rights
whatsoever and shall not be deemed to guarantee any employment of the Contractor or any employee of the Contractor
or any subcontractor or any employee of any subcontractor by the County at the present time or in the future.
31.2 Patent/Copyright Infringement Not Applicable
32.1 Confidentiality: Not Applicable
33.1 Right to Review:
This contract is subject to review by any Federal, State or County auditor. The County or its designee shall have the
right to review and monitor the financial and service components of this program by whatever means are deemed
expedient by the Administrative Officer or by the County Auditor's Office. Such review may occur with or without notice
and may include, but is not limited to, on -site inspection by County agents or employees, inspection of all records or
other materials which the County deems pertinent to the Agreement and its performance, and any and all
communications with or evaluations by service recipients under this Agreement. The Contractor shall preserve and
maintain all financial records and records relating to the performance of work under this Agreement for three (3) years
after contract termination, and shall make them available for such review, within Whatcom County, State of Washington,
upon request. Contractor also agrees to notify the Administrative Officer in advance of any inspections, audits, or
program review by any individual, agency, or governmental unit whose purpose is to review the services provided within
the terms of this Agreement. If no advance notice is given to the Contractor, then the Contractor agrees to notify the
Administrative Officer as soon as it is practical.
34.1 Proof of Insurance:
County and Contractor are both members of the Washington Counties Risk Pool, a joint self - insurance liability pool
created under Ch. 48.62 RCW and as such each party to this Contract has third party liability coverage of not less than
$10 million.
A Certificate of insurance is attached hereto as Exhibit "C ".
34.2 Industrial Insurance Waiver:
With respect to the performance of this agreement and as to claims against the County, its officers, agents and
employees, the Contractor expressly waives its immunity under Title 51 of the Revised Code of Washington, the
Industrial Insurance Act, for injuries to its employees and agrees that the obligations to indemnify, defend and hold
harmless provided in this agreement extend to any claim brought by or on behalf of any employee of the Contractor.
This waiver is mutually negotiated by the parties to this agreement.
34.3 Defense & Indemnity Agreement.
The Contractor agrees to defend, indemnity and save harmless the County, its appointed and elected officers and
employees (hereinafter collectively "the County") from and against all loss or expense, including, but not limited to,
judgments, settlements, attorney's fees and costs reason of any and all claims and demands upon the County for
damages arising from personal or bodily injury, including death arising at any time therefrom, sustained by any person or
persons and/or property damage, including loss of use thereof, if such personal or bodily injury or property damage is
due to the negligence of the Contractor, its subcontractors, its successors or assigns or its agents, servants or
employees (hereinafter collectively "the Contractor. ") This duty to defend, indemnity and save harmless shall not apply
to claims and demands for damages arising from the sole negligence of the County.
HL ]00113 Jefferson_ County_Healthy_Communities_Work
In case of damages caused by the concurrent negligence of Contractor and County, then this indemnification provision
is enforceable only to the extent of the negligence of the Contractor.
It is further provided that no liability shall attach to the County by reason of entering into this contract, except as
expressly provided herein.
The parties specifically agree that this Agreement is for the benefit of the parties only and this Agreement shall create no
rights in any third party.
35.1 Non - Discrimination in Employment:
The County's policy is to provide equal opportunity in all terms, conditions and privileges of employment for all qualified
applicants and employees without regard to race, color, creed, religion, national origin, sex, sexual orientation, age,
marital status, disability, or veteran status. The Contractor shall comply with all laws prohibiting discrimination against
any employee or applicant for employment on the grounds of race, color, creed, religion, national origin, sex, sexual
orientation, age, marital status, disability, or veteran status, except where such constitutes a bona fide occupational
qualification.
Furthermore, in those cases in which the Contractor is governed by such laws, the Contractor shall take affirmative
action to insure that applicants are employed, and treated during employment, without regard to their race, color, creed,
religion, national origin, sex, age, marital status, sexual orientation, disability, or veteran status, except where such
constitutes a bona fide occupational qualification. Such action shall include, but not be limited to: advertising, hiring,
promotions, layoffs or terminations, rate of pay or other forms of compensation benefits, selection for training including
apprenticeship, and participation in recreational and educational activities. In all solicitations or advertisements for
employees placed by them or on their behalf, the Contractor shall state that all qualified applicants will receive
consideration for employment without regard to race, color, religion, sex or national origin.
The foregoing provisions shall also be binding upon any subcontractor, provided that the foregoing provision shall not
apply to contracts or subcontractors for standard commercial supplies or raw materials, or to sole proprietorships with no
employees.
35.2 Non - Discrimination in Client Services: Not Applicable
36.1 Waiver of Nonoompetition: Not Applicable
36.2 Conflict of Interest:
If at any time prior to commencement of, or during the term of this Agreement, Contractor or any of its employees
involved in the performance of this Agreement shall have or develop an interest in the subject matter of this Agreement
that is potentially in conflict with the County's interest, then Contractor shall immediately notify the County of the same.
The notification of the County shall be made with sufficient specificity to enable the County to make an informed
judgment as to whether or not the County's interest may be compromised in any manner by the existence of the conflict,
actual or potential. Thereafter, the County may require the Contractor to take reasonable steps to remove the conflict of
interest. The County may also terminate this contract according to the provisions herein for termination.
37.1 Administration of Contract:
This Agreement shall be subject to all laws, rules, and regulations of the United States of America, the State of
Washington, and political subdivisions of the State of Washington. The Contractor also agrees to comply with applicable
federal, state, county or municipal standards for licensing, certification and operation of facilities and programs, and
accreditation and licensing of Individuals.
The County hereby appoints, and the Contractor hereby accepts, the Whatcom County Executive, and his or her
designee, as the County's representative, hereinafter referred to as the Administrative Officer, for the purposes of
administering the provisions of this Agreement, including the County's right to receive and act on all reports and
documents, and any auditing performed by the County related to this Agreement. The Administrative Officer for
purposes of this agreement is:
Katie Hicks I Community Health Specialist Lead I NW WA Healthy Communities Regional Coordinator
Whatcom County Health Department
1500 North State Street I Bellingham, WA 98225
e: khicksRwhatcomcounty.us
HL-100113—Jefferson County—Healthy _Communities _Work
p:360- 676 -6724 #50862 1 f:360- 676 -6729
37.2 Notice:
Except as set forth elsewhere in the Agreement, for all purposes under this Agreement except service of process, notice
shall be given by the Contractor to the County's Administrative Officer under this Agreement. Notice to the Contractor
for all purposes under this Agreement shall be given to the address provided by the Contractor herein above in the
"Contractor Information" section. Notice may be given by delivery or by depositing in the US Mail, first class, postage
prepaid.
38.1 Certification of Public Works Contractor's Status under State Law: Not Applicable
38.2 Certification Regarding Federal Debarment Suspension Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transactions:
The Contractor further certifies, by executing this contract, that neither it nor its principles is presently debarred,
suspended, proposd for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by
any Federal department or Agency.
The Contractor also agrees that it shall not knowingly enter into any lower tier covered transactions (a transaction
between the Contractor and any other person) with a person who is proposed for debarment, debarred, suspended,
declared ineligible, or voluntarily excluded from participation in this covered transaction, and the Contractor agrees to
include this clause titled "Certification Regarding Federal Debarment, Suspension, Ineligibility and Voluntary Exclusion -
Lower Tier Covered Transaction" without modification, in all lower tier covered transactions and in all solicitations for
lower tier transactions.
The "General Service Administration List of Parties Excluded from Federal Procurement or Non - procurement Programs'
is available to research this information at http: / /epls.arnet.gov /.
38.3 E -Vert : Not Applicable
Series 40 -49: Provisions Related to Interpretation of Agreement and Resolution of Disputes
40.1 Modifications:
Either party may request changes in the Agreement. Any and all agreed modifications, to be valid and binding upon
either party, shall be in writing and signed by both of the parties.
402 Contractor Commitments Warranties and Representations: Not Applicable
411 Severabili :
If any term or condition of this contract or the application thereof to any person(s) or circumstances is held invalid, such
invalidity shall not affect other terms, conditions or applications which can be given effect without the invalid term,
condition or application. To this end, the terms and conditions of this contract are declared severable.
41.2 Waiver:
Waiver of any breach or condition of this contract shall not be deemed a waiver of any prior or subsequent breach. No
term or condition of this contract shall be held to be waived, modified or deleted except by an instrument, in writing,
signed by the parties hereto. The failure of the County to insist upon strict performance of any of the covenants and
agreements of this Agreement, or to exercise any option herein conferred in any one or more instances, shall not be
construed to be a waiver or relinquishment of any such, or any other covenants or agreements, but the same shall be
and remain in full force and effect.
42,1 Disputes:
General:
Differences between the Contractor and the County, arising under and by virtue of the Contract Documents, shall be
brought to the attention of the County at the earliest possible time in order that such matters may be settled or other
appropriate action promptly taken. Except for such objections as are made of record in the manner hereinafter specified
and within the time limits stated, the records, orders, rulings, instructions, and decisions of the Administrative Officer
shall be final and conclusive.
HL 100113 Jefferson County_ Healthy_ Communities—Work
Notice of Potential Claims:
The Contractor shall not be entitled to additional compensation which otherwise may be payable, or to extension of time
for (1) any act or failure to act by the Administrative Officer or the County, or (2) the happening of any event or
occurrence, unless the Contractor has given the County a written Notice of Potential Claim within ten (10) days of the
commencement of the act, failure, or event giving rise to the claim, and before final payment by the County. The written
Notice of Potential Claim shall set forth the reasons for which the Contractor believes additional compensation or
extension of time is due, the nature of the cost involved, and insofar as possible, the amount of the potential claim.
Contractor shall keep full and complete daily records of the work performed, labor and material used, and all costs and
additional time claimed to be additional.
C. Detailed Claim:
The Contractor shall not be entitled to claim any such additional compensation, or extension of time, unless within thirty
(30) days of the accomplishment of the portion of the work from which the claim arose, and before final payment by the
County, the Contractor has given the County a detailed written statement of each element of cost or other compensation
requested and of all elements of additional time required, and copies of any supporting documents evidencing the
amount or the extension of time claimed to be due.
d. Arbitration: Not Applicable
43.1 Venue and Choice of Law:
In the event that any litigation should arise concerning the construction or interpretation of any of the terms of this
Agreement, the venue of such action of litigation shall be in the courts of the State of Washington in and for the County
of Whatcom. This Agreement shall be governed by the laws of the State of Washington.
44.1 Survival:
The provisions of paragraphs 11.1, 11.2, 11.3 , 21.1, 22.1, 30.1, 31.1, 31.2, 32.1, 33.1, 34.2, 34.3, 36.1, 40.2, 41.2, 42.1,
and 43.1, if utilized, shall survive, notwithstanding the termination or invalidity of this Agreement for any reason.
45.1 Entire Agreement:
This written Agreement, comprised of the writings signed or otherwise identified and attached hereto, represents the
entire Agreement between the parties and supersedes any prior oral statements, discussions or understandings
between the parties.
HL 100113 Jefferson County_Heatthy_Communities_Work
EXHIBIT "A"
(SCOPE OF WORK)
Background
In 2012 the Washington Department of Health designated Whatcom County as the
regional hub for activities related to their 5 -year federally funded Community
Transformation Grant. With this hub designation, Whatcom is responsible for
administering grant - related activities in 7 counties in the region including Jefferson
County. The purpose of the grant is to improve the health of communities, reduce chronic
diseases and reduce health disparities through policy, systems and environmental and
infrastructure change strategies. Under a previous grant funded agreement with Jefferson
County significant activities were accomplished to build local organizational leadership,
establish priorities, and conduct community planning. The purpose of this agreement is to
fund the adoption and implementation of specific policies related to smoke free venues,
school district wellness, and safe routes to school.
Scope of Work
This statement of work is governed by Whatcom's contract with DOH for Healthy Community
activities and will be subject to change if Whatcom's contract with DOH changes. Any changes
occurring due to a contract amendment with DOH will be communicated to Jefferson without a
further amendment to this agreement unless the change results in alteration of the
reimbursement amount of this agreement.
Jefferson will:
• Participate in all required conference calls and trainings.
• Participate in monthly Northwest WA Healthy Communities Regional meetings or
conference calls.
• Maintain accurate records of staff time dedicated to Healthy Communities activities.
• Complete the following local strategies by the target date or no later than September 30,
2014:
Strategy
Target Date
Strategy #1: Work with local partners to implement a smoke -free
policy at all Jefferson County Farmers Market venues throughout
Jefferson County
9/29/2014
• Written policy adopted, communicated and enforced at all
locations
Strategy #2: Collaborate with community & PTSD50 school district
partners to implement a district wide wellness policy that meets state
06/30/2014
and federal physical activity recommendations.
• Policy finalized and adopted
Strategy #3: Collaborate with community & Chimacum School District
(CSD49) to implement a campus -wide Safe Routes to School (SRTS)
08/31/2014
Policy for Chimacum Elementary, Middle and High School Campus.
• CSD49 adopts SRTS routes and registers with WA DOT
HL 100113 Jefferson County_Healthy_Communities_Work
Program Requirements
Jefferson will use all allocated funds so that use aligns with the finalized DOH CTG statewide
implementation plan. Jefferson will perform all work necessary within the limits of the available
resources from this agreement to implement the strategies, action steps, and deliverables
agreed to with regional partners and approved by DOH.
Compliance Requirements
Jefferson will comply with all applicable Federal and State requirements that govern this
agreement.
HL 100113 Jefferson _County _Healthy_Communities_Work 10
EXHIBIT "B"
(COMPENSATION)
Budget and Source of Funding
The source of funding for this agreement is federal funding from Washington State Department
of Health.
Jefferson County will be reimbursed for costs associated with meeting the requirements
established in Exhibit "A ". The start date for this grant funded project is October 1, 2013
therefore the start date of this contract has been established as of that date, regardless of the
time of signing. Due to requirements from the funding source, the contract budget is divided into
3 separate periods of performance. Each period has a funding level that is available only in that
period. Any funds remaining from a period cannot be utilized in subsequent periods. If costs
associated with activities in a period exceed the budget for that period, funds from the
subsequent period can be utilized, up to the maximum budget of $25,000.
Performance
Period
Bud et
3 — 03/28/2014
$ 4,500
LPeriod
3 — 06/29/2014
$ 3,320
3 — 09/30/2014
$ 17,180
10/01/2013 — 09/30/2014 Total Not To Exceed
$ 25,000
Invoicing
Eligible program costs include direct program costs and an indirect cost reimbursement
that does not exceed 15% of the total Contract amount. Direct program costs include,
but are not limited to, personnel costs, supplies, training and travel. Indirect costs require
documentation of the last four quarters Overhead Rate Calculation for the Community
Health Division including a signed statement certifying it was prepared according to the
OMB Circular A -87 cost principles. All reimbursed costs must be allowable as defined
in OMB Circular A -87, Cost Principles for State, Local and Indian Tribal Governments.
2. Jefferson shall submit itemized invoices on a monthly basis in a format approved by
Whatcom. Invoices must be submitted by the 25th of the month following the month in
which costs were incurred. Final invoice is due to the Whatcom County Health
Department on or before close of business 10/30/14. Invoices received after 10/30/14
may not be eligible for payment.
3. A Detail General Ledger report of costs claimed toward this project plus items 4 -6 below
will be sufficient for invoicing this agreement. Whatcom reserves the right to request
further back -up documentation for any costs claimed for reimbursement.
4. For mileage reimbursement, copies of mileage records, including the name of the staff
member, date of travel, starting point and destination of travel, the number of miles
traveled, the per mile reimbursement rate, and a brief description of the purpose of
travel. Mileage will be reimbursed at the current GSA rate.
5. Ground transportation, coach airfare, and ferries will be reimbursed at cost when
accompanied by receipts. Reimbursement requests for allowable travel must include
HL-100113—Jefferson—County Healthy_Communities_Work I1
name of staff member, beginning and ending time and dates of travel, starting point and
destination, and a brief description of purpose.
6. Receipts for registration fees or other documentation of professional training expenses.
Lodging and meal costs for training are not to exceed the U.S. General Services
Administration Domestic Per Diem Rates (www.gsa.gov), specific to location. Receipts
for meals are not required.
7. Restrictions on Funds:
a) No part of any appropriated funds used under this cooperative agreement shall be
used other than for normal and recognized executive legislative relationships, for
publicity or propaganda purposes, for the preparation, distribution, or use of any kit,
pamphlet, booklet, publication, radio, television, or video presentation designed to
support or defeat legislation pending or proposed before the Congress or any State
or local legislature, including city councils or ballot initiatives except in presentation to
the Congress or any State or local legislature, including city councils, itself.
b) No part of any appropriated funds used under this cooperative agreement shall be
used to pay the salary or expenses of any grant or contract recipient, or agent acting
for such recipient, related to any activity designed to influence legislation or
appropriations pending or proposed before the Congress or any State or local
legislature or city council.
c) Recipients may not use funds for research.
d) Recipients may not use funds for clinical care.
e) Recipients may only expend funds for reasonable program purposes, including
personnel, travel, supplies, and services, such as contractual.
f) Recipients may not generally use HHS /CDC /ATSDR funding for the purchase of
furniture or equipment. However, if equipment purchase is integral to a selected
strategy, it will be considered. Any such proposed spending must be identified in the
budget.
g) Recipients may not use funding for construction.
h) The direct and primary recipient in a cooperative agreement program must perform a
substantial role in carrying out project objectives and not merely serve as a conduit
for an award to another party or provider who is ineligible.
i) Reimbursement of pre -award costs is not allowed.
j) Recipients may not use funds for abortions in accordance with Executive Order
13535.
k) If requesting indirect costs in the budget a copy of the indirect cost rate agreement is
required. If the indirect cost rate is a provisional rate, the agreement should be less
than 12 months of age.
Follow guidelines from DOH and the Centers for Disease Control and Prevention (CDC)
related to Section 503 of Division F, Title V, of the FY 12 Consolidated Appropriations
Act (P.L. 112 -74) passed by Congress in December 2011. This section reinforces and
expands restrictions on lobbying activities. The expanded language restricts: lobbying
local governments and officials, lobbying for or against executive or administrative
actions by federal and state agencies, and lobbying activities related to the Prevention
and Public Health Fund of the Affordable Care Act.
8. Jefferson shall submit invoices to:
Attention: Business Office
Whatcom County Health Department
509 Girard Street
Bellingham, WA 98225
HL-100113—Jefferson County_Healthy_Communities_Work 12
9. Payment by Whatcom County will be considered timely if it is made within 30 days of the
receipt and acceptance of billing information from Contractor.
10. Invoices must include the following statement, with an authorized signature and date:
I certify that the materials have been furnished, the services rendered, or the
labor performed as described on this invoice.
11. Duplication of Billed Costs or Payments for Service: Jefferson shall not bill Whatcom for
services performed or provided under this contract, and Whatcom shall not pay
Jefferson, if Jefferson has been or will be paid by any other source, including grants, for
those costs used to perform or provide the services in this contract. Jefferson is
responsible for any audit exceptions or disallowed amounts paid as a result of this
contract.
HL 100113 Jefferson_ County_Healthy_Communities_Work 13
EXHIBIT "C
(CERTIFICATE OF INSURANCE)
HL-100 I 13 Jefferson_ County_Healthy_Communities_Work 14
N
THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS NO KFJHtS UPON THE CERTFICATE HOLDER
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY BELOW
. . . ..........
... .............
...... . .. .
. 77.777.7777 ... ...........
. ...... ........ .
Jefferson County, Washington
Washington Counties Risk Pool
Attn: Leslie Locke
2558.R.W. Johnson Road SW, Suite 106
PO Box 1220
Turnwater, Washington 98512 -6103
Port Townsend, WA 98369
THIS IS TO CERTIFY THAT THE LIABILITY POLICY LISTED BELOW HAS BEEN ISSUED TO THE PARTICIPATING MEMBER
NAMED ABOVE FORTHE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR
CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
ISSUED OR MAY PERTAIN, THE COVERAGES AFFORDED BY THE POLICY DESCRIBED HEREIN IS SUBJECT TO ALL
THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY.
POLICY NUMBER; 20132014-RISKPOOL-JFCO
POLICY EFFECTIVE DATE: October 1, 2013
POLICY EXPIRATION DATE: October 1, 2014
LIMITS OF LIABILITY EACH OCCURRENCE
BI AND PD COMBINED: $10,000,000.00
TYPES OF INSURANCE AFFORDED:
General Liabilitv
Including: Bodily Injury
Personal Injury
Property Damage
Errors and Ommissions/Professional
Advertising Injury
Contractual
Automobile Liability
Including: Owned, nonowned and hired autos
SHOULD THE ABOVE DESCRIBED POLICY BE CANCELED
Covers all Jefferson county Employees
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUER WILL
ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
Agreement to provide breast and cervical health
CERTIFICATE HOMER, BUT FAILURE TO MAIL SUCH NOTICE
care programs: King County
SHALL DAPOSE NO OBLIGATION OR LLAISELITY OF ANY KIND
UPON THE ISSUER, OR ITS AGENTS OR REPRESENTATIVES.
During the policy period loitl 1/13- 10/01/14
CERTIFLC ATE.
.... .......
..........
... ......... ftast:29; 2013�:�::.
Authorized Represc dle
od- �; Uk
J
Claims Assistant
EXHIBIT "D"
SUB - RECIPIENT AGREEMENT
BETWEEN
WHATCOM COUNTY AND
JEFFERSON COUNTY
THIS SUB- RECIPIENT AGREEMENT is made and entered into by and between Whatcom County, herein after referred
to as the "County', and Jefferson County, herein after referred to as the "Agency."
This is a sub -grant of funds awarded to Whatcom County by the Washington Department of Health and Includes
federal funding including CFDA# 93.283 CDC Investigations, Technical Assistance and CFDA# 93.991 DSHS
Preventive Health and Health Services Block Grant. Funding source changes are possible during the contract period.
The Agency will be notified if there are any different funding sources involved. That notification may be by letter and
does not require an amendment to this agreement.. At the end of each calendar year the Agency will be notified in
writing as to the amount of revenues pertaining to each CFDA number.
The purpose of this sub -award is as stated in this agreement.
The Agency agrees to comply with the following General Terms and Conditions and to incorporate the terms and
conditions included herein in any and all subcontracting agreements entered into pursuant to this agreement.
GENERAL TERMS AND CONDITIONS
Administrative Requirements:
The Agency shall comply with all requirements within OMB Circular A -87, Cost Principles for State, Local, and
Indian Tribal Governments or OMB Circular A -122, Cost Principles for Non - Profit Organizations; OMB Circular
A -102, Administrative Requirements for Grants and Cooperative Agreements with State and Local Governments
or OMB Circular A -110, Administrative Requirements for Non -Profit Organizations; and OMB Circular A -133,
Audits of States, Local Governments, and Non -Profit Organizations, as are applicable.
The Agency shall comply with all federal and state laws and regulations, including all nondiscrimination
laws, but not limited to, Title VII of the Civil Rights Act, 42 USC 12101 et seq.; the Americans with
Disabilities Act (ADA); and Chapter 49.60 RCW.
2. Single Audit Reporting:
Non- federal entities receiving financial assistance of $500,000 or more in federal funds from all sources,
direct and indirect, are required to have a single or a program- specific audit conducted in accordance with
the Office of Management and Budget (OMB) Circular A -133, Audits of States, Local Governments, and
Non - Profit Organizations, Circular A -133 is available on the OMB Home Page at http: /Iwwwomb.gov. If this
is applicable, the Agency has the responsibility of notifying the State Auditor's Office and requesting an
audit. Non - federal entities that spend less than $500,000 a year in federal awards are exempt from federal
audit requirements for that year, except as noted in OMB Circular A -133.
The Agency shall maintain records and accounts so as to facilitate the audit requirement
and shall ensure that any subcontractors also maintain auditable records. The Agency
shall include the above audit requirements in any subcontracts.
The Agency is responsible for any audit exceptions incurred by its own organization or that
of its subcontractors. Responses to any unresolved management findings and disallowed
or questioned costs shall be included with the audit report. The Agency must respond to
County's requests for information or corrective action concerning audit issues within 30
days of the date of request. The County reserves the right to recover from the Agency all
disallowed costs resulting from the audit.
HL 100113 Jefferson County_Healthy_Communities_Work 15
Once the single audit has been completed, the Agency must send a full copy of the audit
to the County and a letter stating there were no findings or, if there were findings, a list of
the findings.
3. Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion — Lower -Tier Covered Transactions:
The Agency certifies, by submission of this proposal or contract, that neither it nor its principals is presently
debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in
this transaction by any Federal department or agency.
The Agency further agrees that it shall not knowingly enter into any lower -tier covered transactions (a
transaction between the Agency and any other person) with a person who is proposed for debarment,
debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, and the Agency agrees to include this clause titled "Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion — Lower Tier Covered Transaction" without modification, in
all lower -tier covered transactions and in all solicitations for lower tier transactions.
The "General Service Administration List of Parties Excluded from Federal Procurement or Non -
procurement Programs" is available to research this information at http.Jlwww.eols.aovJ.
HL 100113 Jefferson County_ Healthy_Communities —Work 16
Exhibit "E"
STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES
Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded (in
whole or in part) agreements administered by the Washington State Department of Health.
CERTIFICATIONS
1. CERTIFICATION REGARDING
DEBARMENT AND SUSPENSION
The undersigned (authorized official signing for
the contracting organization) certifies to the best
of his or her knowledge and belief, that the
contractor, defined as the primary participant in
accordance with 45 CPR Part 76, and its
principals:
a) are not presently debarred, suspended,
proposed for debarment, declared ineligible,
or voluntarily excluded from covered
transactions by any Federal Department or
agency;
b) have not within a 3 -year period preceding
this contract been convicted of or had a civil
judgment rendered against them for
commission of fraud or a criminal offense in
connection with obtaining, attempting to
obtain, or performing a public (Federal,
State, or local) transaction or contract under
a public transaction; violation of Federal or
State antitrust statutes or commission of
embezzlement, theft, forgery, bribery,
falsification or destruction of records,
making false statements, or receiving stolen
property;
c) are not presently indicted or otherwise
criminally or civilly charged by a
governmental entity (Federal, State, or local)
with commission of any of the offenses
enumerated in paragraph (b) of this
certification; and
d) have not within a 3 -year period preceding
this contract had one or more public
transactions (Federal, State, or local)
terminated for cause or default.
Should the contractor not be able to provide this
certification, an explanation as to why should be
placed after the assurances page in the contract.
The contractor agrees by signing this contract
that it will include, without modification, the
clause titled "Certification Regarding
Debarment, Suspension, In eligibility, and
Voluntary Exclusion - -Lower Tier Covered
Transactions" in all lower tier covered
transactions (i.e., transactions with sub- grantees
and /or contractors) and in all solicitations for
lower tier covered transactions in accordance
with 45 CFR Part 76.
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 notifying employees
that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled
substance is prohibited in the grantee's
workplace and specifying the actions that
will be taken against employees for violation
of such prohibition;
b) Establishing an ongoing drug -free awareness
program to inform employees about
(1) The dangers of drug abuse in the
workplace;
(2) The contractor's policy of maintaining a
drug -free workplace;
(3) Any available drug counseling, rehabilitation, and
employee assistance programs; and
(4) The penalties that may be imposed upon
employees for drug abuse violations
occurring in the workplace;
c) Making it a requirement that each employee
to be engaged in the performance of the
contract be given a copy of the statement
required by paragraph (a) above;
HL. 100113 Jefferson_ County_Healthy_Communities_Work 17
d) Notifying the employee in the statement
required by paragraph (a), above, that, as a
condition of employment under the contract,
the employee will —
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or
her conviction for a violation of a criminal
drug statute occurring in the workplace no
later than five calendar days after such
conviction;
e) Notifying the agency in writing within ten
calendar days after receiving notice under
paragraph (d)(2) from an employee or
otherwise receiving actual notice of such
conviction. Employers of convicted
employees must provide notice, including
position title, to every contract officer or
other designee on whose contract activity
the convicted employee was working, unless
the Federal agency has designated a central
point for the receipt of such notices. Notice
shall include the identification number(s) of
each affected grant;
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).
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
WA 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:
(1) No Federal appropriated funds have been
paid or will be paid, by or on behalf of the
undersigned, to any person for influencing
or attempting to influence an officer or
employee of any agency, a Member of
Congress, an officer or employee of
Congress, or an employee of a Member of
Congress in connection with the awarding of
any Federal contract, the making of any
Federal grant, the making of any Federal
loan, the entering into of any cooperative
agreement, and the extension, continuation,
renewal, amendment, or modification of any
Federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than Federally
appropriated funds have been paid or will be
paid to any person for influencing or
attempting to influence an officer or
employee of any agency, a Member of
Congress, an officer or employee of
Congress, or an employee of a Member of
Congress in connection with this Federal
contract, grant, loan, or cooperative
agreement, the undersigned shall complete
and submit Standard Form -LLL, 'Disclosure
of Lobbying Activities," in accordance with
HL 100113 Jefferson_ County_Healthy_Communities_Work 18
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 sub - recipients shall certify and disclose
accordingly.
This certification is a material representation of
fact upon which reliance was placed when this
transaction was made or entered into.
Submission of this certification is a prerequisite
for making or entering into this transaction
imposed by Section 1352, U.S. Code. Any
person who fails to file the required certification
shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each
such failure.
4. CERTIFICATION REGARDING
PROGRAM FRAUD CIVIL REMEDIES
ACT (PFCRA)
The undersigned (authorized official signing for
the contracting organization) certifies that the
statements herein are true, complete, and
accurate to the best of his or her knowledge, and
that he or she is aware that any false, fictitious,
or fraudulent statements or claims may subject
him or her to criminal, civil, or administrative
penalties. The undersigned agrees that the
contracting organization will comply with the
Public Health Service terms and conditions of
award if a contract is awarded.
5. CERTIFICATION REGARDING
ENVIRONMENTAL TOBACCO
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 of health, day care, early childhood
development services, education or library
services to children under the age of 18, if the
services are funded by Federal programs either
directly or through State or local governments,
by Federal grant, contract, loan, or loan
guarantee. The law also applies to children's
services that are provided in indoor facilities that
are constructed, operated, or maintained with
such Federal funds. The law does not apply to
children's services provided in private residence,
portions of facilities used for inpatient drug or
alcohol treatment, service providers whose sole
source of applicable Federal funds is Medicare
or Medicaid, or facilities where WIC coupons
are redeemed.
Failure to comply with the provisions of the law
may result in the imposition of a civil monetary
penalty of up to $1,000 for each violation and/or
the imposition of an administrative compliance
order on the responsible entity.
By signing the certification, the undersigned
certifies that the contracting organization will
comply with the requirements of the Act and
will not allow smoking within any portion of
any indoor facility used for the provision of
services for children as defined by the Act.
The contracting organization agrees that it will
require that the language of this certification be
included in any subcontracts which contain
provisions for children's services and that all
subrecipients shall certify accordingly.
The Public Health Services strongly encourages
all recipients to provide a smoke -free workplace
and promote the non -use of tobacco products.
This is consistent with the PHS mission to
protect and advance the physical and mental
health of the American people.
6. CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS
INSTRUCTIONS FOR
CERTIFICATION
1) By signing and submitting this proposal, the
prospective contractor is providing the
certification set out below.
2) The inability of a person to provide the
certification required below will not
necessarily result in denial of participation
in this covered transaction. The prospective
contractor shall submit an explanation of
why it cannot provide the certification set
out below. The certification or explanation
will be considered in connection with the
HL 100113 Jefferson_ County_Healthy_Communities_Work 19
3)
4)
5)
6)
7)
8
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.
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.
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.
The terms covered transaction, debarred,
suspended, ineligible, lower tier covered
transaction, participant, person, primary
covered transaction, principal, proposal, and
voluntarily excluded, as used in this clause,
have the meanings set out in the Definitions
and Coverage sections of the rules
implementing Executive Order 12549. You
may contact the person to whom this
contract is submitted for assistance in
obtaining a copy of those regulations.
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.
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.
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 Non - procurement List (of
excluded parties).
9) Nothing contained in the foregoing shall be
construed to require establishment of a
system of records in order to render in good
faith the certification required by this clause.
The knowledge and information of a
participant is not required to exceed that
which is normally possessed by a prudent
person in the ordinary course of business
dealings.
10) Except for transactions authorized under
paragraph 6 of these instructions, if a
participant in a covered transaction
knowingly enters into a lower tier covered
transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded
from participation in this transaction, in
addition to other remedies available to the
Federal Government, DOH may terminate
this transaction for cause or default.
7. CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS
-- PRIMARY COVERED
TRANSACTIONS
1) The prospective contractor certifies to the
best of its knowledge and belief, that it and
its principals:
a) Are not presently debarred, suspended,
proposed for debarment, declared
ineligible, or voluntarily excluded from
covered transactions by any Federal
department or agency;
b) Have not within a three -year period
preceding this contract been convicted
of or had a civil judgment rendered
against them for commission of fraud or
a criminal offense in connection with
obtaining, attempting to obtain; or
performing a public (Federal, State or
local) transaction or contract under a
public transaction; violation of Federal
or State antitrust statutes or commission
of embezzlement, theft, forgery, bribery,
F1L 100113 Jefferson_ County_Healthy_ Communities _Work 20
falsification or destruction of records,
making false statements, or receiving
stolen property;
c) Are not presently indicted for or
otherwise criminally or civilly charged
by a governmental entity (Federal, State
or local) with commission of any of the
offenses enumerated in paragraph (1)(b)
of this certification; and
d) Have not within a three -year period
preceding this contract had one or more
public transactions (Federal, State or
local) terminated for cause or default.
2) Where the prospective contractor is unable
to certify to any of the statements in this
certification, such prospective contractor
shall attach an explanation to this proposal.
/Y)n/TAA!T"P Q1f- VdTVPF RFf)1JPFr)
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
'TITLE
Please also print or type name:
ORGANIZATION NAME: (if applicable)
L.
DATE
HL 100113 Jefferson_ County_Healthy_Communities_Work 21
ASSURANCES —NON CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response,
including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
the Office of Management and Budget, Paperwork Reduction Project (0348- 0040), Washington, DC 20503
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please
contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the contractor, I certify that the contractor:
Has the legal authority to apply for Federal
assistance, and the institutional, managerial and
financial capability (including funds sufficient
to pay the non - Federal share of project cost) to
ensure proper planning, management, and
completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States, and if appropriate, the State,
through any authorized representative, access to and the
right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the
applicable time frame after receipt of approval of the
awarding agency.
5
0
Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. 0 -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).
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. 0 _ 1681-
1683, and 1685- 1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. 0794), which
prohibits discrimination on the basis of handicaps; (d)
the Age
Discrimination Act of 1975, as amended (42 U.S.C. J ❑
6101 - 6107), which prohibits discrimination on the basis
of age; (e) the Drug Abuse Office and Treatment Act of
1972 (P.L. 92 -255), as amended, relating to
nondiscrimination on the basis of drug abuse; (t) the
Comprehensive Alcohol Abuse and Alcoholism
Prevention, Treatment and Rehabilitation Act of 1970
(P.L. 91 -616), as amended, relating to nondiscrimination
on the basis of alcohol abuse or alcoholism; (g) 0 0 523
and 527 of the Public Health Service Act of 1912 (42
U.S.C. C ❑ 290 dd -3 and 290 ee 3), as amended, relating
to confidentiality of alcohol and drug abuse patient
records; (h) Title VIII of the Civil Rights Act of 1968
(42 U.S.C. 0 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 Q) the
requirements of any other nondiscrimination statme(s)
which may apply to the application.
7. Will comply, or has already complied, with the
requirements of Titles IT 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
HL—too I 13 Jefferson_ County_Healthy_Communities_Work 22
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with the provisions of the
Hatch Act (5 U.S.C. -_ - 1501 -1508 and 7324 -7328)
which limit the political activities of employees
whose principal employment activities are funded in
whole or in part with Federal funds.
8. Will comply, as applicable, with the provisions of the
Davis -Bacon Act (40 U.S.C. C7,276a to 276a -7), the
Copeland Act (40 U.S.C. -276c and 18 U.S.C.
-0874) and the Contract Work Hours and Safety
Standards Act (40 U.S.C. 0 327 -333), regarding
labor standards for federally assisted construction
sub - agreements.
9.
10. Will comply, if applicable, with flood insurance
purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93 -234) which
requires recipients in a special flood hazard area to
participate in the program and to purchase flood
insurance if the total cost of insurable construction
and acquisition is $10,000 or more.
11. Will comply with environmental standards which
may be prescribed pursuant to the following: (a)
institution of environmental quality control measures
under the National Environmental Policy Act of 1969
(P.L. 91 -190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO
11738; (c) protection of wetlands pursuant to EO
11990; (d) evaluation of flood hazards in floodplains
in accordance with EO 11988; (e) assurance of
project consistency with the approved State
management program developed under the Coastal
Zone Management Act of 1972 (16 U.S.C. 01451
et seq.); (f) conformity of Federal actions to State
(Clear Air) Implementation Plans under Section
176(c) of the Clean Air Act of 1955, as amended (42
U.S.C. L'I 7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended, (P.L. 93-
also print or type name:
TION
523); and (h) protection of endangered species under
the 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. C -1721 et seq.) 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 National Historic
Preservation Act of 1966, as amended (16 U.S.C.
0470), EO 11593 (identification and protection of
historic properties), and the Archaeological and
Historic Preservation Act of 1974 (16 U.S.C.
-- 469a -1 et seq.).
14. Will comply with P.L. 93 -348 regarding the
protection of human subjects involved in research,
development, and related activities supported by this
award of assistance.
15. Will comply with the Laboratory Animal Welfare
Act of 1966 (P.L. 89 -544, as amended, 7 U.S.C.
E02131 et seq.) pertaining to the care, handling, and
treatment of warm blooded animals held for research,
teaching, or other activities supported by this award
of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. 11-4801 et seq.) which
prohibits the use of lead- 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.
TITLE
Ht, 100113 Jefferson_ County_Healthy_Communities_Work 23