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Consent Agenda
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street · Port Townsend · Washington · 98368
www.jefferson eou nty pub lie h e a Ith .0 rg
January 11, 2010
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE: January 19, 2010
SUBJECT: Agenda Item - Contract Agreement with Public Health of King County
for Breast Cervical & Colon Health Program Services; January 1, 2010 -
December 31, 2010; $26,265
STATEMENT OF ISSUE:
Jefferson County Public Health, Community Health, is requesting Board approval of the Contract Agreement
with Public Health of King County for Breast, Cervical and Colon Health Program Services; January 1, 2008 -
December 31, 2008; $26,265
ANALYSIS/ STRATEGIC GOALS/ PRO'S and CON'S:
This agreement between Jefferson County and King County Department of Public Health provides Breast
and Cervical Health Care, (Screening & Referral Services) to a specific segment of the population'. Services
are available to women who lack insurance to pay for .preventive services such as health exams,
mammograms and pap tests. This includes women age 40-64 with incomes at or below 2500/0 of Federal
Poverty Level and women below 3000/0 of FPL, pending special Susan G. Komen grant funds, for cancer
diagnoses. These services will also be available to women who may not be eligible for Medicare. This
contract provides for colon health services to certain counties that contract with Public Health of King
County, Jefferson County is not one of those counties.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
The agreement provides $26,265 in State funding. No general fund dollars support this program.
The agreement provides:
$10,000 in Public Education/Outreach
$13,000 for Clinical Services (Fee-for-Service)
$3,000 for Client Support Services
$265 for Incidental Expenses
COMMUNITY HEALTH
DEVELOPMENTAL DISABiliTIES
MAIN: (360) 385-9400
FAX: (360) 385-9401
PUBLIC HEALTH
ALWAYS WORKING.FOR A SAFER AND
HEALTHIER COMMUNI"
ENVIRONMENTAL HEALTH
WATER QUALITY
MAIN: (360) 385-9444
FAX: (360) 379-4487
Consent Agenda
RECOMMENDATION:
JCPHmanagement request approval of the Contract Agreement with Public Health of King County for Breast,
Cervical and Colon Health Program Services; January 1, 2010 - December 31, 2010; $26,265
REVIEWED BY:
L ~r;~
Date
~~~!-~C;K1!geC~~~ ~
Contract, Procurement and Real Estate Services
401 Fifth Avenue, Suite 1300
Seattle, WA 98104
206-296-4600 1TY Relay: 711
Fax 206-296-0629
Contract for Medical/Health
Professional Services
Amount: Twenty Six Thousand Two
Hundred Sixty Five Dollars
and Zero Cents
Duration:01/01/2010 to 12/31/2010
Services Provided:BCCHP
Department:PubUc Health
Contractqr:Jefferson County Public
Health
Fund$ourc;,:State
Contract No.:D39950D
Federal TaxpayerID:91-6001322
THIS CONTRACT is entered into by KING COUNTY (the "Countyll), and Jefferson County Public Health
(the "Contractor"), whose address is 615 Sheridan, Port Townsend, WA 98368.
The County is undertaking certain activities related to providing Breast. Cervical and Colon Health
Proaram services to the community, and the County desires to engage the Contractor to render certain
services in connection with such undertakings of the County,
NOW, THEREFORE, in consideration of payments, covenants, and agreements hereinafter mentioned,
to be made and performed by the parties hereto, the parties covenant and do mutually agree as follows:
I. CONTRACT DOCUMENT
The Contractor shall provide services and comply with the requirements set forth herein. The Contract
shall consist of the following documents and attached exhibits, each of which are made a part hereof by
this reference in the following order of precedence:
1. Contract Amendments executed pursuant to Section XIX herein.
2. Contract for Medical/Health Professional Services, which includes:
· Scope of Services............................................................ Attached hereto as Exhibit 1
· Budget.............................................................................. Attached hereto as Exhibit 2
Invoice...... ................. .... .... ................ ........... ........... .... ..... Attached hereto as Exhibit 3
Credentials Requirements............................................... Attached hereto as Exhibit 4
Certificate(s) of Insurance and Policy Endorsement....... Attached hereto as Exhibit 5
W9 Farm (if required)....................................................... Attached hereto as Exhibit 6
Page: 1
II. DURATION OF CONTRACT
This Contract shall commence on 01/01/2010, and shall terminate on 12/31/2010, unless extended or
terminated earlier, pursuant to the terms and conditions of the Contract.
III. COMPENSATION AND METHOD OF PAYMENT
A. The County shall reimburse the Contractor for satisfactory completion of the services and
requirements specified in this Contract in an amount not to exceed Twenty Sjx Thousand Two
Hundred Sixty Five Dollars and Zero Cents, payable in the following ,manner:
Upon receipt and approval of an invoice that will be provided by the BCHP Program and signed by
the Contractor, in the form of the sample set forth in Exhibit 3 that cQmpJies with the budget in
Exhibit 2.
B. The Contractor shall submit its final invoice and such other documents as are required pursuant to
this Contract within ten (10) calendar days of completion of the Scope of Services. Unless waived
by the County in writing failure by the Contractor to submit the final invoice and required
documents will relieve the County from any and allliabiJity for payment _to the Contractor for the
amount set forth in such invoice or any subsequent invoice.
C. If the Contractor fails to comply with any terms or conditions of this Contract or to provide in any
manner the work or services agreed to herein, the County may withhold any payment due the
Contractor until the County is satisfied that corrective action, as specified by the County, has been
completed. This right is in addition to and not in lieu of the County's right to terminate this Contract
as provided in Section IV below.
D. 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.
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.
IV. TERMINATION
A. This Contract may be terminated by the County without cause, in whole or in part, upon providing
the Contractor ten (10) calendar days' advance written notice of the termination.
If the Contract is terminated pursuant to this Section IV, paragraph A: (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; and (2) the Contractor shall be released from any obligation to
provide further services pursuant to the Contract.
B. The County may terminate this Contract, in whole or in part, upon five (5) calendar days' advance
written notice in the event: (1) the Contractor materially breaches any duty, obligation, or services
required pursuant to this Contract, or (2) the duties, obligations, or services required herein
become impossible, illegal, or not feasible.
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If the Contract is terminated by the County pursuant to this Subsection IV (B) (1), the Contractor
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 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.
C. If expected or actual funding is withdrawn, reduced or limited in any w.ay prior to the termination
date set forth above in Section II or in any amendment hereto, the County may, upon written notice
to the Contractor, immediately terminate this Contract in whole or in pa.rt.
If the Contract is terminated pursuant to this Section IV, paragraph C: (1) the County will be liable
only for payment in accordance with the terms of this Contract for sEt.rvi.ces rendered prior to the
effective date of termination; and (2) the Contractor shall be released from any obligation to
provide further services pursuant to the Contract.
Funding under this Contract beyond the current appropriation year is co.nditional upon
appropriation by the County Council of sufficient funds to support the a.ctivities described in this
Contract. Should such an appropriation not be approved, this contract will terminate at the close of
the current appropriation year.
D. Nothing herein shall limit, waive, or extinguish any right or rem.edy provided by this Contract or law
that either party may have in the event that the obligations, terms and .ponditions set forth in this
Contract are breached by the other party. '
V. MAINTENANCE OF RECORDS
A. The Contractor shall maintain, and shall require any subcontractor to maintain, accounts and
records, including personnel, property, financial, and programmatic records and such other records
as may be deemed necessary by the County to ensure proper accounting for all contract funds
and compliance with this Contract. All such records shall suffic.ientlyand properly reflect all direct
and indirect costs of any nature expended and services provided in th" ,perfQrmance of this
Contract. The Contractor shall make such documents available to the County for inspection,
copying, and auditing upon request.
B. All records referenced in subsection (A) shall be maintained for a period of six (6) years after
completion of work or termination hereof unless permission to destroy them is granted by the
Office of the Archivist in accordance with RCW Chapter 40.14, or unle,ss a longer retention period
is required by law.
C. The Contractor shall provide access to its facilities, including those of any subcontractor, to the
County, the state and/or federal agencies or officials at aU reasonable times in order to monitor and
evaluate the services provided under this Contract.
D. The Contractor agrees to cooperate with the County or its designee in the evaluation of the
services provided under this Contract and to make available all information reasonably required by
any such evaluation process. The results and records of said evaluation shall be maintained and
disclosed in accordance with RCW Chapter 42.56.
E. If the Contractor received a total of $500,000.00 or more in federal financial assistance during its
fiscal year from the County, and is a non-profit organization or institution of higher learning or a
hospital affiliated with an institution of higher learning, and is, under this Contract, carrying out or
administering a program or portion of a program, it shall have an independent audit conducted of
its financial statement and condition, which shall comply with the requirements of GAAS (generally
accepted auditing standards), GAD's Standards for Audits of Governmental Organizations,
Programs, Activities and Functions and OMS Circulars A-133 and A-128, as amended and as
applicable. Contractors receiving federal funds from more than one County department or division
shall be responsible for determining if the combined financial assistance is equal to or grater than
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$500,000.00. The Contractor shall provide one copy of the audit report to each County division
providing federal financial assistance to the Contractor no later than six (6) months subsequent to
the end of the Contractor's fiscal year.
VI. CORRECTIVE ACTION
If the County determines that a breach of contract has occurred, that is 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 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 Contractor in writing of the nature of the breach;
B. The Contractor 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
Contract into compliance, which date shall not be more than ten (10) days from the date of the
Contractor's response; unless the County, at its sole discreti.on, specifies in writing an extension in
the number of days 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 plan shall be at the sole discretion of the County;
D. In the event that the Contractor does not respond within the appropr~ate time with a corrective
action plan, or the Contractor's corrective action plan is determined by the County to be
insufficient, the County may commence termination of this Contracti,n whole orin part pursuant to
Section IV.B;
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; and
F. Nothing herein shall be deemed to affect or waive any rights the parties may have pursuant to
Section IV, Subsections A, 8, C, and D.
VII. ASSIGNMENT/SUBCONTRACTING
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) oeJendar 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 (i) support services not related to the subjectm.stter of this contract, or (ii)
supplies.
VIII. HOLD HARMLESS AND INDEMNIFICATION
A. In providing services under this Contract, the Contractor is an independent contractor, and neither
the Contractor 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 compe,n8ation for these services and
shall make no claim of career service or civil service rights which mayaecrue to a County
employee under state or local law.
The County assumes no responsibility for the payment of any CQmpe:naation, 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 and 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,
Page:4
benefits or taxes; and/or (2) the supplying to the Contractor of work,le",ices, materials, and/or
supplies by Contractor employees or other suppliers in connection wjth or in support of the
performance of this Contract.
B. 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 shall not be diminished or
. extinguished by the prior termination of the Contract purs-uant to the Duratjo_n of Contract, or the
Termination section.
C. The Contractor shall protect, defend, indemnify, and save harmless the CO'-lnty, [and the State of
Washington (when any funds for this ContrCict are provided by the Stat. of Washington)], their
officers, employees, and agents from any and all costs, fees (includi,ngattorney fees), claims,
actions, lawsuits, judgments, awards of damages or liability of any ki"n-d, arising out of or in any
way resulting from the negligent acts or om,issions of the Contractor, it. officers, employees, sub-
contractors of any tier and/or agents. The Contractor agrees that its obligations under this
paragraph extend to any claim, demand, and/or cause of action broug,bt by or on behalf of any of
its employees, sub-contractors of any tier or agents.
In addition to injuries to persons and damage to property, the term "aaims," for purposes of this
paragraph C, shall include, but not be limited to, assertions that the ute or transfer of any software,
book, document, report, film, tape, or sound reproductio.n or material of any kind, delivered
hereunder, constitutes an infringement of any copyright, patent, trademark, trade name, and/or
otherwise results in an unfair trade practice.
D. For purposes of paragraphs A and C above, the Contractor, bymutuall'legotiation, 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.
E. In the event the County incurs attorney fees and/or costs in the defense of claims within the scope
of paragraph A and C.above, such attorney fees and costs shall be reepverable from the
Contractor. In addition King County shall be entitled to recover from the Contractor its attorney
fees, and costs incurred to enforce the provisions of this section.
F. The indemnification, protection, defense and save harmless obligations eontained herein shall
survive the expiration, abandonment or termination of thjs Contract.
G. Nothing contained within this provision shall affect and/or alte_f the ,application of any other
provision contained within this agreement:
IX. INSURANCE REQUIREMENTS
A. By the date of execution of this Contract, the Contractor shall ,procure and maintain for the duration
of this Contract, insurance against claims for injuries to persons or demages to property, including
products-completed operations which may arise from, or in connection with, the performance of
work hereunder by the Contractor, its agents, representative. employees, and/or subcontractors.
The Contractor or subcontractor shall pay the cost of such insurance. The Contractor may furnish
separate certificates of insurance and policy endorsements fro.m each subcontractor as evidence
of compliance with the insurance requirements of this Contract.
For All Coverages:
Each insurance policy shall be written on an "occurrence" form; excepting that insurance for
professional liability, errors and omissions when required, may be a~table on a, Ifclaims made"
form.
If coverage is approved and purchased on a "claims made" basis, the Contractor warrants
continuation of coverage, eithet through policy renewals or the purchase of an extended discovery
period, if such extended coverage is available, for not less than three years from the date of
completion of the work which is the subject of this Contract.
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By requiring such minimum insurance coverage, the County shall not be deemed or construed to
have assessed the risks that may be applicable to the Contractor under this Contract. The
Contractor shall assess its own risks and, if it deems appropriate an'dlor prudent, maintain greater
limits and/or broader coverage.
Nothing contained within these insurance requirements shall be deemed to limit the scope,
application and/or limits of the coverage afforded, which cove,rage will apply to each insured to the
full extent provided by the terms and conditions of the policy(s). Nothing contained within this
provision shall affect and/or alter the application of any other provi,loncontained within this
Contract. -
B. Minimum Scoos Of Insurance
Coverage shall ,be at least as broad as:
1. General Liability:
Insurance Services Office form number (CG 00 01 current editio,n) covering COMMERCIAL
GENERAL liABILITY including Products and Completed Operations.
2. Professional liability:
Professional Liability, Errors and Omissions coverage. J,n the event that services delivered
pursuant to this Contract either directly or indirectly involve or ,req_uire professional services,
Professional Liability, Errors and Omissions coverage shall be provided.
3. Automobile Liability:
Insurance Services Office form number (CA 00 01 current edition) covering BUSINESS
AUTO COVERAGE, symbol 1 "any auto"; or the combination of symbols 2, 8,
and 9.
4. Workers' Compensation:
Workers' Compensation coverage, as required by the Industrial Insurance Act of the State of
Washington.
5. Employers Liability or"Stop-Gap":
The protection provided by the Workers Compensation policy Part 2 (Employers Liability) or,
in states with monopolistic state funds, the protection provided by the' "Stop Gap"
endorsement to the General Liability policy.
c. Minimum Limits of Insurance
The Contractor shall maintain limits no less than,
1. General Liability: $1,000,000 combined single limit per occurren,ce for bodily injury, personal
injury and property damage, and for those policies with aggregate limits, a $2,000,000
aggregate limit.
2. Professional Liability, Errors and Omissions: $1,000,000 PerQlaim and in the Aggregate
3. Automobile Liability: $0 combined single limit per accident for bodily injury and property
damage.
4. Workers' Compensation: Statutory requirements of the State of residency, and
5. Employers' Liability or "Stop Gap" coverage: $1,000,000
D. Deductibles and Self-Insured Reten~ions
Any deductibles or self-insured retentions must be declared to, and approved by, the County. The
deductible and/or self-insured retention of the policies shall not limit or apply to the Contractor's
liability to the County and shall be the sole responsibility of the Contractor.
E. Other Insurance Provisions
Page:6
The insurance coverage(s) required in this Contract are to contain, or be endorsed to contain the
following provisions:
1. All Liability Policies except Workers Compensation and Professional Liability:
a. The County, its officers, officials, employees and agents are to be covered as
additional insureds as respects liability arising out of activities performed by or on
behalf of the Contractor in connection with this Contract
b. The Contractor's insurance coverage shall be primary insurance as respects the
County, its officers, officials, employees and agents. Any insurance and/or self-
insurance maintained by the County, its officers, officials, employees or agents shall
not contribute with the Contractor's insurance or benefit the Contractor in any way.
c. The Contractor's insurance coverage shall apply separately to each insured against
whom a claim is made and/or lawsuit is brought, except with respect to the limits of the
insurer's liability.
2. All Policies:
a. Coverage shall not be suspended, voided, canceled, reduced in coverage or in limits,
except by the reduction of the applicable aggregate limit by claims paid, until after
forty-five (45) calendar days prior written notice, has been given to the County.
F. Acceptabilitv of Insurers
Unless otherwise accepted by the County:
Insurance coverage is to be placed with insurers with a Bests' rating of no less than A: VIII, or, if
not rated with Bests', with minimum surpluses the equivalent of BestsJ surplus size VIII.
Professional Liability, Errors and Omissions insurance coverage may be placed with insurers with
a Bests' rating of 8+:VII. Any exception must be approved by the County.
If at any time any of the foregoing policies fail to meet minimum requirements, the Contractor shall,
upon notice to that effect from the County, promptly obtain a new policy, and shall submit the same
to the County, with the appropriate certificates and endorsements, for approval.
G. Verification of Coveraae
The Contractor shall furnish the County with certificates of insurance and endorsements required
by this Contract. The certificates and endorsements for each insurance policy are to be signed by
a person authorized by that insurer to bind coverage on its behalf. The certificates and
endorsements for each insurance policy are to be on forms approved by the County and are to be
received and approved by the County prior to the commencement of activities associated with the
Contract. The County reserves the rights to require complete, certified copies of all required
insurance policies at any time.
If Professional Liability coverage is required under this contract, the Certificate of Insurance
provided by the Contractor shall specifically state that the activities required under Contract
#0399500 are included under this policy.
H. Subcontractors
The Contractor shall include all subcontractors as insureds under its policies, or shall require
separate certificates of insurance and policy endorsements from each subcontractor. Insurance
coverages provided by subcontractors as evidence of compliance with the minimum insurance
requirements of this Contract shall be subject to all of the requirements stated herein.
X. CONFLICT OF INTEREST, NONCOMPETITIVE PRACTICES AND DISCLOSURE
A. Conflict of Interest
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By entering into this Contract to perform work, the Contractor repreeentsthatit has no interest and
shall. not acquire any interest that conflicts, in any manner or degree 'with the work required to be
performed under this Contract. The Contractor shall not emplQY any person or agent having any
conflict of interest. In the event that the Contractor or its agent., employees or representatives
hereafter acquires such a conflict of interest, it shall immediElteJy di$Close such conflict to the
County. The County shall require that the Contractor take immediattaction to eliminate the
conflict up to and including termination for default.
B. Contingent Fees and Gratuities
By entering into this Contract to perform.Work, the Contractor represents that:
1. No person except as designated by Contractor has been employed -or retained to solicit or
secure this Contract with an agreement or understanding that a eo,mmission, percentage,
brokerage, or contingent fee would be paid. '
2. No gratuities, in the form of entertainment, gifts or otherwise, were offered or given by the
Contractor or any of its agents, employees or representatives, to any official, member or
employee of the County or other governmental agency with a vi,ew toward securing this
Contract or securing favorable treatment with respect to the award.ing or amending, or the
making of any determination with respect to the performance of this Contract.
3. Any person having an existing Contract with the County or set$ing to obtain a Contract who
willfully attempts to secure preferential treatment in his O,f herd..lings with the County by
offering any valuable consideration, thing or promise, in any fo,rm to _ny County official or
employee shall have his or her current Contracts with the County canceled and shall not be
able to enter into any other Contracts with KingC_ounty fora period of two (2) years.
C. Disclosure of Current and Former County Employees; Disclo$ure of Int~rests under KeC 3.04. 120
To avoid any actual or potential conflict of interest or unethic.l;conduct:
1. County employees or former County employees are prohibited from assisting with the
preparation of proposals or contracting with, influencing,EldvP,cating, advising or consulting
with a third party, including. Contractor, while employed bY the County or within one (1) year
after leaving County employment if he/she participated in determining the Work to be done
or processes to be followed while a County employee.
2. 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 termination of this Contract.
3. After Contract award, the Contractor is responsible for notifying the County of current or
former County employees who may become involved in the Contract at any time during the
term of the Contract.
4. If the Contractor is providing professional or technical services to the county costing in
excess of $2,500.00, then pursuant to K.C.C. 3.04.120, which i.. incorporated herein by this
reference, the Contractor shall file both with the County Executive and the King County
Board of Ethics a sworn disclosure statement. The Contractor Rirther agrees to comply with
all provisions set out in K.C.C. 3.04.120.
XI. NONDISCRIMINATION AND EQUAL EMPLOYMENT OPPORTUNITY
A. Nondiscrimination in Emolovment and Provision of Services. During the performance of this
. contract, neither the Contractor nor any party subconsu,lti,ng under tM.uthority of th,is Contract
shall discriminate or tolerate harassment'on the basis of race, color, sex, religion, national origin,
marital status, creed, sexual orientation, age, or the presence of any sensory, mental, or physical
disability in the employment or application for employment or in the administration or delivery of
services or any other benefits under this Contract. King County Code C'KCC") Chapter 12.16,
Page:8
12.17 and 12.18 are incorporated herein by reference, and such requirements shall apply to this
Contract.
B. Eaual Benefits to Emplovees with Domestic Partners. Pursuant to Ordinance 14823, King
County's ~~Equal Benefits" (EB) ordinance, and related admin,istrativerules adopted by the County
Executive, as a condition of award of a contract valued at $25,000 or ",ore, the Contractor agrees
that it shall not discriminate in the provision of employee benefits between employees with
spouses, and employees with domestic partners during the performance of this Contract. Failure to
comply with this provision shall be considered a material breach of this Contract, and may subject
the Contractor to administrative sanctions and remedies for breach.
When the contract is valued at $25,000 or more, the Contracto.rehaUcomplete a Worksheet and
Declaration form for County review and acceptance prior to C:o,ntract execLition. The EB
Compliance forms, Ordinance 14823 (which is codified at KCCChapter 12.19), and related
administrative rules are incorporated herein by reference. They ,areaJ,o available online at:
http://www . m etrokc. gov /procu rementlservi-ces/eb. aspx
C. Nondiscrimination in Subconsulting Practices. During the term of this Contract, the Contractor shall
not create barriers to' open and fair opportunities to participate io Coun.ty contracts or to obtain or
compete for contracts and subcontracts as.sources of suppliEts, equi,pment, construction and
services. In considering offers from and doing business with subcontractor and suppliers, the
Contractor shall not discriminate against Ciny person on the basi. of race, color, religion, sex, age,
national origin, creed, marital status, sexual orientation or the presen.ce of any mental or physical
disability in an otherwise qualified disabled person.
D. Compliance with Laws and Reaulations. The Contractor shall comply fully with aU applicable
federal, state and local laws, ordinances, executive orders andregulatiQns that prohibit
discrimination. These laws include, but are not limited to,RCW Chapter 49.60, Titles VI and VII of
the Civil Rights Act of 1964, the American with Disabilities Act and the Restoration Act of 1987.
The. Contractor shall further comply fully with any affirmative action requirements set forth in any
federal regulations, statutes or rules included or referenced in the contract documents.
E. Small Contractors and Supcliers and Minoritv and WQmen Busir:tes~~:Dterprises OCDortunities.
King County encourages the Contractor to utilize small businesses, in(:luding Small Contractors
and Suppliers (SCS), as defined below, and minority-owned and wome,n-owned business
enterprises in County contracts. The County encourages the Contractor -to use the following
voluntary practices to promote open competitive opportunities for small businesses, including SCS
firms and minority-owned and women-owned business enterprises:
1. Inquire about King County's Contracting Opportunities Progra,m,. King County has
established a Contracting Opportunities Program to maximize the participation of Small
Contractors and Suppliers (SCS) in the award of King Cou,nty contracts. The Program is
open to all SCS firms certified by the King County Busi,ness Development and Contract
Compliance Office (BDCe). As determined by SOCC anq identified in the solicitation
documents issued by the County, the Program will apply to specific oontracts. However, for
those contracts not subject to the Program or for which the Cont;ractor.elected not to
participate in the Program during the solicitation stage, the Contractor is still encouraged to
voluntarily inquire about available firms. Program materials, including application forms and
a directory of certified SCS firms, are available at the follOwing Web-site address:
http://bdcc.metrokc.gov/bred/Lists/SCS.CertifiedContractors/PublicView1.htm . Telephone
206-205-0700, TTY: Relay 711, for more information
The term "Small Contractors and Suppliers" (SCS) mean$ that I bueiriess and the person or
persons who own and control it are in , financial eondition whicb puts the bUliiness ata
substantial disadvantage in attempting to compete for public contracts. The relevant
financial condition for eligibility under the Program is set at fifty percent (50oA>) of the Federal
Small Business Administration (SBA) small business size standards using the North
Page:9
American Industry Classification System and Owners' Personal Net Worth less than $750K
dollars.
2. Contact the Washington State Office of Minority and Women's Business Enterprises
(OMWBE) to obtain a list of certified minority-owned and women"ow,ned business
enterprises by visiting their website at http://www.omwb~.wa.90vJorbY telephone 360-704-
1181.
3. Use the services of available community organizations, consult..nt groups, local assistance
offices, the County, and other organizations that provide assistan,C8 in the recruitment and
placement of small businesses, incJLJding SCS firms and minority.owned and business-
owned enterprises. '
F. Eaual Emplovment Opportunity. The Contractor will implement and carry out the obligations in its
Affidavit and Certificate of Compliance regarding equal employment opportunity, and all other
requirements as set forth in the Affidavit and Certificate of Compliance.
G. Record-Keeoina Reauirements and Site Visits. The Contractor shaU maintain, for at least 6 years
after completion of all work under this Contract, the following:
1. Records of employment, employment advertisements, applicati,on 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 businesses seeking to participate on this Contract, and ~I1Y other information
necessary to document the actual use of and payments t,o subcontractor and suppliers in
this Contract, including employment records.
The County may visit, at any time, the site of the work and the Contractor's office to review the
foregoing records. The Contractor shall provide every assistance requtsted .by the County during
such visits. In all other respects, the Contractor shall- make the forego.ing records available to the
County for inspection and copying upon request. If this Contract involves federal funds, the
Contractor shall comply with all record keeping requirements set forth ,in any federal rules,
regulations or statutes included or referenced in the CO,ntract.
H. Sanctions for Violations. Any violation of the mandatory requirements of the provisions of this
Section shall be a material breach of contract, for which the Contractor may be subject to
damages, withholding payment and any other sanctions provided for by contract and by applicable
law.
XII. REQUIRED SUBMITTALS
A. Required Submittals Upon Completion of Work. Upon completion of work and as a condition
precedent to final payment, the Contractor shall submit a Final Affidavit of Amounts Paid to King
County Business Development and Contract Compliance Section. Identify amounts actually paid,
and any amounts owed, to each subcontractor and/or supplier (if appUcable) for performance
under this Contract. Failure to submit such affidavits may result in withholding of payments or the
final payment. The Contractor may contact the King County Busines$ Development and Contract
Compliance section for assistance with the requirements of this subsection at 206-205-0700. TTY:
Relay 711.
Other assistance is available by contacting the King County Procurem.ent and Contract Services
Section at the address below:
Procurement and Contract Services Section
M/S CNK-ES-0320
401 Fifth Avenue, 3rd Floor
Seattle, WA 98104
Phone: 206-263-9400 TTY: Relay 711
Page:10
XIII. COMPLIANCE WITH SECTION 504 OF THE REHABILITATION ACT OF 1973, AS AMENDED AND
THE AMERICANS WITH DISABILITIES ACT OF 1990
The Contractor has completed a Disability 504/ADA Self-Evaluation Questionnaire for all programs and
services offered by the Contractor (including any services not subject to this Contract); and has
evaluated its services, programs and employment practices for compliance with Section 504 of the
Rehabilitation Act of 1973, as amended ("504"), 8,nd the Americans with Disabilities Act ("ADA"). The
Contractor has completed a 504/ADA Disability Assurance of Compliance a~ it is attached as an exhibit
to this Contract and is incorporated herein by reference.
XIV. PATENTS, COPYRIGHTS AND RIGHTS IN DATA
Any nonderivative patentable result or materials suitable for copyright arising out of this Contract shall be
owned and retained by the County. The County in its sole discretion shall ,determine whether it is in the
public's interest to release or make available any patent or copyright.
The Contractor agrees that the ownership of any plans, drawing, designs,S(:()pe of Work, reports,
operating manuals, calculations, notes and other work submitted or which i,specified to be delivered
under this Contract, whether or not complete (referred to in this subse,ctione. "Subject Datall) shall be
vested in the County.
All such Subject Data furnished by the Contractor pursuant to this Contraet,Qther than documents
exclusively for internal use by the County, shall carry such notations on th,e ,front cover or a title page, (or
in such case of maps, in the name block), as may be requested by the County. The Contractor shall
also place its endorsement on all Contractor-furnished Subject Data. All suehidentification details shall
be subject to approval by the County prior to printing.
The Contractor shall ensure that the substance of foregoing subsectiQnsifJinclLJdedin ellch subcontract
for the Work under this Contract.
XV. ENVIRONMENTAL PURCHASING POLICY
In accordance with King County Code 10.16, Contractors are required to ulerecycled and recyclable
products, and both sides of paper sheets for printed and photocopiedmaterills, whenever practicable, in
fulfilling contractual obligations to the County.
XVI. ENTIRE CONTRACT / WAIVER OF DEFAULT
The parties agree that this Contract 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 Contract. Ws,iver of any default
shall not be deemed to be a waiver of any subsequent default. Waiver or broach 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.
XVII. PUBLIC DISCLOSURE OF CONTRACTS
This Contract shall be considered a public document and will be av.iJable fQrinspection and copying by
the public in accordance with the Public Records Act, Chapter 42.56 RCW(the "Act").
If the Contractor considers any portion of any record provided to King County under this Contract,
whether in electronic or hard copy form, to be protected under law, the Contractor ahall clearly identify
each such portion with words such as "CONFIDE,NTIAL," "PROPRIETARY" or "BUSINESS SECRET."
If a request is made for disclosure of such portion, the County will determ,ine whether the material should
be made available under the Act. If the County determines that the material i, slJ.bject to disclosure, the
County will notify the Contractor of the request and allow the Contractor _.(10) bu.inesI days to take
whatever action it deems necessary to protect its interests. If the Contractor fails or neglects to take
such action within said period, the County will release the portions of record(s) deemed by the County to
be subject to disclosure. King County shall not be liable to the Contractor for inadvertently releasing
Page: 11
records pursuant to a disclosure request not clearly identified by the ContraQtpr as "CONFIDENTIAL,"
"PROPRIETARY" or "BUSINESS SECRET."
XVIII. NOTICES
Whenever this Contract provides for notice to be provided by one party to an.other such notice shall be in
writing.
Any time within which a party must take some action shall be computed from the date that the notice is
received by said party. Notice shall be provided to:
KING COUNTY: CONTRACTOR:
PHSKC Jefferson County Public Health
Feest, Scott Jefferson County Public Health
401 Fifth Avenue, Suite 615 Sheridan
Seattle, WA 98104 Port Townsend, WA 98368
Phone: (206) 263-8175 Phone:
XIX. CONTRACT 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.
XX. DEBARMENT AND SUSPENSION CERTIFICATION
Agencies receiving federal funds that are debarred, suspended, or proposed for debarment are excluded
from contracting with the County. The Contractor, by signature'to thil Contract, certifies that the
Contractor is not presently debarred, suspended, or proposed for d,barmentby any Federal department
or agency. The Contractor also agrees that it will not enter into a subcontract with a contractor that is
debarred, suspended, or proposed for debarment. The Contractor agree. to ,notify King County in the
event it, or a subcontractor, is debarred, suspended, or proposed for debart11,nt by any Federal
department or agency. For more information on suspension and debarment, see Federal Acquisition
Regulation 9.4.
XXI. COMPLIANCE WITH THE HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT OF 1996
(HIPAA)
Terms used in this section shall have the same meaning as those terms in t,he Privacy Rule, 45 Code of
Federal Regulations (CFR) Parts 160 and 164.
A. Obliaations and Activities of the Contractor
1. The Contractor agrees not to use or disclose protected health information other than as
permitted or required by this Contract, HIPAA and the Health Information Technology for
Economic and Clinical Health Act (HITECH). The Contractor shall use and disclose
protected health information only if such use or disclosure, respectively r is in compliance
with each applicable requirement of 45 CFR ~ 164~504(e)JO The Contractor is directly
responsible for full compliance with the privacy provisions of HIPM and HITECH that apply
to business associates.
2. The Contractor agrees to implement administrative, phys,i~al,and technical safeguards that
reasonably and appropriately protect the co nfidentialityJ integrity, and availability of the
protected health information that it creates, receives, maintainer ortra,nsmits on behalf of the
County as required by 45 CFR, Part 164, Subpart C. The CQRtractoris directly responsible
for compliance with the security provisions of HIPMand HI.TECH that apply to business
associates, including sections 164.308, 164.310, 164.312, and 1:14.316 of title 45 CFR.
3. Within two (2) business days of the discovery of a breach as defined at 45 CFR 9 164.402
the Contractor shall notify the County of any breach of unsecured protected health
information. The notification shall include the identification of each individual whose
unsecured protected health information has been, or is reasonably believed by the
Page:12
Contractor to have been, accessed, acquired, or disclosed during such breach; a brief
description of what happened, including the date of the breach find the date of the discovery
of the breach, if known; a description of the types of unsecured _protected health information
that were involved in the breach' (such as whether full name, SQeials8curity number, date of
birth, home address, account number, diagnosis, disability code, or other types of
information were involved); any steps individual. sho..dd take to protect themselves from
potential harm resulting from the breach; a brief description of what the Contractor is doing
to investigate the breach, to mitigate harm to individu'als, and to protect against any further
breaches; the contact procedures of the Contractor for lndivid:ua,ls to ask questions or learn
additional information, which shall include a toll free number, an e-mail address, Web site, or
postal address; and any other information required to be provided to the individual by the
County pursuant to 45 CFR ~ 164.404, as amended. A breach shall be treated as discovered
in accordance with the terms of 45 CFR ~ 164.410. The information shall be updated
promptly and provided to the County as requested by the County.
4. The Contractor agrees to mitigate, to the extent pra,cticable, any harmful effect that is known
to the Contractor of a use or disclosure of protected hEtalth information by the Contractor in
violation of the requirements of this Contract or the law.
5. The Contractor agrees to report in writing all unauthorized or otherwise improper disclosures
of protected health information or security incident to the C~Y,nty within two days of the
Contractor knowledge of such event.
6. The Contractor agrees to ensure that any agent, including a subcontractor, to whom it
provides protected health information received from, or created or received by the Contractor
on behalf of the County, agrees to the same re$trictions and,(X)nditions that apply through
this Contract to the Contractor with respect to such inform.ation.
7. The Contractor agrees to make available protected health information in accordance with 45
CFR ~ 164.524.
8. The Contractor agrees to make available protected he,lth information for amendment and
incorporate any amendments to protected health information in accordance with 45 CFR 9
164.526.
9. The Contractor agrees to make internal practices, books, andreeords, including policies and
procedures and protected health information, relating to thE! UIS4t,nd disclosure of protected
health information received from, or created or received by the Contractor on behalf of King
County, available to the Secretary, in a reasonable time and m.anner for purposes of the
Secretary determining King County's compliance with HIPAA, HITECH or this' Contract.
10. The Contractor agrees to make available the information require~ to provide an accounting
of disclosures in accordance with 45CFR ~164.528. Should an individual make a request to
the County for an accounting of disclosures of his or her protected health information
pursuant to 45 CFR S 164.528, Contractor agrees to promptly provide an accounting, as
specified under 42 U.S.C. ~ 17935(c)(1) and 45 CFR ~164.528"of disclosures of protected
health information that have been made by the Contractor acting on behalf of the County.
The accounting shall be provided by the Contractor to the Co-u,nty or to t,he individual, as
directed by the County.
B. Permitted Uses and Disclosures bv Business Associate
The Contractor may use or disclose protected health info,rmation tOJ)frform functions, activities, or
services for, or on behalf of, King County as specified in this Contr-=t,.provided that such use or
disclosure would not violate HIPAA jf done ,by King County or thtminil.num necess.ary policies and
procedures of King County.
C. Effect of Termination
Page: 13
1. Except as provided in paragraph C.2. of this Section, upon termInation of this Contract, for
any reason, the Contractor shall return or destroy all protected health information received
from the County, or created or recei.ved by the Contractor on behalf of the County. This
provision shall apply to protected health information that i$ in the po$session of
subcontractors or agents of the Contractor. The Contractor shal.l retain no copies of the
protected health information.
2. In the event the Contractor determines that returning or deslroyjog the protected health
information is infeasible, the Contractor shall provide to King Co,unty notification of the
conditions that make return or destryction infeasible. _ Uponnotlfi;ation that return or
destruction of protected health information is infeasible, .the Contractor shall extend the
protections of the Contract to such protected health informati,on and limit further uses and
disclosure of such protected health Information to those,purpqs:I' that make the return or
destruction infeasible, for so long as the Contractor maintains aueh protected health
information.
D. Reimbursement for Costs Incurred Due to Breach
1. Contractor shall reimburse the County, without limitation, foraH costs of investigation,
dispute resolution, notification of individuals, the m,edia,,$nd the government, and expenses
incurred in responding to any audits or other investigation relating to or arising out of a
breach of unsecured protected health information by th, Contractor.
E. Visitor Confidentialitv
Contractor and any Person visiting a facility of the Seattl~KingCoun~yDepartment of Public
Health will be required to adhere to the Department of PubliC H"alth', HIPAA policies, including
but not limited to the policy on Health Information Privacy (General) f1"()5-o~005and the signing
of a Visitor Confidentiality Agreement.
Page:14
XXII. APPLICABLE LAW AND FORUM
This Contract shall be governed by and construed according to the laws of the State of Washington,
including, but not limited to, the Uniform Commercial Code, Title 62A RCW.Any eJaim or suit concerning
this Contract may only be filed and prosecuted in either the King County S...perior Court or u.s. District
for the Western District of Washington, in Seattle. '
KING COUNTY: . CONTRACTOR:
FOR
Signature - King County Executive
Signature
Date
Name (Type ,or Print)
Title (Type or Print)
Date (Type Pf Print)
Approved as to Form:
OFFICE OF THE KING COUNTY
PROSECUTING ATTORNEY
Contract # 039950D I PREV1282 - BCCHP
3:rO~/3d as to formt rr~r~o jO
i'?ff@,l"Sgn Ct:hPtoseQ\lt Oflic0
Page:15
Exhibit 1-8cope of Work
JEFFERSON COUNTY PUB4/Q liEAIJJ:1
OUTREACH & RECRUITMENT, CLINICAL SERVICES (Fee-for.Servlce) and
CLIENT SUPPORT SERVICES I CASE MANAGEMENT
January 1, 2010 through December 31, 2010
BACKGROUND
This contract is made by Public Health-Seattle & King County'sBreEist, Cervical and Colon
Health Program (BCCHP) with Jefferson County Public Health to provide outreach and
recruitment, office visits with clinical services, including women's health exams. Pap
smears, colposcopies, etc. with follow-up client coordination & tracking or case
management, contingent on Public Health-Seattle & King County (hereafter referred to as
Public Health) being awarded Breast, Cervical and Colon Health Program Prime
Contractor status from the State of Washington, Department of Health (DOH), and that
DOH receives funds from the State of Washington, Centers for Pisels, C-ontrol and
Prevention (CDC) and/or the Susan G. Komen for the Cure - Puget Sound Affiliate.
The purpose of this program is to establish a comprehen~ive, public health Eipproach to
reduce breast, cervical and colon cancer morbidity and mortality of targeted underserved
populations through screening, tracking, follow-up and client coQrdinalion case
management, public and professional education, quality assurance, surveUla,nce,
evaluation, and coalition development.
ELIGIBLE POPULATIONS SERVED
Public Health serves women who meet the following criteria:
. Are aged 40-64
· Have incomes at or below 2500/0 of the Federal Poverty Level (FPl);
· Lack insurance or have high insurance deductibles as barriers to paying for preventive
services such as mammograms, Pap tests,
Women not eligible for Medicare may be served by the BCCHP.
Outreach efforts should be geared toward the priority populations of women with lower
screening &/or higher mortality rates. These include women aged 50..64, Lesbians,
African-Americans, Asian/Pacific Islanders, American Indians/Native Alaskans, Latinas
and people living in rural communities.
PROGRAM ADMINISTRATION
The contractor will perform the services outHnedin this Scope of WQ*(Exhibit 1} after
ensuring BCCHP Enrollment and Consent forms have bee_" obtained_~Program and fiscal
performance will be monitored and evaluated monthly by PublieHealth staff by review of
the invoice, and BCCHP forms where applicable, Le., the BCCHP Outreach form,
Women's Health Examination and Reimbursement form, Cervical D,iagnostlc form, etc. In
the event of cancer diagnosis, complete the Consent for Cancer T,rQUr'l,en,t form, Case
Management Comprehensive Needs Assessment,Transition to Med'icaid.Treatment
Tracking form and Case Management Written Plan. Any required anesthesia or pathology
lab work will be paid to the contractor per patient's CPT coded procedures by the date-of-
JCH 039950D 2010 SOW
Page 1 of 4
service at current Fee Schedule rates, channeling reimbursement v.is pass..through
payment.
Failure of the Contractor to perform services as described in the BCCHP Contractor's
Procedure Manual and subsequent amendments in accordance with the CDC and DOH
Policies and Procedures, and with any applicable local, state and federal law or regulation,
may result in the reduction of funds, suspension of services or the term'ination of this
contract. Public Health reserves the right to determine the amount afany reduction, based
on Contractor performance or fund source grant reduction, and to unilaterally effect any
reduction upon written notification. Any reduction shall be based on a review of the
Contract's expenditure patterns and actual performance.
PERFORMANCE REQUIREMENTS
The agency will provide clinical and client coordination & tracking services for eligible
women through BCCHP as allowed by the DOH in accordance withguldeJines and the
current Fee Schedule established by the DOH and CDC.
A brief description- of services provided under this agreement is as follows:
OUTREACH and RECRUITMENT
Outreach, Recruitment and Case Management programs are part of Pub He Health's
Medicaid Administrative Match program for state fundedprogrc:lms. The objectives of these
efforts are, 1) to increase the number of women receiving ann_usl hea,lth screenings, Pap
tests, and mammograms through BCCHP and other programs,2}alleviate barriers that
prohibit women from receiving screening services, 3) raise community awareness about
the importance of breast and cervical health screening and how and where to obtain those
services and 4) to educate women about Medicaid support for treatm,ent of breast and
cervical cancer. Contracted activities should be planned to focus 00 reaching women in
our priority populations.
Successful programs may incorporate any or all of the fonowing:
1. Identify communication networks for women in priority populations In ord_er to identify
and refer women in need of mammograms, Pap smears aociother women's health
services to appropriate providers.
2. Use a combination of small group, one-to..one education and media to educate women
regarding breast and cervical health and other health issues to encourage and assist
women to obtain mammograms, Pap smears and other women's b,ealthservices.
3. Use outreach & recruitment techniques that are developed with community input
appropriate for priority populations, (Le., our video presentation, ",Mammogram
Screening-Taking Care of Ourselves & Each Other") to encourage and assist women to
obtain mammograms.
4.. Identify women eligible for BCCHP and refer for services. Motivate. assist and follow-
up with women who are rarely screened or haven't seen a provider in years to help
them obtain screening services. Work with Pubic Health to ,dev~aIQcal media plan.
5. Work with clinic screening coordinators to schedule cHent ap,pointments and assure
they obtain an exam, Pap smear, etc~ and return for their next scheduled exam.
6. Provide information and referral about Medicaid programs and services and eligibility
requirements. Assist eligible women to apply for Medicaid.
7. Maintain confidentiality concerning outreach clients.
JCH D399500 2010 SOW
Page 2 of 4
8. Collect data about outreach activities.
9. Assist Public Health in designing community awareness activities that are appropriate
for the priority population that encourage women to seek out .mam;mography, Pap
smear and other women's health care services.
CLINICAL SERVICES (Fee-for-Service)
The contractor shall provide breast, cervical and/or colon cancer scree,ning and diagnostic
services where applicable to eligible women in accordance withguideli,nes in the BCCHP
Contractor Procedure Manual and as allowed within the Budget (Exhlbit 2) and payable by
the current DOH/CDC developed BCCHP Fee Schedule, of which updated revisions would
be forwarded and take precedence over earlier versions.
The contractor will:
1. Maintain confidentiality of all medical records and other data about .cUents.
2. Ensure written informed consent and enrollment had been obtained from clients prior to
the provision of clinical services and/or cancer treatment.
3. Comply with CDC and DOH Performance Indicators~
. Less than 60 days from date of documented abnormal test result to complete
diagnostic work-up.
. Less than 60 days from date of documented diagnosis to treatm-ent for breast,
cervical or colorectal cancer,
4. Make best efforts to report client services results to Public Health within 10 business
days (or two weeks) after the date of service. Findings shaU include all pertinent
information required on the BCCHP forms, Protocol requires forms to be submitted
within 60 days of services rendered to be eligible for reimbursemE)nt, although
exceptions will be evaluated on a case by case basis.
5. Maintain appropriate licensing.
. Cvtoloaical screenina - meets the standards and rEiQulationsof the eli.nical
Laboratory Improvement Act (CLIA). The provider shall supply the name of the
laboratory to Public Health and shall notify Public Health within 30 days of any
change.
. Health care orofessionals - maintain current licensure and/or certification.
Contractor shall maintain documentation of current licensure or certification.
CLIENT SUPPORT ,SERVICES (Case Management)
Case management programs are part of Public Health's Medicaid Ad,ministrative Match
Program, and include any follow-up, documentation and coordination of services needed
as the result of an abnormal test or exam finding. Clients with abnormal test or exam
results require a Case Management plan.
The contractor will:
1. Develop patient tracking systems to assure timely and apprpprj..follow~up of women
with abnormal breast or cervical cancer tests with submittal of the Client Comprehensive
Needs Assessment.
2. Assure access to treatment and monitor clients monthly through their course of
treatment.
JCH 039950D 2010 SOW
Page 3 of 4
3. Implement a re-screening reminder system.
4. Assure appropriate follow-up tests are scheduled and return appointments are made~
5. Assure that test results are reviewed by providers in, a timEtly manner a:nd that
enrollees receive test results in a tim(9ly man,nar.
6. Document all findings and assure Public Health has documentatipn.
7. Attend two mandatory meetings per year and a minimum of two regula.r meetings
and/or trainings as scheduled by the DOH or Public Health.
BilliNG PROCEDURES AND PAYMENT
BCCHP clients must not be billed.
Public Health will prepare monthly clinical services billing reports for the contractor from
complete, timely and accurate BCCHP forms as submitted by the contractor. The reports
will detail client names, dates of service, CPT codes and fees. Public Health will then
generate a monthly invoice with the billing reports used to complete the "Clin.ical Services-
Fee-for-Service" section. The contractor will review the billing reports and make best
efforts to mail the original ink signature-signed invoice to Public health within 1 0 business
days of receipt.
Client Support Services I Case Management is based on the budgeted BCC,HP rate per
woman enrolled and screened per annum.
Services must be provided within the corresponding contract period~
Public Health shall pay for services under this contract up to a total .not to exceed th.e
contract amount stated in the Budget (Exhibit 2), based on the current Fee Schedule.
The contractor certifies 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.
JCH D39950D 2010 SOW
Page 4 of 4
Exhibit 2: Budget
Jefferson County Public Health
615 Sheridan
Port Townsend, WA 98368
January 1, 2010 thru December 31, 2010
BUDGET DETAIL 2010 TOTAL FUNDS
ALLOCATED
Breast, Cervical & Colon Health Program
..
Outreach & Recruitment $ 10,000.~OO
Clinical Services (Fee-for-Service) $ 13,OOO~OO
Client Support Services I Case Management $ 3,000.00
Approved Incidental Expenses $ 265~OO
I ,
Total Annual Budget $ 26,265.00
The Budget is Based on Averaaed Weiahts per CPT Coded Procedures, Specialists. Treatment or Facilities
Fees, &/or Ne otiated Fundin toward Outreach & Recruitment Services as Follows...
Antici ated #s
WBCHP
100
100
X
IlliW.~lliliiilli1lMl%!i~i!, ,fl) ",Kf&~':-'1~'4J!<~'b;~'" 0 ,-
WBCHP ServjcesAvera ea'Combined$115/ atient
Client Su ..011 Services Arestt,t $301 atient
Outreach & ReQruitment DetCtrininedb. FTE/NEED
JCH 2010 Budget D399500
Breast and C ervicalHealth .progratn
Women's Health Unit
401 F ifthA venue I Suite 900
Seattle.WA 98104-1818
206 -263~82 05. Fax 206..296-0208
TTY Relay: 711
'VWNV.k i ngcClunty. gOY /health
EXHIBIT 3
SAMPLE INVOICE
PubliCHealthtQ~.
S;atiie&Kiii"gc~;";ty ·
BCCHP
CONTRACTING PROVIDER'S NAME
1234 5TH Avenue
Seattle, WA 98999-9999
ROC# DXXXXXD CPN
Contract Period: January 1, 2009 - December 31 J 2009
Please review, sign and
MAIl,. this /nvoJOflwithln 10 days of receipt:
Atten,tlon: Scott F.e.t, @ Address Above
Call w/.quest.lons TEL = 206.263-8175
In'loice#t I.. ...1Q
Current Billing Period
Month I Year
Contracted Line Items
A vsUable
BaJance
Outreach & Recruitment
Clinical Services (fee-far-service)
Clienj SUJ?port_._~~~ices ____,._________,_
Approved Incidental Expenses
TOT A L claimed on th. i
$
.$
$
$
$
M
sible, the tru.e V.tUB of the costs being claimed.
x
Date
lease Print Name Below Si nature
For BCHP Department Use
Expense Summary - ORG/PROJ: 8052/358
Iy ------ -.--------. BELOW THIS LINE ..... ~v.. 'f"- . . 11'"1"17. ForBCHPDe artment Use Only
Contracted Aceumuhlt.ed Available
Bud et Ix en.. Balance
Pay Current
Fundsource Name
Fundsource Name
12345 A
67890 B
$
$
$
$
S
$
$
$
TOTAL to be paid off this invoice $
$
$
$
PH-SKC BCCHP Monitor Si nature
Date
THIS IS ONLY A SAMPLE OF THE INVOICE TEMPLATE. YOUR PERIODIC INVOICE WILL BE
MAILED TO YOU BY THE PUBLIC HEALTH - SEATTLE, & KING COUNTY BCHP PROGRAM.
S/Contracts/Contract Components/Invoices
EXHIBIT 4
Credentials Requirement
If your agency assigns licensed health care professionals to provide servi,ces under the attached contract, the
following becomes material to this contract and non-compliance with this Exhibit will be cause for termination of
the contract in accordance with Section II of the contract:
A. If a licensed health care professional provides health care services .t a Public H.,,1th ,~ S.attle & King
County (PHSKC) clinic or site, each health care p,rofessional mustinitiaJly regiater within 10 days of
beginning to provide health care services by completing a Licensed Indep.,ndelltPractitioner Profile form.
This form can be obtained by contacting PHSKC Credentials Office at 206-26W360. As additionally
required, each practitioner must further complete enroUment forms. provi,de cOPkt, of credentials, National
Provider Identifier (NPI), and complete an enrollmentlcredentialing process by healthcare entities and
insurance plans (with re-credentialing intervals). Many services are biUableandagreements between PHSKC
and contractors must be complied with. These agreements include practitioner enrollments and are primarily
addressed to, but not limited to, independent health care practitioners such as MO$, ARNPs, PAs, Dentists,
some mental health care and allied health professionals.
B. If a licensed health care professional does not perform services at a ,PHSKC cl.i.nioJ ,but performs health care
services pursuant to this contract, your agency agrees to internally require ear;h' practitioner to undergo a
credentialing process and meet the essential credentialing standards. (No contact needs to be made to the
PHSKC Credentials Office and no registration is required.) At a minimum. the following for each of said
practitioners must be on file at your agency for annual audits by PHSKC:
1. Evidence of primary source verification of the practitioner's licensure,certifj~n and/or registration.
2. Evidence of review and verification of the professional education degree(s).
3. Evidence of review and verification of professional references.
4. Evidence of review or history of liability claims and adverse actions.
5. Evidence of review of the practitioner's health fitness for work.
6. Evidence of review of any findings from professional review organizations.
7. Evidence of practice reviews by peers.
8. Evidence of protocols and procedures that establish a secure environment to Nlfeguard the confidentiality
of each practitioner's professional credentials.
If you have any questions about these requirements, please contact the ,PHSKC Credentials Office at 401 Fifth
Avenue, Suite 1000, Seattle, WA 98104-1818, Phone: 206-263-8360, Fax: 206~205~236, Email:
ioseph. tridente@kingcou nty. gov.
EXHIBIT 6 ~
2009488
Washington Breast ~nd Cervical Health Program P b.. 11. C..: H.... ea. Ith W.
Women's Health Unit . .. .. ... .. ... .. ~
401 Fifth Avenue, Suite 900 . REC'O PR OCURf:iEt"\"P~t'ie..& King. Co~.nty ...
Seattle, WA 98104..1818
206-Z63-82Q5 Fax 206.296..0208 09 OCT 15 PM 12= 02
TTY Relay; 711
www.klngcounty.gov/health
October 2, 2009
TO:
Ken Guy, Djvjsion Direc[or
Finance & Business Operations Division
VIA:
David Leach, Section Manager
Procurernent & Contract Services Section
RE:
David Fleming, MD, Director and Health Officer
Department of Public Health ~~ ~~
Waiver from Standard Procurement Procedures
FROM:
The Seattle-King County Department of Public Health is seeking approval of a Wlivcr from the slandard
procurement procedures in order to procure Washington Breast & CervicaJ(WBCHP) and Washington
CoJon Health Program (WCHP) services for the period I/J/2010 through 12/31/2010.
The estimated dollar value is 52,212,050.00 broken out by tile contractors listed in the table belo\v.
Contactor Name
Advanced Medical Imaging S 104.000.00
Bastyr Center for Natural Health $ 1 0,700.00'
Breast Imaging Associates (at Overlakc) $9,800.00
Cenlcr for Multi-Cultural 'tlcaJth $ 12.250.00
Cherry Hill Family Medicjne 58..100.00
C)-lAP (Communjty I-Ieallh Access Program) 52 s. 00 0.00
CJaJJarn County 1.lospilal Dislrict fI 1 $8.000.00
Counlry Doctor & Carolyn Do\vns 570.000.00
Digestive J.lealth Specjaljsls S30.0oo.00
Evergreen Heahhcare $60,000.00
Fanlily Planning ofClallanl County $78.000.00
HeahhPoinl $272,000.00
1-1 igh I jne Medjcal Center 528,300.00
HjghJine IJuaging, LLC $8.. 700 .00
Imaging Assocjates $ J 96,000.00
In "Iealth Imaging, LLC $ S..Ooo.oo
InternationalCommunily Hcahh Services $108.000.00
Jamcslo\yn S'Klallam Tribe $6,000.00
Jefferson COUnlY Public Health $29.000.00
Kitsap County Health District $37,000.00
Medical Imaging NW, LLC S 2.000..00
Multicare Health Systems S 4.500.00
Neighborcare Health S 106.000.00'
Nonh\veSl HospitaJ-SeanJe Breast Cenler $ 4.500.00
Olympic Medical Center $55.000.00
OverJake Hospilal $26,000.00
Peninsula Community Health Services $60,000.00
Puget Sound G.1. (Seattle G.I.. Assoc. dba) $68~OOO.OO
Qliance $.5.600.00
Sea Mar Communjty Health Cenlers $6S,000.00
Seaule Cancer Care Alliance $26.000.00
Seanle Indian I-Ieahh Board ~~6.000.00
Senior Services 511.500.00
Snoqualmje Tribe $ 2.000.00
South Counly Medical Clinic $ 2.100.00
St Francis Hospital $11.000.00
Suquamjsh Tribe $ 2..SD().OO
Swedish Family Medicine...l~ HilJ $ 4.SOO,OO
S\vcdish Health Services $ 425.000.00
Tacoma Radiological Associates, P.S. S 9.700.00
Valley Medicnl Cenler S 64~OOO.OO
Valley Radiologists S 9.800.00
Vashon Natural Medicine $ 4j)OO.OO
Via Radiology (Weslern Radiology ^sso~. dba Via) S 2_000.00
West Seattle Community Clinjc $34.000.00
White River Family Heallh Clinic S '~SOO.OO
YWCA $ 62.000.00
CONTRACT TOTAL AMOUNT 51,212.050 .00
Pursuant to King County codes 4. J 6.040, we request lhat the above requirementbc: ~n.lracted on a
proprietary basis due to Single Source Availability.
Rationale for Selection ofPro~osed Source(s)~ The contractors Jisted above serve. WBCHP and WCHP
larget populations in King) Kitsap, Clallam and Jefferson counLics where currently there are no other
service providers available.
Ralionale for Proposed Waiver: The WBCHP and WeHP [lave "lade Qvcrtu.rC$to all major women!ls
health care faciJities in the region. The contractors listed above are the only fuJI..",iceor specially
providers in their respective regions and contracls Wilh them assurePHSKCeol11plcte geographical
coverage.
Please contact Scott Feest, PPM II 8l 206-263-8175 M.S. CNK-PH~0900 for qu.ions a,nd addjtional
information.
Certj fjcatiOIl:
I hereby cerlify Ihal the facts and statenlents concenling this request for a waIver from standard
procurClncnt procedures are accurate to the best of In)' kno\vJedge.
~I(stIRHuua
~.J. j, Chief of .1'1
DepanmenrJ Agency Head ,.
ManagerJ Procurement Contract ervices
~~ ~I:th..N
Director, Finance & Business Opernlions Division
IiY'
D
, .lblA~. Ill?
Date I '
/t2'(9-?(7
Date
1'.'"1.
Date
Approve/Disapprove
9-' ET
S/ContracIs/Wajvcrs/2009 Waiver for Sole Source.doc