ADHS BRFSS IGA (00).PDF

INTERGOVERNMENTAL AGREEMENT
MARICOPA COUNTY
by and through the
DEPARTMENT OF PUBLIC HEALTH
4041 N. Central Avenue, #1400, Phoenix, Arizona 85012
1. Agreement No: C-86-18 2. Agreement Type: Fixed Price
3. Agreement Amount: $7,100.00 (Year 1) 4. Purpose: 2018 BRFSS Survey
5. Start Date: January 1, 2018 6. Expiration Date: December 31, 2018
This Agreement is entered into by and between the Arizona Department of Health Services (ADHS) (referred to herein as
"Contractor"), and Maricopa County, by and through its Department of Public Health (MCDPH) (referred to herein after as
"County"). Contractor and the County are collectively referred to herein as the "Parties" and individually as a "Party."
Contractor, for and in consideration of the covenants and conditions set forth herein, shall provide and perform the services as
set forth below. All rights and obligations of the Parties shall be governed by the terms of this Agreement, its exhibits,
attachments, and appendices, including any subcontracts or amendments as set forth herein and in:
Section I General Provisions Section III Work Statement
Section II Special Provisions Section IV Compensation
This Agreement contains all the terms and conditions agreed to by the Parties. No other understanding, oral or otherwise,
regarding the subject matter of this Agreement shall be deemed to exist or to bind the Parties. Nothing in this Agreement shall
be construed as consent to any lawsuit or waiver of any defense in a lawsuit brought against the County or the Contractor in any
State or federal Court.
Legal Notice under this Agreement shall be given by personal delivery or by registered or certified mail, postage prepaid, return
receipt requested, to the addresses set forth below and shall be effective upon receipt by the Party to whom addressed unless
otherwise indicated fn the notice.
Notice to Contractor: Office Chief, Arizona Health Disparities Center, ADHS Phone 602-542-2849
Address: 150 N. le Avenue Phoenix AZ 85007
Notice to Department: MCDPH Grants/Contract Unit Phone: (602) 372-0674
Address: 4041 North Central Avenue Suite #1400 Phoenix, Arizona 85012
IN WITNESS WHEREOF, the parties enter into this Agreement:
MARICOPA COUNTY BOARD OF SUPERVISORS
Signature Signature
Name Name Denny Barney
Title Title Chairman, Board of Supervisors
Date Date
ATTEST:
Signature
Clerk of the Board
Date
Pursuant to A.R.S. § 11-952, the undersigned public agency Pursuant to A.R.S. § 11-952, the Attorney for the Board of
attorney has determined that this Intergovernmental Agreement Supervisors has determined that this Intergovernmental
is in proper form and is within the powers and authority granted Agreement is within the powers and authority granted under the
under the laws of the State of Arizona. laws of the State of Arizona.
Signature Signature
Attorney for Maricopa County
Date Date
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SECTION I GENERAL PROVISIONS
1. EFFECT
To the extent the Special Provisions are in conflict with the General Provisions, the
Special Provisions shall control. To the extent the Work Statement(s) and the Special or
General Provisions are in conflict, the Work Statement(s) shall control.
2. DEFINITIONS
As used throughout this Agreement, the following terms shall have the following
meanings:
A. Agreement means this document and all attachments and amendments hereto.
B. Contractor means the person, firm or organization listed on the Cover Page of
this Agreement.
C. County means Maricopa County, Arizona.
D. Department means the Maricopa County Department of Public Health.
E. Funding Source means any federal, State, or private agency funding source,
which may impose conditions on the funding that will be passed on to the
Contractor.
F. Contractor Staff, Employee or Faculty means a person or persons employed
by, contracted with, or retained by the Contractor for the purpose of providing the
services and responsibilities contained in this Contract.
G. HIPAA means the Health Insurance Portability and Accountability Act of 1996
(PL 104-191) and the United States Department of Health and Human Services
(DHHS) final regulations on "Privacy Standards for Individually Identifiable Health
Information", as amended and clarified from time to time.
3. GENERAL REQUIREMENTS
A. The terms of this Agreement shall be construed in accordance with Arizona law.
Any lawsuit arising out of this Agreement shall be brought in the appropriate
court in Maricopa County.
B. The Contractor shall, without limitation, obtain and maintain all licenses, permits,
and authority necessary to do business, render services, and perform work under
this Agreement, and shall comply with all laws regarding unemployment
insurance, disability, and workers' compensation.
C. The Contractor is an independent contractor in the performance of work and the
provision of services under this Agreement and is not to be considered an officer,
employee, or agent of the County.
4. AMENDMENTS
All Amendments to this Agreement must be in writing and signed by authorized persons
for both Parties. All amendments shall clearly state the effective date of the action.
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SECTION I GENERAL PROVISIONS
5. ADEQUACY OF RECORDS
If the Contractor's books, records and other documents related to this Agreement are not
sufficient to support and document that allowable services were provided to eligible
clients, the Contractor shall reimburse the County for the services not adequately
supported and documented.
6. RETENTION OF RECORDS
A. This provision applies to all financial and programmatic records, supporting
documents, statistical records, and other records of the County and Contractor
that relate to this Agreement.
B. The County and Contractor shall retain all financial books, records, and other
documents related to this Agreement for five (5) years after final payment or until
after the resolution of any audit questions, which could be more than five (5)
years, whichever is longer. County, federal, or State auditors, and any other
persons duly authorized by the County, shall have full access to and the right to
examine, copy and make use of any and all such financial books, records and
other documents.
7. ASSIGNMENT AND SUBCONTRACTING
No rights, liability, obligations or duties under this Agreement may be assigned,
delegated, or subcontracted without the prior written approval of the County and
Contractor.
8. AUDIT DISALLOWANCES
A. The Contractor shall, upon written demand therefore, reimburse the County for
any payments made under this Agreement that are disallowed, by a federal,
State or County audit in the amount of the disallowance, as well as court costs
and attorney fees the County incurs to pursue legal action relating to a
disallowance.
B. If the County determines that a cost for which payment has been made is a
disallowed cost, the County shall notify the Contractor in writing of the
disallowance and the required course of action, which shall be at the option of
the County either to adjust any future claim submitted by the Contractor by the
amount of the disallowance or to require immediate repayment of the disallowed
amount by the Contractor.
C. The County shall, upon review and agreement of the Parties, remit to the
Contractor any payments determined to have been insufficiently paid, in the
amount of the payment shortfall, as well as court costs and attorney fees the
Contractor incurs to pursue legal action relating to such short payment.
9. AGREEMENT COMPLIANCE MONITORING
County may monitor the Contractor's compliance with, and performance under, the
terms and conditions of this Agreement. On-site visits for compliance monitoring may be
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SECTION I GENERAL PROVISIONS
made by the County and/or its grantor agencies at any time during the Contractor's
normal business hours, announced or unannounced. During an on-site visit, the
Contractor shall make its records and documents related to work performed or services
provided under this Agreement available to the County for inspection and copying.
10. AVAILABILITY OF FUNDS
A. The provisions of this Agreement relating to the payment for services shall
become effective when funds assigned for the purpose of compensating the
Contractor, as provided herein, are actually available to the County for
disbursement. The Department shall be the sole authority in determining the
availability of funds under this Agreement and the County shall keep the
Contractor fully informed as to the availability of funds. The County shall refer no
clients to Contractor for periods of time for which funding is not available unless
at the discretion of both parties, an alternate source of funds are made available
to continue the medical service.
If any action is taken by any State agency, federal department, or any other
agency or instrumentality to suspend, decrease, or terminate its fiscal obligations
under or in connection with this Agreement, the County may amend, suspend,
decrease, or terminate its obligations under or in connection with this Agreement.
If this Agreement is terminated, the County shall be liable for payment only for
services rendered prior to the effective date of the termination, provided that such
services are performed in accordance with the provisions of this Agreement. The
County shall give written notice of the effective date of any suspension,
amendment, or termination under this section at least ten (10) days in advance.
11. CONTINGENCY RELATING TO OTHER CONTRACTS AND GRANTS
A. The Contractor shall, during the term of this Agreement, immediately inform the
County in writing of the award of any other contract or grant where the award of
such contract or grant may affect either the direct or indirect costs being paid or
reimbursed under this Agreement. Failure by the Contractor to notify the County
of such award shall be considered a material breach of this Agreement and the
County may immediately terminate this Agreement without liability.
B. County may request, and the Contractor shall provide within a reasonable time,
not exceeding ten (10) working days, a copy of such other contract or grant,
when, in the opinion of the Department, the award of the contract or grant may
affect the costs being paid or reimbursed under this Agreement.
C. If the County determines that the award to the Contractor of such other contract
or grant has affected the costs being paid or reimbursed under this Agreement,
the County shall prepare an amendment to this Agreement effecting a cost
adjustment. If the Contractor disputes the proposed cost adjustment, the dispute
shall be resolved pursuant to the "Disputes" clause section contained herein.
12. DEFAULT
For material breach of contractual obligations, or upon the happening of any event which
would jeopardize the ability of the Contractor to perform its contractual obligations, the
County may suspend, modify, or terminate this Agreement immediately upon giving
written notice to the Contractor in the event of non-performance of any stated objectives.
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SECTION I GENERAL PROVISIONS
Unless expressly stated otherwise this in this Agreement, such determination will not be
made until such time as the disputes process has been exhausted.
13. TERMINATION
A. Either Party may terminate this Agreement at any time by giving the other Party
at least thirty (30) calendar days prior written notice. The notice shall be given by
personal delivery or by registered or certified mail, postage prepaid, return
receipt requested.
B. This Agreement may be terminated by mutual written agreement of the Parties
specifying the termination date therein.
C. The County may terminate this Agreement upon twenty-four (24) hours' notice
when the County deems the health or welfare of a patient is endangered or the
Contractor's non-compliance jeopardizes funding source financial participation. If
not terminated by one of the above methods, this Agreement will terminate upon
the expiration date of this Agreement as stated on the Cover Page of this
Agreement,
D. Either Party has the right to terminate this Agreement for cause upon fourteen
(14) working days written notice for any of the following reasons:
(1) Breach of this Contract which is not corrected within fourteen (14) working
days after written notice thereof or registered mail, return receipt requested.
(2) Inability to discharge the duties and responsibility under this Contract for
a continual period of 30 days or more.
E. This contract is subject to cancellation in accordance with the provision of A.R.S.
§ 38-511.
14. SEVERABILITY
Any provision of this Agreement that is determined to be invalid, void, or illegal by a
court shall in no way affect, impair, or invalidate any other provision hereof, and the
remaining provisions shall remain in full force and effect.
15. STRICT COMPLIANCE
Acceptance by the County of performance that is not in strict compliance with the terms
of this Agreement shall not be deemed to waive the requirement of strict compliance for
all future performance. All changes in performance obligations under this Agreement
must be in writing and signed by the Parties.
16. NON-LIABILITY
A. The County and its officers, representatives, agents, and employees shall not be
liable for any act or omission by the Contractor or any subcontractor, employee,
officer, agent, or representative of the Contractor or any subcontractor occurring in
the performance of this Agreement, nor shall they be liable for purchases or
contracts made by the Contractor or any subcontractor in connection with this
Agreement,
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SECTION I GENERAL PROVISIONS
B. The Contractor and its officers, representatives, agents, and employees shall not be
liable for any act or omission by the County or any County subcontractor, employee,
officer, agent, or representative of the County or any County subcontractor occurring
in the performance of this Agreement, nor shall they be liable for purchases or
contracts made by the County or any County subcontractor in connection with this
Agreement.
17. INDEMNITY
Each Party (as "Indemnitor") agrees to indemnify, defend, and hold harmless the other
Party (as "I ndemnitee") from and against all claims, losses, liability, costs, and 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 liability to Indemnitee, are
caused by the act, omission, negligence, misconduct, or other fault of Indemnitor, its
officers, agents, employees, or volunteers.
18. COVENANT AGAINST CONTINGENT FEES
The Contractor warrants that no person or entity has been employed or retained to solicit
or secure this Agreement upon an agreement or understanding for a commission,
percentage, brokerage, or contingent fee. For breach or violation of this warranty, the
County may immediately terminate this Agreement without liability.
19. SAFEGUARDING CLIENT INFORMATION
The use or disclosure by any Party of any information concerning an eligible individual
served under this Agreement is directly limited to the performance of this Agreement.
County and Contractor shall safeguard confidential and privileged client and patient
information i.e., medical, financial and patient specific information, and shall only
disclose such information in accordance with all applicable federal, state and local laws,
rules, and/or regulations, including HIPAA. The use or disclosure by any party of any
information concerning a client or patient served under this Agreement or any other
applicable payer contract is directly limited to services under this Agreement subject to
applicable federal, state and local laws, rules and/or regulations. Contractor's obligation
to maintain the confidentiality of all medical, financial and patient specific information
shall exist after termination or expiration of this Contract. County shall assist Contractor
with regard to Contractors' obligation to comply with HIPAA.
20. RIGHTS IN DATA
The Parties shall have the use of data and reports resulting from this Agreement without
cost or other restriction, except as otherwise provided herein or by law. Each Party shall
supply to the other Party, upon request, any available information known to the
supplying Party that is relevant to this Agreement and to the performance hereunder.
21. OWNERSHIP OF INFORMATION
Subject to applicable state and federal laws, rules and regulations, including, without
limitation, those concerning confidentiality of patient records, the Contractor shall have
full and complete ownership rights to and the sole and exclusive right to inspect,
reproduce, duplicate, adapt, distribute, display, disclose and otherwise use all reports,
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SECTION 1 GENERAL PROVISIONS
information, data and material prepared by the Contractor in performance of the
Agreement. County may examine and may receive copies of such information necessary
for County's performance of this Agreement.
22. NON-DISCRIMINATION
The Contractor, in connection with any service or other activity under this Agreement,
shall not in any way discriminate against any person on the grounds of race, color,
religion, sex, national origin, age, disability, affiliation or belief. The Contractor shall
include this clause in all of its subcontracts related to this Agreement.
23. EQUAL EMPLOYMENT OPPORTUNITY
The Contractor shall not discriminate against any employee or applicant for employment
because of race, age, disability, color, religion, sex, or national origin. The Contractor
shall take affirmative action to insure that applicants are employed and that employees
are treated during employment without regard to their race, age, disability, color, religion,
sex, or national origin. Such action shall include, but is not limited to, the following:
employment, upgrading, demotion or transfer, recruitment or recruitment advertising, lay-
off or termination, rates of pay or other forms of compensation, and selection for training,
including apprenticeship. The Contractor shall, to the extent such provisions apply,
comply with Titles VI and VII of the Civil Rights Act of 1964, as amended (42 U.S.C. §§
2000a, et seq.); the Rehabilitation Act of 1973, as amended (29 U.S.C. §§ 701, et seq.);
the Age Discrimination in Employment Act of 1967, as amended (29 U.S.C. §§ 621, et
seq.); the Immigration Reform and Control Act of 1986 (Pub. L. No. 99-603) ("1RCA");
and Arizona Executive Order 2009-09, which mandates that all persons shall have equal
access to employment opportunities. The Contractor shall also comply with all
applicable provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. §§ 12101,
et seq.).
24. RIGHT OF PARTIAL CANCELLATION
If more than one activity is funded by this Agreement, the County reserves the right to
terminate this Agreement or any part thereof based on the Contractor's failure to perform
any part of this Agreement without impairing, invalidating or canceling the remaining
Work Statement obligations.
25. RIGHT TO EXTEND AGREEMENT
Subject to the availability of funds and acceptable Contractor performance, the
Contractor hereby acknowledges and agrees that the County shall have the right to
extend this Agreement for additional one-year periods, not to exceed a total extended
term of five (5) years, except that the cost will be subject to renegotiation. Any extension
of this Agreement shall be in writing mutually acceptable to the Department and the
Contractor and signed by both Parties.
26. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
A. The undersigned, an authorized representative of the Contractor, certifies, to the
best of his or her knowledge and belief, that the Contractor, defined as the
primary participant in accordance with 45 C.F.R. Part 76, and its principals:
1) are not presently debarred, suspended, proposed for debarment, declared
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SECTION I GENERAL PROVISIONS
ineligible, or voluntarily excluded from covered transactions by any federal
department or agency;
2) have not within the 3-year period preceding this Agreement been convicted of
or had a civil judgment entered against them for the commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing
a public (federal, State or local) transaction or contract under a public
transaction; violation of federal or State antitrust statues or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
3) are not presently indicted or otherwise criminally or civilly charged by a
government entity (federal, State or local) with the commission of any of the
offenses enumerated in paragraph (2) of this certification; and
4) have not within the 3-year period preceding this Agreement had one or more
public transactions (federal, State or local) terminated for cause or default.
B. If the Contractor is not able to provide this certification, an explanation as to why
shall be attached to this Agreement.
C. The Contractor shall include, without modification, this Paragraph in all lower tier
covered transactions (i.e., transactions with subcontractors) and in all
solicitations for lower tier covered transactions related to this Agreement.
27. E-VERIFICATION OF EMPLOYEES
The Contractor warrants that it is in compliance with A.R.S. § 41-4401 and further
acknowledges:
A. That the Contractor and its subcontractors, if any, warrant their compliance with
all federal immigration laws and regulations that relate to their employees and
their compliance with A.R.S. § 23-214;
B. That a breach of the warranty under subsection A above shall be deemed a
material breach of this Agreement that entitles the County to, among other
things, immediately terminate this Agreement without liability;
C. That the County and any contracting government entity retains the legal right to
inspect the papers of any contractor or subcontractor employee who works on
this Agreement to ensure that the contractor or subcontractor is complying with
the warranty provided under subsection A above and that the contractor agrees
to make all papers and employment records of said employee(s) available during
normal working hours in order to facilitate such an inspection;
D. That nothing herein shall make any contractor or subcontractor an agent or
employee of the County or contracting government entity.
28. DISPOSITION OF PROPERTY
All property acquired with funds provided for in this agreement shall become the property
of the funding source.
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SECTION II SPECIAL PROVISIONS
EFFECT
To the extent that the Special Provisions are in conflict with the General Provisions, the
Special Provisions shall control. To the extent that the Work Statement(s) are in conflict
with the Special or General Provisions, the Work Statement(s) shall control.
2. DISPUTES
Except as otherwise provided by law, or otherwise specifically agreed to by the Parties,
any dispute not involving a question of law arising out of this Agreement that is not
resolved between the Parties within a reasonable time, which shall not exceed 120 days,
shall be resolved as follows:
A. Disputes must be filed with the person administering this Agreement for
the County, if one has been appointed, or, if not, with the Procurement
Officer, within ten (10) days from the date the Contractor knew or should
have known the basis of the dispute.
B. The person administering this Agreement or the Procurement Officer, as
applicable, shall respond in writing to the dispute within fourteen (14)
days.
C. The Contractor may abide by the decision or may appeal the decision to
the Director of the Department within seven (7) days.
D. Any claim or controversy arising out of or in connection with this
Agreement not resolved in accordance with paragraphs 2.A. through 2.C.
above shall be resolved through binding arbitration conducted by a single
arbitrator in accordance with the American Arbitration Association (AAA)
Commercial Arbitration Rules, then in effect, in Phoenix, Arizona;
provided, however, matters that primarily involve Provider's professional
competence or conduct shall not be eligible for arbitration. If possible the
arbitrator shall be an attorney with at least fifteen {15) years of
experience, including at least five (5) years' experience in managed
health care. The parties shall conduct a mandatory settlement conference
at the initiation of arbitration, to be administered by W. The arbitrator
shall have no authority to provide a remedy or award damages that would
not be available to such prevailing party in a court of law, nor shall the
arbitrator have the authority to award punitive damages. Each party shall
bear its own costs and expenses, including its own attorneys' fees, and
shall bear an equal share of the arbitrator's and administrative fees of
arbitration. The parties agree to accept any decision by the arbitrator as a
final determination of the matter in dispute, and judgment on the award
rendered by the arbitrator may be entered in any court having jurisdiction.
Arbitration must be initiated within one year of the earlier of the date the
claim or controversy arose, was discovered or should have been
discovered with reasonable diligence; otherwise it shall be deemed
waived. The use of binding arbitration shall not preclude a request for
equitable and injunctive relief made to a court of appropriate jurisdiction.
This Paragraph shall not apply to claims arising from bodily injury, death, or property
damage.
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SECTION II SPECIAL PROVISIONS
3. CHANGES
A. The Department may, at any time, by written order, make changes within the
general scope of this Agreement in any one or more of the following areas:
1 Work Statement activities reflecting changes in funding source or County
regulations, policies, or requirements.
2. Administrative requirements, such as changes in reporting periods,
frequency of reports, or report formats, required by funding source or
County regulations, policies, or requirements.
3. Contractor reimbursement schedules and/or program budgets.
B. The order will not increase or decrease the maximum reimbursable amount to be
paid the Contractor. Additionally, the order will not direct substantive changes in
services to be rendered by the Contractor.
C. Any dispute or disagreement caused by such order shall constitute a 'Dispute"
within the meaning of the Disputes Clause of the Special Provisions of this
Agreement and shall be administered accordingly.
4. AUDIT REQUIREMENT
A. If the Contractor expends $750,000 or more in a year in federal awards, the
Contractor shall have a single audit conducted for that year according to the
Office Management and Budget, Title 2, Subtitle A, Chapter II, PART 200—
UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND
AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in Title 2 C.F.R. §
200. The audit report shall be submitted to the County for review within nine (9)
months following the close of the fiscal year. The Contractor shall take any
necessary corrective action to remedy any material weaknesses and/or
reportable conditions identified in the audit report within six (6) months after the
release date of the report. The County may consider sanctions as described in §
.225 of OMB Circular A-133 for contractors not in compliance with the audit
requirements. All books and records shall be maintained in accordance with
Generally Accepted Accounting Principles (GAAP).
B. The Contractor shall schedule an annual financial audit to be submitted to the
County for review within twelve (12) months following the close of the program's
fiscal year. Contractor understands that its failure to meet this requirement may
result in the loss of current funding and disqualification from consideration for
future County-administered funding.
C. Comply with the requirement of the Federal Office of Management and Budget
("OMB") Circular A-133. The Contractor is responsible for having an audit
performed in accordance with, and when required, by OMB Circular A-133, and
for sending a copy of the report issued as a result of the audit to the County
within thirty (30) days of issuance. The County reserves the right to engage an
auditor, at the Contractor's expense, to perform an OMB Circular A-133 audit of
the Contractor in the event that the Contractor fails to engage an auditor or the
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SECTION II SPECIAL PROVISIONS
County rejects or disapproves of the auditor engaged by the Contractor.
5. INSURANCE
A. The Contractor shall have in effect at all times during the term of this Agreement
insurance or comparable self-insurance that is adequate to protect the County,
its officers, employees, property, and equipment against the losses set forth
below. The Contractor shall provide the County with a certificate of insurance or
a certified copy of the insurance policy naming the County as an additional
insured, or, if the Contractor is self-insured, shall provide the County with a letter
indicating that it is self-insured.
B. The following types and amounts of insurance are required as minimums:
1. Workers' compensation and unemployment insurance as required by law.
2. Unemployment insurance as required by Arizona law.
3. Public liability, bodily injury, and property damage policies that insure
against claims for liability for the Contractor's negligence or maintenance
of unsafe vehicles, facilities, or equipment brought by clients receiving
services pursuant to this Agreement and by lawful visitors of such clients.
The limits of the policies shall not be less than $2,000,000 per occurrence
and $4,000,000 aggregate.
C. Automobile and Truck Liability, Bodily Injury and Property Damages:
1. General liability, each occurrence; $1,000,000
2. Property damage; $1,000,000
3. Combined single limit; $1,000,000
D. Standard minimum deductible amounts are allowable. Any losses applied
against insurance deductible are the sole responsibility of the Contractor.
E. Professional Liability:
1 Insurance for the Contractor and its agents, employees, and other staff
shall be maintained with coverage limits of one million dollars
($1,000,000) per person, three million dollars ($3,000,000) per
occurrence.
2 The Contractor agrees that in the event it, or any of its agents,
employees, and other staff working under this Agreement, is named as a
defendant in litigation, or is identified in a written notice of claim, wherein
professional misconduct is alleged and such allegations arise under the
services or terms of this Agreement, the Contractor will promptly notify
the Department in writing. The duty to notify under this paragraph applies
whether or not the County is alleged to be involved, is named as a party
to the matter, or could be potentially liable as a party.
F. The Contractor shall immediately inform the Department of any cancellation of its
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SECTION II SPECIAL PROVISIONS
insurance or any decrease in its lines of coverage at least thirty (30) days before
such action takes place.
G. In the event the Contractor(s) is/are a public entity, then the Insurance
Requirements shall not apply. Such public entity shall provide a Certificate of
Self-Insurance. If the Contractor(s) is/are a State of Arizona agency, board,
commission, or university, none of the above shall apply.
6. SPECIAL REQUIREMENTS
A. If the use of subcontractors is approved by the County, the Contractor agrees to
use written subcontracts or consultant agreements that conform to federal and
State laws and regulations and the requirements of this Agreement appropriate
to the service or activity covered by the subcontract. These provisions apply with
equal force to the subcontract as if the subcontractor were the Contractor. The
Contractor is responsible for performance under this Agreement whether or not
any subcontractors are used. The Contractor shall submit a copy of each
subcontract to the County upon written request.
7. REPORTING REQUIREMENTS
If requested by the County, the Contractor shall submit annual progress reports on or
before the third (3rd) day of the month following the end of the reporting period.
8. STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST
Pursuant to A.R.S. § 38-511, the County may cancel this Agreement without penalty or
further obligation, within three years after execution of this Agreement, if any person
significantly involved in initiating, negotiating, securing, drafting, or creating this
Agreement on behalf of the County is, at any time while this Agreement or any extension
of this Agreement is in effect, an employee or agent of any other Party to this Agreement
in any capacity or is a consultant to any other Party to this Agreement with respect to the
subject matter of this Agreement. In addition, the County may recoup any fee or
commission paid or due to any person significantly involved in initiating, negotiating,
securing, drafting, or creating this Agreement on behalf of the County from any other
Party to this Agreement arising as the result of this Agreement.
9. POLICY ON CONFIDENTIALITY
The Contractor and the County understand and agree that this Agreement is subject to
all State and federal laws protecting client confidentiality of medical, behavioral health
and drug treatment information.
10. LAWS, RULES AND REGULATIONS
The Contractor and the County understand and agree that this Agreement is subject to
all State and federal laws, rules, and regulations that pertain hereto.
11. SPONSORSHIP ACKNOWLEDGMENT
All promotional materials, brochures, and flyers prepared by the Contractor relating to
this Agreement shall include the following statement, "Sponsored by Maricopa County
Department of Public Health."
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SECTION III WORK STATEMENT
1. BACKGROUND:
The Arizona Behavioral Risk Factor Surveillance System (BRFSS) telephone survey has
been in existence since 1984 and is partially funded by the Center of Disease Control
and Prevention (CDC). This surveillance collects and summarizes the data on health-
related topics as reported by Arizona adults aged 18 and over living at home.
2. PURPOSE:
Using a scientifically selected telephone sample, the BRFSS Survey is given to unpaid
family caregivers in Arizona. This survey is completed annually by ADHS. The data is
then used to strategically design programming and resources in an effort to:
a. Ensure the availability, accessibility and acceptability of supportive resources for
people living with Alzheimer's disease and their caregivers in Arizona.
b. Expand the Availability of Evidence-Based Supportive Services
c. Expand Respite Opportunities to Provide Needed Relief for Unpaid Caregivers to
continue as the Backbone of the Long-Term Care System
d. Remove Barriers to Engagement for those Caring for Those with Alzheimer's
disease.
e. increase Education and Skill Training Opportunities for Caregivers
3. RESPONSIBILITIES OF CONTRACTOR (ADHS)
A. Assign Arizona BRFSS Program Manager/Coordinator, Bureau of Public Health
Statistics, to serve as a project liaison
B. Regularly communicate with Maricopa County, as needed, through the duration of the
project to ensure project goals are achieved.
C. Work in collaboration with MCDPH to conduct public relations activities about the
project and findings from the survey.
D. Include 5 specific questions from the Caregiver Module in the Arizona 2018 BRFSS
survey that were initially developed by the Centers for Disease Control and
Prevention (CDC),
E. Survey residents of Arizona in accordance with standard BRFSS survey processes,
and use the 5 caregiver questions as State-Added questions in accordance with the
policies and practices of CDC and ADHS.
F. Notify Maricopa County when the data from the BRFSS 2018 survey is ready to
export from the AZ BRFSS website.
G. Receive and accept a contribution of $7,100 from Maricopa County as restricted
earmarked funds designated specifically toward the costs of the 5Caregiver questions
as State-Added in the 2018 BRFSS survey.
H. Any notice or other communication to be given shall be in writing and may be
personally served, sent by a recognized overnight courier or sent by U.S. mail, and
shall be deemed to have been delivered or, if delivery is refused, when tendered for
delivery properly addressed as directed below or to such other address later
designated by a party in writing to the other party.
4. RESPONSIBILITIES OF COUNTY
A. Reimbursement for the acquisition of the BRFSS question(s).
B. Effectively utilize the survey questions to design programs and allocate resources.
13

SECTION III WORK STATEMENT
5. SCOPE OF WORK:
A. ADHS agrees to include the attached questions. See Attachment A.
B. The BRFSS 2018 will commence on January 2, 2018 and will expire on December
15, 2018.
14

COMPENSATION
SECTION IV
1. COMPENSATION
A. The Contractor shall submit a detailed monthly invoice by the 25 th of the following
month.
B. The Department shall, within thirty (30) working days from the date of receipt of
Contractor's invoice, process and remit to the Contractor a warrant for payment.
Should the Department make disallowance in the claim, the claim shall be
processed to the reduced amount. The Contractor shall be notified at the address
below in writing of the amount and reasons for any disallowances, and shall be
afforded the opportunity to document the appropriateness of the disallowed costs
and to resubmit an invoice for payment.
C. Each Party assumes sole and exclusive responsibility for payment of any federal
and state income taxes, federal social security taxes, workers' compensation,
and unemployment insurance benefits for its physicians, staff, agents, and
employees, as well as any and all other mandatory governmental deductions or
obligations.
D. The Agreement amount is not-to-exceed $7,100.00 for Year one (1). The
Agreement amount for each year of the subsequent years of the term may be
negotiated based on the availability of funds.
2. METHOD OF PAYMENT
A. The Contractor shall submit one (1) legible copy of their detailed invoice before
payment(s) can be made. At a minimum, the invoice must provide the following
information:
• Company name, address and contact
• County bill-to name and contact information
• Contract Serial Number
• County purchase order number
• Invoice number and date
• Payment terms
• Date of service or delivery
• Quantity
• Contract Item number(s)
• Description of Purchase (services)
• Pricing per unit of service
• Extended price
• Total Amount Due
B. Problems regarding billing or invoicing shall be directed to the using agency as
listed on the Purchase Order
C. The Contractor must maintain and have available upon request supporting
documents for each monthly reimbursement request, including invoices of costs
incurred and expenditure reports.
D. Subject to the availability of funds, the County will, within thirty (30) working days
from the date of receipt of documents enumerated herein, process and remit to
15

SECTION IV COMPENSATION
the Contractor a warrant for payment up to the maximum total allowable for
services provided. Should the County make a disallowance in the claim, the
claim shall be processed for the reduced amount. If the Contractor protests the
amount or the reason for a disallowance, the protest shall be construed as a
dispute concerning a question of fact within the meaning of the "Disputes" clause
of the Special Provisions of this Agreement.
E. The Contractor understands and agrees that the County will not honor any claim
for payment submitted six (6) months after the date of service. The Contractor
understands and agrees that the County will not process any claim for payment
for services rendered prior to the expiration date that is submitted sixty (45) days
after the expiration date without approval of the County.
F. Payments made by the County to the Contractor are conditioned upon the timely
receipt of applicable, accurate, and complete invoices submitted by the
Contractor. The Contractor forfeits the right to reimbursement for costs incurred
in any month for which it fails to meet the deadline for submitting the monthly
reports, except if such failure is beyond the reasonable control of the Contractor.
G. The Contractor shall submit one invoice to:
Maricopa County Department of Public Health
Program Operations Administrator
4041 N Central Ave, Suite #1400
Phoenix, AZ 85006
602-506-4926
4. NOTICE
Any notice given under this Agreement shall be sent to the attention of the following:
Department
Maricopa County Department of Public Health
Program Operations Administrator
4041 North Central Ave., Suite #1400
Phoenix, Arizona 85006
Telephone: (602)506-4926
Maricopa County Department of Public Health
Grants and Contracts Unit
Attn: Katherine Mason, Grants/Contracts Administration
4041 N. Central Ave., Suite 1400
Phoenix, Arizona 85012
Telephone: (602)372-0674
Contractor:
Arizona Department of Health Services
Bureau of Public Health Status and Vital Statistics
Attn: Ms. Judy Bass, Az BRFSS Program Manager
150 North 18tr Ave., Suite 550
Phoenix, Arizona 85007
Telephone: (602)542-1125
Fax: (602)364-0296
16

ATTACHMENT A
1. During the past 30 days, did you provide regular care or assistance to a friend or
family member who had a health problem or disability?
INTERVIEWER INSTRUCTIONS: If caregiving recipient has died in the past 30
days, code 8 and say: I'm so sorry to hear of your loss.
1 Yes
2 No [Go to Question 91
7 Don't know/Not sure [Go to Question 91
8 Caregiving recipient died in past 30 days [Go to next module]
9 Refused [Go to Question 9]
2. What is his or her relationship to you?
INTERVIEWER NOTE: If more than one person, say: Please refer to the person
to whom you are giving the most care.
DO NOT READ:
01 Mother 77 Don't know/Not Sure
02 Father 99 Refused
03 Mother-in-law
04 Father-in-law
05 Child
06 Husband
07 Wife
08 Live in partner
09 Brother or brother-in-law
10 Sister or sister-in-law
11 Grandmother
12 Grandfather
13 Grandchild
14 Other relative
15 Non-relative/Family friend
3. In an average week, how many hours do you provide care or assistance? Would you
say...
READ:
1 Up to 8 hours per week
17

ATTACHMENT A
2 9 to 19 hours per week
3 20 to 39 hours per week
4 40 hours or more
7 Don't know/Not sure
9 Refused
4. What is the main health problem, long-term illness, or disability that the person you
care for has?
IF NECESSARY: Please tell me which one of these conditions would you
say is the major problem?
[DO NOT READ: RECORD ONE RESPONSE]
1 Arthritis/Rheumatism
2 Asthma
3 Cancer
4 Chronic respiratory conditions such as Emphysema or CORD
5 Dementia or other Cognitive Impairment Disorders, Alzheimer's disease
6 Developmental Disabilities such as Autism, Down's Syndrome, and Spina
Bifida
7 Diabetes
8 Heart Disease, Hypertension, Stroke
9 Human Immunodeficiency Virus Infection (HIV)
10 Mental Illnesses, such as Anxiety, Depression, or Schizophrenia
11 Other organ failure or diseases such as kidney or liver problems
12 Substance Abuse or Addiction Disorders
13 Injuries, including broken bones
14 Old age/infirmity/frailty
15 Other
77 Don't know/Not sure
99 Refused
6. Of the following support services, which one do you, as a caregiver, most need
that you are not currently getting?
[INTERVIEWER NOTE: IF RESPONDENT ASKS WHAT RESPITE CARE
IS]: Respite care means short-term breaks for people who provide care.
[READ OPTIONS I —6]
1 Classes about giving care, such as giving medications
2 Help in getting access to services
18

ATTACHMENT A
3 Support groups
4 Individual counseling to help cope with giving care
5 Respite care
6 You don't need any of these support services
[DO NOT READ]
7 Don't Know /Not Sure
9 Refused
[If Qi = I or 8, GO TO NEXT MODULE]