HomeMy WebLinkAboutAmendment No. 1 re: Breast, Cervical 615 Sheridan Street
Port Townsend, WA 98368
Tom www.JeffersonCountyPublicHealth.org
Consent Agenda
Public Healt
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, County Administrator
FROM: Apple Martine, Public Health Director
Denise Banker, Community Health Director
DATE:
SUBJECT: Agenda Item —Amendment 1 to Contract Agreement with Public Health of
Seattle & King County for Breast, Cervical & Colon Health Program Services;
June 30, 2022 —June 29, 2023; $1,400
STATEMENT OF ISSUE:
Jefferson County Public Health, Community Health Division, requests Board approval of the first amendment to
the Contract Agreement with Public Health of Seattle & King County for Breast, Cervical & Colon Health
Program Services; June 30, 2022 —June 29, 2023: $1,400
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
This is an ongoing agreement between Jefferson County and Public Health of Seattle & King County to provide
Breast and Cervical Health Care (screening & referral services), to uninsured or underinsured women. This
Amendment 1 extends the contract end date to June 29, 2023; no other terms of the contract are affected.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
The agreement provides $1,400 in Federal funding. No general fund dollars are used to support this program.
This amendment does not alter the contract maximum amount.
RECOMMENDATION:
JCPH management requests approval of Amendment 1 to the Contract Agreement with Public Health of Seattle
& King County for Breast, Cervical & Colon Health Program Services; June 30, 2022 —June 29, 2023; $1,400
REVIEW BY:
` h'V z
Mark McCauley, C04ty Administrator Date
Community Health
Developmental Disabilities Environmental Public Health
360-385-9400 360-385-9444
360-385-9401 (f) (f)360-379-4487
N-22-031-A1 Always working for a safer and healthier community
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Public Health
Seattle& King County
PHSKC Agreement# 9045 CDIP -Amendment 1
AMENDMENT
This Amendment between PHSKC and the Recipient changes the referenced Agreement for the following
purpose(s): This amendment changes the contract end date to June 29, 2023 from December 31, 2022. No
changes to contract maximum amount.
Recipient Name&Address: Jefferson County Public Health, 615 Sheridan, Port Townsend, WA 98368
Project Title: BCCHP Clinical Services
Effective Date of Amendment: December 31, 2022
Agreement End Date: ❑ No Change ® Change to: Jun 29, 2023
Agreement Amount: ® No Change ❑ Change to:
Funding Details: ® No Change ❑ Revise the following funding details:
Funding Source PHSKC Contract# Amount Effective Dates New or
Revised
Funding Summary: ® No Change ❑ Revise to read:
FEDERAL: COUNTY: STATE: OTHER:
Exhibits: ® No Change ❑ Revise as follows:
All exhibits will be extended to June 29, 2023.
King County Terms &Conditions: ® No Change ❑ Revise as follows.
All other terms and conditions of the referenced Agreement and any previous Agreement amendment not
revised herein shall remain unchanged and in full force and effect.
RECIPIENT SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Greg Brotherton, Chair
Board of County Commissioners
Jefferson County,Washington
PHSKC SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Approved as to form only:
January 19,2023
Philip C. Hunsucker, Date
Chief Civil Deputy Prosecuting Attorney
Jefferson County,Washington
N-22-031-At
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Public Health PHSKC Contract#
FEDERAL COMMUNITY
Seattle & King County SERVICES CONTRACT 9045 CDIP
This Contract is between King County and the Contractor identified below. The County department
overseeing the work to be performed in this Contract is the Department of Public Health (PHSKC).
CONTRACTOR NAME CONTRACTOR FEDERAL TAX ID#
Jefferson County Public Health 91-6001322
--- ----- ---
CONTRACTOR ADDRESS CONTRACTOR CONTACT&EMAIL ADDRESS
615 Sheridan, Port Townsend, WA 98368 Heidi Eisenhour; dbanker@co.jefferson.wa.us
PHSKC DIVISION PROJECT TITLE
CDIP BCCHP Clinical Services
CONTRACT START DATE CONTRACT END DATE INITIAL AUT�$7,400.00
ZED AMOUNT
June 30, 2022 December 31, 2022
PHSKC may,upon availability of additional funding or at its discretion,increase or decrease the Authorized Amount by issuing an Order
Form such that the Total Authorized Amount does not exceed$2 800.00.
FUNDING DETAILS
Funding Source PHSKC Contract# Amoun Effective PIM
HHS,CDC,Cancer Prevention and 8272 ODIR $1,400.00 Jun 30 2O22 TO Dec 31 2022
Control Programs for State,Territorial and
Tribal Organizations CFDA 93.898
FUNDING SUMMARY
FEDERAL:$1,400.00 COUNTY:$0.00 STATE:$0.00 OTHER:$0.00
The Contractor Is NOT oonsidered a subreciplent for purposes of this Contract.
EXHIBITS. The following Exhibits are attached and are Incorporated Into this Contract by reference:
Exhibit A-Scope of Work; Exhibit B-Budget; Exhibit C-Invoice template; Exhibit D-Order Form.
In consideration of payments,covenants,and agreements hereinafter mentioned,to be made and performed by the
parties hereto,the parties mutually agree that the Contractor shall provide services and comply with the requirements set
forth in this Contract,which consists of Part A-King County Terms and Conditions, Part B-Federal Terms,and attached
exhibits,each of which are made a part hereof by reference.The parties signing below represent that they have read and
understand this Contract and have the authority to execute this Contract. Furthermore,in addition to agreeing to the
terms and conditions provided herein, by signing this Contract,the Contractor certifies that it has read and understands
the Contract requirements on the PHSKC website(http:/twww.kingcounty.gov/depts/health/partnerships/contracts.aspx)
and agrees to comply with all of the Contract terms and conditions detailed on that site, including EEO/Nondiscrimination,
HIPA& Insurance,and Credentialin ,as applicable.
CO RACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
t !� Heidi Eisenhour
I
PHSKC SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Nadine Chan
CDocusipnea by. 8/11/2022
NX 0/A;VX ("14, Interim Chief. APDE and CDIP, PHSKC
Approved as to Form: OFFICE OF THE KING COUNTY PROSECUTING ATTORNEY
(This form is available in alternate formats for people with disabilities upon request.)
Approved as to form only:
N-22-031 July 21,2022
Philip C.Hunsucker Date
Chief Civil Deputy Prosecuting Attorney,
1 Jefferson County,WA
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PART A. KING COUNTY TERMS AND CONDITIONS
1. Contract Term and Termination
A. This Contract shall begin on the Contract Start Date and shall terminate on the Contract End
Date as specified on page 1 of this Contract, unless extended or terminated earlier, pursuant
to the terms and conditions of the Contract.
B. This Contract may be terminated by the County or the Contractor without cause, in whole or in
part, prior to the Contract End Date, by providing the other party thirty (30) days advance
written notice of the termination. The Contract may be suspended by the County without
cause, in whole or in part, prior to the date specified in Subsection I.A. above, by providing
the Contractor thirty (30) days advance written notice of the suspension.
C. The County may terminate or suspend this Contract, in whole or in part, upon seven (7) days
advance written notice if: (1) the Contractor breaches any duty, obligation, or service required
pursuant to this Contract, or(2)the duties, obligations, or services required herein become
impossible, illegal, or not feasible. If the Contract is terminated by the County pursuant to this
Subsection 1.C. (1), the Contractor shall be liable for damages.
If the termination results from acts or omissions of the Contractor, including but not limited to
misappropriation, nonperformance of required services, or fiscal mismanagement, the
Contractor shall return to the County immediately any funds, misappropriated or unexpended,
which have been paid to the Contractor by the County.
D. If 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 seven business
days advance written notice to the Contractor, terminate or suspend this Contract in whole or
in part.
If the Contract 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 Contract for services rendered
prior to the effective date of termination or suspension; and (2) in the case of termination the
Contractor shall be released from any obligation to provide such further services pursuant to
the Contract ; and (3) in the case of suspension the Contractor 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 Contract beyond the current appropriation year is conditional
upon appropriation by the County Council of sufficient funds to support the activities described
in the Contract. If such appropriation is not approved, this Contract 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 Contract or
by law that either party may have in the event that the obligations, terms, and conditions set
forth in this Contract are breached by the other party.
2. Compensation and Method of Payment
A. The County shall compensate the Contractor for satisfactory completion of the services and
requirements specified in this Contract, payable upon receipt and approval by the County of a
signed invoice in substantially the form of the attached Invoice Exhibit, in accordance with the
terms found in the attached Budget Exhibit.
B. The Contractor 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 Contractor not more than 30 days after a
complete and accurate invoice is received.
C. The Contractor shall submit its final invoice and all outstanding reports within 30 days of the
date this Contract terminates. If the Contractor's final invoice and reports are not submitted by
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the day specified in this subsection, the County will be relieved of all liability for payment to the
Contractor of the amounts set forth in said invoice or any later invoice.
D. When a budget is attached hereto as an exhibit, the Contractor shall apply the funds received
from the County under this Contract in accordance with said budget. The Contract may
contain separate budgets for separate program components. The Contractor shall request
prior approval from the County for an amendment to this Contract when the cumulative
amount of transfers among the budget categories is expected to exceed 10% of the Contract
amount in any Contract 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 Contractor not timely expend funds allocated
under this Contract, the County may recapture and reprogram any such under-expenditures
unilaterally and without the need for further amendment of this Contract. The County may
unilaterally make changes to the funding source without the need for an amendment. The
Contractor 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 Contractor 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 Contractor does not request government rates, the
Contractor 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 Contractor 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 Contractor shall establish and maintain a system of accounting and internal controls that
complies with the generally accepted accounting principles issued by the Financial Accounting
Standards Board (FASB), the Governmental Accounting Standards Board (GASB), or both as is
applicable to the Contractor's form of incorporation.
4. Debarment and Suspension Certification
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 Contractor, by signature
to this Contract, certifies that the Contractor is not currently debarred, suspended, or proposed for
debarment by any Federal department or agency. The Contractor also agrees that it will not enter
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into a subcontract with a person or entity that is debarred, suspended, or proposed for debarment.
The Contractor will notify King County if it, or a subcontractor, is debarred, suspended, or proposed
for debarment by any Federal department or agency.
5. Maintenance of Records/Evaluations and Inspections
A. The Contractor shall maintain for a period of six years after termination of this Contract
accounts and records, including personnel, property, financial, and programmatic records and
other such records the County may deem necessary to ensure proper accounting for all
Contract funds and compliance with this Contract.
B. In accordance with the nondiscrimination and equal employment opportunity requirements set
forth in Section 13. below, the Contractor shall maintain the following for a period of six years
after termination of this Contract:
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 Contract; and
2. Records, including written quotes, bids, estimates or proposals submitted to the
Contractor by all entities seeking to participate on this Contract, and any other
information necessary to document the actual use of and payments to subcontractors
and suppliers in this Contract, including employment records.
The County may visit the site of the work and the Contractor's office to review these records.
The Contractor shall provide all help requested by the County during such visits and make
the foregoing records available to the County for inspection and copying. At all reasonable
times, the Contractor shall provide to the County, state, and/or federal agencies or officials,
access to its facilities---�including those of any subcontractor assigned any portion of this
Contract in order to monitor and evaluate the services provided under this Contract. The
County will give reasonable advance notice to the Contractor in the case of audits to be
conducted by the County. The Contractor shall comply with all record keeping requirements
of any applicable federal rules, regulations or statutes included or referenced in the Contract
documents. If different from the Contractor's address listed above, the Contractor shall
inform the County in writing of the location, of its books, records, documents, and other
evidence for which review is sought 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 Contract. The records and documents with respect to all matters covered
by this Contract 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 Contract 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 Contractor 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 Contractor ceases operations under this
Contract, the Contractor shall be responsible for the disposition and maintenance of such
medical records.
E. The Contractor agrees to cooperate with the County or its agent in the evaluation of the
Contractor's performance under this Contract 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 Contractor agrees that all information, records, and data collected in connection with this
Contract shall be protected from unauthorized disclosure in accordance with applicable state
and federal law.
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6. Compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Contractor shall not use protected health information created or shared under this Contract in
any manner that would constitute a violation of HIPAA and any regulations enacted pursuant to its
provisions. Contractor shall read and certify compliance with all HIPAA requirements at
http://www.kingcounty.gov/depts/health/partnerships/contracts.aspx.
7. Financial Reports and Audits
Contractor is required to submit a financial reporting package as described in A through C below. All
required documentation must be submitted by email to MonitoringTechnicalSupport@kingcounty.gov
by the stated due date.
A. If the Contractor is a Non-Federal entity as defined in 2 CFR Part 200.69, and expends
$750,000 or more in Federal awards during the its fiscal year, then the Contractor shall meet
the audit requirements as described in 2 CFR Part 200 Subpart F. Audit packages are due to
the County within nine months after the close of the Contractor's fiscal year.
B. If the Contractor is not subject to the requirements in subsection A, the following apply:
Entity Type Non-Profit For Profit
Gross Revenue Gross Revenue Gross Revenue Gross Revenue Gross Revenue
Under 3M on Over.$3M on Under $3M on Over 3M on
average in the average in the average in the average in the
previous three previous three previous three previous three
fiscal years. fiscal years. fiscal years. fiscal years.
Required a Form 990 Audited financial . Income tax Audited financial
Documentation within 30 days statements return; and statements
of its being prepared by an * A full set of prepared by an
filed; and independent independent
Certified Public annual internal Certified Public
• A full set of Accountant or financial Accountant or
annual internal Accounting Firm statements Accounting Firm
financial
statements
Due Date Within 30 Within 9 months Within 30 Within 9 months
calendar days following the close calendar days following the
from the forms of the Contractor's from the forms close of the
being filed. fiscal year. being filed. Contractor's
fiscal year.
C. Waiver
A Contractor that is not subject to the requirements in subsection A may request,
and in the County's sole discretion be granted, a waiver of the audit requirements. If
approved by the County, the Contractor may substitute for the above requirements
other forms of financial reporting or fiscal representation certified by the
Contractor's Board of Directors.
D. The County may require additional audit or review requirements and the Contractor will be
required to comply with any such requirements.
8. Corrective Action
If the County determines that the Contractor has failed to comply with any terms or conditions of
this Contract or the Contractor has failed to provide in any manner the work or services (each a
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"breach"), and if the County determines that the breach warrants corrective action, the following
procedure will apply:
A. The County will notify the Contractor in writing of the nature of the breach.
B. The Contractor shall respond with a written corrective action plan within ten (10) working days
of its receipt of such notification, unless the County, at its sole discretion, extends in writing
the response time. The plan shall indicate the steps being taken to correct the specified
breach and shall specify the proposed completion date for curing the breach, which shall not
be more than thirty (30) days from the date of the Contractor's response, unless the County,
at its sole discretion, specifies in writing an extension to complete the corrective actions.
C. The County will notify the Contractor in writing of the County's determination as to the
sufficiency of the Contractor's corrective action plan. The determination of sufficiency of the
Contractor's corrective action plan shall be at the sole discretion of the County.
D. If the Contractor does not respond within the appropriate time with a corrective action plan, or
the Contractor's corrective action plan is determined by the County to be insufficient, the
County may terminate or suspend this Contract in whole or in part pursuant to Section 1.
E. In addition, the County may withhold any payment owed the Contractor or prohibit the
Contractor from incurring additional obligations of funds until the County is satisfied that
corrective action has been taken or completed.
F. 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 Contract. Both parties will make a good faith effort to continue without
delay to carry out their respective responsibilities under this Contract while attempting to resolve the
dispute under this section.
10. Hold Harmless and Indemnification
A. Duties as Independent Contractor:
In providing services under this Contract, the Contractor is an independent contractor, and
neither it nor its officers, agents, or employees are employees of the County for any purpose.
The Contractor 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 Contractor, its employees, and/or others by reason of this
Contract. The Contractor 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 Contractor's failure to pay any such
compensation, wages, benefits, or taxes, and/or(2) the supplying to the Contractor of work,
services, materials, or supplies by Contractor employees or other suppliers in connection with
or support of the performance of this Contract.
B. Contractor's Duty to Repay County:
The Contractor 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 Contract by the Contractor,
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 Contract pursuant to the Term
and Termination section.
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C. Contractor Indemnifies County:
The Contractor 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 Contractor,
its officers, employees, subcontractors and/or agents, in its performance or non-performance
of its obligations under this Contract. The Contractor 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 Contractor, by mutual negotiation,
hereby waives, as respects the County only, any immunity that would otherwise be available
against such claims under any industrial insurance act, including Title 51 RCW, other
Worker's Compensation Act, Disability Benefit Act, or other employee benefit act of any
jurisdiction which would otherwise be applicable in the case of such claim. In addition, the
Contractor shall protect and assume the defense of the County and its officers, agents and
employees in all legal or claim proceedings arising out of, in connection with, or incidental to
its indemnity obligation; and shall pay all defense expenses, including reasonable attorneys'
fees, expert fees and costs incurred by the County on account of such litigation or claims. If
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 Contractor.
D. County Indemnifies Contractor:
The County shall protect, defend, indemnify, and save harmless the Contractor, 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 Contract. 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 Contractor only, any immunity that would otherwise be
available against such claims under the Industrial Insurance provisions of Title 51 RCW. In the
event the Contractor 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. Intellectual Property Infringement:
For purposes of this section, 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. The indemnification, protection, defense and save harmless obligations contained herein shall
survive the expiration, abandonment or termination of this Contract.
11. Insurance Requirements
The Contractor shall procure and maintain for the term of this Contract, insurance covering King
County as an additional insured, 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 Contractor,
its agents, representatives, employees, and/or subcontractors. The costs of such insurance shall be
paid by the Contractor or subcontractor. The Contractor may furnish separate certificates of
insurance and policy endorsements for each subcontractor as evidence of compliance with the
insurance requirements of this Contract. The Contractor is responsible for ensuring compliance with
all of the insurance requirements stated herein. Failure by the Contractor, its agents, employees,
officers, subcontractor, providers, and/or provider subcontractor to comply with the insurance
requirements stated herein shall constitute a material breach of this Contract. Specific coverages
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and requirements are at http://www.kingcounty.gov/depts/health/partnerships/contracts.aspx. The
Contractor shall read and provide required insurance documentation prior to the signing of this
Contract.
12. AssignmenVSubcontract
A. The Contractor shall not assign or subcontract any portion of this Contract or transfer or
assign any claim arising pursuant to this Contract without the written consent of the County.
Said consent must be sought in writing by the Contractor not less than fifteen (15) days prior
to the date of any proposed assignment.
B. "Subcontract' shall mean any agreement between the Contractor and a subcontractor or
between subcontractors that is based on this Contract, provided that the term "subcontract'
does not include the purchase of(1) support services not related to the subject matter of this
Contract, or(2) supplies.
C. The Contractor shall include Sections 2.D., 2.E., 3, 4, 5, 6, 10.A., 10.B., 10.F., 12, 13, 14, 15,
16, 17, 23, 24, 26, and the Federal Terms and Conditions as contained herein, in every
subcontract or purchase agreement for services that relate to the subject matter of this
Contract.
D. The Contractor agrees to include the following language verbatim in every subcontract for
services which relate to the subject matter of this Contract:
Subcontractor 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 act or omissions of subcontractor, its
officers, employees, and/or agents in connection with or in support of this Contract.
Subcontractor expressly agrees and understands that King County is a third party beneficiary
to this Contract and shall have the right to bring an action against subcontractor to enforce the
provisions of this paragraph."
13. Nondiscrimination; Equal Employment Opportunity; Payment of a Living Wage
The Contractor shall comply with all applicable federal, state and local laws regarding
discrimination, including those set forth in this Section.
A. During performance of the Contract, the Contractor shall not discriminate against any
employee or applicant for employment because of the employee's 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 Contractor 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.kingcounty.gov/depts/health/partnerships/contracts.aspx. The Contractor shall read
and certify compliance.
B. Requirements of King County Living Wage Ordinance
In accordance with King County Ordinance 17909, for agreements for services with an initial
or amended value of$100,000 or more, the Contractor 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 Contract. The
requirements of the ordinance, including payment schedules, are detailed at
https:Hkingcounty.gov/depts/finance-business-operations/procurement/about-us/Living-
Wage.aspx.
Violations of this requirement may result in disqualification of the Contractor 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 Contract; remedial
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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 Contract, but that is
not less than a total of one hour in any one week period.
14. Conflict of Interest
A. The Contractor shall comply with applicable provisions of K.C.C. 3.04. Failure to comply with
such requirements shall be a material breach of this Contract, and may result in termination of
this Contract and subject the Contractor to the remedies stated in this contract, or otherwise
available to the County at law or in equity.
B. The Contractor agrees, pursuant to K.C.C. 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
County official or employee. The Contractor acknowledges that if it is found to have violated
the prohibition found in this paragraph, its current contracts with the County will be cancelled
and it shall not be able to bid on any County contract for a period of two years.
C. The Contractor 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. Contractor 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 Contract. Failure to identify current or former County
employees involved in this transaction may result in the County's denying or terminating this
Contract. After Contract award, the Contractor is responsible for notifying the County's Project
Manager of current or former County employees who may become involved in the Contract
any time during the term of the Contract.
15. Equipment Purchase, Maintenance, and Ownership
Funder's requirements may take precedence over this section as applicable.
A. The Contractor agrees that any equipment purchased, in whole or in part, with Contract funds
at a cost of$5,000 per item or more (hereinafter referred to as "Equipment"), is upon its
purchase or receipt the property of the County and/or federal/state government. The
Contractor shall be responsible for all such property, including the proper care and
maintenance of the Equipment.
B. The Contractor shall ensure that all such Equipment will be returned to the County or
federal/state government upon termination of this Contract unless otherwise agreed upon by
the parties.
C. All Equipment not listed as a budget line item purchased under this Contract requires prior
written approval from the County.
D. All Equipment purchased under this Contract shall be recorded and tagged as an asset in
inventory and reported to the County.
16. Proprietary Rights
A. Ownership Rights of Materials Resulting from Contract:
Except as indicated below or as described in an Exhibit, the parties to this Contract
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. To the extent that any rights in
such materials vest initially with the Contractor by operation of law or for any other
reason, the Contractor hereby perpetually and irrevocably assigns, transfers and
quitclaims such rights to the County. The County agrees to and does hereby grant
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to the Contractor, a nonexclusive, and royalty-free license to use, and create
derivative works, according to law, any material or article and use any method that
may be developed as part of the work under this Contract.
B. Ownership Rights of Previously Existing Materials.
The Contractor shall retain all ownership rights in any pre-existing patentable or
copyrightable materials or articles that are delivered under this Contract, but do not
originate from the work described herein. The Contractor agrees to and does
hereby grant to the County a perpetual, irrevocable, nonexclusive, and royalty-free
license to use and create derivative works, according to law, any pre-existing
material or article and use any method that may be delivered as part of the work
under this Contract.
C. Continued Ownership Rights:
The Contractor shall sign all documents and perform other acts as the County
deems necessary to secure, maintain, renew, or restore the rights granted to the
County as set forth in this section.
17. Political Activity Prohibited
None of the funds, materials, property, or services provided directly or indirectly under this Contract
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 Contractor 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 under this Contract and assumes no
obligation for future support of the activity under this Contract except as expressly set forth in this
Contract.
20. Entire ContractlWaiver of Default
The parties agree that this Contract is the complete expression of described subject matter, 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 Contract.
Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or
breach of any provision of the Contract 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 Contract
unless stated to be such through written approval by the County, which shall be attached to the
original Contract.
21. Amendments
Either party may request changes to this Contract. Proposed changes which are mutually agreed
upon shall be incorporated by written amendments to this Contract.
22. Notices
Whenever this Contract provides for notice by one party to another, such notice shall be in writing
and directed to the Contractor contact and the project representative of the County department
specified on page one of this Contract. Any time within which a party must take some action shall
be computed from the date that the notice is received by that party.
23. Services Provided in Accordance with Law and Rule and Regulation
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The Contractor and any subcontractor 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 Contract, all of which are
incorporated herein by reference.
If there is a conflict between any of the language contained in any exhibit or attachment to this
Contract, the language in the Contract 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 Contract 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.
26. Electronic Processinq and Signatures
The parties agree that this Contract 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 Contract. Therefore, the parties expressly agree that this Contract 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 Contract.
The parties executing this Contract electronically have authority to sign and bind its represented
party to this Contract.
26. No Third Party Beneficiaries
Except for the parties to whom this Contract is assigned in compliance with the terms of this
Contract, there are no third party beneficiaries to this Contract, and this Contract shall not impart
any rights enforceable by any person or entity that is not a party hereto.
27. Mandatory Vaccination for COVID-19 Due to Public Health Emergency
in accordance with Executive OrderACO-8-28-EO (Executive Order), all County contractors
working at Executive branch agencies shall be fully vaccinated if the work is required to be
performed in person and on site or requires interaction with the general public regardless of
frequency. This includes but is not limited to work on County property or in County facilities,
whether or not other workers are present, and including indoor or outdoor worksites. The Executive
Order does not apply to contractors who are present onsite for only a short period of time and have
a fleeting physical presence with others. The Contractor shall be responsible for the full COVID-19
vaccination verification of its onsite workers. The Attestation Form shall be signed and submitted to
procurement.web(cD-kingcounty.gov. Further information on the Executive Order and responses to
Frequently Asked Questions may be found at https://kingcounty.gov/depts/finance-business-
operations/procureme nt/for-busi ness/vacci nation-mand ate.aspx.
END OF COUNTY TERMS AND CONDITIONS
PART B. FEDERAL TERMS AND CONDITIONS
Appendix II to 2 CFR Part 200—Contract Provisions for Non-Federal Entity Contracts
Under Federal Awards
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In addition to other provisions required by the Federal 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, 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, "Equal Employment Opportunity" (30 FR 12319, 12935, 3 CFR
Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive
Order 11246 Relating to Equal Employment Opportunity," and implementing regulations at 41
CFR part 60, "Office of Federal Contract Compliance Programs, Equal Employment
Opportunity, Department of Labor."
(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, "Labor
Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted
Construction"). 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, "Contractors and Subcontractors on Public Building or Public Work
Financed in Whole or in Part by Loans or Grants from the United States"). 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 all hours worked in excess of 40 hours in the
work week. 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
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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
definition 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, "Rights to Inventions Made by Nonprofit Organizations and
Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," 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.
7401-7671q) 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 governmentwide exclusions in the
System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 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) 2 CFR 200.323 Procurement of recovered materials.
A non-Federal entity that is a state agency or agency of a political subdivision of a state and its
contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the
Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring
only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR
part 247 that contain the highest percentage of recovered materials practicable, consistent with
maintaining a satisfactory level of competition, where the purchase price of the item exceeds
$10,000 or the value of the quantity acquired during the preceding fiscal year exceeded
$10,000; procuring solid waste management services in a manner that maximizes energy and
resource recovery; and establishing an affirmative procurement program for procurement of
recovered materials identified in the EPA guidelines.
(K) 2 CFR 200.216 Prohibition on certain telecommunications and video surveillance
services or equipment.
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(a) Recipients and subrecipients are prohibited from obligating or expending loan or grant funds
to:
(1) Procure or obtain;
(2) Extend or renew a contract to procure or obtain; or
(3) Enter into a contract (or extend or renew a contract) to procure or obtain equipment,
services, or systems that uses covered telecommunications equipment or services as a
substantial or essential component of any system, or as critical technology as part of any
system. As described in Public Law 115-232, section 889, covered telecommunications
equipment is telecommunications equipment produced by Huawei Technologies Company or
ZTE Corporation (or any subsidiary or affiliate of such entities).
(i) For the purpose of public safety, security of government facilities, physical security
surveillance of critical infrastructure, and other national security purposes, video surveillance
and telecommunications equipment produced by Hytera Communications Corporation,
Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any
subsidiary or affiliate of such entities).
(ii) Telecommunications or video surveillance services provided by such entities or using such
equipment.
(iii) Telecommunications or video surveillance equipment or services produced or provided by
an entity that the Secretary of Defense, in consultation with the Director of the National
Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an
entity owned or controlled by, or otherwise connected to, the government of a covered foreign
country.
(b) In implementing the prohibition under Public Law 115-232, section 889, subsection (f),
paragraph (1), heads of executive agencies administering loan, grant, or subsidy programs shall
prioritize available funding and technical support to assist affected businesses, institutions and
organizations as is reasonably necessary for those affected entities to transition from covered
communications equipment and services, to procure replacement equipment and services, and
to ensure that communications service to users and customers is sustained.
(c) See Public Law 115-232, section 889 for additional information.
(d) See also §200.471.
(L) 2 CFR 200.322 Domestic preferences for procurements.
(a) As appropriate and to the extent consistent with law, the non-Federal entity should, to the
greatest extent practicable under a Federal award, provide a preference for the purchase,
acquisition, or use of goods, products, or materials produced in the United States (including but
not limited to iron, aluminum, steel, cement, and other manufactured products). The
requirements of this section must be included in all subawards including all contracts and
purchase orders for work or products under this award.
(b) For purposes of this section
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(1) "Produced in the United States" means, for iron and steel products, that all manufacturing
processes, from the initial melting stage through the application of coatings, occurred in the
United States.
(2) "Manufactured products" means items and construction materials composed in whole or in
part of non-ferrous metals such as aluminum; plastics and polymer-based products such as
polyvinyl chloride pipe; aggregates such as concrete; glass, including optical fiber; and lumber.
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Exhibit A: Scope of Work 9046 CDIP
JEFFERSON COUNTY PUBLIC HEALTH
CLINICAL and CLIENT SUPPORT SERVICES
June 30, 2022 through December 31, 2022
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 screenin & annual exam Cervical^
40-64, or If last pap normal & > 3 years or co-testing
35-39, if being seen for breast symptoms, (Pap normal and HPV negative) > 5 years:
or screening and surveillance for increased 21-64
risk clients under 40" or
64+ if ineligible for Medicare ^As per USPSTF 2012 Cervical Cancer Screening
Guidelines. If not eligible for Pap Test, pelvic exam
Prioritv for Mammography: paid only if done as part of visit for breast
Ages 50 or older, and last screening/annual exam
mammogram > 2 years
• Suspicious breast findings
Strong family history or other high
risk
*documentation is necessa
At or below 250% of Federal Poverty Level (FPL)^
Uninsured or Underinsured (deductible over $500)
Ineligible for Apple Health (Medicaid)
Washington State Residents
9045 CDIP-Jefferson County Public Health Page 1 of 4
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PRIORITY POPULATIONS
Some populations have lower screening and/or higher morbidity or mortality rates.
• 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
PERFORMANCE REQUIREMENTS
Clinical Services
The Contractor will:
• Make best efforts to comply and coordinate with BCCHP to meet ALL CDC and
DOH Performance Indicators relevant to screenings provided.
• Complete exam and reimbursement forms and, if applicable, diagnostic forms.
Forms are available online at:
http://www.kingcounty.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 raise awareness about cancer screening and distribute
educational materials, when appropriate.
• Work with BCCHP to identify clients at high-risk for not completing breast and
cervical cancer screening or accessing diagnostic care. Provide navigation support
according to BCCHP navigation policy to ensure these clients are able to complete
screening, diagnostics or initiate cancer treatment. Refer to the BCCHP Navigation
policy and BCCHP Fee Schedule for required documentation and related
reimbursement.
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.
9045 CDIP-Jefferson County Public Health Page 2 of 4
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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 program reimbursement forms and, if applicable, diagnostic forms.
Include U690s or Health Insurance Claim Forms with reports attached. Program
forms are available online at:
http://www kingcounty gov/heaIthservices/health/chronic/bchp/downloads.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. The navigation CPT code applies to BCCHP and non-BCCHP clients, as
long as the navigation is related to assisting the client to complete breast and
cervical cancer screening, access cancer diagnostic procedures or initiate cancer
treatment. Required documentation of navigation services must be provided to
BCCHP prior to reimbursement.
• Review billing reports and certify that work performed under this contract does not
duplicate any work charged against any other contract, subcontract, or other
funding source.
• Review BCCHP-generated invoices promptly and approve to BCCHP.
• 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 B).
Exhibit B 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. Please carefully review Exhibit B
REIMBURSEMENT PROCEDURES
BCCHP at Public Health will:
• Pay for services provided within the corresponding contract period.
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• Send the current Fee Schedules for Breast and Cervical 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.
• 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.
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Exhibit B: Budget
Jefferson County Public Health
615 Sheridan St
Port Townsend, WA 98368
June 30, 2022 - December 31, 2022
BUDGET DETAIL Initial Not to Exceed Maximum Not to
Amount Exceed Amount
Breast and Cervical Health Services
Includes one or more of the following: annual
exam with Clinical Breast Exam (CBE),
problem-focused visit, Pap tests, HPV tests. $ 1,400.00 $ 2,800.00
Total Funding $ 1,400.00 $ 2,800.00
Services will a paid by CPT code according tot 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 5 8
BCHP Services average$/client"
9045 CDIP-Jefferson County Public Health
DocuSign Envelope ID:6ACAOOA7-9DA1-4E71-8490-066DAC7816EO
Public Health
Seattle & King County ALL FIELDS MUST BE COMPLETED FOR PROMPT PAYMENT PROCESSING
King County Accounts Payable Information
INVOICE Purchase Order#
Supplier Name JEFFERSON COUNTY
Contract Number: 9045 CDIP Supplier# 6649
Exhibit:C Supplier Pay Site PUBLIC HEALTH
Contract Period of Performance:Jun 30,2022-Dec 31,2022 Remit Address 615 Sheridan St
Port Townsend,WA 98368
Jefferson County Public Health Invoice Date
Jefferson County Public Health Invoice#
Port Townsend,WA 98368 Amount to be Paid $0.00
Veronica Shaw Note to AP Pay Immediately
Payment Type (CircieOne) CHECK or ACH
Print on Remittance BCCHP
PH Prog.name/phone Jodi Olson,206-263-8200
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 Start End
Date Date
Invoice for services rendered under
this contract for the period of: I t
MM/DD/YY
King County AP Payment Information:
DPH
Project Organization Expend Acct Task Award Acct CPA CFDA Amount
11234921 800107 53180 1 100 101562 1 1 59694781 93.898 $ -
Breast Cervical&Colon Health Program Invoicing Information:
Costs I Award I Budget I Previously Billed Current Cumulative Balance
B&C-Fed 1101562 1 $ 1,400.00 $ $ 1 $ $ 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 clalm 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 PH Program Manager Approval Date
Veronica Shaw
Print Name
DocuSign Envelope ID:6ACAOOA7-9DA1-4E71-8490-066DAC7816EO
Exhibit D
Order Form
BCCHP Program
Contract # 9045 CDIP F-1
Contractor:Jefferson County Public Health
615 Sheridan
Port Townsend,WA 98368
Order Form 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:
Prior Not to Total Increase or Amended Not to
Description Exceed Decrease Exceed Amount
Amount
Breast and Cervical Services:
Annual exam with Clinical Breast $1,400 $ $1,400
Exam (CBE), problem-focused
visit, Pap tests, HPV tests.
Total reimbursable Contract $1,400 $ $1,400
Amount
The total reimbursement shall not exceed the amount set forth in this Order Form
******************************************************************************
Prior Not Total Amended Not
Funding Sources to Exceed Increase or to Exceed Effective Dates
Amount Decrease Amount
FEDERAL
Federal Catalogue No. $1,400 $ $1,400 6/30/22— 12/31/22
93.898
TOTAL $1,400 $ $1,400
Public Health Signature Date
Name
5/2022
DocuSign Envelope ID:6ACAOOA7-9DA1-4E71-8490-066DAC7816EO
CONTRACTOR ATTESTATION
KING COUNTY
COVID-19 VACCINATION REQUIREMENTS
Contractor Name: Jefferson County Public Health
Contract Number, if applicable: 9045 CDIP
Contractor named above must complete the section below and return via email to:King County:
procurement.webCiDkinQcountV.qov. If you are unable to comply with the requirements of this notice, you
must immediately notify King County in writing at the above email address.
By this Attestation, I, Heidi Eisenhour the at
(name) (title)
Jefferson Countv Public Health the "Contractor" named above, affirm that I am the authorized
(company name)
representative of the named contractor of the contract identified above, and acknowledge that I have
received, reviewed, and understand the following King County COVID-19 Vaccine Mandate Executive Order
("Vaccine Mandate"), as well as Governor Inslee's Proclamation 21-14.1 ("Proclamation") and agree to comply
with the Order and Proclamation.
1. A contractor(defined to include all vendors and suppliers, as well as subcontractors) shall assume
responsibility of verifying full COVID-19 vaccination for each of its own workers (including workers
of subcontractors) by manually reviewing a paper or digital copy of the worker's COVID-19 vaccine
record card.As the principal contractor, if you do not receive the requisite paper or digital proof of
vaccination from your worker, that worker is considered unvaccinated.
2. Workers for any contractor who are not fully vaccinated may not enter a King County operated
facility.
3. Workers for any contractor who test positive for COVID-19 may not enter a King County operated
facility until 5 days after symptoms have ended.
4. Workers for any contractor must wear an appropriate face mask while at a King County operated
facility.
5. It is the responsibility of the contractor to ensure there is no interruption of service to King County
if the contractor, or any personnel of the contractor, are precluded from working at a King County
operated facility due to non-compliance with the requirements outlined above.
6. Contractors are responsible for contacting any subcontractors and informing them of the Vaccine
Mandate and Proclamation requirements,and contractors are responsible for either providing an
attestation covering any subcontractors or for providing separate subcontractor attestations or proof of
subcontractor worker vaccination consistent with these requirements.
7. The contractor agrees to submit additional signed declarations upon request of and by the date
designated by King County.
8. The contractor further agrees to cooperate with any investigation or inquiry King County makes
into the contractor's compliance with the Vaccine Mandate as required by the Order.
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DocuSign Envelope ID:6ACAOOA7-9DA1-4E71-8490-066DAC7816E0
CONTRACTOR ATTESTATION
KING COUNTY
COVID-19 VACCINATION REQUIREMENTS
This includes providing information and records upon request, except any information or records
that the contractor is prohibited by law from disclosing.
For the purposes of this attestation, a contractor's worker is considered "fully vaccinated" when it has been
at least two weeks since receiving the final dose, as recommended by the manufacturer, of a vaccine that has
been authorized by the FDA for use in the United States, including vaccinations that have been approved
pursuant to an Emergency Use Authorization.
I declare under penalty of perjury under the law of the Washington that the foregoing is true and accurate.Signed
on J i `��t1 S r / S c�C>> Z at Port Townsend . WA.
(city) (state)
Z��l Heidi Eisenhour
Contractor Signature Print Name
Title
Jefferson County Public Health 615 Sheridan
Company/Contractor Name Street Address
dbanker@co.iefferson.wa.us Port Townsend, WA 98368
Email address City,State, Zip
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