FTFTECHNICALASSISTANCEFULLCOLORMPSIGNED.PDF

FIRST THINGS FIRST

Government Agreement Summary

GRA Number: GRA-STATE-24-1254-01 Region/Funding Source: Statewide

Grantee: Maricopa County Department of Public Health

Strategy: Child Care Health Consultation Funding Available: $187,000

Regional: $134,500
DES ARPA: $52,500

Target Service Units: N/A

Brief Description:

The intent of this government agreement is to fund a grant partner to provide Child Care Health
Consultation (CCHC) Technical Assistance (TA) and Professional Development (PD) to Child Care Health
Consultants (CCH Consultants) in Arizona, who are implementing the FTF CCHC strategy. CCH
Consultants provide health and safety professional development consultation services to staff in early
care and education programs. The CCHC TA and PD grant partner will support the CCH Consultant’s
learning of best practice health and safety standards by providing professional development and
technical assistance through training, professional development sessions, related educational
materials, and other supportive means.

Required Data Template Training
The grantee is required to participate in data template training. Further instruction will be provided
closer to grant start date.

Grant Term/Estimated Start Date: Contact Information:

The estimated grant term is July 1, 2023 Russ Spencer

through June 30, 2024, unless terminated, Director Fiscal Operations
cancelled or extended. First Things First

Email: rspencer@firstthingsfirst.org

READY FOR SCHOOL. SET FOR LIFE.

GOVERNMENT AGREEMENT
GRA-STATE-24-1254-01

Between The
Arizona Early Childhood Development and Health Board
(First Things First)
And
Maricopa County Department of Public Health
(Grantee)

Purpose

The intent of this government agreement is to fund a grant partner to provide Child
Care Health Consultation (CCHC) Technical Assistance (TA) and Professional
Development (PD) to Child Care Health Consultants (CCH Consultants) in Arizona, who
are implementing the FTF CCHC strategy. CCH Consultants provide health and safety
professional development consultation services to staff in early care and education
programs. The CCHC TA and PD grant partner will support the CCH Consultant’s
learning of best practice health and safety standards by providing professional
development and technical assistance through training, professional development
sessions, related educational materials, and other supportive means. Ultimately, the
CCHC TA and PD grant partner will support the outcomes of the CCHC strategy, which is
for CCHC participants to have increased knowledge in best practice health and safety
practices, and an increase in compliance with best practice health and safety policies
and practices.

The Technical Assistance Grant Partner will provide services to CCH Consultants in the
following First Things First Regions: Cochise, Coconino, Cocopah, Colorado River Indian
Tribes, East Maricopa, Gila, Gila River Indian Community, Graham/Greenlee, Hualapai
Tribe, La Paz/Mohave, Navajo Nation, Navajo/Apache, Northwest Maricopa, Pascua
Yaqui Tribe, Phoenix North, Phoenix South, Pima North, Pima South, Pinal, San Carlos
Apache, Salt River Maricopa Indian Community, Santa Cruz, Southeast Maricopa,
Southwest Maricopa, Tohono O’odham Nation, White Mountain Apache Tribe, Yavapai,
and Yuma.

Term, Renewal

The term of this Agreement is July 1, 2023 through June 30, 2024. The parties may
renew this Agreement for up to three (3) additional twelve (12) month extensions
(including lesser parts thereof).

GRA-STATE-24-1254-01 Page 2 of 38

Description of Services

The CCHC Strategy is one of the components of the Quality First program model. Quality
First provides support to early care and education and preschool providers throughout
the state of Arizona that help improve the quality of early learning settings. The CCHCs
work with participants who are enrolled in Quality First. Through this agreement, a
grant partner provides Child Care Health Consultation (CCHC) Technical Assistance (TA)
and Professional Development (PD) to Child Care Health Consultants (CCH Consultants)
in Arizona, who are implementing the FTF CCHC strategy.

GRANTEE’S Responsibilities

The Grantee will:

A. Prior to entering into this Agreement, have completed and submitted to First Things
First for review and approval the following forms and documents:

1. Agency/Organization Profile

2. Personnel - Program Personnel Table and Program Organization Chart
3. Budget - Line-Item Budget and Budget Narrative

4. Fiscal Information - Funding Sources and Financial Controls

The completed forms and documents comprise part of this Agreement.

B. In providing programming described in Sections III and IV.A, the Grantee will act in
accordance with the Description of Services, the approved budget, the Scope of
Work (Exhibit A), Guidance Materials and Required Documents (Exhibit B), and the
Data Security, Submission and Suppression Guidelines and Requirements for
Collaborators (Exhibit C).

C. Coordinate and collaborate with all First Things First grant recipients, as
collaboration is critical to developing a seamless service delivery system for children
and families.

D. Submit timely the reports described in Section VI.

Payment

The Child Care Health Consultation Government Agreement includes funding from
multiple sources which are available for varying periods as described below. The funding
may fluctuate over time, and the grant partner must demonstrate flexibility in order to
provide services as funding variations occur.

A. First Things First will pay the Grantee for expenses approved in the budget, up to
$187,000 on the terms described in this Section.

1. FTF Regional Partnership Council Funding: This is a multi-regional contract with
funding available from First Things First regions. Should a region discontinue

GRA-STATE-24-1254-01 Page 3 of 38

Vi.

participation during the program year or not seek renewal at the end of a grant
period, adjustments in administrative costs, scope of work for direct services and
target service units may be necessary. First Things First shall provide up to $187,000
to the Grant Partner for services provided under Paragraph IV.

Department of Economic Security Child Care and Development Fund (DES CCDF):
The Department of Economic Security (DES) Expansion grant, funded through the
Child Care and Development Fund (CCDF) Block Grant, is dedicated to providing
Quality First programming to early care and education programs enrolled in Quality
First and therefore receiving CCHC services strategy as part of their participation in
2the grant. The amount of DES funding from ARPA for SFY 24 is $52,500. This
funding is anticipated to end June 30, 2024.

Payment is conditioned upon First Things First’s receipt of timely, accurate and
complete (i) reimbursement documents, (ii) Program Narrative Reports and (iii) Data
Submission Reports submitted via the First Things First Partner Grant Management
System (PGMS). Payments will be made only for those services performed or goods
received.

The Grantee will submit reimbursement requests at least quarterly, though not
more frequently than monthly. The Grantee must submit a final reimbursement
request marked “final” no more than forty-five (45) days after the Agreement term
end date. The Grantee must pay, accrue or obligate expenses eligible for
reimbursement by the Agreement term end date. Final payment is conditioned
upon receipt of all fiscal, programmatic, and data reports required of the Grantee
under this Agreement. Requests for reimbursement received later than forty-five
(45) days after the Agreement end date will not be paid.

. The Grantee will only use funds provided under this Agreement to fulfill the

Grantee’s responsibilities under this Agreement. Any questions regarding the
appropriate use of the funds will be resolved by mutual agreement between the
parties.

If the Grantee receives reimbursement for expenditures that are disallowed by an
audit exception by First Things First, the state or the federal government, the
Grantee will promptly repay the funds to First Things First.

For auditing purposes, we are required to supply the following information related
to the American Rescue Plan Act:

CFDA # - 93.575

Total Federal Amount Awarded - $52,500

Quarterly Program Narrative and Data Submission Reporting Requirements

A. Ata minimum, the Grantee will submit quarterly one Program Narrative Report and

one Data Submission Report by the 20" of the month following the quarter via

GRA-STATE-24-1254-01 Page 4 of 38

PGMS. Failure to submit timely reports will result in suspension of reimbursement.
The reports will contain the information deemed necessary by First Things First.

B. Program Narrative and Data Submission Reports are due:

15t Quarter (July 1 - September 30) Due: October 20
2"4 Quarter (October 1 - December 31) Due: January 20
3 Quarter (January 1 - March 31) Due: April 20

4% Quarter (April 1 - June 30) Due: July 20

C. When a report due date falls on a weekend or holiday, the reports are due the
following business day.

D. Ifthe Grantee provides services to more than one First Things First region (multi-
regional strategies), the Grantee will collect, store and report the data for the Data

Submission Reports separately for each region served.

VII. Agreement Administration and Operations

A. Working on Tribal Land. If the Grantee performs any work under this Agreement on
sovereign land of a tribe, the Grantee must comply with any requirements of the
tribe in relation to essential functions of the grant operation, including data
collection. It is a material requirement of this Agreement that the Grantee follow all
First Things First tribal policies and procedures including the Tribal Data Policy as
applicable, obtain all appropriate parental consents and obtain appropriate tribal
approvals as designated by tribal authorities, which approval may include a
requirement to participate in cultural education and community orientation classes.

B. Advertising, Publishing and Promotion of Agreement. The Grantee will not use,
advertise or promote information for commercial benefit concerning this grant
without the prior written approval of First Things First.

C. Review of Printed Materials. First Things First must review and approve all Grantee
publications and/or media funded or partially funded through this Agreement for
compliance with this Agreement. The Grantee will submit to First Things First via
PGMS all print and electronic materials related to the programs and services funded
under this Agreement before publicly distributing those materials so that First
Things First may first review and approve prior to release. If deemed necessary by
First Things First, the Grantee will revise the materials as indicated by First Things
First before publicly distributing the materials. First Things First will have full and
complete rights to reproduce, duplicate, disclose, perform, and otherwise use all
materials prepared under this Agreement.

D. Acknowledgment of FTF Funding. The Grantee will recognize First Things First as a
funding source of programs and services funded in whole or part under this
Agreement in all publicly distributed print or electronic materials related to those
programs and services. The Grantee will make this recognition in a manner
described in First Things First’s most current protocol and style guide. First Things

GRA-STATE-24-1254-01 Page 5 of 38

First will post any updates to the protocol and style guide under the Grantee
Resources section of PGMS. The Grantee will also recognize First Things First as a
funding source of programs and services funded in whole or part under this
Agreement in all formal oral presentations and media interviews related to those
programs and services.

E. Public Awareness Efforts. The Grantee will consult with First Things First in the
planning of public awareness/marketing strategies, such as websites, advertising or
media campaigns, related to the programs or services funded under this Agreement.

F. Ownership of Materials and Data. Any materials and data required to be collected,
delivered or created under this Agreement, including but not limited to reports,
computer programs and other deliverables are the sole property of the State (First
Things First). The Grantee will not use or release these materials or data without the
prior written consent of First Things First. The Grantee is not entitled to a patent or
copyright on these materials and data and may not transfer the patent or copyright
to anyone else.

G. Ownership of Intellectual Property. First Things First will be the owner (for and on
behalf of the State of Arizona) of any and all intellectual property, including but not
limited to copyright, invention, trademark, trade name, service mark and/or trade
secrets, created or conceived in the course of carrying out this Agreement and any
related subcontract or subgrant (“Intellectual Property”). The parties agree that the
Intellectual Property will be considered a work made for hire under the U.S.
Copyright Act to the extent applicable. To the extent the Intellectual Property is not
a work made for hire, the Grantee hereby transfers all of its ownership of the
Intellectual Property to First Things First. First Things First will own the entire right,
title and interest to the Intellectual Property throughout the world. The Grantee will
notify First Things First, within thirty (30) days, of the creation of any Intellectual
Property by it, its subcontractor or its subgrantee. The Grantee, on behalf of itself
and any subcontractors and subgrantees, agrees to execute all documents necessary
to assure ownership of the Intellectual Property vests in First Things First and will
take no affirmative action that might have the effect of vesting all or part of the
Intellectual Property in any other entity. The Grantee and its subcontractors and
subgrantees will not disclose inventions or trade secrets covered by this paragraph
to any entity not the State without the express written authorization of First Things
First.

Vill. General Terms

A. FTF Grants Uniform Terms and Conditions. First Things First’s Grants Uniform Terms
and Conditions (revision date October 2019) are hereby incorporated by reference
into this Agreement as if fully set forth herein. Copies of this document are available
by emailing the First Things First Procurement Specialist, grants@azftf.gov.

B. Mandated Reporting of Child Abuse and Neglect. The Grantee will ensure that all
employees, contractors and volunteers report child injuries, abuse, neglect and

GRA-STATE-24-1254-01 Page 6 of 38

other reportable offenses, if and as required by A.R.S. § 13-3620 or 18 U.S.C. §
1169(a). The federal law is limited to incidents on federally recognized tribal

lands. To help comply with this provision, the Grantee may need to provide
professional development or information to staff concerning signs and symptoms of
child abuse and neglect, laws and procedures for reporting suspected child abuse or
neglect, whether and how to inform parents about a report and following up with
the Department of Child Safety.

C. Non-Availability of Funds. In accordance with A.R.S. § 35-154, if First Things First’s
performance under this Agreement depends on the appropriation of funds by the
Arizona Legislature, and if the Legislature fails to appropriate the funds necessary for
performance, then First Things First may provide written notice of this to the
Grantee and terminate this Agreement without further obligation of First Things
First. Appropriation is a legislative act and is beyond the control of First Things First.

D. Capital Expenditures. Certain capital expenditures with a cost totaling $20,000 or
more may be subject to First Things First’s Capital Expenditure Policy regarding
construction, renovation, real property and vehicles. This Capital Expenditure Policy
(revision date December 2019) is incorporated by reference into this Grant
Agreement as if fully set forth herein. Copies of this document are available by
emailing the First Things First Procurement Specialist, grants@azftf.gov.

E. Sectarian Purposes. Funds provided under this Agreement may not be expended for
any sectarian purpose or activity, including religious worship or instruction, except
as consistent with the First Amendment of the United States Constitution. The
Grantee will implement the programs or services funded under this Agreement
consistent with the First Amendment as well. With respect to these programs or
services, the Grantee also will not discriminate against any program or service
beneficiary or applicant on the basis of religion. First Things First reserves the right
to verify or monitor compliance with this paragraph. The Grantee will repay any
funds awarded under this Agreement that the Grantee spends in violation of this
paragraph.

IX. State and Federal Mandated Terms

A. Non-Discrimination. In accordance with State Executive Orders 2023-01 and 2009-
09, the Grantee will not discriminate in employment based on race, color, sex,
pregnancy, childbirth or medical conditions related to pregnancy or childbirth,
political or religious affiliation or ideas, culture, creed, social origin or condition,
genetic information, sexual orientation, gender identity or expression, national
origin, ancestry, age, disability, military service or veteran status, or marital status;
however, this requirement does not affect the applicability of federal and state law
exemptions contemplated by the Executive Orders. The provisions of Executive
Order 2009-09 are incorporated herein by reference into this Agreement as if fully
set forth herein. The Grantee will also comply with all other applicable state and
federal statutes, regulations and executive orders concerning non-discrimination
practices, including the Americans with Disabilities Act and Federal Executive Order

GRA-STATE-24-1254-01 Page 7 of 38

No. 13279 — Equal Protection of the Laws for Faith-Based and Community
Organizations.

B. Records. Pursuant to A.R.S. § 8-1174, the Grantee will retain and will contractually
require each subcontractor and subgrantee to retain all books, accounts, reports,
files and other records (“records”) relating to the Agreement for a period of five
years after the completion of the Agreement. All records will be subject to
inspection and audit by the State (including First Things First) and by an independent
auditor at all reasonable times. Upon request, the Grantee will produce the records
at First Things First’s main office in Phoenix, Arizona.

Notwithstanding the foregoing paragraph, pursuant to 2 C.F.R. § 200.333, if the
grant includes federal pass-through funds, then the Grantee will retain and will
contractually require each subcontractor and subgrantee to retain all records
pertaining to the federal pass-through funds for a period of three years from the
date of submission of the final expenditure report and until any litigation, claims or
audit findings involving the records have been resolved and final action taken. All
such records will be accessible and subject to audit in accordance with 2 C.F.R. §
200.336. This paragraph does not apply to a grantee, subgrantee or subcontractor
that is a federal agency.

x. Relationship of Parties

The Grantee under this Agreement is an independent contractor. Neither party to this
Agreement shall be deemed to be the employee or agent of the other party.

Xl. Indemnification

A. Not State Agency. This paragraph applies if the Grantee is not a department,
agency, board, commission or university of the State. Each party (as “Indemnitor”)
agrees to defend, indemnify, and hold harmless the other party (as “Indemnitee”)
from and against any and all claims, actions, liabilities, damages, losses, costs or
expenses (including reasonable attorneys’ fees) (hereinafter collectively referred to
as “Claims”) arising out of bodily injury of any person (including death) or property
damage, but only to the extent that such Claims which result in vicarious/derivative
liability to the Indemnitee are caused by the act, omission, negligence, misconduct,
or other fault of the Indemnitor including its officers, officials, agents, employees or
volunteers. The State of Arizona, Early Childhood Development and Health Board
(First Things First) is self-insured per A.R.S. § 41-621.

B. Patent and Copyright. The Grantee will indemnify and hold harmless the State
against any liability, including costs and expenses, for infringement of any patent,
trademark or copyright arising out of grant performance or use by the State of
materials furnished or work performed under this Agreement. The State will
reasonably notify the Grantee of any claim for which it may be liable under this
paragraph. This paragraph does not apply if the Grantee is insured pursuant to
A.R.S. § 41-621.

GRA-STATE-24-1254-01 Page 8 of 38

Xl.

XIII.

C. Subcontractors. The Grantee will contractually require its subcontractors and
subgrantees, if any, to defend, indemnify and hold harmless the State of Arizona and
its departments, agencies, boards, commissions, universities, officers, officials,
agents and employees (“State”) from and against any and all Claims (including court
costs, attorneys’ fees, and costs of claim processing, investigation and litigation) for
bodily injury or personal injury (including death), or loss or damage to tangible or
intangible property caused, or alleged to be caused, in whole or in part, by the
negligent or willful acts or omissions of the subcontractor or subgrantee or any of its
owners, officers, directors, agents, employees, volunteers, or subcontractors. This
indemnity will include any claim or amount arising out of or recovered under the
Workers’ Compensation Law or arising out of the failure of the subcontractor or
subgrantee to conform to any federal, state or local law, statute, ordinance, rule,
regulation, or court decree. It is the specific intention of the parties that the State
will, in all instances, except for Claims arising solely from the negligent or willful acts
or omissions of the State, be indemnified by the subcontractor or subgrantee from
and against any and all Claims. It is agreed that the subcontractor or subgrantee will
be responsible for primary loss investigation, defense and judgment costs where this
indemnification is applicable. The subcontractor or subgrantee will agree to waive
all rights of subrogation against the State for losses arising from the work performed
by the subcontractor or subgrantee for the State.

Insurance.

The Grantee will provide a Certificate of Self-Insurance. The Certification will be sent
directly to First Things First, Fiscal Specialist, 4000 N. Central, Suite 800, Phoenix,
Arizona 85012. If the Grantee is a department, agency, board, commission or university
of the State of Arizona, then the Certificate of Self-Insurance requirement does not

apply.

In addition, the Grantee will contractually require its subcontractors to procure and
maintain until all of its obligations have been discharged or satisfied, including any
warranty periods under this Agreement, insurance against claims for injury to persons or
damage to property which may arise from or in connection with the performance of the
work by the subcontractor and its owners, officers, directors, agents, employees, or
volunteers. The insurance policies will be in accordance with recommendations of the
Risk Management Division of the Arizona Department of Administration, including its
published Insurance Modules, and in consultation with First Things First.

Termination Upon 30 Days Notice

In addition to the termination provisions incorporated by reference, either party may
terminate the Agreement for any or no reason by giving at least thirty (30) days written
notice of termination to the other party. If the Grantee requests termination under this
provision, the Grantee will cooperate with reasonable requests from First Things First to
decrease services and costs related to the Agreement.

GRA-STATE-24-1254-01 Page 9 of 38

XIV. Notices

The Grantee will address all notices related to this Agreement to:
First Things First
Finance Division
4000 N. Central Avenue, Suite 800
Phoenix, AZ 85012

First Things First will address all notices related to this Agreement to:
Maricopa County Department of Public Health

4041 N. Central Ave., Ste. 1400
Phoenix, AZ 85012

GRA-STATE-24-1254-01 Page 10 of 38

XV. Grantee Assurances

Grantee’s Authorized Official to initial the following:

L
To adhere to the most current version of the
Standards of Practice documents (available at
http://www. firstthingsfirst.org/grants/strategy-
olkit)

To adhere to the Data Security Submission and

Suppression Guidelines and Requirements for
ollaborators, as applicable.

To review and adhere to the First Things First

Grants Uniform Terms and Conditions. Copies of

this document are available by emailing
/ wrants@arttt.gov ‘

To accept funds and administer the programs in
accordance with all applicable federal and state
statutes and regulations and Grant Agreement
requirements.

To maintain internal controls, including policies and
procedures, for assuring compliance with
applicable cost principles and other Grant
Agreement requirements.

To follow established personnel policies related to
salary scales and fringe benefits.

To use the State of Arizona Travel Policy on rate
limitations for mileage, lodging, and meals
(https://gao.az.gov/travel/welcome-gao-travel) for
both in-state and out-of-state travel.

To use generally accepted accounting principles
(GAAP).

To perform required financial and compliance
audits in accordance with federal law and
guidelines, including the Single Audit Act and 2 CFR
Part 200.

To maintain documentation for employees working
across multiple funding sources to ensure the
amount of time charged to each employee does
not exceed 100%.

To have fiscal control and fund accounting
procedures in place to ensure proper disbursement
of and accounting for any funds paid to
subcontractors.

To maintain enrollment and participate in e-verify,
if an employer.

RIS BK IS AS AS

To maintain a system of contract administration to
ensure conformance with the Grant Terms and
Conditions.

GRA-STATE-24-1254-01

PRO MMATIC
To use proven, effective and/or evidence based

programs.
AP maintain the personnel qualifications outlined in

he Standards of Practice with subsequent hires.

To comply with any applicable federal, state, and
local health and safety requirements that apply to
the facilities used for a program.

To actively participate in the Quality Assurance
process, including assessments.

To coordinate, to the extent possible, with other
programs in the same geographic area that serve
similar target populations.

To coordinate with First Things First during the
length of the program period.

To acknowledge funding from FTF in publicly-
distributed materials in compliance with FTF’s
brand guidelines and submit such materials in
advance for review.

To consult with FTF in the planning of public
awareness/marketing strategies such as websites,
advertising or media campaigns.

& SIA AIS |

ATION

To provide regular and timely reporting and to
participate in all pertinent First Things First
research and evaluation efforts.

N

wi To review the data requirements document
required for the strategy(ies) and adhere to the
requirements therein, found on the First Things
First website,

W toolkit,

https://www. firstthingsfirst.org/strate;

If an evaluation outcome study or an
implementation study has been completed on the

proposed program, a copy of the study and its
y ae will be submitted to First Things First.

If funds are being requested to conduct an

evaluation study, approval by First Things First

Research and Evaluation team will be obtained
/prrior to implementation.

If the evaluation study will include a tribal
community, approval by First Things First Research
and Evaluation team and Tribal Affairs division will
be obtained prior to implementation.

Page 11 of 38

XVI. Authority to Execute this Agreement

Each individual executing this Agreement represents and warrants that the individual is
duly authorized to do so.

XVII. In Witness Whereof
The parties hereto agree to carry out the provisions of this Agreement.

FOR AND BEHALF OF FOR AND BEHALF OF THE
Maricopa County Department of Public Health Arizona Early Childhood Development

And Health Board
whl lL, Bal, Drake

Name Josh Allen

Title CFO/COO
4-#P-27

Date Date

FOR AND ON BEHALF OF MARICOPA COUNTY

By:

Chairman, Board of Supervisors Date
ATTEST

Clerk of the Board Date

APPROVED AS TO FORM

Attorney for Maricopa County Date

GRA-STATE-24-1254-01 Page 12 of 38

Government Agreement Attachments and Exhibits

Attachment A Agency/Organization Profile

Attachment B Personnel - Program Personnel Table/Program Organization Chart
Attachment C Budget - Line Item Budget and Budget Narrative

Attachment D Fiscal Information - Funding Sources and Financial Controls

Exhibit A Scope of Work and Appendix A

Exhibit B Guidance Materials and Required Documents

Exhibit C Data Security, Submission and Suppression Guidelines and Requirements for

Collaborators

GRA-STATE-24-1254-01 Page 13 of 38

Agency/Organization Profile

A. Grantee Information:

Agency/Organization: Maricopa County

Contact Person: Karen Hoffman Email: Karen.Hoffman@maricopa.gov

Title/Position: Child Care Nurse Consultant Supervisor Phone: 602-506-1582

Address: 4041 N. Central Ave. Ste 600

City: Phoenix State: AZ Zip:85028

County: Maricopa

Employer Identification Number (EIN): 86-6000472

Agency Classification: | 0 State Agency X County Government O Local Government QO Schools
0 Tribal QO Faith Based O Non Profit O Charitable Private Organization | O Other
Have you conducted business with First Things First using this EIN within the last year? | X Yes O No

If not or if there has been address or EIN changes, please go to:
https://gao.az.gov/sites/default/files/GAO-W-9 072815-S%26S%26A.pdf_and download the State of Arizona
Substitute W-9 Form, and submit with your application.

Approximate federal funding (from a federal source) to be received in current fiscal year? | $77,500,000

Agency’s fiscal year-end date: 06/30/2023

Agency’s accounting method: O Cash

X Accrual

Does your organization undergo an annual independent audit in accordance with 2 CFR Part | X Yes O No
200, Subpart F?

Contact information for firm conducting agency audit:

Name of audit firm: | State of Arizona: Office of the Auditor General

Address: | 2910 N. 44'' St., Suite 410, Phoenix, AZ 85018

Phone: 602.553.0333

GRA-STATE-24-1254-01 Page 14 of 38

B. Program Details:

Program Name: N/A
(The specific name of the program if different from the name of the strategy, organization, or model. If none, then enter N/A)

Program Model: N/A
(The specific name of the program model that has been proposed. If none, then enter N/A)

Geographic Area and/or Target Population: Maricopa County, Coconino, Navajo County, Apache County, Mohave
County, Yavapai County Gila County, Pinal County, Graham County, Greenlee County, Cochise County, Santa Cruz
County, Pima County, Yuma County, La Paz County.

Brief Program Description (250 words or less):

C. Contact Information:

The First Things First Partner Grant Management System (PGMS) has four contact slots per contract. The same person
may be assigned to more than one slot.

Main Contact: is responsible for the overall program and will have access to all financial, programmatic, and data
reports in PGMS.

Finance Contact: is responsible for the submission of reimbursement requests through PGMS and will have access
to budget and reimbursement information in PGMS.

Program Contact: is responsible for program implementation and will have access to the program and data
reports in PGMS.

Evaluation Contact: is responsible for the program evaluation and data collection activities and will have access
to only the data reports in PGMS.

PGMS Contacts

Main Contact

Name: Email:

Title/Position: Phone:

Physical Address (if different than the agency address):

Program Contact

Name: Email:
Karen Hoffman Karen.Hoffman@maricopa.gov
Title/Position: Phone:602-506-1582

Child Care Health Consultant Supevisor

Physical Address (if different than the agency address):

Finance Contact

Name: Email:
Maricela Arizmendi Maricela.Arizmendi@maricopa.gov

GRA-STATE-24-1254-01 Page 15 of 38

Title/Position:
Accountant

Phone:
602-506-9337

Physical Address (if different than the agency address):

Evaluation Contact

Name:

Email:

Title/Position:

Phone:

Physical Address (if different than the agency address):

GRA-STATE-24-1254-01

Page 16 of 38

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Attachment B= Personnel
Program Organization Chart

For all of the personnel or positions that will be fully or partially funded through the proposed
program, provide a program organizational chart that illustrates the hierarchy of
positions/responsibilities specific to the proposed program.

Example:

Wendi Ayers

CCNC - Nurse Lead

Claudia Corral

Administrative
Assistant

GRA-STATE-24-1254-01 Page 19 of 38

Attachmenti¢ - Budget

SFY24 Line-Item Budget

Budget period: July 1, 2023 — June 30, 2024

Meenbecennton |

IRE

Hested|Funds:

Total Cost

PERSONNEL SERVICES

Personnel Services Sub Total

$116,054

Salaries

1.5 FTEs

116.054

EMPLOYEE RELATED EXPENSES

Employee Related Expenses Sub Total

$43,589

Fringe Benefits or Other ERE

Variable (116,054) @ 19.94%
Fixed @ $13,632. x 1.5 FTEs

23,141
20,448

PROFESSIONAL AND OUTSIDE SERVICES

Professional & Outside Services Sub Total

Contracted Services

TRAVEL

Travel Sub Total

$2,000

In-State Travel

Mileage at $0.625/mile

2,000

Out-of-State Travel

AID TO ORGANIZATIONS OR INDIVIDUALS

Aid to Organi:

zations or Individuals Sub Total

Subgrants or Subcontracts to
organizations/agencies/entities

OTHER OPERATING EXPENSES

Othe

r Operating Expenses Sub Total

$8,357

¢ Telephones/Communications Services

Cell Phone $51.58/month x 1 user

619

¢ Internet Access

¢ General Office Supplies

Gen/Office Supplies for 1.5 FTEs

2,000

¢ Food

e Rent/Occupancy

¢ Utilities

e Furniture

© Postage

¢ Software (including IT supplies)

¢ Dues/Subscriptions

e Advertising

¢ Printing/Copying

e Equipment Maintenance

e Professional Development (staff Training,
Conferences, Workshops, Training Fees for Staff)

Training, Conferences, Workshops fee for
1.5 FTEs

2,738

e Insurance

e Program Materials

e Program Supplies

3,000

e Scholarships

e Program Incentives

NON-CAPITAL EQUIPMENT

Non-Capital Sub Total

Equipment $4,999 or less in value

SUBTOTAL DIRECT PROGRAM COSTS:

$170,000

ADMINISTRATIVE/INDIRECT COSTS

Total Admin/Indirect

$17,000

Indirect/Admin Costs

| July 2023 - June 2024 at 10%

$ 17,000

$

TOTAL

$187,000

$187,000

Authorized Signature

gf
ey

Date

G-19-23

GRA-STATE-24-1254-01

Page 20 of 38