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HomeMy WebLinkAboutWashington State Department of Social & Health Services, Amendment No. 2 - 071116DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Approved as to form only d zx116 Je crson CO. David Alvarez, Chief Civil DPA Page 1 t 4, t.D Agreement Number Vosb �jt'lfts#aoe COUNTY PROGRAM AWWRIENtO 1563-42479 Department of social 8eaith Services AMENDMENT Amendment No. _Transforming lives Prevention Services 02 This Program Agreement Amendment is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS) and the County identified below. Agreement Number Click here to enter text. County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODE Behavioral Health Division of Behavioral 1223 1223 Administration Health and Recovery DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Lucilla Mendoza 4500 10th Ave SE Lacey, WA 98503- DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL (360)725-3760 Click here to enter text. mendol2@dshs.wa.gov COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend, WA 98368 - COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Julia Danskin COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL 360 385-9420 360 385-9401 jdanskin@co.jefferson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? 93.959 Yes AMENDMENT START DATE PROGRAM AGREEMENT END DATE 06/01/2016 06/30/2017 PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUMPROGRAM AGREEMENT AMOUNT AMOUNT $179,559.00 $-6,000.00 $-173,559.00 REASON FOR AMENDMENT; CHANGE OR CORRECT MAXIMUM CONTRACT AMOUNT EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are incorporated into this Program Agreement Amendment by reference: ❑ Exhibits (specify): This Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment , shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Program Agreement: Amendment, and have authority to enter into this Pro ram Agreement Amendment. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED 1Ca,+ Ieeyl f<ler DSHS SIGNATURE PRINTED AME AN TI DATE SIGNED %i AConttr ts� DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Approved as to form only d zx116 Je crson CO. David Alvarez, Chief Civil DPA Page 1 This Program Agreement between the County and the State of Washington Department of Social and Health Services (DSHS) is hereby amended as follows: Amend the maximum contract consideration to reduce by $6,000, therefore decreasing the maximum consideration from $179,559 to $173,559. The Awards and Revenues (A&R) is attached as Exhibit B. All other terms and conditions of this Program Agreement remain in full force and effect. DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Page 2 AWARD AND REVENUES 2015-2017 Biennium CONTRACTOR NAME Jefferson County CONTRACT NUMBER 1563-42479 COUNTY Jefferson The above named Contractor is hereby awarded the following amounts for the purposes listed. REVENUE SOURCE TYPE OF SERVICE CODE: 333.99.59 SABG Prevention Exhibit B AWARD AMOUNTS SFY 16 SFY 17 Biennial Total 15-17 Funds Biennium $30,098 $30,098 $60,19 334.04.6X GF -State- Admin (for SABG Prevention) $2,617 $2,617 $5,234 334.04.6X Dedicated Marijuana Account -Fund 315 -State $17,364 $23,364 $40,728 333.92.43 PFS -Total $53,921 $13,480 $0 $67,401 Year 2 FFY14 (7.1.15-9.29.15) $13,480 $13,480 Year 3 FFY15 (9.30.15-9.29.16) $40,441 $13,480 $53,921 Year 4 FFY16 (9.30.16-6.30.17) Total Federal Funds $84,019 $43,578 $0 $127,597 Total State Funds $19,981 $25,981 $0 $45,962 TOTAL ALL AWARDS $104,000 $69,559 $0 $173,559 Federal CFDA: SABG-Substance Abuse Block Grant -CFDA 93.959 Substance Abuse and Mental Health Services Administration (SAMHSA) PFS -Partnership for Success-CFDA 93.243 Substance Abuse and Mental Health Services Administration (SAMHSA) 2015-17 Jefferson Amend #2 __ V"'s^ r, !0n Sta:e Department of social 790 V & Health Sen!ices Transforming Jives COUNTY PROGRAM AGREEMENT AMENDMENT Prevention Services This Program Agreement Amendment is by and between the State of Washington Department of Social and Health Services (DSHS) and the County identified below. DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUM Behavioral Health and Service Division of Behavioral 1223 Integration Health and Recove DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Lucilla Mendoza 4500 10th Ave SE Lacey, WA 98503- DSHS CONTACT TELEPHONE DSHS CONTACT FAX 360)725-3760 COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend, WA 98368 - COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER DSHS Agreement Number 1563-42479 Amendment No. 01 Administration or Division Agreement Number Click here to enter text. County Agreement Number CCS CONTRACT CODE 1223 DSHS CONTACT E-MAIL mPnrinl20dshs.wa.c Julia Danskin COUNTY CONTACT TELEPHONE GOUNTY CONTACT FAX COUNTY CONTACT E-MAIL (360 385-9420 360) 385-9401 jdanskin@co.jefferson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? No AMENDMENT START DATE I PROGRAM AGREEMENT END DATE 10/15/2015 PRIOR MAXIMUM PROGRAM AMOUNT $132,831.00 06/30/2017 AMOUNT OF INCREASE OR $46,728.00 TOTAL MAXIMUM AMOUNT $179,559.00 REASON FOR AMENDMENT; CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are incorporated into this Program Agreement Amendment by reference: ❑ Exhibits (specify): This Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Program Agreement Amendment, and have authority to enter into this Pro ram Agreement Amendment. DATE(S) SIGNED COUNTY }� SIG7UR PRINTED NAME(S) AND TI I LE(S) Yd{F t `'( --- -- DATE SIGNED DSHS SIGNATURE P TED AME AND TL rte-, C�" /t SIA Contracts / ;t jAprovedas to form only DEC 04 2015 ,4 a Finance Jefferson Co. Prosecutor's e C.HSIiu gee a DSHS Central Contracts and Legal Services David Alvarez, Chief Civil A 1644CS County Program Agreement Amendment (10-28-2015) Page 1 rrssv+asrar Srstr 1 Department Social COUNTY DSHS Agreement Number 1563-42479 of i & Health Services PROGRAM AGREEMENT Prevention Services Transforming lives This Program Agreement is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS) and the County identified Agreement Number below, and is issued in conjunction with a County and DSHS Agreement On County Agreement Number General Terms and Conditions, which is incorporated by reference. DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Behavioral Health and Service Division of Behavioral Health 1223 1644CS-63 Integration and Recovery DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Lucilla Mendoza 4500 10th Ave SE Prevention Services Lead Lacey, WA 98503- DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL (360)725-3760 mendo]2@dshs.wa.gov COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend, WA 98368 - COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Julia Danskin COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL (360) 385-9420 (360 385-9401 jdanskin@co.jefferson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? 93.959 Yes PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT 07/01/2015 06/30/2017 $132,831.00 EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this County Program Agreement by reference: ® Exhibits (specify): Exhibit A: Data Security; Exhibit B: Awards and Revenue ❑ No Exhibits. The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive understanding between the parties superseding and merging all previous agreements, writings, and communications, oral or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only upon signature by DSHS. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED 'L Ov/©'5aw (/fJi U" &gSe4 UAOLINTy DSHS SIGNATURE PRINTED NAME ANDTITLLEE%�� DA4E N� x� yw` \ lYv`rl I �`�rr� g 1�ECE.VF ) BHSIA Contracts A116 19 5 DSHS Central Contract Services 1644CS Prevention Services - County (6-26-2015) 4htltv as t form only erson Cght o. Prosecutor's O 1 e David Alvarez, Chief Civil A BHS(A Budget & F1,Fa0c 17 Page 1 is Hea 615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org Consent Agenda June 20, 2016 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Julia Danskin, Public Health Manager DATE: e7 //r SUBJECT: Agenda Item — Agency Agreement — Division of Behavioral Health and Recovery with DSHS A-2, July 1, 2015, 2016 — June 30, 2017; $(6,000.) for a total of $173,559 STATEMENT OF ISSUE: Jefferson County Public Health is requesting Board approval of the Agency Agreement — Division of Behavioral Health and Recovery (DBHR) with DSHS, July 1, 2015 — June 30, 2017; $(6,000) for a total of $173,559. ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S: This ongoing contract with DBHR provides Federal and State funding through Substance Abuse Block Grant (SABG) CFDA 93.959, Partnership for Success CFDA 93.243 to coordinate and implement prevention programs designed to prevent or delay the misuse and abuse of alcohol, marijuana, tobacco, and other drugs among youth up to age 18 and adults ages 18-25. The DBHR contract funds Community Prevention and Wellness Initiatives and Community Coalition activities including coordination, prevention, and training based on evidence -based practices as identified in the Excellence in Prevention Strategies List. This amendment to the current contract, 1563-42479, (reference 15-152 Jefferson County Civil PDA), reduces by ($6000.) funding from the Dedicated Marijuana Account (DMA) program and strategy training and implementation. These funds were unspent in fiscal 2016 and do not carryover. FISCAL IMPACT/COST BENEFIT ANALYSIS: This contract is fully funded through Federal Substance Abuse Block Grant, CFDA 93.959 and Partnership for Success CFDA 93.243, and the state's general fund and reduces by ($6000) the amount of funding for a total of $173,559. RECOMMENDATION: JCPH management request approval of the Agency Agreement — Division of Behavioral Health and Recovery with DSHS A-2 which reduces the Dedicated Marijuana Account by ($6000), October 10, 2015 — June 30, 2017; for a total of $173,599. REVIEWED BY: 'Z X�Z, � 47" � 6 1p orley, tAnty A ministrator Date Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487 /�- / 2,y 615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org SA -15-07-A2 CONTRACT REVIEW FORM JUN 2 2 2016 TY CONTRACT WITH: Department of Social and Health Services h CONTRACT FOR: Div. Of Behavioral Health and Recovery for TERM: 7/1/2015 —June 30, 2017 Substance Abuse Prevention #1563 -42479 - Amendment #Xe, COUNTY DEPARTMENT For More Information Contact Contact Phone #: Jefferson County Public Health Julia Danskin X420 RETURN TO: Denise Banker RETURN BY: ASAP AMOUNT: $-6,000 Revenue: $-6,000 Expenditure: Matching Funds Required: Source(s) of Matching Funds: Step 1: REVIEW BY RISK Review by: r - Date Reviewed: APPROVED FORM Comments: PROCESS: ❑ Exempt from Bid Process ❑ Consultant Selection Process ❑ Cooperative Purchase ❑ Competitive Sealed Bid ❑ Small Work Roster ❑ Vendor List Bid ❑ RFP or RFQ ©Other: Continuation of services rued for revision (See Comments) Step 2: REVIEW BY P�Pjy� Mre EY Review by: LLjj// Date Reviewed: APPROVED AS TO FORM ❑ Comments: (This form to stay with contract throughout the contract review process) Comments) Community Health Environmental Health Developmental Disabilities Water Quality 360-385-9400 360-385-9444 360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487