Extracted text (via pymupdf_layout)
9850 characters
ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303 AMENDMENT Phoenix, Arizona 85007 (602) 542-1040 MAIN (602) 542-1741 FAX CONTRACT No.: ADHS14-053007 AMENDMENT No.: 5 Jacqueline PROCUREMENT S. Ortega-Avila OFFICER WIC, BFPC, FMNP and ONEDS SERVICES C-86-14-023-3-10 Effective October 1, 2016, it is mutually agreed that the Contract referenced is amended as follows: 1. Pursuant to the Terms and Conditions, Provision Nineteen (19), THE FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA OR TRANSPARENCY ACT - P.L.109-282, AS AMENDED BY SECTION 6202(A) OF P.L. 110-252), FOUND AT https://www.fsrs.gov/ is hereby added to read as follows: 19. If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form. This form and the instructions can be downloaded from the ADHS Procurement website at http://www.azdhs.gov/operations/financial-services/procurement/index.php#ffata and must be returned to the ADHS by the 15th of the month following that in which the award was received. The form shall be completed electronically, and submitted using the steps outlined in the Grant Reporting Certification Form Instructions to the following email address: ADHS_Grant@azdhs.gov. All required fields must be filled including Top Employee Compensation, if applicable. Completing the Grant Reporting Certification Form is required for compliance with the Office of Management and Budget (OMB), found at http://www.whitehouse.gov/omb/open. Failure to timely submit the Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during the term of the Award. CONTINUED ON NEXT PAGE CONTRACTOR SIGNATURE MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH Contractor Name Contractor Authorized Signature 4041 NORTH CENTRAL AVENUE, SUITE 1400 Address Printed Name PHOENIX ARIZONA 85012 City State Zip Title CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the Pursuant to A.R.S. § 11-952, the undersigned public agency attorney date indicated. The Public Agency is hereby cautioned not to commence has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS the State of Arizona. signatory. State of Arizona Signed this ______ day of _______________________ 20_______ Signature Date Printed Name Procurement Officer Attorney General Contract No. P0012014000078, which is an RESERVED FOR USE BY THE SECRETARY OF STATE Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney General, who Under House Bill 2011, A.R.S. § 11-952 has determined that it is in proper form and is within the powers and authority granted under the laws of the State of Arizona. was amended to remove the requirement that Intergovernmental Agreements be filed with the Secretary of State. Signature Date Assistant Attorney General Printed Name: ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303 AMENDMENT Phoenix, Arizona 85007 (602) 542-1040 MAIN (602) 542-1741 FAX CONTRACT No.: ADHS14-053007 AMENDMENT No.: 5 Jacqueline PROCUREMENT S. Ortega-Avila OFFICER 2. The WIC Price Sheet in Amendment Four (4) is hereby replaced with the revised WIC Price Sheet of this Amendment Five (5). The WIC Price Sheet decreased by $348,270.00 from $10,489,246.00. The total of the new budget amount for the WIC Price Sheet is now $10,140,976.00. 3. The BFPC Price Sheet in Amendment Four (4) is hereby replaced with the revised BFPC Price Sheet of this Amendment Five (5). The WIC Price Sheet increased by $10,000.00 from $475,000.00. The increase is a result of cost associated to; Personnel and ERE. The total of the new budget amount for the WIC Price Sheet is now $485,000.00. 4. In ProcureAZ the “Items” Tab of the Master Blanket Purchase Order will be revised to reflect the pricing upon execution of this Amendment Five (5). 2 ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303 AMENDMENT Phoenix, Arizona 85007 (602) 542-1040 MAIN (602) 542-1741 FAX CONTRACT No.: ADHS14-053007 AMENDMENT No.: 5 Jacqueline PROCUREMENT S. Ortega-Avila OFFICER REVISED PRICE SHEET OCTOBER 1, 2016 TO SEPTEMBER 30, 2017 WOMEN, INFANTS, AND CHILDREN (WIC) LINE ITEM BUDGET AMOUNT PERSONNEL COSTS/SALARY EXPENSES $4,725,940.00 EMPLOYEE RELATED EXPENSES $2,369,138.00 PROFESSIONAL & OUTSIDE EXPENSES $29,000.00 TRAVEL EXPENSES $25,000.00 OCCUPANCY EXPENSES $640,715.00 OTHER OPERATING EXPENSES $118,948.00 CAPITAL OUTLAY EXPENSES $1.00 INDIRECT COST EXPENSES (IF AUTHORIZED) $1,194,220.00 RD SUPPLEMENT $1,038,014.00 TOTAL $10,140,976.00 OCTOBER 1, 2016 TO SEPTEMBER 30, 2017 BREASTFEEDING PEER COUNSELING SERVICES (BFPC) LINE ITEM BUDGET AMOUNT PERSONNEL COSTS/SALARY EXPENSES $263,351.00 EMPLOYEE RELATED EXPENSES $143,500.00 PROFESSIONAL & OUTSIDE EXPENSES $1.00 TRAVEL EXPENSES $7,100.00 OCCUPANCY EXPENSES $1.00 OTHER OPERATING EXPENSES $7,420.00 CAPITAL OUTLAY EXPENSES $0.00 INDIRECT COST EXPENSES (IF AUTHORIZED) $63,627.00 TOTAL $485,000.00 MARCH 1, 2017 TO SEPTEMBER 30, 2017 FARMER'S MARKET NUTRITION PROGRAM (FMNP) TYPE OF SERVICE UNIT RATE UNIT OF ESTIMATED NUMBER MEASURE OF PARTICIPANTS WIC FMNP CHECK ISSUANCE $1.25 WIC Participant AS NEEDED 3 ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303 AMENDMENT Phoenix, Arizona 85007 (602) 542-1040 MAIN (602) 542-1741 FAX CONTRACT No.: ADHS14-053007 AMENDMENT No.: 5 Jacqueline PROCUREMENT S. Ortega-Avila OFFICER ADDITIONAL TERMS AND CONDITIONS: With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between funded line items except for Registered Dietitian Expenses. Transfers of funds are only allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an amendment. The Registered Dietitian line item is meant to fund additional Registered Dietitian position(s) to meet high-risk counseling requirements. Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase Order that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount on the Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of ADHS unless a.) the Purchase Order is modified with an official ADHS Procurement Change Order, and/or b.) an additional Purchase Order is issued for purchase of services under this Contract. ADHS reserves the right to adjust awards given to local agencies depending on federal dollars received. Adjustments will be at the discretion of ADHS. ADDITIONAL WIC PROGRAM: Should additional administrative monies become available through state or federal grants, ADHS may increase the purchase order to increase the number of participants served and increase the total of this contract. The assigned caseload for FFY 2017 is: 65,000 Additional administrative monies are provided to the Contractor to assist in their participation in the Online Nutrition Education Discussion Sessions (ONEDS). The Contractor shall perform all work required to support the WIC Special Grant ONEDS project ensuring that all ONEDS-related activities required of the intervention and control clinics are performed on a timely basis. These activities include but are not limited to staff attendance in required trainings, recruitment of participants to the study, and ensure completion of evaluation and questionnaires by both participants and staff. ADDITIONAL BREASTFEEDING PEER COUNSELING PROGRAM: Allowable costs for the Peer Counseling Program include compensation for peer counselors and designated peer counselor managers/coordinators, and related costs such as training and training materials; telephone expenses for participant contacts (including pager, cell phones and answering machines); travel for training and home and hospital visits; recruitment of peer counseling staff; and the purchase of demonstration materials (e.g., breast pumps for demonstration purposes, videos). Out of state travel must be pre-approved by ADHS. Items and materials for distribution to WIC participants (e.g. breast pumps, breastfeeding aids, written materials) are not allowable costs. FARMER’S MARKET NUTRITION PROGRAM: If funding for additional FMNP checks becomes available and the contract budget (as shown on the Contract Price Sheet) has been fully expended, Contractor may choose whether or not to distribute the additional checks with no increase in the contract budget. ALL OTHER PROVISIONS OF THIS AGREEMENT SHALL REMAIN IN THEIR ENTIRETY. 4 ATTACHED TO AND A PART OF: ADHS IGA Amendment 5, ADHS14-053007 WIC Services C-86-14-023-3-10 IN WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments: FOR AND ON BEHALF OF MARICOPA COUNTY By_____________________________ Clint Hickman, Chairman, Board of Supervisors _______________________________ Date ATTEST: _______________________________ Clerk of the Board _______________________________ Date APPROVED AS TO FORM: _______________________________ Attorney for Maricopa County _______________________________ Date 5