HomeMy WebLinkAboutPublic Health - Seattle & King County - 082018DocuSign Envelope ID: D6D634AA-A57E-4jC��BO--A4A2-4A6FB8354BCD
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Health 'PHSKC
Agreement#
Public
COMMUNITY SERVICES
Seattle & King County M
AGREEMENT
3317 CDIP
This Agreement is between King County and the Recipient identified below. The County
department overseeing the work to be performed in this Agreement is the Department of Public
Health (PHSKC).
RECIPIEdT NAME
RECIPIBIT FEDERAL TAXIDP
Jefferson County Public Health
916001322
RECIPIENT ADDRESS
RECIPIENT CONTACT &MAILADDRBSS
615 Sheridan, Port Townsend, WA 98368
Julia Danskin; jdanskin@co.jefferson.wa.us
PHSKC DIVISION
PROJECT TITLE
CDP
BCCHP Clinical SeMces
AGREEMENT START DATE
AGRE111111BQT END DATE
Initial Authorbad Amount:
Jul 01 2018
Jun 14 2019
I $1,400,00
PHSKC may, upon availability of additional funding orat its discretion, increase ordecrease the Authorized Amount by
issuin an OrderForrn such that the Total Authorized Amountdoes not exDeed $2,800.00.
FUNDING DETAILS
Fundlim Source PHSKC Contract# Arnount MIGM Dates
CDneolklated Contract, 2746 ODR $2,800.00 Jul 012018 TO Jun 14 2019
FID B&C
CFDIA 93.283
FUNDING SUMMARY
FEDERAL: $2,800.00
COUNTY: $0.00
STATE: $0.00
OTHER: $0.00
IS THE RECIPIENT A SUBRBCIPIEWT FOR PURPOSES OF THIS AGRE3UEIT: NO
EXHIBITS. The following Exhibits are attached and are Incorporated Into this Agreement by reference:
Exhibit A: Federal Special Terms 8 Conditions; Exhibit B: Scope of Work; Exhibit C: Budget; Exhibit D:
Invoice; Exhibit E: Order Form
In consideration of payments, covenants, and agreements hereinafter mentioned to be made and performed by the
parties hereto, the parties m utuallyagree that the Recipientshail provide services and complywith the requirements set
forth in this Agreement The parties signing below representthatthey have read and understand this Agreement, and
have the authority to macuta this Agreement Furthermore, in addition to agreeing to the terms and conditions provided
herein, by signing this Agreement, the Recipient certifies thatit has read and understands the Agreement requirements
on the PHSKC website(httpJNvww.kingcountygoWhealth/Contracts), and agrees to complywith all of the Agreement
terms and conditions detailed on that site, including EEONondiscrimination, HIPAA, Insurance, and Credenfialing, as
applicable.
RECIPIE SIGNATUREpW
?T"�"'N^ TIS E
DATE SIGNED
v
PHSKC SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
����
Marguerite Ro
AYY�IAt,Ytt`,
Ir
Chief, APDE
9/4/2018
Approved as to Form: OFFICE OF THE KING COUNTY PROSECUTING ATTORNEY
❑ (This form is available in alternate formats for people with disabilities upon request.)
roved asloliforrW
C'. Date: a
Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attomey's Office tomey
Public Health '
PHSKCAgreement#
COMMUNITY SERVICES
Seattle & King County
AGREEMENT
3317 CDIP
This Agreement is between King County and the Recipient identified below. The County
department overseeing the work to be performed in this Agreement is the Department of Public
Health (PHSKC).
RECIPIENT NAME
RECIPIENT FOAL TAXID#
Jefferson County Public Health
91-6001322
RECIPIENT ADDRESS
RECIPIENT CONTACT&EMAIL ADDRESS
615 Sheridan, Port Townsend, WA 98368
Julia Danskin; jdanskin@co.jefferson.wa.us
PHSKC DIVISION
PROJECT TITLE
CDIP
BCCHP Clinical Services
AG ENT START DATE ----JAGREEMENT
END DATE
InitialAuthorizedAmount:
Jul 01 2018
Jun 14 2019
I $1,400.00
PHSKC may, upon availability of additional funding orat its discretion, increase ordecrease the Authorized Amountby
issuing an Order Form such that the Total Authorized Amountdoes not exceed $2,800.00.
FUNDING DETAILS
Funding Source PHSKC Contract# Amount Effective Dates
Consolidated Contract, 2746 ODIR $2,800.00 Jul 012018 TO Jun 14 2019
F® B&C
CFDA 93.283
FUNDING SUMMARY
FEDERAL: $2,800.00
COUNTY: $0.00
STATE: $0.00
OTHER: $0.00
IS THE RECIPIENT A SUBRBCIPIENT FOR PURPOSES OF THIS AGENT: No
EXHIBITS. The following Exhibits are attached and are incorporated into this Agreement by reference:
Exhibit A: Federal Special Terms & Conditions; Exhibit B: Scope of Work; Exhibit C: Budget; Exhibit D:
Invoice; Exhibit E: Order Form
In consideration of payments, covenants, and agreements hereinafter mentioned, to be made and performed by the
parties hereto, the parties m utuallyagree that the Recipients hall provide services and com plywith the requirements set
forth in this Agreement. The parties signing below represent that they have read and understand this Agreement, and
have the authority to a)ecute this Agreement. Furthermore, in addition to agreeing to the terms and conditions provided
herein, by signing this Agreement, the Recipient certifies thatit has read and understands the Agreement requirements
on the PHSKC website (http:/twww.kingcounty.gov/health/Contracts), and agrees to complywith all of the Agreement
terms and conditions detailed on that site, including EEO/Nondiscrimination, HIPAA, Insurance, and Credentialing, as
applicable.
RECIPIE SIGNATURE
..�-�'��
De?A1TCn A1°"., Ahj TTLE _
�j�.4•{=C!�`►') ('L�l�� � "lam fG.� �.�
DATE SIGNED
�/r�U// U
PHSKC SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Approved as to Form: OFFICE OF THE KING COUNTY PROSECUTING ATTORNEY
El Approved
form is available in alternate formats for people with disabilities upon request.)
A roved ast for
0.//��Date:
Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office torney
KING COUNTY TERMS AND CONDITIONS
1. Agreement Termand Termination
A This Agreement shall commence on the Agreement Start Date and shall terminate on the
Agreement End Date as specified on page 1 of this Agreement, unless extended or
terminated earlier, pursuant to the terms and conditions of the Agreement.
B. This Agreement may be terminated by the County or the Recipient without cause, in whole or
in part, prior to the Agreement End Date, by providing the other party thirty (30) days advance
written notice of the termination. The Agreement may be suspended by the County without
cause, in whole or in part, prior to the date specified in Subsection 1.A above, by providing
the Recipient thirty (30) days advance written notice of the suspension.
C. The County may terminate or suspend this Agreement, in whole or in part, upon seven (7)
days advance written notice in the event: (1) the Recipient materially breaches any duty,
obligation, or service required pursuant to this Agreement, or (2) the duties, obligations, or
services required herein become impossible, illegal, or not feasible. 9 the Agreement is
terminated by the County pursuant to this Subsection 1.C. (1), the Recipient shall be liable for
damages, including any additional costs of procurement of similar services from another
source.
IF the termination results from acts or omissions of the Recipient, including but not limited to
misappropriation, nonperformance of required services, or fiscal mismanagement, the
Recipient shall return to the County immediately any funds, misappropriated or unexpended,
which have been paid to the Recipient by the County.
D. 9 County or other expected or actual funding is withdrawn, reduced, or limited in any way prior
to the termination date set forth above in Subsection 1.A, the County may, upon written
notification to the Recipient, terminate or suspend this Agreement in whole or in part.
9 the Agreement is terminated or suspended as provided in this Section: (1) the County will be
liable only for payment in accordance with the terms of this Agreement for services rendered
prior to the effective date of termination or suspension; and (2) in the case of termination the
Recipient shall be released from any obligation to provide such further services pursuant to
the Agreement ; and (3) in the case of suspension the Recipient shall be released from any
obligation to provide services during the period of suspension and until such time as the
County provides written authorization to resume services..
Funding or obligation under this Agreement beyond the current appropriation year is
conditional upon appropriation by the County Council of sufficient funds to support the
activities described in the Agreement. Should such appropriation not be approved, this
Agreement will terminate at the close of the current appropriation year.
E. Nothing herein shall limit, waive, or extinguish any right or remedy provided by this Agreement
or law that either party may have in the event that the obligations, terms, and conditions set
forth in this Agreement are breached by the other party.
2. Compensation and Method of Payment
A The County shall reimburse the Recipient for satisfactory completion of the services and
requirements specified in this Agreement, payable upon receipt and approval by the County of
a signed invoice in substantially the form of the attached Invoice Exhibit, which complies with
the rates set forth in the Budget Exhibit. The maximum amount payable under this Agreement
is listed on page 1, subject to the amount approved by King County on an Order Form. The
Recipient shall not be reimbursed in excess of the amount listed on the Order Form. Such
Order Form will be substantially in the form of Exhibit F.
2
B. The Recipient shall submit an invoice and all accompanying reports as specified in the
attached exhibits not more than 15 working days after the close of each indicated reporting
period. The County shall make payment to the Recipient not more than 30 days after a
complete and accurate invoice is received.
C. The Recipient shall submit its final invoice and all outstanding reports within 30 days of the
date this Agreement terminates. If the Recipient's final invoice and reports are not submitted
by the day specified in this subsection, the County will be relieved of all liability for payment to
the Recipient of the amounts set forth in said invoice or any subsequent invoice.
D. When a budget is attached hereto as an exhibit, the Recipient shall apply the funds received
from the County under this Agreement in accordance with said budget. The Agreement may
contain separate budgets for separate program components. The Recipient shall request
prior approval from the County for an amendment to this Agreement when the cumulative
amount of transfers among the budget categories is expected to exceed 10% of the
Agreement amount in any Agreement budget. Supporting documents necessary to explain
fully the nature and purpose of the amendment must accompany each request for an
amendment. Cumulative transfers between budget categories of 10% or less need not be
incorporated by written amendment; however, the County must be informed immediately in
writing of each such change.
E. Should, in the sole discretion of the County, the Recipient not timely expend funds allocated
under this Agreement, the County may recapture and reprogram any such under -expenditures
unilaterally and without the need for further amendment of this Agreement. The County may
unilaterally make changes to the funding source without the need for an amendment. The
Recipient shall be notified in writing of any changes in the fund source or the recapturing or
reprograming of under expenditures.
F. If travel costs are contained in the attached budget, reimbursement of Recipient travel,
lodging, and meal expenses are limited to the eligible costs based on the following rates and
criteria.
1. The mileage rate allowed by King County shall not exceed the current Internal
Revenue Service (IRS) rates per mile as allowed for business related travel. The IRS
mileage rate shall be paid for the operation, maintenance and depreciation of
individually owned vehicles for that time which the vehicle is used during work hours.
Parking shall be the actual cost. When rental vehicles are authorized, government
rates shall be requested. If the Recipient does not request government rates, the
Recipient shall be personally responsible for the difference. Please reference the
federal web site for current rates: http://www.gsa.gov.
2. Reimbursement for meals shall be limited to the per diem rates established by federal
travel requisitions for the host city in the Code of Federal Regulations, 41 CFR § 301,
App.A Please reference http://www.gsa.gov for the current host city per diem rates.
3. Accommodation rates shall not exceed the federal lodging limit plus host city taxes.
The Recipient shall always request government rates.
4. Air travel shall be by coach class at the lowest possible price available at the time the
County requests a particular trip. In general, a trip is associated with a particular work
activity of limited duration and only one round-trip ticket, per person, shall be billed per
trip. Any air travel occurring as part of a federal grant must be in accordance with the
Fly America Act.
3. Internal Control and Accounting System
The Recipient shall establish and maintain a system of accounting and internal controls which
complies with generally accepted accounting principles promulgated by the Financial Accounting
3
Standards Board (FASB), the Governmental Accounting Standards Board (GASB), or both as is
applicable to the Recipient's form of incorporation.
4. Debarmentand SuspensionCertification
Entities that are debarred, suspended, or proposed for debarment by the U.S. Government are
excluded from receiving federal funds and contracting with the County. The Recipient, by signature
to this Agreement, certifies that the Recipient is not presently debarred, suspended, or proposed for
debarment by any Federal department or agency. The Recipient also agrees that it will not enter
into a sub -agreement with a Recipient that is debarred, suspended, or proposed for debarment. The
Recipient agrees to notify King County in the event it, or a sub-awardee, is debarred, suspended, or
proposed for debarment by any Federal department or agency.
5. Maintenance of Records/Evaluations and Inspections
A The Recipient shall maintain accounts and records, including personnel, property, financial,
and programmatic records and other such records as may be deemed necessary by the
County to ensure proper accounting for all Agreement funds and compliance with this
Agreement.
B. In accordance with the nondiscrimination and equal employment opportunity requirements set
forth in Section 13. below, the Recipient shall maintain the following:
1. Records of employment, employment advertisements, application forms, and other
pertinent data, records and information related to employment, applications for
employment or the administration or delivery of services or any other benefits under
this Agreement; and
2. Records, including written quotes, bids, estimates or proposals submitted to the
Recipient by all businesses seeking to participate on this Agreement, and any other
information necessary to document the actual use of and payments to sub-awardees
and suppliers in this Agreement, including employment records.
The County may visit the site of the work and the Recipient's office to review the foregoing
records. The Recipient shall provide every assistance requested by the County during such
visits and make the foregoing records available to the County for inspection and copying
upon request. The Recipient shall provide right of access to its facilities—including those of
any sub-awardee assigned any portion of this Agreement pursuant to Section 12—to the
County, the state, and/or federal agencies or officials at all reasonable times in order to
monitor and evaluate the services provided under this Agreement. The County will give
advance notice to the Recipient in the case of fiscal audits to be conducted by the County.
The Recipient shall comply with all record keeping requirements set forth in any federal rules,
regulations or statutes included or referenced in the Agreement documents. The Recipient
shall inform the County in writing of the location, if different from the Recipient address listed
on page one of this Agreement, of the aforesaid books, records, documents, and other
evidence and shall notify the County in writing of any changes in location within ten (10)
working days of any such relocation.
C. The records listed in A and B above shall be maintained for a period of six (6) years after
termination of this Agreement. The records and documents with respect to all matters covered
by this Agreement shall be subject at all time to inspection, review, or audit by the County
and/or federal/state officials so authorized by law during the performance of this Agreement
and six (6) years after termination hereof, unless a longer retention period is required by law.
D. Medical records shall be maintained and preserved by the Recipient in accordance with state
and federal medical records statutes, including but not limited to RCW 70.41.190, 70.02.160,
and standard medical records practice. If the Recipient ceases operations under this
Agreement, the Recipient shall be responsible for the disposition and maintenance of such
medical records.
4
E. The Recipient agrees to cooperate with the County or its agent in the evaluation of the
Recipient's performance under this Agreement and to make available all information
reasonably required by any such evaluation process. The results and records of said
evaluations shall be maintained and disclosed in accordance with RCW Chapter 42.56.
F. The Recipient agrees that all information, records, and data collected in connection with this
Agreement shall be protected from unauthorized disclosure in accordance with applicable
state and federal law.
6. Compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Recipient shall not use protected health information created or shared under this Agreement in
any manner that would constitute a violation of HIPAA and any regulations enacted pursuant to its
provisions. Recipient shall read and certify compliance with all HIPAA requirements at
http://www.kingcounty.gov/healthservices/health/partners hips/contracts
7. Audits
A A Recipient, for-profit or non-profit that receives in excess of $100,000 in funds during its
fiscal year from the County, shall provide fiscal year audited financial statements
prepared by an independent Certified Public Accountant or Accounting Firm within nine
months subsequent to the close of the Recipient's fiscal year (if applicable, see Section
7.101.) and shall meet the following requirement, if applicable:
If the Recipient is a non-profit organization as defined in 2 CFR Part 200, and
expends a total of $750,000 or more in federal financial assistance and has
received federal financial assistance from any sources during its fiscal year,
then the Recipient shall meet the audit requirements as described in 2 CFR
Part 200 Subpart F.
B. Non-profit Recipients who receive less than $100,000 from the County during their fiscal
year shall provide 1) IRS Form 990 within 30 days of its being filed; and 2) a full set of
annual financial statements.
C. For-profit Recipients who receive less than $100,000 from the County during their fiscal
year shall provide 1) income tax return within 30 days of its being filed; and 2) a full set of
annual financial statements.
D. A Recipient subject to the requirements in Section 7.A may, in extraordinary
circumstances, request a waiver of audit requirements and, with the review and upon
approval of the County, substitute for the above requirements other forms of financial
reporting or fiscal representation certified by the Recipient's Board of Directors, provided
the Recipient meets the following criteria:
1. That financial reporting and any associated management letter show no
reportable conditions or internal control issues; and
2. There has been no turnover in key staff since the beginning of the period for
which the financial reporting was completed.
E. Additional audit or review requirements which may be imposed on the County will be passed
on to the Recipient and the Recipient will be required to comply with any such requirements.
8. Corrective Action
If the County determines that a breach of Agreement has occurred, that is, the Recipient has failed
to comply with any terms or conditions of this Agreement or the Recipient has failed to provide in
any manner the work or services agreed to herein, and if the County deems said breach to warrant
corrective action, the following sequential procedure will apply:
A. The County will notify the Recipient in writing of the nature of the breach;
5
The Recipient shall respond in writing within three (3) working days of its receipt of such
notification, which response shall indicate the steps being taken to correct the specified
deficiencies. The corrective action plan shall specify the proposed completion date for bringing
the Agreement into compliance, which date shall not be more than ten (10) days from the date
of the Recipient's response, unless the County, at its sole discretion, specifies in writing an
extension in the number of days to complete the corrective actions;
B. The County will notify the Recipient in writing of the County's determination as to the
sufficiency of the Recipient's corrective action plan. The determination of sufficiency of the
Recipient's corrective action plan shall be at the sole discretion of the County;
C. In the event that the Recipient does not respond within the appropriate time with a corrective
action plan, or the Recipient's corrective action plan is determined by the County to be
insufficient, the County may commence termination or suspension of this Agreement in whole
or in part pursuant to Section 1.C.;
D. In addition, the County may withhold any payment owed the Recipient or prohibit the
Recipient from incurring additional obligations of funds until the County is satisfied that
corrective action has been taken or completed; and
E. Nothing herein shall be deemed to affect or waive any rights the parties may have pursuant to
Section 1., Subsections B, C, D, and E.
9. Dispute Resolution
The parties shall use their best, good -faith efforts to cooperatively resolve disputes and problems that
arise in connection with this Agreement. Both parties will make a good faith effort to continue without
delay to carry out their respective responsibilities under this Agreement while attempting to resolve
the dispute under this section.
10. Hold Harmless and Indemnification
A In providing services under this Agreement, the Recipient is an independent contractor, and
neither it nor its officers, agents, or employees are employees of the County for any purpose.
The Recipient shall be responsible for all federal and/or state tax, industrial insurance, and
Social Security liability that may result from the performance of and compensation for these
services and shall make no claim of career service or civil service rights which may accrue to
a County employee under state or local law.
The County assumes no responsibility for the payment of any compensation, wages, benefits,
or taxes, by, or on behalf of the Recipient, its employees, and/or others by reason of this
Agreement. The Recipient shall protect, indemnify, defend and save harmless the County, its
officers, agents, and employees from and against any and all claims, costs, and/or losses
whatsoever occurring or resulting from (1) the Recipient's failure to pay any such
compensation, wages, benefits, or taxes, and/or (2) the supplying to the Recipient of work,
services, materials, or supplies by Recipient employees or other suppliers in connection with
or support of the performance of this Agreement.
B. The Recipient further agrees that it is financially responsible for and will repay the County all
indicated amounts following an audit exception which occurs due to the negligence, intentional
act, and/or failure, for any reason, to comply with the terms of this Agreement by the
Recipient, its officers, employees, agents, and/or representatives. This duty to repay the
County shall not be diminished or extinguished by the prior termination of the Agreement
pursuant to the Term and Termination section.
C. The Recipient shall protect, defend, indemnify, and save harmless the County, its officers,
employees, and agents from any and all costs, claims, judgments, and/or awards of damages,
arising out of, or in any way resulting from, the negligent acts or omissions of the Recipient, its
officers, employees, sub-awardees and/or agents, in its performance and/or non-performance
of its obligations under this Agreement. The Recipient agrees that its obligations under this
subparagraph extend to any claim, demand, and/or cause of action brought by, or on behalf
of, any of its employees or agents. For this purpose, the Recipient, by mutual negotiation,
hereby waives, as respects the County only, any immunity that would otherwise be available
against such claims under the Industrial Insurance provisions of Title 51 RCW. In the event
the County incurs any judgment, award, and/or cost arising therefrom including attorneys'
fees to enforce the provisions of this article, all such fees, expenses, and costs shall be
recoverable from the Recipient.
D. The County shall protect, defend, indemnify, and save harmless the Recipient, its officers,
employees, and agents from any and all costs, claims, judgments, and/or awards of damages,
arising out of, or in any way resulting from, the sole negligent acts or omissions of the County,
its officers, employees, and/or agents, in its performance and/or non-performance of its
obligations under this Agreement. The County agrees that its obligations under this
subparagraph extend to any claim, demand, and/or cause of action brought by, or on behalf
of, any of its employees or agents. For this purpose, the County, by mutual negotiation,
hereby waives, as respects the Recipient only, any immunity that would otherwise be
available against such claims under the Industrial Insurance provisions of Title 51 RCW. In the
event the Recipient incurs any judgment, award, and/or cost arising therefrom including
attorneys' fees to enforce the provisions of this article, all such fees, expenses, and costs
shall be recoverable from the County.
E. Claims shall include, but not be limited to, assertions that use or transfer of software, book,
document, report, film, tape, or sound reproduction or material of any kind, delivered
hereunder, constitutes an infringement of any copyright, patent, trademark, trade name,
and/or otherwise results in unfair trade practice.
F. Nothing contained within this provision shall affect and/or alter the application of any other
provision contained within this Agreement.
G. The indemnification, protection, defense and save harmless obligations contained herein shall
survive the expiration, abandonment or termination of this Agreement.
11. Insurance Requirements
By the date of execution of this Agreement, the Recipient shall procure and maintain for the
duration of this Agreement, insurance against claims for injuries to persons or damages to property
which may arise from, or in connection with, the performance of work hereunder by the Recipient,
its agents, representatives, employees, and/or sub-awardees. The costs of such insurance shall be
paid by the Recipient or sub-awardee. The Recipient may furnish separate certificates of insurance
and policy endorsements for each sub-awardee as evidence of compliance with the insurance
requirements of this Agreement. The Recipient is responsible for ensuring compliance with all of the
insurance requirements stated herein. Failure by the Recipient, its agents, employees, officers, sub-
awardee, providers, and/or provider sub-awardees to comply with the insurance requirements
stated herein shall constitute a material breach of this Agreement. Specific coverages and
requirements are at http://www.kingcounty.gov/healthservices/health/partnerships/contracts;
Recipients shall read and provide required insurance documentation prior to the signing of this
Agreement.
12. Assignment/Sub-agreements
A. The Recipient shall not assign or sub -award any portion of this Agreement or transfer or
assign any claim arising pursuant to this Agreement without the written consent of the County.
Said consent must be sought in writing by the Recipient not less than fifteen (15) days prior to
the date of any proposed assignment.
B. "Sub -agreement" shall mean any agreement between the Recipient and a sub-awardee or
between sub-awardees that is based on this Agreement, provided that the term "sub-
awardee" does not include the purchase of (1) support services not related to the subject
matter of this Agreement, or (2) supplies.
C. The Recipient shall include Sections 2.D., 2.E., 3, 4, 5, 6, 10.A, 10.B., 10.G., 12, 13, 14, 15,
16, 17, 23, 24, 26, and the Funder's Special Terms and Conditions, if attached, in every sub -
agreement or purchase agreement for services that relate to the subject matter of this
Agreement.
D. The Recipient agrees to include the following language verbatim in every sub -agreement for
services which relate to the subject matter of this Agreement:
"Sub-awardee shall protect, defend, indemnify, and hold harmless King County, its officers,
employees and agents from any and all costs, claims, judgments, and/or awards of damages
arising out of, or in any way resulting from the negligent actor omissions of sub-awardee, its
officers, employees, and/or agents in connection with or in support of this Agreement. Sub-
awardee expressly agrees and understands that King County is a third party beneficiary to this
Agreement and shall have the right to bring an action against sub-awardee to enforce the
provisions of this paragraph."
13. Nondiscrimination; Equal Employment Opportunity; Payment of a Living Wage
The Recipient shall complywith all applicable federal, state and local laws regarding discrimination,
including those set forth in this Section.
A During performance of the Agreement, the Recipient agrees that it will not discriminate against
any employee or applicant for employment because of the employee or applicant's sex, race,
color, marital status, national origin, religious affiliation, disability, sexual orientation, gender
identity or expression or age except by minimum age and retirement provisions, unless based
upon a bona fide occupational qualification. The Recipient will make equal employment
opportunity efforts to ensure that applicants and employees are treated, without regard to their
sex, race, color, marital status, national origin, religious affiliation, disability, sexual orientation,
gender identity or expression or age. Additional requirements are at
http://www.ldngcounty.gov/healthservices/health/partnerships/contracts; Recipients shall read
and certify compliance.
B. Requirements of King County Living Wage Ordinance
In accordance with King County Ordinance 17909, as a condition of award for agreements
beginning on or after April 1, 2015, for services with an initial or amended value of $100,000
or more, the Recipient agrees that it shall pay and require all sub-awardees and
subcontractors to pay a living wage as described in the ordinance to employees for each hour
the employee performs a Measurable Amount of Work on this Agreement. The requirements
of the ordinance, including payment schedules, are detailed at
http://www. kingcounty.gov/operations/procurement/Resources/ordinance-17909.as px.
Violations of this requirement may result in disqualification of the Recipient from bidding on or
being awarded a County agreement or contract for up to two years; contractual remedies
including, but not limited to, liquidated damages and/or termination of the Agreement;
remedial action as set forth in public rule; and other civil remedies and sanctions allowed by
law. For purposes of this Section, a "Measurable Amount of Work" is defined as a definitive
allocation of an employee's time that can be attributed to work performed under this
Agreement, but that is not less than a total of one hour in any one week period.
14. Conflict of Interest
A The Recipient agrees to complywith applicable provisions of K.C.C. 3.04. Failure to comply
with such requirements shall be a material breach of this Agreement, and may result in
termination of this Agreement pursuant to Section II and subject the Recipient to the remedies
stated therein, or otherwise available to the County at law or in equity.
B. The Recipient agrees, pursuant to KCC 3.04.060, that it will not willfully attempt to secure
preferential treatment in its dealings with the County by offering any valuable consideration,
thing of value or gift, whether in the form of services, loan, thing or promise, in any form to any
E]
county official or employee. The Recipient acknowledges that if it is found to have violated the
prohibition found in this paragraph, its current Agreements with the county will be cancelled
and it shall not be able to bid on any county Agreement for a period of two years.
C. The Recipient acknowledges that for one year after leaving County employment, a former
County employee may not have a financial or beneficial interest in an agreement or grant that
was planned, authorized, or funded by a County action in which the former County employee
participated during County employment. Recipient shall identify at the time of offer current or
former County employees involved in the preparation of proposals or the anticipated
performance of Work if awarded the Agreement. Failure to identify current or former County
employees involved in this transaction may result in the County's denying or terminating this
Agreement. After Agreement award, the Recipient is responsible for notifying the County's
Project Manager of current or former County employees who may become involved in the
Agreement any time during the term of the Agreement.
15. Equipment Purchase, Maintenance, and Ownership
A The Recipient agrees that any equipment purchased, in whole or in part, with Agreement
funds at a cost of $5,000 per item or more, when the purchase of such equipment is
reimbursable as an Agreement budget item, is upon its purchase or receipt the property of the
County and/or federal/state government. The Recipient shall be responsible for all such
property, including the proper care and maintenance of the equipment.
B. The Recipient shall ensure that all such equipment will be returned to the County or
federal/state government upon termination of this Agreement unless otherwise agreed upon
by the parties.
16. Proprietary Rights
The parties to this Agreement hereby mutually agree that if any patentable or copyrightable material
or article should result from the work described herein, all rights accruing from such material or
article shall be the sole property of the County. The County agrees to and does hereby grant to the
Recipient, irrevocable, nonexclusive, and royalty -free license to use, according to law, any material
or article and use any method that may be developed as part of the work under this Agreement.
The foregoing products license shall not apply to existing training materials, consulting aids,
checklists, and other materials and documents of the Recipient which are modified for use in the
performance of this Agreement.
The foregoing provisions of this section shall not apply to existing training materials, consulting aids,
checklists, and other materials and documents of the Recipient that are not modified for use in the
performance of this Agreement.
17. Political Activity Prohibited
None of the funds, materials, property, or services provided directly or indirectly under this
Agreement shall be used for any partisan political activity or to further the election or defeat of any
candidate for public office.
18. King County Recycled Product Procurement Policy
In accordance with King County Code 18.20, the Recipient shall use recycled paper, and both sides
of sheets of paper whenever practicable, when submitting proposals, reports, and invoices, if paper
copies are required.
19. Future Support
The County makes no commitment to support the services awarded for herein and assumes no
obligation for future support of the activity awarded herein except as expressly set forth in this
Agreement.
20. Entire AgreementlWaiver of Default
9
The parties agree that this Agreement is the complete expression of the terms hereto and any oral
or written representations or understandings not incorporated herein are excluded. Both parties
recognize that time is of the essence in the performance of the provisions of this Agreement.
Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or
breach of any provision of the Agreement shall not be deemed to be a waiver of any other or
subsequent breach and shall not be construed to be a modification of the terms of the Agreement
unless stated to be such through written approval by the County, which shall be attached to the
original Agreement.
21. Amendments
Either party may request changes to this Agreement. Proposed changes which are mutually
agreed upon shall be incorporated by written amendments to this Agreement. Changes to the
County's Agreement numbering system or fund source may be made unilaterally by the County and
without the need for amendment of this Agreement. The Recipient shall be notified in writing of any
changes in the Agreement number or fund source assigned by the County; provided, however, that
the total compensation allocated by the County through this Agreement does not change.
22. Notices
Whenever this Agreement provides for notice to be provided by one party to another, such notice
shall be in writing and directed to the chief executive office of the Recipient and the project
representative of the County department specified on page one of this Agreement. Any time within
which a party must take some action shall be computed from the date that the notice is received by
said party.
23. Services Provided in Accordance with Law and Rule and Regulation
The Recipient and any sub-awardee agree to abide by the laws of the state of Washington, rules
and regulations promulgated thereunder, and regulations of the state and federal governments, as
applicable, which control disposition of funds granted under this Agreement, all of which are
incorporated herein by reference.
In the event that there is a conflict between any of the language contained in any exhibit or
attachment to this Agreement, the language in the Agreement shall have control over the language
contained in the exhibit or the attachment, unless the parties affirmatively agree in writing to the
contrary.
24. Applicable Law
This Agreement shall be construed and interpreted in accordance with the laws of the State of
Washington. The venue for any action hereunder shall be in the Superior Court for King County,
Washington.
25. Electronic Processing and Signatures
The parties agree that this Agreement may be processed and signed electronically, which if done
so, will be subject to additional terms and conditions found at
https://www.docusign.com/company/terms-of-use.
The parties acknowledge that they have consulted with their respective attorneys and have had the
opportunity to review this Agreement. Therefore, the parties expressly agree that this Agreement
shall be given full force and effect according to each and all of its express terms and provisions and
the rule of construction that any ambiguities are to be resolved against the drafting party shall not
be employed in the interpretation of this Agreement.
The parties executing this Agreement electronically have authority to sign and bind its represented
party to this Agreement.
26. No Third Party Beneficiaries
Except for the parties to whom this Agreement is assigned in compliance with the terms of this
Agreement, there are no third party beneficiaries to this Agreement, and this Agreement shall not
impart any rights enforceable by any person or entity that is not a party hereto.
END OF COUNTY TERMS AND CONDITIONS
11
Exhibit A - Federal Special Terms and Conditions
As applicable, the Contractor shall adhere to the Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Dept. of Health & Human Services awards as codified in 45
CFR part 75 effective December 26, 2014 the HHS Grants Policy Statement, and Contract Provisions
below.
APPENDIX II TO 45 CFR 75 --CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY
CONTRACTS UNDER FEDERAL AWARDS
In addition to other provisions required by the HHS agency or non -Federal entity, all contracts made by
the non -Federal entity under the Federal award must contain provisions covering the following, as
applicable.
A. Contracts for more than the simplified acquisition threshold currently set at $150,000, which is the
inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense
Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address
administrative, contractual, or legal remedies in instances where contractors violate or breach contract
terms, and provide for such sanctions and penalties as appropriate.
B. All contracts in excess of $10,000 must address termination for cause and for convenience by the
non -Federal entity including the manner by which it will be effected and the basis for settlement.
C. Equal Employment Opportunity. Except as otherwise provided under 41 CFR part 60, all contracts
that meet the definition of "federally assisted construction contract" in 41 CFR part 60-1.3 must
include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive
Order 11246, as amended by Executive Order 11375, and implementing regulations at 41 CFR part
60.
D. Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program
legislation, all prime construction contracts in excess of $2,000 awarded by non -Federal entities must
include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-
3148) as supplemented by Department of Labor regulations (29 CFR part 5). In accordance with the
statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the
prevailing wages specified in a wage determination made by the Secretary of Labor. In addition,
contractors must be required to pay wages not less than once a week. The non -Federal entity must
place a copy of the current prevailing wage determination issued by the Department of Labor in each
solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance
of the wage determination. The non -Federal entity must report all suspected or reported violations to
the Federal awarding agency. The contracts must also include a provision for compliance with the
Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as supplemented by Department of Labor
regulations (29 CFR part 3). The Act provides that each contractor or subrecipient must be prohibited
from inducing, by any means, any person employed in the construction, completion, or repair of
public work, to give up any part of the compensation to which he or she is otherwise entitled. The
non -Federal entity must report all suspected or reported violations to the Federal awarding agency.
E. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all
contracts awarded by the non -Federal entity in excess of $100,000 that involve the employment of
mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as
supplemented by Department of Labor regulations (29 CFR part 5). Under 40 U. S.C. 3702 of the Act,
each contractor must be required to compute the wages of every mechanic and laborer on the basis of
a standard work week of 40 hours. Work in excess of the standard work week is permissible provided
that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for
Exhibit A - Federal Special Terms and Conditions
all hours worked in excess of 40 hours in the workweek. The requirements of 40 U.S.C. 3704 are
applicable to construction work and provide that no laborer or mechanic must be required to work in
surroundings or under working conditions which are unsanitary, hazardous or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles ordinarily available on
the open market, or contracts for transportation or transmission of intelligence.
F. Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the defmition
of "funding agreement" under 37 CFR 401.2 (a) and the recipient or subrecipient wishes to enter into
a contract with a small business firm or nonprofit organization regarding the substitution of parties,
assignment or performance of experimental, developmental, or research work under that "funding
agreement," the recipient or subrecipient must comply with the requirements of 37 CFR part 401 and
any implementing regulations issued by the awarding agency.
G. Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C.
1251-1387), as amended --Contracts and subgrants of amounts in excess of $150,000 must contain a
provision that requires the non -Federal award to agree to comply with all applicable standards, orders
or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671 q) and the Federal Water
Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal
awarding agency and the Regional Office of the Environmental Protection Agency (EPA).
H. Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR
180.220) must not be made to parties listed on the government -wide exclusions in the System for
Award Management (SAM), in accordance with the OMB guidelines at 2 CFR part 180 that
implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989
Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties
debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under
statutory or regulatory authority other than Executive Order 12549.
I. Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award
exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will
not and has not used Federal appropriated funds to pay any person or organization for influencing or
attempting to influence an officer or employee of any agency, a member of Congress, officer or
employee of Congress, or an employee of a member of Congress in connection with obtaining any
Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose
any lobbying with non -Federal funds that takes place in connection with obtaining any Federal award
Such disclosures are forwarded from tier to tier up to the non -Federal award.
J. See § 75.331 Procurement of recovered materials.
Exhibit B: Scope of Work 3317 CDIP
JEFFERSON COUNTY PUBLIC HEALTH
CLINICAL and CLIENT SUPPORT SERVICES
July 1, 2018 through June 14, 2019
BACKGROUND
The Breast, Cervical, and Colon Health Program (BCCHP) helps eligible clients get
screened for breast, cervical, and colorectal cancers, and connects clients with diagnostic
services and treatment when needed. The program serves clients with low incomes and
who lack health insurance coverage for cancer screening. BCCHP improves access to
services, especially for people who face extra barriers to getting health care.
PURPOSE
Jefferson County Public Health will enroll BCCHP eligible clients and provide
recommended cancer screening services. They will refer BCCHP enrolled clients with
abnormal cancer screening results to other BCCHP contracted providers for appropriate
follow-up services. They will also use outreach activities outlined below to recruit clients
for the BCCHP.
SERVICES
Enrollment Site:
Annual exam with Clinical Breast Exam (CBE)
Problem -focused visit
Pap tests
HPV tests
ELIGIBLE POPULATION
Women —all services;
Breast screening & annual exam
40-64, or
35-39, if being seen for breast
symptoms, or screening and
surveillance for increased risk clients
under 40* or
64+ if ineligible for Medicare
Priority for Mammography:
• Ages 50 or older, and last
mammogram > 2 years
• Suspicious breast findings
• Strong family history or other
high risk
*documentation is necessary
and
Cervical'
If last pap normal & > 3 years or co -
testing (Pap normal and HPV
negative) > 5 years:
• 40-64
• 35-39, if being seen for breast
symptoms
^As per USPSTF 2012 Cervical Cancer
Screening Guidelines. If not eligible for Pap
Test, pelvic exam paid only if done as part of
visit for breast screening/annual exam
diagnostics available to clients at or below
Exhibit B Scope of Work 3317 CDIP - Jefferson County Public Health Page 1 of 4
PRIORITY POPULATIONS
Some populations have lower screening and/or higher morbidity or mortality rates.
Jefferson will focus enrollment efforts on clients who:
• Have never or rarely received breast or cervical services
• Are ages 50 or older (breast services) or 40-49 (cervical services)
• Are new to BCCHP
• Are from a racial or ethnic minority population, including African American, Asian,
Pacific Islander, American Indian/Alaskan Native, and Hispanic/Latina
• Are lesbian, gay, bisexual, or transgender
• Have a disability (as defined by the client)
• Have a strong family history or other high risk, including ages 40-49 for breast services
PERFORMANCE REQUIREMENTS
Clinical Services
The Contractor will:
• Make best efforts to comply with CDC and DOH Performance Indicators:
o Assist the client to complete the diagnostic work-up within 60 days of a
documented abnormal breast finding.
o Assist the client to start breast cancer treatment within 60 days of a
documented diagnosis of breast cancer or breast pre -cancer.
o Assist the client to start cervical cancer treatment within 90 days of a
documented diagnosis of cervical cancer or pre -cancer.
o Refer colon health clients to Public Health within 10 days of a positive
FOBT/FIT, to schedule colonoscopy.
o Assist the client to receive a colonoscopy within 90 days of a positive
FOBT/FIT.
• Document attempts to contact each client for follow-up services per BCCHP protocol.
It is the contractor's responsibility to get clients in for timely follow-up.
• Review and follow instructions in the Contractor's Procedure Manual, available at:
http://www.ki ngcounty.gov/healthservices/health/chronic/bchp/downloads.aspx
• Maintain HIPAA regulated confidentiality of all BCCHP client data and medical records.
• Provide effective, understandable, and respectful care to clients in their preferred
language. Make reasonable efforts to provide care that is compatible with clients'
cultural health beliefs and practices.
• Maintain documentation of current WA State licensure and/or certification for all health
care professionals who perform medical procedures under this contract. Present
documentation to BCCHP staff upon request.
• Send a representative to the annual BCCHP mandatory meeting and a minimum of two
other meetings and/or trainings as scheduled by the DOH or Public Health.
• Work with BCCHP staff to distribute educational materials, upon request.
Exhibit B Scope of Work 3317 CDIP - Jefferson County Public Health Page 2 of 4
Client Support Services at Jefferson
The contractor will:
1. Track BCCHP clients to make sure they receive timely follow-up after abnormal breast
or cervical cancer findings. Monitor clients until they receive a diagnosis.
2. Implement a re -screening reminder system for BCCHP clients.
3. Document scheduling for appropriate follow-up tests and return appointments.
4. Review and give test results to clients in a timely manner.
5. Document all findings and send to Public Health.
REIMBURSEMENT PROCESS:
The Contractor will:
• Complete exam and reimbursement forms and, if applicable, diagnostic forms. Forms
are available online at:
http://www.ki ngcounty.gov/healthser\ices/health/chronic/bchp/downioads.aspx
• Make best efforts to submit reimbursement forms to BCCHP at Public Health within 10
business days from the date of service.
• Accept the amounts for CPT -coded services listed on the current BCCHP Fee
Schedule.
• Certify that work to be performed under this contract does not duplicate any work to be
charged against any other contract, subcontract, or other funding source.
• Monitor funds spent and clients scheduled, to stay within the total budget.
• In the case of any overpayment, contact BCCHP staff before taking any action to
discuss how to correct the error.
BCCHP will not pay for services if we receive reimbursement forms later than 45 days from
the service date. We will evaluate exceptions on a case-by-case basis. We may impose
an earlier deadline to submit forms for June services, to achieve timely fiscal year-end
close out.
REIMBURSEMENT LIMITS:
Payment will not exceed the total budgeted contract amount (Exhibit Q.
Exhibit C shows the "anticipated number of clients" (sometimes called "slots") that the
clinical funding may cover for each type of service. These are estimates based on
average historical costs per type of clinical service. Since costs may vary, these estimates
are only a guideline to show a possible mix of services that the Contractor could provide
with total available funds. Funds for breast and cervical services are not interchangeable
with funds for colon health services or outreach services. Please carefully review
Exhibit C
REIMBURSEMENT PROCEDURES
BCCHP at Public Health will:
• Pay for services provided within the corresponding contract period.
Exhibit B Scope of Work 3317 CDIP - Jefferson County Public Health Page 3 of 4
• Send the current Fee Schedules for Breast and Cervical Cancer Screening and
Diagnosis and Colorectal Cancer Screening and Diagnosis to the Contractor, as well as
any subsequent revisions. Revisions will replace earlier versions.
• Pay for CPT -coded services at rates listed on the Fee Schedule. When applicable,
payment will include facility fee costs, as described on the Fee Schedule. We
reimburse clinic services at "Professional non -facility office" rates.
• Pay for Client Support Services (case management) based on the BCCHP rate per
client enrolled and screened (Exhibit C).
• Monitor contracted funds.
• Generate monthly clinical services billing reports for the contractor, based on forms the
contractor submits. The reports will detail client names, dates of service, CPT codes,
and fees.
• Create a monthly invoice from the billing reports and send to the Contractor to review
and approve.
• Pay the Contractor based on the approved invoice.
The Contractor will not bill BCCHP clients for any differences between service
charges and BCCHP reimbursement.
Exhibit B Scope of Work 3317 CDIP- Jefferson County Pubfic Health Page 4 of 4
Exhibit C: Budget
Jefferson County Public Health
615 Sheridan St
Port Townsend, WA 98368
July 1, ZU7S - June 14, 1U1V
I BUDGET DETAIL I Initial Not to Exceed I Maximum Not to I
Amount Exceed Amount
Services will be paid by CPT code according to the rates listed on the most current Breast,
Cervical, and Colon Health Program Fee Schedule. The fee schedule changes annually on
July 1.
Anticipated Breast and Crevical Clients #s 4 8
BCHP Services average $ /client
3317 CDIP - Jefferson County Public Health
Public Health 1491
Seattle & King County LN
INVOICE
Contract Number: 3317 CDIP
Exhibit: D
Contract Period of Performance:
July 1, 2018 - June 14, 2019
Jefferson County Public Health
615 Sheridan St
Port Townsend, WA 98368
Julia Danskin
(360)385-9420
Odanskin@co.lefferson.wa.us
Submit signed hardcopy invoice to:
Jodi Olson
Breast Cervical & Colon Health Program
Public Health - Seattle & King County
401 5th Ave., Suite 1110
Seattle, WA 98104
Invoice for services rendered under
this contract for the period of:
1111 CICI INC MI ICT OC rr1MD1 CTCV CAO DOnRADT DAVMCNT DOd"AMCCINC
King County Accounts Payable Information
Purchase Order #
Supplier Name JEFFERSON COUNTY
Supplier # 6649
Supplier Pay Site PUBLIC HEALTH
Remit Address 615 Sheridan St
Port Townsend, WA 98368
Invoice Date
Invoice #
Amount to be Paid $0.00
Note to AP Pay Immediately
Payment Type Larde one) CHECK or ACH
Print on Remittance BCCHP
H Prog. name/phone Jodi Olson, 206-263-8200
Start End
Date Date
MM/DD/YY
King County AP Payment Information:
Project Organization Expend Acct Task Award DPH CPA CFDA Amount
11234921 800107 1 53180 100 101562 1 1 59694781 93.283 1 $ -
Ireast Cervical & Colon Health Program Invoicing Information:
:osts I Award I Budget I Previously Billed Current Cumulative Balance
I&C-Fed 11015621$ 1,400.00 $ $ $ - $ 1,400.00
Total $ 1,400.00 $ - $ - $ - $ 1,400.00
Amount Due
I, the undersigned, do hereby certify under the laws of the State of Washington penalty of perjury, that this is a true and correct claim for reimbursement services rendered.
I understand that any false claims, statements, documents, or concealment of material fact may be prosecuted under applicable Federal and State laws. This certification
includes any attachments which serve as supporting documentation to this reimbursement request.
Signed Date
Julia Danskin
Print Name
PH Program Manager Approval Date
Exhibit E
Order Form
BCCHP Program
Contract # 3317 CDIP F-1
Contractor: Jefferson County Public Health
615 Sheridan
Port Townsend, WA 98368
Julia Danskin
jdanskin�a.co.jefferson.wa.us
Effective Date:
Public Health Seattle & King County hereby amends the not to exceed amount and authorizes the following not -to -
exceed amount for the services provided in the Scope of Work Exhibit under the above referenced contract at the
rates set forth in the Budget Exhibit:
Description
Prior Not to
Exceed
Amount
Total Increase or
Decrease
Amended Not to
Exceed Amount
Breast and Cervical Services:
Funding Sources
to Exceed
Increase or
Annual exam with Clinical Breast
$1400
$
$1400
Exam (CBE), problem -focused
Amount
FEDERAL
visit, Pap tests, HPV tests.
Federal Catalogue No.
$1400
$
$1400
Total reimbursable Contract
$1400
$
$1400
Amount
TOTAL
1400
The total reimbursement shall not exceed the amount set forth in this Order Form
Public Health Signature Date
ame
7/2018
Prior Not
Total
Amended Not
Funding Sources
to Exceed
Increase or
to Exceed
Effective Dates
Amount
Decrease
Amount
FEDERAL
Federal Catalogue No.
$1400
$
$1400
7/1/18 —6/14/19
93.283
TOTAL
1400
1400
Public Health Signature Date
ame
7/2018
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.orqq
Consent /agenda
August 6, 2018
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
TO:
FROM:
DATE:
SUBJECT:
AGENDA REQUEST
Board of County Commissioners
Philip Morley, County Administrator
Vicki Kirkpatrick, Director
goI
Agenda Item - Contract Agreement with Public Health of King County
for Breast Cervical & Colon Health Program Services; July 1, 2018 -
June 14, 2019; $1,400
STATEMENT OF ISSUE:
Jefferson County Public Health, Community Health, requests Board approval of the Contract Agreement with
Public Health of King County for Breast Cervical & Colon Health Program Services; July 1, 2018 —
June 14, 2019; $1,400
ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S:
This is an ongoing agreement between Jefferson County and Public Health Seattle & King County to provide
Breast and Cervical Health Care (screening & referral Services), to a uninsured or underinsured women.
Services are available to eligible clients to pay for preventive services such as health exams, mammograms
and pap tests. This includes breast screening and annual exam for women age 40-64 with incomes at or
below 250% of Federal Poverty Level and mammography and breast diagnostics available to women below
300% of FPL. These services will also be available to women who may not be eligible for apple Health
(Medicaid). This contract provides for colon health services to certain counties that contract with Public
Health of Seattle & King County, Jefferson County is not one of those counties. JCPH will continue to do
outreach.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
The agreement provides $1,400 in State and Federal funding. No general fund dollars support this program.
RECOMMENDATION:
JCPH management request approval of the Contract Agreement with Public Health of King County for Breast
Cervical & Colon Health Program Services; July 1, 2018 — June 14, 2019; $1,400
REVIEWED BY:
�z
alpMorl4ey,tomy Administra
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Date
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487
615 Sheridan Street
Port Townsend, WA 98368
www. Jeff ersonCountyPublic Health.org
CONTRACT REVIEW FORM
RISC EMED
Q N-18-44
AUG 0 8 2018
JEFFERSON COUNTY
CONTRACT WITH: Public Health — Seattle & King County PROSECUTING ATTORNEY
CONTRACT FOR: Breast, Cervical, Colon Health Program TERM: July 1, 2018 —June 14, 2019
COUNTY DEPARTMENT: Jefferson County Public Health
For More Information Contact: Vicki Kirkpatrick
Contact Phone #: X408
RETURN TO: Jenny Matter RETURN BY: ASAP
AMOUNT: $1,400.00
Revenue: $1,400.00
Expenditure:
Matching Funds Required:
Source(s) of Matching Funds:
Step 1
APPROVED FORM
mments:
REVIEW BY RISK
Review by:
Date Reviewed:
PROCESS:
Ste 2: REVIEW BY PROSEC NG A
Review by: G'
Date Reviewed
AUG 092818
0 Exempt from Bid Process
❑ Consultant Selection Process
❑ Cooperative Purchase
❑ Competitive Sealed Bid
❑ Small Work Roster
❑ Vendor List Bid
❑ RFP or RFQ
❑Other:
'l5ll�
for revisio`Pf ee Comments)
APPROVED AS TO FORM * etuurr d for revision (See Comments)
Comments: kl.'� G v.1 � � C4 of � (i
(This form to stay with contract throughout the contract review process)
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487