GRANT AGRMT RE ORAL HEALTH WITH FIRST THINGS FIRST.PDF

FIRST THINGS FIRST
4000 North Central Avenue, Suite 800, Phoenix, Arizona 85012
602.771.5100 I 877.803.7234 I azftf.gov
Chair May 19, 2015
Janice Decker
Vice Chair Vincent Torres
Dr. Pamela Powell
Office of Oral Health Supervisor
Members Maricopa County Department of Public Health
Nadine Mathis Basha 1645 E Roosevelt
Shawnna L.M. Bolick Phoenix, AZ 85016
Gayle Burns E-Mail: VincentTorres@mail.maricopa.gov
Gerald Szostak
Vivian Saunders
Ruth Solomon Subject: Request for Grant Application (RFGA) #FTF-MULTI-16-0519-00
Contract number: FTF-MULTI-16-0519-02
Ex-Officio Members
Hon. Diane Douglas Dear Mr. Torres:
Superintendent, ADE
Timothy Jeffries Your application to provide an Oral Health Grant program for the East
Director, DES Maricopa, Northwest Maricopa, Southwest Maricopa, Southeast
Cory Nelson Maricopa, Phoenix North and Phoenix South Regional Partnership
Interim Director, DHS Councils of the Arizona Early Childhood Development and Health Board
(First Things First) has been accepted. Please find attached, a
Chief Executive Officer countersigned copy of your Offer and Acceptance form. The initial
Sam Leyvas
contract period shall be from July 1, 2015 through June 30, 2016. The
amount of your contract grant award is $2,125,000.
Additionally, pursuant to the Insurance Requirements contained in the
Uniform Terms and Conditions, it is your responsibility to ensure that
all required coverage, in the types and amounts stated, shall be
maintained in full force and effect during the term of this contract and
shall not serve to limit any liabilities or any other Contractor
obligations. The applicable Certificate of Insurance must be submitted
to this office, to my attention no later than July 15, 2015. Please
indicate your contract number in the description section of the
certificate.
Also as a reminder, pursuant to the Acknowledgement of FTF Funding
section of the RFGA, First Things First reserves the right to review and
approve all publications funded or partially funded through this
contract. First Things First has decided to exercise this right. Please
contact our Communications Division at communication@azfttgov for
approval of publications and/or media.
READY FOR SCHOOL. SET FOR LIFE.

A member of the Finance team will be contacting you within the next 30 days to set up time for
a grantee orientation. The purpose of the meeting will be to provide current information
regarding the management of your grant and to establish a relationship with the First Things
First staff that will support your grant award.
Congratulations on your contract award. First Things First looks forward to working with you. If
you have any questions, please contact me at 602-771-5114 or via e-mail at jmartin@azftf.gov .
Sincerely,
Procurement Specialist

FIRST THINGS FIRST
Ready for School. Set for Life.
OFFER and ACCEPTANCE
and
STATEMENT of ASSURANCES
TO THE STATE OF ARIZONA, ARIZONA EARLY CHILDHOOD DEVELOPMENT AND HEALTH BOARD:
APPLICANT OFFER
By signing and initialing below, the applicant hereby offers and agrees to complete the program and
implementation plan described in its grant application and approved by the Arizona Early Childhood
Development and Health Board and to be bound by and comply with the Grant Terms and Conditions
contained in the RFGA and with all other documents constituting the Grant Agreement, including the
following Assurances.
Maricopa County by and through its
Department of Public Health
Applicant Name (Agency/Organization) Signature of A uthorized Official
4041 N. Central Ave Ste 1400 Bob England, M.D., M.P.H
Address Printed Name
Phoenix, AZ 85012 Director
City State Zip Title
Arizona Transaction Privilege (Sales) Tax Point of Contact Concerning this Application:
License No:
Name: Vincent Torres
Federal Employer Identification No: Phone: 1602) 506-6890
86-6000472 E-Mail: VincentTorres@mail.maricopa.gov
APPLICANT ASSURANCES
Initial the following:
GENER
To adhere to the most recent version of the / To 1 review and adhere to the First Things First Grants
Standards of Practice documents. Uniform Terms and Conditions Copies of this
To adhere to the Data Security Guidelines, as document are available at htto://www.azftf.gov
applicable. (under Funding/Eligibility & How to Apply)
FTF-MULTI-16-0519-00 Page v

To perform required financial and compliance audits in
/To accept funds and administer the programs in accordance with federal law and guidelines, Including
accordance with all applicable federal and state the Single Audit Act and 2 CFR Part 200.
statutes and regulations and Grant Agreement
i requirements. k To maintain documentation for employees working
4 across multiple funding sources to ensure the amount
To maintain internal controls, including policies of time charged to each employee does not exceed
and procedures, for assuring compliance with 100%.
applicable cost principles and other Grant
Agreement requirements. To have fiscal control and fund accounting procedures
In place to ensure proper disbursement of and
To follow established personnel policies related accounting for any funds paid to subcontractors.
to salary scales, fringe benefits, and travel
reimbursement. To maintain enrollment and participate In e-verify, if
an employer.
To use generally accepted accounting principles
(GAAP). To maintain a system of contract administration to
ensure conformance with the Grant Terms and
Conditions.
PROGRAMMATIC
ii
To use proven, effective and/or evidence based To provide regular and timely reporting and to
Ii, programs. participate in all pertinent First Things First research
I- 1 and evaluation efforts.
To maintain the personnel qualifications outlined
in the Standards of Practice with subsequent 4 To coordinate with First Things First during the length
ire omply of the program period.
'V I
To comply with any applicable federal, state, and To acknowledge funding from FTF In publicly.
local health and safety requirements that apply distributed materials In compliance with FTF's brand
to the facilities used for a program. guidelines and submit such materials In advance for
t
I A To actively participate in the Quality Assurance review.
process, Including assessments. /fp 4"*To consult with FTF in the planning of public
t. awareness/marketing strategies such as websltes,
To coordinate, to the extent possible, with other advertising or media campaigns.
programs in the same geographic area that serve
similar target populations.
ACCEPTANCE OF APPLICATION AND OFFER
The grant application Is hereby accepted. The applicant Is now bound to perform the program and
Implementation plan described in the grant application and approved by the Arizona Early Childhood
Development and Health Board and to comply with the Grant Terms and Conditions contained In the RFGA
and with all other documents constituting the Grant Agreement, Including the Assurances above.
This grant shall henceforth be referred to as Grant No.F7F4 UM I 6-05/0 .14
Arizona Early Ch id ood Develop pent id Health Board
Awarded this3 day of ii{U 2015—
First Things First Authorized Designee
FTF-MULTI-16-0519-00 Page

C-86-15- ATTACHED TO AND A PART OF
Request for Grant Application (RFGA)
FTF-MULTI-16-0519-00
Contract Number FTF-MULTI-16-0519-02
ORAL HEALTH PROGRAM
.
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
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

Gr-iiiitTermrand conditions
1. Grant Agreement. The Request for Grant Applicants (RFGA), the Offer and Acceptance and Statement
of Assurances (Offer and Acceptance), and the grantee's grant application, together with all exhibits,
incorporated documents and amendments, constitute the Grant Agreement.
2. Term. The term of this Grant Agreement is July 1, 2015 through June 30, 2016, unless terminated,
cancelled or renewed as otherwise provided herein. This Grant Agreement shall be effective only if a
First Things First authorized designee has signed the Offer and Acceptance or another official grant
form indicating acceptance of the Offer.
3. Renewal. The parties may renew the Grant Agreement for additional twelve (12) month periods
(including lesser parts thereof) as indicated in the Available Funding section of the RFGA.
4. Services. The grantee shall complete the program and implementation plan described in its grant
application and approved by First Things First. In providing these services, the grantee shall follow the
Scope of Work, the Standards of Practice and the Data Security Guidelines and Requirements for
Collaborators found in the RFGA.
5. Reimbursement! Payment.
5.1. The grantee shall be paid on a cost-reimbursement basis for expenses approved in the
budget. Payment is conditioned upon receipt by First Things First 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).
5.2. The grantee shall submit reimbursement requests at least quarterly, though not more
frequently than monthly. The grantee shall submit a final reimbursement request marked
"final" no more than forty-five (45) days after the Grant Agreement end date. Expenses
eligible for reimbursement must be paid, accrued or obligated by the grantee by the Grant
Agreement term end date. Final payment shall be contingent upon receipt of all fiscal,
programmatic, and data reports required of the grantee under this Grant Agreement. Requests
for reimbursement received later than forty-five (45) days after the Grant Agreement end date
will not be paid.
5.3. if awarded a grant, the grantee must have sufficient funds to meet obligations for at least
sixty (60) days while awaiting reimbursements. If an exception is requested to this
requirement, it should be provided in writing in the grant application describing the
justification and need for alternative considerations, which will be separately considered during
the application review and may not be approved. Requests for exceptions to reimbursement-
based payments submitted after awards are also made are subject to separate review and may
not be approved.
5.4. Funds awarded to the grantee under this Grant Agreement shall only be used to fulfill the
grantee's responsibilities under this Grant Agreement. Therefore, if the full amount of the
grant award is not expended for any reason, including due to completion of the work at a lower
cost than budgeted or ending of the work before completion, the grantee will only receive the
amount of the grant award spent in accordance with the Grant Agreement and will not receive
FTF-MULTI-16-0519-00 Page 6

the full original award. If the grantee is under budget, the parties may amend the Grant
Agreement to increase the contracted service units so as to use the full amount of the original
grant award.
5.5. 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 shall promptly
repay the funds to First Things First.
6. Quarterly Program Narrative and Data Submission Reports.
6.1. At a minimum, the grantee shall submit quarterly one Program Narrative Report and three
Data Submission Reports (one per month) by the 20th of the month following the quarter via
PGMS. Failure to submit timely reports will result in suspension of reimbursement.
6.2. Program Narrative and Data Submission Reports are due:
15t Quarter (July 1 September 30) Due: October 20
2nd Quarter (October 1 - December 31) Due: January 20
3rd Quarter (January 1- March 31) Due: April 20
4th Quarter (April 1 -June 30) Due: July 20
6.3. If the grantee provides services to more than one First Things First region (multi-regional
strategies), the grantee shall collect, store and report the data for the Data Submission Reports
separately for each region served.
7. FTF Grants Uniform Terms and Conditions. First Things First's Grants Uniform Terms and Conditions
(revision date January 2015) are hereby incorporated by reference into this Grant Agreement as if fully
set forth herein. Copies of this document are available at http://wvvw.azftf.gov (under
Funding/Eligibility & How to Apply), by ennailing grants@azfttgov or by calling the First Things First
Procurement Specialist at 602-771-5114.
8. Working on Sovereign Tribal Land. If the grantee performs any work under this Grant Agreement on
sovereign land of an Indian tribe or nation, the grantee shall comply with any requirements set forth by
the tribal government in relation to essential functions of the grant operation, including data collection.
It is a material requirement of this Grant Agreement that the grantee follow all First Things First tribal
policies and procedures including the Tribal Data Policy, complete all Institutional Review Board (IRS)
requirements, obtain all appropriate parental consents and obtain appropriate tribal approvals as
designated by tribal authorities.
9. Non-Discrimination. The provisions of State Executive Order 2009-09 are incorporated herein by
reference. These provisions mandate, in part, that contractors will not discriminate against any
employee or applicant for employment because of race, age, color, religion, sex or national origin. The
grantee shall 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 No. 13279 — Equal Protection of the Laws for Faith-Based and Community
Organizations.
10. Nonprofit Corporation Audit Reports. As required by A.R.S. § 35-181.03, if the grantee is a nonprofit
corporation that receives in excess of two hundred fifty thousand dollars ($250,000) in state assistance
in any fiscal year, the grantee shall file with First Things First for each such fiscal year at the grantee's
FTF-MULTI-16-0519-00 Page 7

expense either audited financial statements prepared in accordance with federal single audit
regulations or financial statements prepared in accordance with generally accepted accounting
principles and audited by an independent certified public accountant
11. Records. Pursuant to A.R.S. §§ 8-1174 and 35-214, the grantee shall retain and shall contractually
require each subcontractor and subgrantee to retain all books, accounts, reports, files and other
records ("records") relating to the Grant Agreement for a period of five years after the completion of
the Grant Agreement. All records shall 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 shall
produce any or all such 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 shall retain and shall 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 shall 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.
12. Non-Availability of Funds. Every payment obligation of First Things First under this Grant Agreement is
conditioned upon the availability of funds appropriated or allocated for the payment of such obligation.
If funds are not allocated and available for the continuance of this Grant Agreement, this Grant
Agreement may be terminated by First Things First at the end of the period for which funds are
available. No liability shall accrue to First Things First in the event this provision is exercised, and First
Things First shall not be obligated or liable for any future payments or for any damages as a result of
termination under this paragraph.
13. Grant Administration and Operation.
13.1. Advertising, Publishing and Promotion of Grant. The grantee shall not use, advertise or
promote information for commercial benefit concerning this Grant Agreement without the
prior written approval of First Things First.
13.2. Acknowledgment of FTF Funding. The grantee shall recognize First Things First as a funding
source of programs and services funded in whole or part under this Grant Agreement in all
publicly distributed print or electronic materials related to those programs and services. The
grantee shall make this recognition in a manner described in First Things First's most current
protocol and style guide. First Things First will post any updates to the protocol and style guide
under the Grantee Resources section of PGMS. The grantee shall also recognize First Things
First as a funding source of programs and services funded in whole or part under this Grant
Agreement in all formal oral presentations and media interviews related to those programs and
services.
The grantee shall submit to First Things First via PGMS all print and electronic materials related
to the programs and services funded under this Grant Agreement before publicly distributing
those materials so that First Things First may first review and approve the grantee's compliance
with this subsection. In consultation with First Things First, the grantee shall revise the
materials to meet First Things First's protocol and style requirements before publicly
distributing the materials. First Things First shall have full and complete rights to reproduce,
FTF-MULT1-16-0519-00 Page 8

duplicate, disclose, perform and otherwise use all materials prepared under this Grant
Agreement.
13.3. Public Awareness Efforts. The grantee shall 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 Grant Agreement.
13.4. Property of the State. Any materials and data required to be collected, delivered or created
under this Grant Agreement, including but not limited to reports, computer programs and
other deliverables are the sole property of the State (First Things First). The grantee is not
entitled to a patent or copyright on those materials and may not transfer the patent or
copyright to anyone else. The grantee shall not use or release these materials without the prior
written consent of First Things First.
13.5. Ownership of Intellectual Property. Any and all intellectual property, including but not limited
to copyright, invention, trademark, trade name, service mark and/or trade secrets created or
conceived pursuant to or as a result of this Grant Agreement and any related subcontract or
subgrant ("Intellectual Property"), shall be work made for hire and First Things First shall be
considered the creator of such Intellectual Property. First Things First shall own (for and on
behalf of the State) the entire right, title and interest to the Intellectual Property throughout
the world. The grantee shall notify First Things First, within thirty (30) days, of the creation of
any Intellectual Property by it or its subcontractor(s) and subgrantee(s). The grantee, on behalf
of itself and any subcontractor(s) and subgrantee(s), agrees to execute any and all document(s)
necessary to assure ownership of the Intellectual Property vests in the State and shall take no
affirmative action that might have the effect of vesting all or part of the intellectual Property in
any entity other than the State. The Intellectual Property shall not be disclosed by the grantee
or its subcontractor(s) and subgrantee(s) to any entity not the State without the express
written authorization of First Things First.
13.6. Fund Management. The grantee must maintain any funds received under this Grant
Agreement on other than a cost reimbursement basis in separate ledger accounts and cannot
mix these funds with other sources. The grantee must manage all funds according to applicable
regulations for administrative requirements, cost principles and audits. The grantee shall
maintain proper audit trails for all reports related to this Grant Agreement.
14. Relationship of Parties. The grantee under this Grant Agreement is an independent contractor. Neither
party to this Grant Agreement shall be deemed to be the employee or agent of the other party.
15. Indemnification.
15.1. Not Government Agency. This paragraph applies if the grantee is not a governmental entity.
To the extent allowed by law, the grantee shall 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, actions, liabilities,
damages, losses, costs or expenses (including court costs, attorneys' fees and costs of claim
processing, investigation and litigation) ("Claims") 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 grantee or any of its
owners, officers, directors, agents, employees, volunteers, subcontractors or subgrantees. This
indemnity includes any Claim or amount arising out of, or recovered under, the Workers'
FTF-MULTI-16-0519-00 Page 9

Compensation Law or arising out of the failure of the grantee 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 shall, in all instances, except for Claims arising solely from the
negligent or willful acts or omissions of the State, be indemnified by the grantee from and
against any and all Claims. It is agreed that the grantee will be responsible for primary loss
investigation, defense and judgment costs where this indemnification is applicable. In
consideration of the award of this grant, the grantee agrees to waive all rights of subrogation
against the State for losses arising from the work performed by the grantee for the State.
15.2. Government Agency. This paragraph applies if the grantee is a governmental entity and is not a
department, agency, board, commission or university of the State of Arizona. Each party (as
"Indemnitor") agrees to indemnify, defend and hold harmless the other party (as "Indemnitee")
from and against any and all 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 or any of its officers, officials, agents, employees or volunteers.
15.3. Patent and Copyright. The grantee shall 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 Grant Agreement. The State shall 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.
15.4. Subcontractors. The grantee shall contractually require its subcontractors and subgrantees, if
any, to defend, indemnify and hold harmless the State as described in this Section unless the
subcontractor or subgrantee is a state agency.
16. Insurance.
16.1. In the event the grantee is a governmental entity, then the insurance requirements in this
Section do not apply, except that such governmental entity grantee shall provide a Certificate
of Self-Insurance. If the governmental entity grantee is a department, agency, board,
commission or university of the State of Arizona, then the Certificate of Self-Insurance
requirement does not apply either.
16.2. The grantee shall procure and maintain until all of its obligations have been discharged or
satisfied, including any warranty periods under this Grant Agreement, insurance in the amounts
stated below against claims for injury to persons or damage to property which may arise from
or in connection with the performance of the work hereunder by the grantee and any of its
owners, officers, directors, agents, employees, volunteers or subcontractors. The grantee shall
require and ensure that all of its subcontractors comply with this Section as well.
16.3. The insurance requirements herein are minimum requirements for this Grant Agreement and in
no way limit the indemnity covenants. First Things First in no way warrants that these
minimum requirements are sufficient to protect the grantee from liabilities that might arise out
of the performance of the work under this Grant Agreement, and the grantee is free to
purchase additional insurance. The minimum insurance requirements are as follows:
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Commercial General Liability Occurrence Form
Policy shall include bodily injury, property damage, personal and advertising injury and broad
form contractual liability coverage.
• General Aggregate $2,000,000
• Products — Completed Operations Aggregate $1,000,000
• Personal and Advertising Injury $1,000,000
• Damage to Rented Premises $50,000
• Each Occurrence $1,000,000
The policy shall include coverage for sexual abuse and molestation. This coverage may be sub-
limited to no less than $500,000. The limits may be included with the General Liability limit,
provided by separate endorsement with its own limits or provided as separate coverage
included with the professional liability.
The grantee must provide the following statement on its Certificate(s) of Insurance: "Sexual
Abuse/Molestation coverage is included." Policies/certificates stating that "Sexual
Abuse/Molestation coverage is not excluded" do not meet this requirement.
The policy shall be endorsed to include the following additional insured language: "The State of
Arizona and its departments, agencies, boards, commissions, universities, officers, officials,
agents and employees shall be named as additional insureds with respect to liability arising out
of the activities performed by or on behalf of the grantee." Such additional insureds shall be
covered to the full limits of liability purchased by the grantee, even if those limits of liability are
in excess of those required by this Grant Agreement,
The policy shall contain a waiver of subrogation endorsement in favor of the "State of Arizona
and its departments, agencies, boards, commissions, universities, officers, officials, agents and
employees" for losses arising from work performed by or on behalf of the grantee.
Business Automobile Liability
Bodily Injury and Property Damage for any owned, hired, and/or non-owned vehicles used in
the performance of this grant.
• Combined Single Limit (CSL) $1,000,000
The policy shall be endorsed to include the following additional insured language: "The State of
Arizona and its departments, agencies, boards, commissions, universities, officers, officials,
agents and employees shall be named as additional insureds with respect to liability arising out
of the activities performed by or on behalf of the grantee, involving automobiles owned,
leased, hired or borrowed by the grantee."
The policy shall contain a waiver of subrogation endorsement in favor of the "State of Arizona
and its departments, agencies, boards, commissions, universities,,officers, officials, agents and
employees" for losses arising from work performed by or on behalf of the grantee.
The policy shall contain a severability of interests provision.
Workers' Compensation and Employers' Liability
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• Workers' Compensation Statutory
• Employers' Liability
Each Accident $1,000,000
Disease — Each Employee $1,000,000
Disease — Policy Limit $1,000,000
The policy shall contain a waiver of subrogation in favor of the 'State of Arizona and its
departments, agencies, boards, commissions, universities, officers, officials, agents and
employees' for losses arising from work performed by or on behalf of the grantee.
This requirement shall not apply to each grantee or subcontractor exempt under A.R.S. Chapter
23, Title 6 (§ 23-901 et seq.) when such grantee or subcontractor executes the appropriate
waiver (Sole Proprietor/Independent Contractor) form.
Professional Liability (Errors and Omissions Liability)
Each Claim $1,000,000
Annual Aggregate 63,000,000
In the event that the professional liability insurance required by this Grant Agreement is written
on a claims-made basis, the grantee warrants that any retroactive date under the policy shall
precede the effective date of this Grant Agreement and that either continuous coverage will be
maintained or an extended discovery period will be exercised for a period of two (2) years
beginning at the time work under this Grant Agreement is completed.
The policy shall cover professional misconduct or wrongful acts for the positions of
professionals/Key Personnel identified in this Grant Agreement.
16.4. Additional Insurance Requirements. The policies shall include, or be endorsed to include, the
following provisions:
The grantee's policies shall stipulate that the insurance afforded the grantee shall be primary
insurance and that any insurance carried by First Things First, its agents, officials, employees or
the State of Arizona shall be excess and not contributory insurance, as provided by A.R.S. § 41-
621(E).
Coverage provided by the grantee shall not be limited to the liability assumed under the
indemnification provisions of this Grant Agreement
16.5. Notice of Cancellation. With the exception of ten (10) day notice of cancellation for non-
payment of premium, any changes material to compliance with this Grant Agreement in the
insurance policies shall require thirty (30) days written notice to the State of Arizona. Such
notice shall be sent directly to First Things First, Fiscal Specialist, 4000 N. Central, Suite 800,
Phoenix, AZ 85012, and shall be sent by certified mail, return receipt requested.
16.6. Acceptability of Insurers. The grantee's insurance shall be placed with companies licensed in
the State of Arizona or on hold approved non-admitted status on the Arizona Department of
Insurance List of Qualified Unauthorized Insurers. Insurers shall have an "A.M. Best" rating of
not less than A- VII. The State of Arizona in no way warrants that the above-required minimum
insurer rating is sufficient to protect the grantee from potential insurer insolvency.
FTF-MU LTI-16-0519-00 Page 12

16.7. Verification of Coverage. The grantee shall furnish the State of Arizona with certificates of
insurance (ACORD form or equivalent approved by the State of Arizona) as required by this
Grant Agreement. The certificates for each insurance policy are to be signed by an authorized
representative.
All certificates and endorsements are to be received and approved by the State of Arizona
before work commences. Each insurance policy required by this Grant Agreement must be in
effect at or prior to commencement of work under this Grant Agreement and remain in effect
for the duration of the program. Failure to maintain the insurance policies as required by this
Grant Agreement or to provide evidence of renewal is a material breach of the Agreement.
All certificates required by this Grant Agreement shall be sent directly to First Things First, Fiscal
Specialist, 4000 N. Central, Suite 800, Phoenix, AZ 85012. The State of Arizona program/grant
number and program description shall be noted on the certificate of insurance. The State of
Arizona reserves the right to require complete copies of all insurance policies required by this
Grant Agreement at any time. DO NOT SEND CERTIFICATES OF INSURANCE TO THE STATE OF
ARIZONA'S RISK MANAGEMENT SECTION.
16.8. Subcontractors. The grantee's certificate(s) shall include all subcontractors as insureds under
its policies or grantee shall furnish to the State of Arizona separate certificates and
endorsements for each subcontractor. All coverages for subcontractors shall be subject to the
minim urn requirements identified above.
16.9. This Section assumes the grant award is for more than $50,000, that the grantee will be using
vehicles beyond commuting in order to provide the services under the Grant Agreement, that
the grantee will be working with children in order to provide the services under the Grant
Agreement, and that the grantee will be providing professional services in order to provide the
services under the Grant Agreement. If any of these assumptions do not apply to this Grant
Agreement, then upon agreement of First Things First, the insurance requirements will be
reduced or removed in part from the Grant Agreement as appropriate.
16.10. If the Grant Agreement requires the grantee to handle money on behalf of the State, the
grantee shall also procure and maintain a fidelity insurance policy, consistent with the State of
Arizona Risk Management Insurance Modules, that includes third party fidelity coverage.
16.11. If the Grant Agreement requires the grantee to provide information technology (IT) services,
the grantee shall also procure and maintain errors and omissions coverages, consistent with the
State of Arizona Risk Management Insurance Modules, including technology errors and
omissions, network security/privacy and media liability.
16.12. The grantee understands and agrees that any modification or variation from the insurance
requirements in this Grant Agreement may only be made by First Things First in consultation
with the Department of Administration, Risk Management Section or in accordance with its
published insurance modules. Such action will not require a formal grant amendment, but may
be made by administrative action.
17. Notices. Notices to the grantee required by this Grant Agreement shall be made by First Things First to
the person indicated on the Offer and Acceptance form submitted by the grantee unless otherwise
stated in the Grant Agreement. Notices to First Things First required by the Grant Agreement shall be
made by the grantee to an authorized First Things First representative, unless otherwise stated. An
FTF-MULTI46-0519-00 Page 13

authorized First Things First representative and an authorized grantee representative may change their
respective person to whom notice shall be given by written notice to the other and an amendment to
the Grant Agreement shall not be necessary.
FTF-MULTI-16-0519-00 Page 14

In response to the RFGA, Maricopa County Department of Public Health's First Teeth First
program will merge with Dignity Health's Early Childhood Oral Health Program (ECOHP) to form
one program to provide a coordinated approach to oral health prevention services in Maricopa
County. Additionally, a partnership with Arizona Department of Health Services, Office of Oral
Health (ADHS OOH) will allow billing for fluoride varnish services through the Arizona Health Care
Cost Containment system (AHCCCS). Effective July 1, the new collaborative oral health program
will be First Teeth First. First Teeth First will provide preventive oral health education, screening,
and fluoride varnish to children ages zero to five in an effort to decrease the number of children
with early childhood tooth decay and the associated risks for pain and infections that can lead to
lifelong complications to health and wellbeing. As requested in the First Things First oral health
strategy, First Teeth First will provide outreach and training to medical and dental professionals
that serve the target population.
Services will continue at Women, Infant and Children (WIC) clinics, Immunization clinics
and will collaborate with preschools, childcare providers, school districts, and other community
based organizations to provide oral health screening and fluoride varnish treatments to children
and oral health education to children and their families, pregnant women, and caregivers.
Educational supplies will be provided to all those who receive services including a toothbrush kit
and referral information as appropriate. Because First Teeth First and Dignity Health will continue
offering services seamlessly and uninterrupted the expectation will be to exceed the TSUs
A medical model of fluoride varnish application and education will provide cost effective,
high quality and compassionate care. A community-based approach provides opportunities for
underserved children to receive oral health screenings, education, fluoride varnish and referrals.
The program utilizes the expertise of both dental and medical professionals to provide a
comprehensive approach to oral health prevention services.
The First Teeth First program and Dignity Health currently provide services throughout
Maricopa County to the target population. In this partnership, 15 WIC locations, 8 Immunization
clinics, approximately 164 childcare centers, 93 preschools, 38 Head Starts receive services,
complemented with approximately 115 community events. The programs will continue to utilize
registered dental hygienists, nurses, bilingual site assistants and health educators for services
within the program.
Success is measured by meeting or exceeding the proposed service numbers, increased
understanding of the importance of early childhood oral health, and increased access to dental
care. Parent understanding is assessed by administering satisfaction surveys after services are
rendered. This quantitative evaluation provides an overview of services provided (including
general results) to childcare centers and preschools. A reminder for services six months later is
provided. Monthly quality assurance assessments are utilized to increase consistency of patient
care and process of care. An established referral model developed with AHCCCS Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) Coordinators provides access to care and
comprehensive services including efforts to establish dental homes. These feedback loops and
measurement tools demonstrate the program's ability to achieve proposed TSUs, overall program
satisfaction, provider quality assurance and quality patient care. Program evaluation has been
conducted annually since fiscal year 2012. An updated report will be completed in May 2015,
summarizing December 2011 through February 2015 program data.
FTF-M ULTI-16-0519-00 Page 15

Respond to each of the following items:
1. Provide examples of experience implementing related programs and the outcomes of
those programs. It should be noted that past performance on any grants may be taken
into consideration in the evaluation of your proposal.
Dignity Health has been providing oral health prevention services in Phoenix's East Valley
since 2005. Oral screening and fluoride varnish services provided at immunization clinics
highlighted the need for preventive dental services and in 2008, the Children's Dental Clinic began
providing full preventive services to low-income children at a school-based clinic. In 2010 Dignity
Health launched the Early Childhood Oral Health Program (ECOHP), funded by First Things First, to
meet the needs of very young children and their families. The ECOHP provides oral health
education, screening, and fluoride varnish application to children at WIC offices, Head Start and
preschool classrooms, childcare centers, immunization clinics, and Family Resource Centers.
Recurring visits provide the opportunity to reinforce good brushing and nutrition habits through
child-friendly education sessions which include the use of puppets, books, pictures, and hands-on
activities. Additionally, repeat visits offer fluoride varnish application two to four times per year
for each participating child. Through these two programs, Dignity Health provides approximately
800 clinic appointments, 3000 screenings and fluoride varnish applications and more than 20,000
education encounters every year. Dignity Health has a proven record of meeting its grant
obligations and has met all past and current targeted service numbers. These established
locations and partnerships allow for a continued effective and flourishing delivery system of care.
Since implementation of services with First Things First funding in 2010, Dignity Health has
provided 19,348 basic oral screenings for children in the East Valley through January 2015. Of
those children that received an oral health screening, 17,158 received fluoride varnish. With the
strong community presence and program experience, we look to continue providing these
preventive services to the community as an integrated program. Dignity Health has noticed
consistent growth in the number of children receiving basic oral screenings and fluoride varnish
applications. Successful outcomes with educating patients and families on proper oral health
behaviors and external influences have created a more steady growth rate.
A variety of factors impact the services provided in the community which result in
fluctuations in the number of children served from year to year. In 2010, when Arizona passed
SB1070, Dignity Health saw decreased attendance at many community sites. Decreased
attendance was further noted at immunization clinics when the Centers for Disease Control and
Prevention ruled that children with insurance could no longer receive no-cost vaccines through the
Vaccines for Children Program. Program success can also contribute to service number
fluctuations. As parents and caregivers become more aware of the importance of healthy oral
habits and early dental visits, it was found that children were receiving dental exams and fluoride
varnish applications at dental offices, resulting in a decrease in consent return rate. Program staff
used data analysis to identify those clinics with declining participation and adjusted clinic
frequency. Additional partnerships were developed to compensate for the fluctuation.
FTF-MULTI-16-0519-00 Page 16

In 2011, First Teeth First was funded by First Things First to provide varnish services and aid
in the oral health strategy mission. First Teeth First has provided direct preventive services at
some point within the following First Things First Regions: NW Maricopa, SW Maricopa, NE
Maricopa, North Phoenix, Central Phoenix and South Phoenix (previous regional names used).
This fluoride varnish program was new to all of the regions and full implementation was required.
Creation of a training manual, hiring of personnel, training of personnel, opening of each
permanent location (11 currently), creating partnerships with community dental clinics to refer the
urgent needs children to, provide outreach into the community to provide services at childcare
centers, preschools, and community events. Since the inception of First Teeth First, the program
has witnessed consistent growth, especially related to the Target Service Unit deliverables. With
this new grant First Things First can expect First Teeth First to continue providing optimal oral
health services and successful outcomes related to target service units.
Since implementation of services with First Things First funding in 2011, Maricopa County
First Teeth First program has grown immensely since the inception of the program. The oral
health program provided approximately 10,000 children with screenings and fluoride varnish in
the first year of services. With the number of children screened increasing each year, First Teeth
First has accumulated 56,305 basic oral screenings for children in Maricopa County through
February 2015. Of those children that received an oral health screening, 50,849 have received
fluoride varnish. Maricopa County First Teeth First program has become the largest fluoride
varnish program in the state and recognition of the program's services has become well known
within the community by providers and patients alike.
2. Describe your agency/organization's professional knowledge of and experience in
working with the target population.
Maricopa County is the nation's fourth most populous county with an estimated 3.8
million people and is home to 60% of the state's residents and the city of Phoenix, now the
nation's fifth largest city. Spread out over 9,200 square miles, the county is a mix of urban and
rural areas and includes the whole or parts of five Indian Reservations. One of the fastest
growing areas of the country during the 1990s and early 2000s, Maricopa County is the state's
major center of political and economic activity.
Maricopa County Department of Public Health (MCDPH) is the public health agency of
Maricopa County government. Its mission is to protect and promote the health and well-being of
Maricopa County residents and visitors. MCDPH is organized into offices that are housed in five
Divisions: Community Health Action, Community Transformation, Disease Control, Clinical
Services and Administration. Additionally, the Office of Community Engagement, Office of
Performance Improvement, and Public Health Policy Consultant report independently to the
director. As the third largest health jurisdiction in the U.S., the Maricopa County Department of
Public Health (MCDPH) has more than 674 employees and a FY 2015 budget of $61.2 million.
MCDPH provides an extensive array of grant funded clinical and community health services.
Major programs include maternal and child health home visiting and community education,
parenting education, childhood immunizations, HIV/AIDS counseling and education, STD
prevention and treatment, oral health, tobacco use prevention, health promotion and education,
Women, Infants and Children (WIC) and other nutrition and education services, and health care
FTF-MULTI-16-0519-00 Page 17

for the homeless. Many of these programs target the First Teeth First Program target population.
WIC is a primary program partner.
MCDPH and the Office of Oral Health have proven track records of engaging community
stakeholders and successfully serving Maricopa County's most vulnerable populations,
specifically underserved, uninsured/underinsured children ages zero to five. The Health
Improvement Partnership of Maricopa County or HIPMC is a county-wide multi-sector coalition
and is the focal point for collaboration and partnerships at MCDPH. The HIPMC has developed
broad-based strategies focusing on health improvement of the more than 3.8 million county
residents. It is guided by Collective Impact Process philosophies of a common agenda, shared
measurement strategies, mutually reinforcing activities and continuous communication. Since
June 2012, more than sixty partner agencies and collaborative groups have come together
quarterly to share ideas and resources, identify gaps and barriers to existing services, and engage
in thoughtful planning to achieve a shared vision of community-based work ongoing in four
sectors: Healthcare, Community, Worksites and Education. MCDPH has built a solid foundation
that provides MCDPH programs and community partners technical assistance support with data
and policy analysis, evidence-based approaches, strategic planning, marketing and
communications, evaluation, and support for large-scale community initiatives. Also, as a neutral
convener - especially for organizations that often compete for resources, the HIPMC promotes a
safe environment for non-traditional partnerships to blossom. One such partnership is the
MCDPH FTF Program and Dignity Health in this grant proposal.
Dignity Health, Chandler Regional Medical Center and Mercy Gilbert Medical Center have
demonstrated a growing investment in community outreach and educational programs, advocacy
efforts and collaborative community partnerships. The Community Integration team has created
partnerships with schools, community centers, churches, medical personnel, community leaders,
state and local government, and Native American communities to establish health and wellness
programs throughout the Phoenix East Valley. In addition to early childhood oral health services,
Dignity Health serves children and their families through prenatal and parenting education,
gestational diabetes classes, immunization clinics, and hearing and vision screening.
3. Describe the capacity and/or infrastructure required to implement the proposed
program.
Currently, services are being provided at various location types throughout Maricopa County.
Permanent locations are considered locations where services are provided on a regular basis (daily, weekly,
bimonthly or monthly). An example of one of these locations would be a WiC or Immunization clinic and
resource centers. All other services are provided at non-permanent locations, which is a location that we
provide services at every six months to one year. Examples of these locations would be childcare centers,
preschools, community events, etc. (See Appendix A1-A5)
First Teeth First has been providing services to the target population of children zero through five
and pregnant women for the last four years. We have been able to reach this target population by
providing services in locations where this population goes for services with our primary focus on providing
services at Maricopa County Women, Infant and Children (WIC) clinics which service children zero to five
and pregnant women. This mutually beneficial partnership has promoted a synergistic approach as both
programs are able to provide services to the WIC clients and educate them on the importance of oral health
and how it relates to overall health. First Teeth First will continue to provide services every six months
FTF-MULTI-16-0519-00 Page 18

regardless of the insurance status of the child. Through additional visits, staff will be able to reinforce
beneficial oral health habits and promote access to care through dental homes.
The First Teeth First program also provides services at childcare centers, preschools and community
events across the county. Partnerships have been developed with several agencies dedicated to reaching
the target population. Examples of these partnerships include other First Things First grantees (Readiness
Basket, S.N.A.C.K., Peoria Unified School District, etc.), Teen Outreach Pregnancy Services (TOPS), Nurse
Family Partnership (train the trainer model) and working with professionals that are providing services to
children, such as Arizona Academy of Pediatrics. Outreach is provided to child care centers, preschools and
community events by health educators/outreach specialists to reach children in a different setting that we
can return to every six months.
Partnering with organizations that serve the target population to provide professional development
for increased oral health knowledge will be expanded upon. First Teeth First will utilize the model created
by Dignity Health for professional development. A registered dental hygienist will be hired to partner with
Dignity Health's staff to implement this service across Maricopa County. Dignity Health is currently
implementing the Early Childhood Oral Health Program so necessary infrastructure is currently in place to
continue providing oral screenings, fluoride varnish and education. Dignity Health and Maricopa County
Department of Public Health's Office of Oral Health (MCDPH 00H) will work together to create the
additional infrastructure required for the Administrative Home model of the First Things First Oral Health
Strategy. Services will continue to be provided during the time of transition so there will be no lapse in
services provided to the community. Community partnerships that have been established by both programs
will continue and additional partnerships will be developed. Dignity Health and MCDPH 00H will continue
to partner with First Things First grantees throughout the six Maricopa Regions.
This success story is a perfect example of how we are reaching the target population to provide
services, education and referring children to a dental home. (See Appendix B)
4. Identify how qualified personnel will be recruited and supervised.
Maricopa County has a human resource structure to recruit and retain qualified personnel.
The entire range of MCDPH human resource functions of selection, recruitment, compensation,
training and performance management are aligned and consistent with state-of-the-art,
professional human resource management. Fundamental values of efficiency, economy, fairness
and high performance are paramount to the program's success. Evaluation of applicant training,
experience, and education is used in the recruitment and selection process.
The First Teeth First program benefits tremendously from incomparable organizational
infrastructure in terms of program leadership and supervision. First Teeth First is a program of the
Office of Oral Health, administered by Vincent Torres, Supervisor. He is a licensed dental hygienist
with a Bachelor of Science degree in Dental Hygiene and a Master's degree in Healthcare
Innovation. Mr. Torres also serves as Adjunct Dental Hygiene Faculty at Fortis College, an Arizona
institution that prepares students for employment with dental clinics, in higher education and
public health settings. Mr. Torres develops and teaches community and oral health curriculum
focused on public health program planning and program review. The Office of Oral Health is
within the Department of Public Health Community Health Action Division, administered by Toby
Urvater. With more than twenty years of public health experience, Ms. Urvater is a seasoned,
highly respected program administrator with exceptional organizational
development/management skills and extraordinary success in community collaboration.
FTF-MULTI-16-0519-00 Page 19

At the program level, First Teeth First is fully staffed and prepared to enhance provision of
services in a highly functioning partnership with Dignity Health. Both organizations have
demonstrated excellent staff retention throughout the life of the program. This staff continuity
provides a stable platform from which to improve and expand the program. Recruitment for
additional staff will be conducted in order to provide services at additional locations. Specific
MCDPH First Teeth First staffing information is required and provided in the RFGA budget
justification and personnel table (See RFGA Section D-Program Personnel Table and Section F-
Budget Narrative) Subcontracted Dignity Health program staff information is presented below:
The Dignity Health organization has demonstrated excellent staff retention throughout the
life of the program. This staff continuity provides a stable platform from which to improve and
expand the program. Program staff includes:
Community Integration Director. Kathleen Dowler, RN, BSHA, reports directly to Vice
President of Mission Integration for Chandler Regional and Mercy Gilbert Medical Centers.
Kathleen is responsible for the program and will spend 5% of her time on its administration.
Kathleen is responsible for budget, productivity, personnel, and strategic planning for the
Center for Diabetes Management, Community Education, Lactation Program, Community
Outreach, Community Benefit Program development and reporting, Grants Committee, and
Community Investment Committee.
Program Manager, .5 FTE. Megan Miks, MPH reports directly to the Director of Community
Integration. Megan has managed the ECOHP since November 2009. Megan's responsibilities
include oversight of program staff, fiscal management, curriculum development, reporting,
evaluation, partnership development and strategic planning.
Program Coordinator. 1.0 FTE. Melva Molina-Lucas reports directly to the Program
Manager. She has been program coordinator since January 2013. Melva assumes an active role in
program development, planning initiation, evaluation, and performance improvement of the
ECOHP. She is responsible for scheduling clinics and staffing, data reporting, development of
Community partnerships, and supply management.
Community Health Nurse. .8 FTE. Currently Vacant. The RN reports directly to the Program
Manager. The RN is responsible for patient care and follow-up, assistance with planning,
implementing and evaluating the oral health program. The RN will conduct oral health screenings
and fluoride varnish applications for children and educate children and parents about important
areas of preventive oral health care. The RN will educate caregivers and medical and dental
professionals and will be fluent in Spanish. Clinical responsibilities will be supervised by a
registered dental hygienist including training, calibration.
Oral Health Educator 2.0 FTE. Reyna Hively and Myriam Aispuro have both worked for
Chandler Regional Medical Center as Qualified Medical Interpreters and are bi-lingual in Spanish.
The oral health educators provide oral health prevention information to children and their families
in community settings. Their duties include assisting staff with data collection and reporting,
supply management, curriculum development and program planning.
Dental Hygienist 1.5 FTE. Laurie Clark and Karen Felty each have many years of private
practice and community oral hygiene experience. As members of the ECOHP they serve as clinical
experts, provide support and training to staff, and provide oral health education, oral screening,
and fluoride varnish application at community-based clinics. Karen and Laurie will assist with
FTF-MULTI-16-0519-00 Page 20

curriculum development, program planning and professional education to dental and medical
professionals.
PRN staff: Four registered nurses and two oral health educators currently work on an as
needed basis for the ECOHP. Their duties mirror those outlined above. All PRN staff receives the
same training and supervision as full-time staff.
5. Describe plans for ensuring personnel will be linguistically and culturally competent to
work with the target population.
The First Teeth First program and Dignity Health currently hire bicultural, bilingual site
assistants (Spanish speaking) and Oral Health Educators in order to effectively translate services
and educate parents and children receiving services. FTF program office 'staff including health
educators and program assistant are all fluently bilingual in Spanish as well. Providing personnel
that are linguistically and competent within the culture of the target population inhibits any
erosion within the program's communications systems.. Additionally, services are contracted
through Language Line to be able to reach populations that speak languages other than Spanish
and English. Spanish-speaking staff reduces misunderstanding and increase the likelihood that the
positive oral health messages will be heard and practiced. Annually, First Teeth First staff will be
provided cultural competency education through the classes offered by the Department of Public
Health and AZ TRAIN.
Dignity Health staff are required to participate in annual cultural competency education.
Patients needing health care come from many backgrounds, ethnicities, and cultures. Being
sensitive to the differences among all patients is an important indicator for providing quality care.
Additionally, staff participates in age-appropriate educational opportunities to increase their
proficiency to educate both children and adults. FTF and Dignity Health are committed to
providing culturally appropriate services to the changing population and continue to hire diversity
in staff.
6. Describe how your agency will collaborate with existing programs/grantees to provide
oral health screenings and education. Attach any existing Memorandums of Agreements
or Letters of Commitment.
The First Teeth First program is extremely fortunate to be able to partner with several
groups and organizations within the Maricopa County Department of Public Health. Our main
partner is the Women, Infant and Children (WIC) office that serve multiple locations throughout
Maricopa County. Collaborating with the WIC program provides the ideal environment and ability
to provide preventive services such as oral health screenings and education to expectant mothers
and children as well as, fluoride varnish applications to children. This is a vulnerable target
population that oftentimes does not receive oral health services. First Things First has a defined
vision that focuses on early childhood development. The oral health program is an extension of
this vision and the strategy is inclusive of all children regardless of their insurance status.
Initially, our team will collaborate with First Things First to locate preschools and childcare
centers in the region that are Quality First locations to service those children. After health
educators reach out to the Quality First Childcare Centers, First Teeth First staff then looks to find
FTF-MULT1-16-0519-00 Page 21

additional childcare centers in the regions to provide additional services as they are available.
Additionally, we have an Intergovernmental Agreement in place with Peoria Unified School District
(PUSD) (See Appendix C) to provide continued services to children in that school district. The oral
health program also provides services at schools within the Scottsdale Unified School District,
Laveen Elementary School District, and Prendergast Elementary School District.
Regarding more comprehensive services, First Teeth First also partners with local dental
clinics such as Mountain Park, John C. Lincoln Children's Dental Clinic and Maricopa Integrated
Health Services (MU-IS) to refer children with urgent needs for immediate treatment. First Teeth
First looks to integrate a referral base system that is utilized by Dignity Health on a county wide
level.
A formal subcontract with Dignity Health will be established to be able to continue delivery
of services in the East Valley. A Notice of Intent has been completed between Dignity Health and
Maricopa County to provide the following services: oral health screening, and fluoride varnish
application to children ages zero to five, oral health screenings to pregnant women and preventive
oral health education and outreach and training to medical and dental professionals. Services and
outreach will be provided in diverse location settings. (See Appendix D) Dignity Health has
developed partnerships with numerous agencies throughout the East Maricopa and Southeast
Maricopa Regional Partnership areas. These partners were chosen because they have existing
relationships with families of children ages zero to five. This trusting relationship with WIC offices,
Family Resource Centers, childcare centers, and preschools supports access to services. Partnering
with First Things First grantees emphasizes the connection between early childhood development
and health.
7. Identify how your agency will reinvest funds collected through reimbursement in to
expanded oral health service delivery
A partnership with the Arizona Department of Health Services Office of Oral Health (ADHS-
00H) will allow the First Teeth First program to submit claims for Arizona Health Care Cost
Containment System (AHCCCS) eligible children. ADHS will be a sub grantee to the MDPCH First
Teeth First Program. The utilization of this expanded function in delivery of care will help create
sustainability of the First Teeth First program. (See Appendix E)
After the first year of revenues received through billing, it is expected the costs for billing
will be covered. In addition, all funds minus the cost of the billing service from ADHS will be
submitted to the First Teeth First program for reinvestment into oral health services within the
program. First Teeth First would hope to elevate the program to more innovative potentials and
visionary practices with the funding that is generated through reimbursement.
8. Describe the established collaboration(s) in place with one or more local organizations
for the delivery of programs and/or services to the target population.
Currently, First Teeth First has partners with agencies across Maricopa County. Services
are provided on a regular basis (more than once every six months) at permanent locations at the
following sites:
WIC clinics
FTF-MULTI-16-0519-00 Page 22

Mexican Consulate
Avondale Care1st Resource Center
Additionally, services have been or are provided every six month or annual (depending on
the event) at:
YMCA locations, Paiute and other neighborhood resource locations, Scottsdale
Unified School district preschools and PANDA programs, Fort McDowell H'man
`Shawa Early Childhood Center, Jewish Community Center, Southwest Human
Development collaborations, Catholic Charities West Valley Head Starts,
Guatemalan Consulate, Readiness Basket, Father Matters, Teen Outreach
Pregnancy Services (TOPS), South Phoenix Healthy Start, Peoria Unified School
District preschools, Fountain Hills Elementary School District preschools,
Scottsdale Library (including Books & Babies and Stay and Play events), various faith
based organizations, City of Scottsdale, City of Glendale, Benevilla, Jewish Family
Service Center, Valley of the Sun Organizations, Ultimate Playdate, West Valley
Summer Lunch program and HopeFest.
Dignity Health has established partnerships with agencies within the East Valley. Services
are provided on a regular basis at the following sites:
WIC offices (Broadway, Greenfield, Mesa, Chandler)
Immunization Clinics: six separate locations
Chandler Care Center
St. Mark's Food Bank
Thrive to Five Family Resource Centers
Dignity Health Child Birth Preparation Classes
Maricopa integrated Health Systems - Guadalupe Family Health Center
Services have been or are provided every six months or annually at:
Childcare centers (84 sites) and School-based preschools (82 sites):
Chandler Unified School District, Gilbert Public Schools, Kyrene school District, Mesa
Public Schools, Tempe Elementary School District, Queen Creek Unified School
District
Head Start - 14 sites
Health Fairs and Community Events:
Chandler Day of Play, Chandler Health Expo, Chandler Back to School Expo, Tempe
Healthy Living Event, Tempe Schools Parent University, Queen Creek Pan de Vida
Community Resource Centers:
Chandler Christian Community Center, Pregnancy Care Center, Mesa Family
Resource Center, Parenting AZ, Parents As Teachers, Save the Family
9. Describe the outcomes achieved as a result of the collaboration(s) including: how service
delivery has improved; how resources are more effectively utilized across partners; and
how the continued work of this collaboration will impact the implementation of the
proposed program.
FTF-MULT1-16-0519-00 Page 23

Collaboration between Maricopa County and Dignity Health to deliver services by
demonstrating a strong and coordinated multi-agency effort to implement the First Things First
Oral Health Strategy within all regions of Maricopa County. With this partnership, we will
demonstrate organizational, fiscal and programmatic capacity to meet the required description in
the scope of work for children and families residing in the Maricopa County First Things First
regions. First Teeth First and Dignity Health will coordinate in a seamless and cohesive county-
wide approach to achieve oral health outcome objectives, focusing on the First Things First mission
of early childhood development and optimal oral health. The outcomes should reduce duplication,
increase efficiency resulting in increased children and families receiving services across Maricopa
County.
Services at locations such as the Mexican and Guatemalan Consulates and the Avondale
Care 1st Resource Center are a great partnership because we are reaching the target population at
a location that they are already going to. Offering a multiple service approach works well for
efficiency and our target population because transportation is often times a challenge thus making
getting our services difficult outside of these locations. Continuing this model will help strengthen
our services and provide the needed services in these underserved populations.
Dignity Health's collaboration with local school districts has streamlined visits to district
preschools, especially those with large numbers of preschool students. Initially, Dignity Health
staff processed consent forms the day of the clinic and provided education sessions in each
classroom. The amount of time to process 60-100 consent forms, provide several different
education sessions, and concerns about patient identification prompted evaluation of clinic
processes. Beginning with Getz Preschool in the Tempe School District, staff worked with school
staff to address these issues. As a result, process changes included accessing consent forms prior
to the clinic for processing, holding education sessions in a central location and using stickers to
identify children by name and date of birth. These changes were then adopted at the large
preschools in the Mesa, Chandler and Higley School Districts. Subsequently, clinic flow is more
efficient, less time is spent on paperwork during clinic time and patient identification concerns are
mitigated. These changes required communication and cooperation from staff of Dignity Health
and the schools and are evidence of the close working relationships which have been developed.
Respond to each of the following items:
1. Describe the proposed program that includes implementation of the Administrative
Home responsibilities and tasks. Include details of how the Administrative Home will
work effectively with sub-grantees and how the Standards of Practice will be adhered to
and how key personnel requirements will be met during program implementation.
Address how a centralized intake and referral will be implemented and specifically how
the referral process will coordinate with subgrantees (if applicable). In addition, describe
the implementation of a model of case management to ensure that urgent/emergent
referrals for dental care are made and that families seek that level of care.
FTE-M ULTI-16-0519-00 Page 24

Maricopa County Department of Public Health Office of Oral Health administrative home
responsibilities and tasks:
A. Fiscal Management and Reporting:
Maricopa County Department of Public Health's First Teeth First program will oversee all
budgetary responsibilities and fiscal oversight. Communications and reporting of overall program
cost-effectiveness and financial responsibilities will be reported by First Teeth First to First Things
First. Any reports related to the sub-grantee will be developed and reported by First Teeth First in
an overall oral health program perspective.
First Teeth First will provide all financial and administrative management for the program
and work with the sub-grantee (Dignity Health) to develop a Target Service Unit forecast. The sub-
grantee will submit an initial annual forecast during the grant application process. Upon
implementation of the oral health program, the sub-grantee will provide the Administrative Home
with reports related to monthly and quarterly target service units and relative units met Any
projections related to performance measures will be discussed on a monthly basis and both
organizations will review the units of services delivered for compliance with the proposed Target
Service Units quarterly. Dignity Health will receive grant funds through the Administrative Home
(First Teeth First) based on their projected cost of delivering services that aid in meeting the Target
Service Units.
A partnership with the Arizona Department of Health Services Office of Oral Health (ADHS-
00H) will allow the First Teeth First program to submit claims for Arizona Health Care Cost
Containment System (AHCCCS) eligible children. After the first year of revenues received through
billing, it is expected the costs for billing will be covered. In addition, all funds minus the cost of
the billing service from ADHS will be submitted to the First Teeth First program for reinvestment
into oral health services within the program. First Teeth First would hope to elevate the program
to more innovative potentials and visionary practices with the funding that is generated through
reimbursement
B. Coordination of data collection and reporting
First Teeth First will continue to utilize a centralized database to collect, track and record
patient information and services. This database is accessed at all First Teeth First permanent
locations (e.g. WIC and immunization clinics) and provides a delivery of care system that decreases
the possibility of duplicative services. Dignity Health will record all data regarding patients and
services rendered which will then be collected by First Teeth First on a weekly basis. Locations
outside of the permanent locations will also be entered into the database weekly. Summary
reports reflecting the deliverables and monitoring of oral health indicators can be produced
through the Maricopa County First Teeth First program. The database can be used to evaluate
performance measures as it relates to providers and the program. Continuous evaluation and
improvement to reduce duplication will be implemented. Data collection will be done regionally in
order to provide regional councils with region specific numbers for reporting purposes.
C. Evaluation and Quality Assurance:
At a minimum, the grantee shall submit quarterly, one Program Narrative Report and three
Data Submission Reports (one per month) by the 20th of the month following the quarter via the
FTF-MULTI-16-0519-00 Page 25

First Things First Partner Grant Management System (PGMS). The reports shall contain summary
information as deemed necessary by First Things First which includes documentation of program
evaluation and quality assurance.
First Teeth First implements quality assurance protocols consisting of site inspections
monthly to ensure programmatic standards are being met. Quarterly trainings are held with all
field registered dental hygienists and site assistants. These meetings are used to review protocols
and policies and procedures for reliable program services. In addition, regular calibration training
is held with the clinical staff to assure consistent implementation of services. Dignity Health
currently practices similar evaluations that elevate successful outcomes related to deliverables and
quality of service. As the two organizations solidify their union within this first year of delivering
services, steps toward creating a single quality assurance and evaluation system will be developed.
D. Service Integration to sub-grantees: Collaboration of program services with sub-
grantees to implement SOW based on SOP
Dignity Health and First Teeth First will align to provide clinical services that address the
needs of families with children ages birth through five and expectant mothers. Both
organizations will complete oral health screenings to children and expectant mothers in a manner
consistent with the scope of practice. Only children ages zero to five are eligible for fluoride
varnish applications. Proper informed consent from a parent or guardian will be documented and
patient confidentiality will be maintained. During the oral health screening, children and
expectant mothers will also receive a complete dental caries risk assessment using the Basic
Screening Survey (BSS).
The development of the initial Basic Screening Survey (BSS) model in 1999 was led by the
Association of State and Territorial Dental Directors, in collaboration with the Ohio Department of
Health. Technical assistance was provided by the Division of Oral Health, National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.
The 2008 revisions to this publication and any accompanying materials were supported by
Cooperative Agreements from the Division of Oral Health, Centers for Disease Control and
Prevention (CDC), and from the Maternal and Child Health Bureau, Health Resources and Services
Administration, Department of Health and Human Services. First Teeth First will work with
statewide grantees to ensure that all oral health grantees are using the 855 correctly and similarly
in order to collect meaningful data in a universally accepted fashion. This survey will help providers
and site assistants deliver patient education and oral hygiene instruction to the children, families
and caregivers.
During fluoride applications on children ages zero to five, appropriate fluoride varnishes
containing the recommended dose of sodium fluoride (5% NaF) will be topically placed on the
teeth to facilitate re-mineralization of the enamel. Fluoride varnish provides a highly
concentrated, temporary dose of fluoride to the tooth surface. 1
Outreach and oral health education will be promoted through individual and group
formats. Group sessions will be provided during locations and visits that consist of child care
centers, preschools, and community events
Association of State and Territorial Dental Directors Fluorides Committee (ASTDD). Fluoride Varnish: an Evidence-
Based Approach. September 2014
FTF-MULTI-16-0519-00 Page 26

Dignity Health and First Teeth First have a close working relationship and have collaborated
previously to enhance program delivery and presentations. As a sub-grantee, Dignity Health will
work closely with First Teeth First as the Administrative Home to ensure alignment in strategy and
service delivery. Dignity Health and First Teeth First will continue to provide oral health screening,
fluoride varnish application and education in accordance with the FTF Scope of Work and
Standards of Practice with the goal of creating a coordinated system of oral health prevention
activities throughout Maricopa County. Dignity Health and First Teeth First will work
collaboratively to identify areas of opportunity regarding service delivery, data collection and
professional development.
E. Centralized Intake and Referral:
First Teeth First has developed and integrated a centralized intake system that is capable of
monitoring and storing data related to patient information, services and record keeping. The use
of this electronic database system as the main server of information will be used for surveillance,
tracking trends, consent intake and record keeping regarding services rendered. All permanent
locations will have access to this database. Providers will enter patient information at each visit
and review a brief patient history of services and documentation notes. This process will alert
providers and site assistants of patient eligibility. All process of care documentation will be
entered into the database at the time of service delivery at permanent locations.
The hygienist and site assistant approach families about the First Teeth First cavity
prevention fluoride varnish program in permanent locations. If the parent agrees to give
permission for services, the site assistant will give them a consent form to record basic information
(name, date of birth, demographics), medical history, risk for cavities questionnaire, and parental
or guardian signature. Initially, the site assistant will review the database to see when was the last
time the client received fluoride services and if they are eligible for this visit. On a daily basis, the
site assistant types the written consent form and treatment record into the database at
permanent locations. The database helps the program keep surveillance, tracking clients,
treatment status, and services given. The database will also provide date of services and the
providers who provided the service from previous visits.
Services are also provided at childcare centers, preschools and community events.
Outreach is provided to locations to give consent forms and inform the location of services. Site
locations distribute forms and on date of service, forms are collected. Services are provided and
urgent children are referred as necessary. Data collected from these services is entered into the
database within the week of services.
Children who have urgent dental needs (i.e. moderate-severe cavities, abscess [infection],
and/or in pain) are referred to a community dental clinic partner and, if AHCCCS enrolled, their
AHCCCS health plan. The community dental clinic partners currently include: Maricopa Integrated
Health Systems (MIHS) Dental Clinic, John C Lincoln/Desert Mission Children's Dental Clinic, and
Mountain Park Health Center Dental Clinic. The referred to dental clinic will attempt to contact the
parent to schedule an appointment within 24-48 hours from when the screening is provided.
Children who are uninsured or underinsured will receive assistance from eligibility coordinators at
each clinic. In addition to being referred to a community dental clinic, AHCCCS children are
referred to their AHCCCS health plan service coordinator for follow up and assisting in finding a
dental home. Dignity has currently developed a DDS referral base for urgent need children in the
FTF-MULT1-16-0519-00 Page 27

East Valley. With this new grant, the oral health program will work to adopt this referral system
on a county wide basis to extend our capacity for referring directly to a dentist. Additionally, we
will include on all community dental clinic referral lists the First Things First Health Teeth AZ
website.
Dignity Health will follow the same intake procedures as the First Teeth First Program.
Program forms will be utilized across all regions in Maricopa County. First Teeth First and Dignity
Health have consulted regarding cross training providers on the intake process. Initially, consent
forms and treatment records will be given to First Teeth First weekly for data entry. First Teeth
First hopes to streamline this intake process by allowing access to the database for Dignity Health
staff during site visits. This added measure will continue to inhibit possible duplicative services.
F. Coordination of professional development and training:
Tooth decay is the most prevalent chronic childhood disease and it negatively impacts the
overall health and wellbeing of children in Arizona. The progression of this disease is amplified by
lack of awareness of this disease, misunderstandings about early oral health care and focus on
individual behavior solutions. A systems-thinking approach to this issue includes partnering with
schools, childcare centers, WIC offices and other community-based sites. Linking oral health
professionals with early childhood system providers, increases awareness of the importance of
early childhood oral health care, and reinforces the idea that the solution to decreasing early
childhood caries lies with the entire community rather than solely focusing on individual
behaviors. Engaging the entire early childhood community to educate parents, provide access to
screening and prevention activities and make connections with dental professionals raises the
level of awareness and expands access to care.
The utilization of a registered dental hygienist for professional development and training
will be incorporated. First Teeth First will implement two training modules focused on oral health.
The modules will differ based on the audiences. One module will be delivered to the health
professionals themselves and it will involve more comprehensive clinical oral health curriculum
and overall systemic health links. The other format will be delivered to personnel of organizations
responsible for carrying out their agency's professional development. This module is intended to
disseminate the oral health strategy to various healthcare settings responsible for delivering
services to expectant mothers and young children.
Outreach and Training (Direct Professional Training):
Educating medical professionals on the importance of oral health care for pregnant women
and young children will incorporate a training module that highlights oral health in non-dental
settings. This training module along with modules such as The Baby Oral Health Program 2 will be
directed at practitioners who provide services to First Things First target populations. The Baby
Oral Health Program is nationally recognized education training on the principles of infant and
toddler oral health. The training focuses on equipping providers with the necessary tools to be
comfortable and competent at providing preventive oral health services for young children.
Building partnerships with medical and dental professionals has been a strong component of
Dignity Health's program in the East Maricopa and Southeast Maricopa Regions and First Teeth
2 School of Dentistry, Manning Dr. & Columbia St., CB#7450, Chapel Hill, NC 27599, p (919) 537-3737 1 0 2015 The
University of North Carolina at Chapel Hill
FIT-MULT1-16-0519-00 Page 28

First will expand this model throughout Maricopa County. Presentations to dental and medical
offices improve the opportunities that very young children and their families receive early oral
health intervention. Presentations to general dentists and their staff will provide them with
strategies for working with young children and expanding their practices as a dental home for
families with very young children. Presentations to pediatricians and their staff include strategies
to identify children at risk for tooth decay and information about referrals to dental professionals.
Through an established partnership with A.T. Still University, First Teeth First and Dignity
Health dental professionals may receive Continuing Education credits recognized by the ADA
Continuing Education Recognition Program (ADA CERP). Pediatricians receive Continuing Medical
Education credits endorsed by the American Medical Association. First Teeth First also provides
free continuing education for tobacco cessation which meets the required chemical dependency
standard for dental professionals. These continuing education sessions are offered to internal
staff as well as professionals in the field. This training program provides valuable education to
health professionals relative to oral health education and the systemic links to overall health.
One critical target population within the professional development piece is medical and
dental healthcare students. These new health care professionals are in a perfect setting to absorb
current practices promoted in public health venues. Not only will partnering with these
organizations promote dental public health, but students will get a better understanding of how
innovative collaborative strategies are used to serve the community. The training will focus on the
First Things First mission of early childhood development and improved oral health among the
target population. Incorporating student rotations into the oral health program upon completion
of the didactic training module will provide further experience for these new professionals.
Ideally, this will enhance student's understanding of the target population's needs and oral health
disparity. Generating a future healthcare professional community that has a better grasp of early
childhood development will contribute to the vision of First Things First.
Currently, Phoenix College is providing oral health services in the Phoenix South region.
Because Phoenix College did not respond to the Notice of Intent from Maricopa County
Department of Public Health, we are unable to collaborate with them on this application.
However, once funded the program will partner with Phoenix College to continue the professional
development already established. The First Teeth First program plans on creating a professional
development piece that mimics the model First Things First funded through Phoenix College
throughout the county with multiple dental hygiene and allied health institutions (e.g. Fortis
College, Rio Salado, Carrington College, etc.). Creating coalitions and enhanced dental teams
through this multidisciplinary approach will extend the idea of early childhood development and
overall health of children to all allied health professionals.
Train the trainer (Organization Training):
In order to provide training and professional development opportunities, we will enhance
existing and further develop partnerships with Arizona Dental Association, Arizona Dental Hygiene
Association and Arizona Department of Health Services. Collaborating with Dignity Health to
conduct outreach to Family Resource Centers and Pediatric offices is a priority and this outreach
will stretch across Maricopa County. Alliances with organizations such as Phoenix Children's
Hospital, CVS, Arizona State University, Tempe Community Council and Worthy Institute are in
developmental stages to implement a training session to educate practitioners on the link
between oral health and overall health. The training will specifically focus on providing
FTF-MULTI-16-0519-00 Page 29

organizations with the necessary information needed to educate their staff. Again, objectives
related to expectant mothers' oral health and evaluating young children in a medical health care
setting will be covered. Supporting printed educational materials are provided as appropriate. As
the First Teeth First program continues to develop the professional development training system,
a continued concentration on current best practices and evidence-based approaches will be
sought and incorporated. Each partnership will serve as an extension of the First Things First
vision for increased knowledge within our healthcare professional community and a focus on
optimal quality delivery care systems.
Both representatives from Dignity Health and First Teeth First will continue to work with
First Things First Community of Practice (COP) to utilize state -wide grantees to provide feedback
and information about current professional development and educational tools to use throughout
Maricopa County. Any web-based training developed will be shared with the COP so all those
providing oral health services across the state can benefit.
G. Policy Advocacy
First Teeth First staff is currently working with the Arizona Dental Association (AzDA),
Arizona Department of Health Services Office of Oral Health (ADHS-00H) and The Arizona
Partnership on Immunization (TAPI) on oral health policy related issues. First Teeth First will
continue to work with AzDA, ADHS and TAP1 and other professional agencies to create a platform
for oral health communications and education to policy stakeholders and the public. Professional
staff will advocate for advancement and awareness of dental public health issues by speaking at
dental professional institutions and schools. The program will work with dental hygiene schools
to create student rotations through community based oral health clinics. The grantee will team up
with organizations (MOLAR, Arizona State Dental Hygiene Association) to advocate for current
policy issues regarding policy that would benefit the early childhood community. The
Administrative Home will provide leadership and assistance to implement solutions to oral health
problems through collaborative efforts with community stakeholders and the First Things First
Community of Practice. Providing evidence based information to community stakeholders, such as
Children's Action Alliance, in order to promote good oral health practices.
H. Supporting Oral Health activities at First Things First
First Teeth First will work with internal and external entities to enhance coordinating
services to reach the First Things First target population of children zero through five years of age.
The programs will work to promote First Things First programs and grantees to the community
while providing services out in the community and connecting program participants to other First
Things First services.
The programs will actively support oral health activities at the regional and statewide level.
First Teeth First and Dignity Health will seek active involvement and representation in First Things
First activities. The grantee will serve as a referral mechanism to the First Things First Healthy
Teeth AZ website and advocate for enrollment of providers. The Administrative Home will align
and practice the mission of First Things First in all programmatic encounters. First Teeth First will
be actively involved in the First Things First Community of Practice (COP). Staff will regularly
attend all COP meetings, participate in subgroups and work towards forwarding and implementing
all efforts put forth by the COP.
FTF-MULTI-16-0519-00 Page 30

2. Identify whether the proposed program is evidence-based, evidence-informed, or a
promising practice, and summarize the supporting research and data that supports this
determination.
The First Teeth First program model is based on evidence from the American Dental
Association, Maternal Child Health Bureau, Centers for Disease Control and Prevention and others.
Oral health education, screening, and fluoride varnish are made available in community locations
in an effort to provide repeat fluoride varnish application every three to six months.
Studies have shown that fluoride varnish application along with dental health information
for caregivers is effective in reducing the incidence of childhood caries. 3 The Maternal and Child
Health Bureau conducted an expert panel in 2007 to develop a decision support matrix on topical
fluoride use for high-risk children. The experts concluded that "an ideal prevention model
targeting high-risk children would include population-based fluoride interventions combined with
individual risk assessments conducted during dental and medical appointments". The matrix was
developed primarily for a non-dental audience including paraprofessionals and professionals
without formal dental education working in public health settings (child care centers, Head Start,
WIC) because the panel recognized the important role of these individuals in primary and
secondary prevention among higher-risk populations because of their ability to reach these
children at younger ages. 4
As stated previously, the ADA recommends that children under age six in a high risk
category receive fluoride varnish application at three-month intervals 5 and the majority of studies
demonstrate that at least two applications hi-annually, for at least two years, are necessary to
demonstrate effective reductions in dental caries". 6
The education provided to parents and children follows the guidelines outlined in the First
Things First Oral Health Standards of Practice and is obtained from:
• American Dental Association
• American Academy of Pediatric Dentistry
• American Academy of Pediatrics
National Children's Oral Health Foundation (NCOHF),
North Carolina Baby Oral Health Kit
Arizona Department of Health Services (ADHS), Office of Oral Health
• Recommendations from the MCHB Expert Panel's Topical Fluoride
Recommendations
for High-Risk Children: Development of Decision Support Matrix (Alta rum Institute,
Washington DC, 2007)
3 J.A. Weintraub, F. Ramos-Gomez, B. Jue, S. Shain, C.1. Hoover, J.D.B. Featherstone, S.A. Gansky, "Fluoride Varnish
Efficacy in Preventing Early Childhood Caries/'Journal of Dental Research, vol 85(2), (2006)
4 Maternal Child Health Bureau Expert Panel, Topical Fluoride Recommendations for High-Risk Children, Development
of Decision Support Matrix, 2007
5 ADA Council on Scientific Affairs, Professionally Applied Topical Fluoride Executive Summary of Evidence-Based
Clinical Recommendations, May 2006
6 Association of State and Territorial Dental Directors, Fluoride Committee, Fluoride Varnish: an Evidence-Based
Approach Research Brief, September 2007. March 2012
FTF-MULTI46-0519-00 Page 31

• Resources listed in the First Things First Oral Health Standards of Practice
The First Teeth First program along with Dignity Health supports the need for early
intervention to prevent tooth decay. Early childhood caries have become increasingly and
alarmingly clear in recent years. The American Academy of Pediatric Dentistry cites the following
statistics.
• Over 40% - 50% of children will be affected by tooth decay before age 5.
• More than half of the children born each year will have cavities by the time they
reach second grade.
• While 9 million children in this nation do not have medical insurance, more than
twice that number (23 million) does not have dental insurance.
• According to the May 2000 Surgeon General's report, Oral Health in America, more
than 51 million school hours are lost each year to dental-related conditions.
The problem is especially prevalent in Arizona. The Arizona Department of Health Services
conducted an open mouth survey of preschool aged children in 2009 and identified the following
key findings: (Office of Oral Health, Arizona Department of Health Services, 2011)
• 52% of 4 year olds have treated and/or untreated tooth decay
• 30% of 2-4 year olds have untreated tooth decay (16% nationally)
• 40% of 4 year olds have early or urgent dental treatment needs
• Parents don't take their children to the dentist because they think the child doesn't
need a visit
(46%), the dentist won't see the child (34%), and they can't afford it (12%)
• 50% of children ages 0 to 4 have never visited a dentist
Research shows that oral health is progressive and cumulative and becomes more complex
over time. If left untreated, tooth decay can lead to needless pain and suffering; difficulty
speaking, chewing, and swallowing; missed school days; increased cost of care, loss of self-esteem;
and the risk of other systemic health problems due to poor nutrition, infection, and abscess.
Tragically, several young children have died as a result of infections caused by tooth decay or the
effects of sedation used during treatment.
Fluoride varnish application has been shown to be an effective method of preventing
dental caries, preventing decalcification, and slowing the progression of existing caries? Fluoride
varnish is simple to apply with very low risk of adverse effects and does not require a dental
cleaning prior to use; making it the ideal choice for community-based oral health prevention
programs. The Association of State and Territorial Dental Directors recommends initiating fluoride
varnish applications as soon as the first tooth erupts, stating that 'rage two is too late for children
at highest risk." 8
The American Dental Association recommends that children under age 6 in a high risk
category receive fluoride varnish application at three-month intervals. 9 Maternal Child Health
Bureau experts state that low socioeconomic status, and specifically income is the best indicator of
7 Center for Disease Control and Prevention, Recommendations for using fluoride to prevent and control dental caries
in the United States. MMWR 2001;50(No. RR-14). March 2012
8 Association of State and Territorial Dental Directors (ASTDID). Fluoride Varnish Policy. April 2010.
9 ADA Council on Scientific Affairs. Professionally Applied Topical Fluoride Executive Summary of Evidence-based
Clinical Recommendations, May 2006
FTF-MULT1-16-0519-00 Page 32

dental decay risk 10 making immunization clinics, WIC offices, and family resource centers ideal
locations for providing oral health prevention activities. Children at moderate risk for dental caries
are recommended to receive fluoride varnish application every six months.
While oral screening and fluoride varnish are important tools to prevent tooth decay,
simple behavior changes can also have a lasting effect on a child's oral health. Interaction with
parents in the community reveals that many parents are unaware of the harmful effects of
common behaviors including putting baby to bed with a bottle, the use of sippy cups, frequent
snacking, and inadequate tooth brushing. Educating parents and caregivers must be a significant
component of any oral health prevention program.
The First Teeth First and Dignity Health programs provide an evidence-based screening
process that is a nationally recognized system of screening preschool and school-age children. The
Basic Screening Survey (BSS) was created by The Association of State & Territorial Dental Directors
(ASTDD) and is a tool for obtaining data for an oral health surveillance system. The data collected
from the BSS consists of Plaque/Gingivitis, Non-Cavitated White Spots, Early Childhood Caries
(ECC), Untreated Decay (with the number of teeth) and Treated Decay (with the number of teeth).
3. If there is a need to adapt an evidence-based or evidence-informed program as a
promising practice, explain what the adaptations are and the justification for why they
are being proposed.
There is no need to adapt any promising practice theories as the Administrative home and
subcontractor are an established delivery care system that promotes current best practices.
4. Describe how the proposed program approach aligns and builds on the early childhood
system development in the Phoenix South, East Maricopa, Northwest Maricopa, Phoenix
North, Southwest Maricopa and Southeast Maricopa regions.
First Things First funding has created a network of programs aligned by the common goal of
ensuring children enter kindergarten ready to succeed. The oral health program addresses the
First Things First Goal to increase access to preventive oral health care and provide oral health
screenings for children through age five. This program network provides an ideal opportunity for
collaboration. First Teeth First and Dignity Health have already established partnerships with other
First Things First grantees including Thrive to Five, Readiness Basket, Teen Outreach Pregnancy
Services (TOPS), FindHelpPhx, Nurse Family Partnerships, South Phoenix Healthy Start, Pregnancy,
Parenting, & Play, Child Crisis Center, Family SPOT Resource Centers, Avondale Care1st Resource
Center, Chandler CARE Center, Health Care Connect, Keogh Foundation, Parents As Teachers,
Quality First Child care centers, and the Chandler Christian Community Center. These partnerships
allow parents to receive multiple services in a single location and understand the connectivity
between the school readiness strategies supported by First Things First.
The program directly addresses the First Things First School Readiness indicator regarding
the number of children age five with untreated tooth decay. Tooth decay is preventable with
10 Maternal Child Health Bureau Expert Panel. Topical Fluoride Recommendations for High-Risk Children, Development
of Decision Support Matrix, 2007
FTF-MULTI-16-0519-00 Page 33

simple behavior modifications. Early oral health screening, identification of children with
untreated tooth decay, fluoride varnish application, basic oral health prevention education, and
referral to dental professionals increases the likelihood that a child will receive early dental care,
thus improving their ability to learn and succeed in school.
5. Identify and describe the target population to be served by the proposed program,
including:
a) Population demographics (e.g., children birth through five, families of infants,
early childhood professionals, etc.)
The First Teeth First and Dignity Health program's only requirement to receive no cost
services and applied fluoride varnish is the child must fall within the age range of zero through five
or be an expectant mother within Maricopa County. Those with no teeth will receive education:
for newborns (0-3 months) and infants (3 months until their first tooth) and provides a Spiffie
Dental Home Kit and a demonstration on how to use them. Most of these children visit the
permanent locations. Most of these permanent locations are housed in the Maricopa County
WICs and Maricopa County Immunization Clinics. We also see expectant mothers anytime during
their pregnancy. In addition to direct services to children ages zero to five and expectant mothers,
the FTF and Dignity Health programs provide education. The education portion can also include
parents/guardians and even family caregivers such as grandparents, aunts/uncles, and older
siblings. In addition to providing direct services and one-on-one education; the health educators
provide community presentations, educational tables at events/ resource centers/ and age specific
educational pamphlets. In the past, the First Teeth First and Dignity Health program has given oral
health presentations to early childhood professions like Arizona Head Start teachers and
administrative staff, preschool teachers and school administration staff. For the future, the First
Teeth First and Dignity Health will continue to visit medical offices such as OB-GYN providers to
promote good oral health during pregnancy and partner with private dentists who are willing to
provide pro bono treatment on urgent dental need children.
The Administrative Home and sub-grantee will serve a specific target population and
they will direct services that align with the oral health strategy of First Things First.
Population Demographics:
• Young children from birth through age 5 and their families
• Expectant mothers
• Caregivers of families
• Early learning and care providers
• Oral health and medical professionals
b) Target Service Number(s) based on the Unit(s) of Service included in the Scope of
Work of this RFGA.
The oral health program will provide oral health education, screening and fluoride
varnish to children birth through five. Oral health education and screening will be offered to
expectant mothers. Oral health education will also be presented to parents and family members,
caregivers, medical and dental professionals. Since there will be no lapse in service delivery, the
FTF-MULTI46-0519-00 Page 34

First Teeth First program will exceed the overall Target Service goals throughout Maricopa County.
Data collection will be done regionally in order to provide regional councils will region specific
numbers for reporting purposes. (See Appendix F)
Targeted units of service include:
• A minimum of 25,500 children receiving oral health screenings
• A minimum of 25,500 children receiving fluoride varnish application
• A minimum of 2,400 expectant mothers receiving oral health screenings.
• A minimum of 9,775 of participating adults.
• A minimum of 425 of participating professionals.
c) How the proposed program will be culturally competent, linguistically
appropriate, age appropriate, and gender responsive for the target population.
The First Teeth First program utilizes bilingual site assistants at all locations that services are
provided. Maricopa County has a large Spanish speaking population requiring a definite need for
linguistically appropriate educational information for increased understanding and retention. Personnel,
program forms (including consent and take home finding form) and educational materials (e.g. brochures
and referral materials) are all provided in both English and Spanish format. Quality Assurance site visits are
conducted monthly at each site location to ensure appropriate use of translation and oral health education
is being provided. Coaching is provided should bilingual site assistants need guidance on translation.
Should a family speak a language other than Spanish, site staff may utilize a contracted
company, the Language Line, which provides translation services for roughly 75 + languages so that services
and educational materials can be provided to the parent in the most culturally competent and linguistically
appropriate way.
Ongoing training ensures staff is competent to provide culturally competent, linguistically, age,
and gender appropriate care. All Dignity Health staff participates in annual hospital-mandated continuing
education including cultural competency, Patient and Family-Centered Care and HIPAA Compliance,
Program specific education has included the learning styles of adults and children. Our bilingual staff
provides care that is culturally sensitive which reduces misinformation and misunderstandings.
d) How the target population will be identified, recruited, and retained in the
program.
Recruitment and outreach efforts are provided through the venues where services are
provided and in the community at large. The First Teeth First and Dignity Health programs have
two specific recruitment models which focus on permanent and off-site locations. The permanent
models are primarily WIC clinics and Immunization clinics where the population visits regularly
which increases the chances of retaining the same clients for their six month follow up oral health
screening and repeated fluoride varnish application until the child turns six. Each permanent
location has the ability to review a child's past treatment records to survey each encounter with
the program. Hygienists are to review the previous treatment record in the system before
applying fluoride. If there were any comments indicating untreated decay or a need for follow up
with the dental provider or clinic, this is addressed at this time.
Parents of children at preschools and childcare centers are provided with take-home
packets which include information about the benefits of oral screening and fluoride varnish. The
FTF-MULTI-16-0519-00 Page 35

last date of service for child care centers, preschools, and head starts are tracked to follow up
every six months for repeat services for continuous cavity prevention.
6. Describe specific initial and ongoing professional development opportunities that will be
provided to existing and/or new staff/subgrantees (if applicable), including how it will be
provided, a timeline for when it will be delivered and how it will enhance skills necessary
for effective program implementation.
First Teeth First and Dignity Health will provide ongoing quality improvement practices
such as new employee orientation on the first day of employment from sources including the
American Dental Association, American Academy of Pediatric Dentistry, American Academy of
Pediatrics, National Children's Oral Health Foundation, and the National Maternal Child Oral
Health Resource Center.
A registered dental hygienist hired by First Teeth First will be responsible for all clinical
oversight regarding delivery of care and have the responsibility of the annual calibration trainings
to ensure proper standards of practice. First Teeth First and Dignity Health will integrate their
professional development programs by participating in trainings and continuous educational
opportunities to ensure competence, calibration and aligned service delivery.
Oral health knowledge is acquired and updated during initial training and continuing
education from sources including the American Dental Association, American Academy of Pediatric
Dentistry, American Academy of Pediatrics, National Children's Oral Health Foundation, and the
National Maternal Child Oral Health Resource Center. Staff participates in ongoing continuing
education covering early childhood oral health, general health, and education techniques.
Initial and continuous education ensures that staff is providing up-to-date, proven oral
health prevention information in a manner that is culturally sensitive and appropriate for all
audiences. Staff training ensures that staff is able to provide patient care in the community that
equal the standards set for our inpatient population. All trainees will be asked to complete a post
training evaluation in order to provide feedback for quality improvement. Additionally, all staff is
required to complete learning modules regarding Cultural Competence, General Workplace Safety,
Corporate Compliance, Patient Rights, Confidentiality, HIPAA, Infection Control and Patient and
Family Centered Care. This training ensures that staff is providing up-to-date, evidence based oral
health information in a manner that is culturally sensitive and appropriate.
Registered Dental Hygienists obtain their clinical training as part of their degree program.
Provider credentials are renewed on a triennial basis through regulatory agencies. These agencies
require a predetermined amount of continuing education (CE) hours that each provider is
responsible for retaining. Quarterly education sessions on a variety of topics is provided for CE's
and a hygienist study group is also available for CE's with groups of five or more hygienist.
Practitioners will have the opportunity to attend the Western Regional Dental Convention as the
oral health program allows for time off during this session. Nursing staff are trained to perform
oral screening and fluoride varnish application using the following training materials.
• AZ Dept. of Health, Dept. of Oral Health, Fluoride Varnish Train the Trainer
Program
FrF-muLT146-0519-00 Page 36

• Oral Health Screening and Treatment Urgency. AZ Dept. of Health Services,
Office of Oral Health.
• Association of State and Territorial Dental Directors Basic Screening Survey
Training for Non-Dental Professionals
• Open Wide: Oral Health Training for Health Professionals. National Maternal
and Child Oral Health Resource Center
Past continuing education has included:
Webinars:
• Common infectious Diseases Encountered in Dentistry—NNOHA
• Promoting oral health through Policy and Partnership
• Dental Health in Children
Seminars/Lectures
• Principles of Adult Learning, Maternal Child Health Education Workshop
• Child Abuse and Neglect
• Oral Health for Young Children, Rene Toscano, AZ Dept. of Oral Health
• Oral health and diabetes, David Rush, DDS
• Oral Health Train the Trainer, Alyssa York, DDS
• Common dental issues occurring in young children
• Learning Styles of Very Young Children
Dignity Health required learning modules
• Cultural Competence
• General Workplace Safety
• Corporate Compliance, Patient Rights, Confidentiality, HIPAA
• Infection Control
• Patient and Family Centered Care
7. Describe the program data collection process, including what resources will be needed;
who will be responsible for data collection and data submission; what procedures will be
in place to ensure timely, accurate, and secure collection and submission; and how data
will be used to inform and improve programming. Describe how child level surveillance
data will be collected and used to eradicate duplication of service delivery. If applicable,
also include the anticipated approval process to collect, submit, and report data from
tribal government programs.
When services are provided at permanent locations (WIC and immunization clinics), the
site assistant will search the database to see if the child has been seen before with our program. If
services have not been provided within the last five to six months, services will be provided and
the information will be input into the database on a daily basis. Each site and site assistant has a
laptop and access to the First Teeth First database at each of the locations to provide timely data
FTF-M ULT1-16-0519-00 Page 37

input. A parent satisfaction survey is offered to each participant of our services to ensure
customer satisfaction is being met; this information is kept in a Satisfaction Survey database for
tracking purposes.
Services are also provided at childcare centers, preschools and community events.
Outreach is provided to locations to give consent forms and inform the location of services. Site
locations distribute forms and on the date of service, forms are collected. Services are provided
and urgent children are referred as necessary. Data collected from these services is entered into
the database within the week of services.
Monthly the consent and treatment records are brought directly to the main office from
each permanent site by staff members for database cross checking. This is done to ensure proper
data entry has occurred at locations. Health educators provide monthly reporting on community
involvement and success stories that are incorporated into a quarterly narrative report to First
Things First. Quarterly, the program coordinator combines all narrative information from all staff
to report directly to First Things First. Additionally, numeric data is reported at this time as well.
This information is used as a feedback loop for program improvement and service delivery
awareness.
Currently, there is no approval process needed from tribal government programs. First
Teeth First does provide services at the Fort McDowell Indian Reservation at their H'rnan 'Shawa
Early Childhood Center every six months. This is a First Things First funded location and no
agreement has been necessary thus far.
8. Describe any anticipated barriers to implementation and your plans to overcome those
barriers.
Challenges to operationalizing the integration of First Teeth First and Dignity Health are as
follows:
• Access to First Teeth First database outside of permanent locations (WIC and
Immunization clinics) and training of Dignity staff on database procedures. First Teeth
First staff will work with Maricopa County's Office of Information Technology to grant
access to the Dignity Health personnel for data entry. Dignity Health staff will be
trained by First Teeth First staff on database systems.
• Combining programmatic materials to be consistent across regional boundaries (e.g.
consent form and language). Both organizations will need to review documents with
the proper entities at the organization for approval prior to implementing services.
This process can occur once this RFGA funding is approved.
• Expanding professional development county wide and integrating into the local
educational institutes. The oral health program will seek relationships with numerous
educational institutions in order to provide provider outreach to allied health
professionals. Creating this network will take time to develop and the oral health
program will nurture these partnerships to communicate quality care and increased
oral health knowledge to medical and dental professionals.
FTF-MULT146-0519-00 Page 38

Dignity Health and MCDPH are already meeting to strategize and streamline the above
challenges and any other transition issues that may come up.
9. Describe how collaboration with one or more local organizations will be carried out in
program implementation, and identify the expected results due to the collaboration.
Specifically, identify your organization's level of collaboration with existing
providers/grantees
First Teeth First and Dignity Health have an exceptional working relationship that is based
on fluid communications, trust and complimentary abilities to deliver impeccable healthcare
services. Both organizations have a long history of working with First Things First and meeting the
expectations of the community and peers. Entering into this grant as two units working together
to provide seamless and quality oral health services across Maricopa County is effortless because
of the outstanding accomplishments by both organizations First Things First can expect optimal
delivery of care and successful outcomes regarding the performance measures related to the oral
heath strategy. Maricopa County along with Dignity Health is enthusiastic about the formation of
the First Teeth First program through all of Maricopa County. All tasks and responsibilities are
taken seriously and the oral health program (First Teeth First) will not disappoint the community
or the grantor.
MCDPH has a long standing positive working relationship with ADHS in general and the
Office of Oral Health. Both organizations are excited to partner in generating revenues for
continued oral health expansion and innovation. The expertise, national relationships and other
collaborations of the ADHS 00H will enhance not only the First Teeth First program, but also the
other oral health programs across the state and the First Things First service delivery.
One innovative vision of the oral health program is a pilot program with CVS minute clinics
regarding implementing an oral health component into their healthcare delivery system. CVS
understands that oral health is paramount to an individual's overall health. CVS minute clinics
provide nurse practitioners and physician assistants at locations throughout Maricopa County.
First Teeth First and Dignity Health have the ability to provide outreach and education to these
health providers regarding oral health education and fluoride varnish application. The recent oral
health Omnibus Bill allows for medical providers such as nurse practitioners and physician
assistants to apply fluoride varnish and properly bill for services. Establishing a relationship with
CVS will help more children throughout Maricopa County receive oral health preventive services
and leverage new policy related to provider scope of practice to accomplish this. As First Teeth
First and Dignity Health don't anticipate an issue reaching the required Target Service Units, this
relationship will allow for an increased organic delivery system of care. Ideally, First Teeth First
will educate and train CVS staff on oral health education and fluoride varnish application to carry
out services in their locations.
FTF-MULTI-16-0519-00 Page 39

Key
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FTF-MULT1-16-0519-00

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FTF-MULTI-16-0519-00

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FTF-MULTI-16-0519-00

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FTF-MULTI-16-0519-00

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FTF-MULTI-16-0519-00

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FTF-MULTI-16-0519-00

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The budget narrative should provide a clear and concise explanation of the methods used to determine
the amounts for each line item in the following line-item budget.
Budget period: July 1, 2015 - June 30, 2016
Requested
Budget Category ini Itern,Descriptie ' Fun s, Total Cost
PERSONNEL SERVICES Personnel Services Sub $964,647
, Total
Salaries Permanent Personnel $42,004
1 FTE Program Coordinator @
$20.04/hr
1 FTE Program Assistant @ $15.27/hr $32,006
1 FTE Registered Dental Hygienist @ $50,143
$25.90/hr
1 FTE Health Educator @ $18.43/hr $38,629
1 FTE Health Educator @ $17.17/hr $35,988
1 FTE Health Educator @ $17.90/hr $37,518
1 FTE Health Educator @ $17.60/hr $36,890
1 FTE Accounting Specialist @ $15.00/hr $29,040 $302,218
Registered Dental Hygienists Temporary Personnel
15 WK. Clinics - Hygienist @18 hrs/wk for 52 wks 14,040 annual hours @ $25.90/hr $363,636
2 Immunization Sites - Hygienist @ 21 hrs/wk for 52 wks 2,184 annual hours @ $25.90/hr $56,566
Community Based Sites - Hygienist @ 42 hrs/mo for 12 504 annual hours @ $25.90/hr $13,053 $433,255
months
Site Assistants
15 WIC Clinics - Site Assistant @ 18hrs/wk for 52 wks 14,040 annual hours @ $13.70/hr $192,348
2 Immunization Sites -Site Assistant @ 21 hrs/wk for 52 2,184 annual hours @ $13.70/hr $29,921
wks
Community Based Sites - Site Assistant @ 42 hrs/mo for 12 504 annual hours @ $13,70/hr $6,905 $229,174
months
EMPLOYEE RELATED EXPENSES ' Employee Related Expenses Sub Total $269,793 _
Fringe Benefits or Other ERE ERE - Permanent Personnel
$10,440 per FTE $83,520
19.31% of Salaries Total $58,358 $141,878
ERE -Temporary Personnel
19.31% of Salaries Total $127,915 $127,915
. PROFESSiONAt , AND , ,. OUTSIDE , SERVICES . Professional . . _ &,Outside .' ' $15 500.
Services Ub Total
Contracted Services
Dental Consultant Provide standing orders for AHCCCS $7,500
billing
Peoria School District Coordination of 0-5 children for varnish $8,000 $15,500
services
TRAVEL . Travel Sub Total $13 408
PIF-Mi lm3 1-16‘115 11.00 Page 56

In-State Travel 21,096 miles @ $0.445/mile $9,388 $9,388
Out-of-State Travel Airfare 3 FTEs @ $400 each $1,200
Hotel @ $150/night for 4 nights for 3 $1,800
FTEs
Per Diem @ $60/day for 4 days for 3 $720
FTEs
Phx & Conference Airport Shuttles for 3 $300 $4,020
FTEs
AID TO ORGANIZATIONS OR INDIVIDUALS Aid to Organizations or Individuals Sub $558,262
Total
Subgrants or Subcontracts to Dignity Health $450,000
organizations/agencies/entities
ADHS 001-I $108,262 $558,262
OTHER OPERATING EXPENSES Other Operating Expenses $160,960 .
• Sub Total
• Telephones/Communications Services I-Phones for Staff @ $515/month x 12 $6,180
months
• General Office Supplies $150/month x 12 months $1,800
• Rent/Occupancy WIC Clinic days/wk @ $20/day for 52 $0
weeks plus annual storage unit fees for
supplies
• Printing/Copying $2,450/month x 12 months $29,400
• Conferences/Workshops/Training Fees WR Dental Conference for 3 FTEs @ $4,980
$135/each, National Oral Health
Conference for 3 FTEs @ $725/each,
Staff Training for 8 FTEs @ $300/each
Clinical Supplies for approx. 25,500 $51,000
• Program Supplies children @ $2/visit (fluoride varnish,
gloves, etc.)
Dental Gift Bags for approx. 25,500 $51,000
children @ $2/bag (toothbrushes,
stickers, educational materials)
Toothbrushes for approx. 2,400 $3,600
pregnant women @ $1.50/toothbrush
Additional brochures, pamphlets, cups $13,000 $160,960
for kids, and other misc. incentives to
encourage program participation.
Subtotal Direct Program • Costs: $1,424,308
ADMINISTRATIVE/INDIRECT COSTS Total $142,430 I
Admin/Inclirect
Indirect/Admin Costs Indirect Costs @ 10% $142,430
Total $2,125,000
Authorized Signature ,/,======. Date 3 /2
FTF-MULTI-16-0519-00 Page 57

Budget Narrative
The purpose of the budget narrative is to provide more clarity and detail on the budget line items. The
budget narrative should explain the criteria used to calculate the amounts entered in the line-item
budget. The budget narrative should include all budgeted items and correspond directly with the
proposed line-item budget.
Personnel Services
Permanent Personnel
The Program Coordinator, Kimberly Richards, will be responsible for management of all aspects of the
First Teeth First program. This position oversees human resources, procurement, budget, reporting,
community relations and any other aspects of the program implementation. At $20.04 per hour x 2,096
annual hours, the 12-month salary for this 1 FTE position is $42,004.
The Program Assistant, Daniel Roman, schedules personnel at the sites, and assists the Program
Coordinator and staff with all administrative functions. At $15.27 per hour x 2,096 annual hours, the 12-
month salary for this 1 FTE position is $32,006.
The Registered Dental Hygienist, New position, in collaboration with the Dignity Health team, this
position will develop partnerships with learning institutions to incorporate oral health education in their
curriculums. Outreach to Pediatric Dentists, Medical providers and community organizations for
professional development purposes and to engage practitioners to see children zero through five for oral
health needs. This position will also provide clinical oversight for the dental hygienists in the field. At
$25.90 per hour x 1,936 annual hours, the 11-month salary for this 1 FTE position is $50,143.
The Health Educators, Mary°la Blancas ($18.43/hr), Jamal Robinson ($17.17/hr), Gustavo Galindo
(17.90/hr), and Trisia Lopez ($17.60/hr), will promote the program in communities and identify partners
drawing large numbers of families, children five years of age and under, and pregnant women where
preventive oral health services will be offered. Health Educators coordinate all services with the child care
centers. They are the daily contact for the dental hygienists and site assistants in the field. At the above
hourly rates x 2,096 annual hours, the 12-month salary for these 4 FTE positions is $149,025.
The Accounting Specialist, Vacant, is responsible for tracking the budget, submitting reimbursement
requests, reconciling the budget and other financial related activities to be in compliance with Maricopa
County and First Things First policies. At $15.00 per hour x 1,936 annual hours, the 11-month salary for
this 1 FTE position is $29,040.
All salaries, except for the Registered Dental Hygienist and Accounting Specialist positions, are calculated
by multiplying the current hourly rate x 2,096 annual hours since February 2016 is leap year with an extra
8 hour work day. The Registered Dental Hygienist and Accounting Specialist positions are not expected to
FTF-MULTI-16-0519-00 Page 58

be filled until August 2015 and therefore their salaries are calculated at 1,936 annual hours for the 11-
month period.
Temporary Personnel
Registered Dental Hygienists (RDHs)
Dental Hygienists are hired by Maricopa County as temporary personnel to provide one on one education,
standardized oral screenings, and fluoride varnish applications. Dental Hygienists are estimated to spend
approximately 18 hours a week for 52 weeks at 15 WIC Clinics, 21 hours a week for 52 weeks at 2
immunization Sites, and 42 hours a month for 12 months at Community Based Sites for a total 16,728
annual hours; at an average rate of $25.90 per hour for a total expense of $433,255 for the 12-month
period. With the additional Phoenix North WIC sites, additional staff will be hired. See attached
personnel detail for current names and hourly rates.
Site Assistants
Site Assistants are hired by Maricopa County as Temporary Personnel to provide translation for Dental
Hygienists who are not bilingual, and to assist the Dental Hygienist on-site with patient flow, forms, and
data entry. They are scheduled at the same time as the Dental Hygienists, for the same number of
hours/days/locations described above for the Dental Hygienists (the difference being the site Assistant's
salary, at an average rate of $13.70/hour). Sites Assistants are estimated to spend a total 16,728 annual
hours; at an average rate of $13.70 per hour for a total expense of $229,174 for the 12-month period.
With the additional Phoenix North WIC sites, additional staff will be hired. See attached personnel detail
for current names and hourly rates.
Total Cost for Personnel Services is $964,647.
Employee Related Expenses:
Fringe Benefits for permanent personnel are calculated at $10,440 per FTE (8 FTE) for a total of $83,520
(fixed rate) for medical and dental coverage. Variable benefits are calculated at 19.31% of salaries for
Medicare, social security, unemployment, workers' compensation, long term disability, life insurance, and
the Arizona State Retirement System. Total variable benefit cost is $58,358 for the 12-month period. The
total cost of fixed and variable benefits for Permanent Personnel is $141,878.
Fringe Benefits for Temporary Personnel only include the variable benefits and are calculated at 19.31% of
salaries for Medicare, social security, unemployment, workers' compensation, long term disability, life
insurance, and the Arizona State Retirement System. Total variable benefit cost for temporary personnel
is $127,915 for the 12-month period.
Total Cost for Employee Related Expenses is $269,793.
FTF-MULTI46-0519-00 Page 59

Professional and Outside Services
Contracted Services
Consulting Dentist
A Dentist will be contracted to provide standing orders and clinical consultation across all sites. The total
cost for this expense is $7,500 for the 12-month period.
Peoria School District
A unique partnership with this district allows us to screen and varnish children 0-5 years of age in large
groups. The cost for this contract will be $8,000.
Total Cost for Professional and Outside Services is $15,500.
Travel
In-State Travel
Travel is necessary between sites for training, events, program monitoring, and meeting attendance (e.g.,
First Things First State and Regional meetings). Travel for the 12-month period for all staff is estimated at
21,096 miles. At $.445/mile, the total cost for in-state travel is $9,388.
Out-of-state Travel
Travel expenses for 3 FTEs to attend the annual National Oral Health Conference is estimated to cost
$1,200 in Airfare ($400/each) + $1,800 for Lodging ($150/night x 4 nights/each) + $720 in Per Diem
($60/day x 4 days/each) + $300 in Transportation (Phoenix & Conference Airport Shuttles) for a total cost
of $4,020. Depending on the location all costs will stay with the federally allotted guidelines.
Total Cost for Travel is $13,408.
Aid to Organizations or Individuals
Dignity Health
As a subcontractor and partner, Dignity Health will be the primary provider of services in the East and
Southeast Maricopa regions. The partnership will allow coordinated services across Maricopa County.
Total Cost for this contract will be $450,000.
Arizona Department of Health Services Office of Oral Health (ADHS 00H)
For the first year ADHS 00H will be a subcontractor and bill the Arizona Health Care Cost Containment
System (AHCCCS) for fluoride varnish treatments. The expectation is that within the first year, the
program will be able to generate enough funds to fully fund the billing service and return funds to the
program to expand prevention services in the community. The cost for this contract will be $108,262.
FTF-MULTI-16-0519-00 Page 60

Total Cost for Aid to Organizations or Individuals is $558,262.
Other Operating Expenses:
Telephone Communications Services
Monthly charges for staff Smart Phones is $515 or $6,180 for the 12-month period.
General Office Supplies
Office supplies are estimated at $150 per month or $1,800 for the 12-month period. Office supplies
include pens, pencils, paper, folders, envelopes, ink-toner, and other miscellaneous office supplies.
Rent/Occupancy
To cover the cost of the first year for the ADHS 00H billing service, WIC will provide the occupancy space
at no charge.
Printing/Copying
Printing and copying of forms, brochures, and educational materials is estimated at $2,450 per month for
the 12-month period total of $29,400.
Conferences/Workshops/Training Fees
The cost for 3 FTEs to attend the annual Western Regional Dental Conference is $405 ($135/each). The
registration fees for 3 FTEs to attend the annual National Oral Health Conference will cost $2,175
($725/each). Additional miscellaneous staff training for 8 FTEs is estimated at $2,400 ($300/each). The
total expense for Conference/Workshops/Training Fees is $4,980.
Program Supplies
Clinical Supplies
Each visit requires approximately $2 in clinical supplies (fluoride varnish, gloves, gauze, etc.).
The total cost for 25,500 children is $51,000 for the 12-month period.
Dental Gift Bags
The dental gift bags (e.g., toothbrush, stickers, toothpaste, educational materials, etc.) are estimated at
$2 per bag. The total cost for 25,500 children is $51,000 for the 12-month period.
Toothbrushes for Expectant Mothers
2,400 adult toothbrushes for pregnant women will be purchase at $1.50 each. The total cost is $3,600 for
the 12-month period.
Educational Materials/Incentives
FTF-MULTI-16-0519-00 Page 61

Pamphlets/brochures will include; the First Teeth First program brochures, brochures for pregnant
women, kids zero to two years and age two to five years. Incentives to encourage program participation
will include items such as toothbrush kits, cups for kids, infant toothbrushes, floss, toothpaste, and other
miscellaneous educational materials for a total cost of $13,000.
Total Cost for Other Operating Expenses is $160,960.
Administrative/Indirect Costs: Administrative costs are general or centralized expenses of
overall administration of an organization that receives grant funds and does not include
particular program costs. For organizations that have an established federally approved indirect
cost rate for Federal awards, indirect costs mean those costs that are included in the
organization's indirect cost rate. Such costs are generally identified with the organizations overall
operation and part of the organization's policies and procedures and consistently used for all
funding sources/types.
Applicants must list either Option A or Option B and provide proper justification for expenses
included:
Option B - Federally Approved indirect Costs: if your organization has a federally approved indirect cost
rate agreement in place, grantees may include an allocation for indirect costs for up to 10% of the grant
request. Applicants must provide a copy of their federally approved Indirect Costs include county central
service costs and departmental common costs such as financial services, information technology,
telecommunications, building maintenance, legal and risk management, human resources/payroll and
other administrative costs shared by the entire grant programs within the department. The indirect rate
is calculated based on actual costs from a prior fiscal year, and is updated annually. The indirect amount
is determined monthly by applying the percentage rated to actual expenditures for the prior month.
The current federally approved indirect rate is 14.80%. Indirect costs @ 10% of the agreement expenses
will be $142,430. (Appendix H - Indirect Cost Plan)
Total Cost for Administrative/Indirect Costs is $142,430.
Date 2/2 S. -45°
Authorized Signature
FTF-MULTI-16-0519-00 Page 62

Funding Sources and Financial Controls
A. in the following table, identify other funding/resources (including federal ) state, local and private
funding) that the agency/organization has made or will make available to achieve the objectives of
the proposed program. First Things First (FTF) funding can be used to enhance or expand the program
funded by these additional funds, but FTF funding cannot supplant or be used to replace any existing
state or federal funding for early childhood development and health programs.
Type of Funding (federal, v If used
state, local, private) and Brief Description of How the Funding Helps Amount for match
Agency/Organization Achieve the Program Objectives on this
Received From: grant
SO $O
• Total: $O
B. Describe the financial controls and accountability measures the agency/organization will employ for
the proposed program.
Maricopa County Department of Public Health (MCDPH) will use a centralized accounting
system to maintain its fiscal integrity through several levels
(Program/Division/Department/County) of financial controls and accountability measures.
MCDPH's Finance and Budget process starts at the program level, using the Maricopa County
Chart of Accounts, the program accounting specialist will conduct the program's financial
processing throughout the grant period, ensuring proper account classification and adequate
documentation for all expenditures. At the Division level, MCDPH will provide a Division
Accountant to monitor all program financial activity and to facilitate Reimbursement Request
Report submissions. Also, at the Department level, the Accounts Payable/Receivable and
Procurement unit will process, review and monitor all financial requests provided by the
program accounting specialist. The Department Finance Manager conducts monthly meetings
with the Finance and Budget staff to review the program budget expenditures and its
projections. Finally, at the County level, the Maricopa County Finance Department will
process issuance and receipts of all payments. Throughout this entire accounting system based
on Generally Accept Accounting Principles (GAAP), there are several checks and balances.
Before posting to Maricopa County's financial system, all procurement and financial
FTF-MULTI-16-0519-00 Page 63

transactions undergo, at a minimum, 3 levels of reviews and approvals, to ensure fiscal
compliance as defined in provisions of the grant agreement, Maricopa County policies and
guidelines, as well as, State and Federal laws and regulations.
Authorized Signature Date
FTF-MULTI-16-0519-00 Page 64

Agency/Organization Profile
A. Agency/Organization:
Program Name Maricopa County Department of Public Health - Oral Health
Maricopa County by and through Its
Agency Department of Public Health Contact Person Vincent Torres
Address 1645 E Roosevelt Position Office of Oral Health Supervisor
Address Email VincentTorres@mail.maricopa.gov
City, State, Zip Phoenix, AZ 85006 Phone (602) 506-6890 Ext
County Maricopa County Fax (602) 506-3081
Employer Identification Number: 86-6000472
Agency Classification: State Agency X County Government Local Government Schools
Tribal Faith Based Non Profit Charitable Private Organization Other
Have you previously conducted business with First Things First using this EIN? X Yes No
If not, or if there has been address or EIN changes, please go to httos://oao.az.aov/afis/vendor-information
And download the State of Arizona Substitute W-9 Form, and submit with your application
Congressional district (federal) in which agency provides most services: District # 4
Legislative district (state) in which agency provides most services: District #
Go to htto://www.azredistrictiraora and click on Final Maps to
identify your congressional and legislative district.
Approximate federal funding (from a federal source) to be received in current fiscal year? $ 29 million
Agency's fiscal year-end date: June 30, 2015
Agency's accounting method: Cash X Accrual
Does your organization undergo an annual independent audit in accordance with 2 CFR Part 200, Subpart F?
X Y N
Contact information for firm conducting agency audit:
Audit firm: State of Arizona, Office of the Auditor General
Address: 2910 N 4e Street, Ste 410, Phoenix, AZ 85018
Phone: 602-553-0333
FTF-MULTI-16-0519-00 Page 65

B. Proposed Program Information/Description:
B. Proposed Program Information/Description:
Amount requested: $2,125,000
Total Number (All Regions) of children ages 0-5 yrs receiving oral health screenings: 25,500
Total Number (All Regions) of fluoride varnishes being applied: 25,500
Total Number (All Regions) of expectant mothers receiving oral health screenings: 2,400
Total Number (All Regions) of participating adults: 9,775
Total Number (All Regions) of participating professionals: 425
East Maricopa:
Number of children ages 0-5 yrs receiving oral health screenings: 3,000
Number of fluoride varnishes being applied: 3,000
Number of expectant mothers receiving oral health screenings: 300
Number of participating adults: 1150
Number of participating professionals: 50
Northwest Maricopa:
Number of children ages 0-5 yrs receiving oral health screenings: 4 500
Number of fluoride varnishes being applied: 4,500
Number of expectant mothers receiving oral health screenings: 300
Number of participating adults: 1,725
Number of participating professionals: 75
Southwest Maricopa:
Number of children ages 0-5 yrs receiving oral health screenings: 3 000
Number of fluoride varnishes being applied: 3,000
Number of expectant mothers receiving oral health screenings: 300
Number of participating adults: 1,150
Number of participating professionals: 50
Southeast Maricopa:
Number of children ages 0-5 yrs receiving oral health screenings: 3,000
Number of fluoride varnishes being applied: 3,000
Number of expectant mothers receiving oral health screenings: 300
Number of participating adults: 1,150
Number of participating professionals: 50
Phoenix North:
Number of children ages 0-5 yrs receiving oral health screenings: 3,000
Number of fluoride varnishes being applied: 3,000
Number of expectant mothers receiving oral health screenings: 300
Number of participating adults: 1,150
Number of participating professionals: SO
Phoenix South:
Number of children ages 0-5 yrs receiving oral health screenings: 9,000
Number of fluoride varnishes being applied: 9,000
Number of expectant mothers receiving oral health screenings: 900
Number of participating adults: 3,450
Number of participating professionals: 150
FTF-MULTI-16-0519-00 Page 66

Please provide a brief description (250 words or less) of the proposed program, including service area and target
population. This description may be used by First Things First for public information regarding the grant.
The First Teeth First program provides oral health screenings, fluoride varnish and education to children
through the age of five years at Maricopa County Women, Infant and Children (WIC) clinics, childcare
centers, preschools and community based organizations in Maricopa County. This program provides a
basic oral health screening to the child and provides one on one education to parents at the time of
service. Children receive a toothbrush kit once services are completed to promote healthy brushing
habits to the child. The parent is encouraged to bring the child back to the site every six months to
receive services again and continue to promote healthy habits. Screenings and education is also provided
to expectant mothers. Professional development and outreach to medical and dental providers will
increase awareness and services to young children. In addition, partnerships with other health
professional learning institutions will enhance knowledge of oral health and how to incorporate this
knowledge into their practice. Finally, submitting claims for reimbursement will allow revenues to be
reinvested in the program for expansion, enhancement, and innovation and to sustain the program.
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 the data reports in PGMS.
PGMS Contacts
Main Contact Name: Vincent Torres Email:
VincentTorres@mail.maricopa.gov
Title/Position: Phone:
Office of Oral Health Program 602-506-6890
Supervisor
Finance Contact Name: T1311 Email:
Title/Position: Phone:
Program Contact Name: Kimberly Richards Email:
kimberlyrichards@mail.maricopa.gov
Title/Position: Phone:
First Teeth First Program 602-372-4650
Coordinator
Evaluation Contact Name: Kimberly Richards Email:
kimberlyrichards@mail.maricopa.gov
Title/Position: Phone:
First Teeth First Program 602-372-4650
Coordinator
FTF-MULT1-16-0519-00 Page 67

APPENDIX Al, A2, A3, A4, AS
SERVICE LOCATIONS
Page 68

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APPENDIX B
SUCCESS STORY
Page 74

Ma ricopa County Office of Oral Health
First Teeth First and Dignity Healthcare
RFGA FTF-Multi-16-0519-00
Appendix B
Success Story:
The First Teeth First program saw three year old Kevin at the Immunization clinic located at 67 th
Ave and Peoria. Kevin was screened by our dental hygienist and found that Kevin had three
teeth with very deep decay in them and was in pain. The hygienist informed the parents of the
cavities. The parents told the hygienist they didn't have any dental insurance and had no place
to take Kevin to receive services. The staff sent the urgent referral over to John C. Lincoln (JCL)
Desert Mission Children's Dental clinic that day and the staff at the clinic contacted Kevin's
parents to make an appointment. Kevin was seen the following Monday to have a dentist
examine him and the family was able to apply for the program at JCL clinic. The JCL clinic staff
was able to find a pedodontist to do all of his dental work pro bono. The family was very happy
with the services from all the agencies and will be taking Kevin back for routine 6 month visits
once all of the treatment has been completed.
Kevin at the Immunization Clinic after
receiving treatment and services.

APPENDIX C
A IGA WITH PEORIA UNIFIED SCHOOL DISTRICT
Page 76

Agendo Item Id:
Item Title
IGA WITH PEORIA UNIFIED SCHOOL DISTRICT FOR TRANSPORTATION AND COORDINATION OF ORAL
HEALTH SERVICES
C Number: C-86-15-041-3-00
Action Requested:
Approve a retroactive Intergovernmental Agreement between Peoria Unified School District (PUSD) and
Maricopa County by and through its Department of Public Health (MCDPH), Office of Oral Health
Services for PUSD to provide transportation and coordination of oral services for pre-school children in
First Things First Northwest Maricopa Region as detailed In Attachment B. The budget amount is a total
not-to-exceed $7,505 as detailed in Attachment A for the budget period July 1, 2014 through June 30,
2015. The County has the right to extend this IGA 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. This Is retroactive
due to processing at school district. No services have been provided to date and the scheduled activity
will commence on final execution of this IGA,
Board Required Information:
This IGA is funded through a grant for (C-86-11-014-3-06), Arizona Early Childhood Development and
Health Board, First Things First, for the East, Northwest and Southwest Maricopa region,
Additional information:
Expenditure Impact By FY:
1Y2014-15 $7,505 Expenditures
Item Notes:
(11/13/2014 10:01:19 AM) - Step: CIrkOfBrd
User: Juanita Garza
Response: APPROVE
(11/7/2014 9:58:33 AM) - Step: Finance
User: Claudia Ramirez
Response: APPROVE

(11/6/2014 11:59:14 AM) - Step: CountyAtty
User: Anne Longo
Response: APPROVE
(11/6/2014 8:43:37 AM) - Step: MtlsMgt
User: James Foley
Response: MOVE FORWARD
Comments:
Not an UPS item
(11/6/2014 8:30:39 AM) - Step: OMB
User: Cindy Goelz
Response: APPROVE
Comments:
Recommend approval.
(11/6/2014 8:16:27 AM) - Step: DepartmentChief
User: Angle Flick
Response: APPROVE
Corn ments:
Recommend approval for Sandi on behalf of Brian
(11/5/2014 12:12:13 PM) - Step: DeptHead
User: Max Porter
Response: APPROVE
(11/5/2014 12:02:30 PM) - Step: DeptCoor
User: Frances Delgado
Response: APPROVE
(11/4/2014 11:40:15 AM) .- Comments From Matt Juan
All edits are complete as requested by MCAO, Item is ready for approval by Dept Head.
• (10/30/2014 8:16:41 AM) - Step: DepartmentChief
User: Brian Hushek
Response: APPROVE
Comments:

Recommend approval for Sandi
(10/29/2014 2:28:13 PM) - Step: DeptHead
User: Max Porter
Response: APPROVE
(10/29/2014 2:19:23 PM) - Step: DeptCoor
User: Matt Juan
Response: APPROVE
Comments:
Item is ready for approval by Dept Head.
(10/29/2014 10:19:49 AM) - Step: Originator
User: Matt Juan
Response: APPROVE
Comments:
All edits are complete and item Is forward to 11/19/14 agenda.
(10/16/2014 9:00:42 AM) - Step: DepartmentChlef
User: Brian Hushek
Response: APPROVE
Comments:
Recommend approval for Sandi in her absence,
(10/15/2014 5:58:10 PM) - Step: DeptHead
User: Matt Juan
Response: APPROVE
Comments:
Item is ready for Dept Chief approval,
(10/15/2014 5:51:31 PM) - Step: DeptCoor
User: Matt Juan
Response: APPROVE
Comments:
Item is ready for Dept Head approval,
(10/15/2014 5:45:05 PM) - Step: Originator
User: Matt Juan
Response: APPROVE

Is there a Financial Impact?
yes
0,0 '''.1 1:5 -z=€'.- Fr -,- v— • . 1,,
....I q•
., .-,..5 .. (r'.'--• . -,-. ,
2015 Y DTSL 532 861 860 8651 0811 00 $7,505 DFO5 0000
Is there related Managing for Results information?
yes
,---.,„ ,,. „„ • , , 4-------:- ..; ,.. - - —7,3-- g-0---e-rr.—. -•„,„- arcerrow — ...,, ---_ .,..,,,,,„ i:,...- :.,..,--..-4. awes , Iivrat - -es, _ , --_,. %---,---=
, ;..4,4., ,,, , , :- ' - -., ..,...,
-,',..e- = -7,--. ,--t.*,gx,,,,,:(0,- c.,e=1,...-EA.' -,mes=asiaa." , --#.- - ' , •,.:.-ds,..,...f-. .5...,.2.rka."-- _ 41?,:-.., -a 1.1a."„foi-,„ ,:t :'.#4.4:7--5, ,' *1":14.1 .7'.4
Family Health Dental Sealants Anticipated number Anticipated 7,500 children
children eligible to receive eligible to receive
sea ha nts sealtants
General item Information
Department: Department of Public Health
Constellation:
Contact Name: Toby Urvater
Phone Number: 602 506-6853
Return To: Matt Juan
Phone Number: 602-372-0675
Location: Supervisors Auditorium
Board:
Meeting Date: 11/19/2014
Item Tracking
Originator APPROVE Matt Juan 10/15/20145:45:03 PM
DeptCoor APPROVE Matt Juan 10/15/2014 5:51:29 PM
DeptHead APPROVE Matt Juan 10/15/2014 5;58:07 PM
DepartmentChief APPROVE Brian Hushek 10/16/2014 9:00:40 AM
OriginatorMonitor RECALL Matt Juan 10/16/2014 10:39:37 AM
Originator APPROVE Matt Juan 10/29/2014 10:19:47 AM
DeptCoor APPROVE Matt Juan 10/29/2014 2:19:21 PM
DeptHead APPROVE Max Porter 10/29/2014 2:28:10 PM
DepartmentChief APPROVE Brian Hushek 10/30/2014 8:16:38 AM
OriginatorMonitor RECALL Matt Juan 10/30/2014 9:32:21 AM
DeptCoor APPROVE Frances Delgado 11/5/2014 12:02:27 PM

DeptHead APPROVE Max Porter 11/5/2014 12:12:11 PM
DepartmentChief ' APPROVE Angie Flick 11/6/2014 8:16:24 AM
OMB APPROVE Cindy Goeiz 11/6/2014 8:3036 AM
MtIsMgt MOVE FORWARD James Foley 11/6/2014 8:43:34 AM
Legal . APPROVE Anne Longo 1116/2014 11:59:11 AM
Finance APPROVE Claudia Ramirez 11/7/2014 9:58:25 AM
Clri<OfBrd APPROVE Juanita darza ' 11/13/2014 10:01:17 AM
Co'untyManager APPROVE Chris Pinuelas 11/13/2014 11:40:32 AM
Board of Supervisors / Directors Approved on 11/19/2014.

INTERGOVERNMENTAL AGREEMENT
MARICOPA COUNTY
by and through the
DEPARTMENT OF PUBLIC HEALTH
4041 N. Central Avenue, #1400, Phoenix, Arizona 85012
1. Agreement No: C-86-15-041-3 -CO 2. Agreement Type: Service Contract
3. Agreement Amount: _57445.19. 4, Purpose: Transoortation/Coordination of Services
5. Start Date: July 1,2014 6. Expiration Date: June 30 2015
This Agreement is entered into by and between the Peoria Unified School District (referred to herein as "Contractor"), and
Maricopa County, by and through its Department of Public Health (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 11 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 in the notice.
Notice to Contractor: Peoria Unified School District Attn: Kenneth Hicks Phone (623) 486-60.66
Address: 6330 W. Thunderbird Road, Glendale, AZ 85306
Notice to Department: MCDPH Grants/Contract Unit . Phone: (602) 372-0675
Address: 4041 North Central Avenue, Ste #1400, Phoenix, Arizona 85012
IN WITNESS WHEREOF, the parties enter into this Agreement:
MARICOPA COUNTY BOARD OF SUEERVISORS
Signature Signature
Name DENNY BARNEY
Name
Title Chairman, Board of Supervisors
Title
DEC 0 3 2014
Date Date
ATTEST:
Signature
CreTk of the Board '"(4 DEC 0 32014
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 Agreement is has within determined the powers that and this authority Intergovernmental granted under the
is in proper form and is within the powers and authority granted laws of the State (*Arizona, / A
under the laws of the State • • a,
( tie
Signature Signature ( ei02
Attorney 'or Maricopa Count
Date /7/s-7/
Date
1

SECTION 1 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.
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 Contractcir 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.
6. 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
2

SECTION I GENERAL PROVISIONS
A. This provision applies to all financial and programmatic records, supporting
documents, statistical records, and other records of the Contractor that relate to
this Agreement.
B. The 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.
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.
9. AGREEMENT COMPLIANCE MONITORING
County shall monitor the Contractor's compliance with, and performance under, the
terms and conditions of this Agreement. On-site visits for compliance monitoring may be
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.
B. 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,
3

SECTION I GENERAL PROVISIONS
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
The County may suspend, modify, or terminate this Agreement immediately upon giving
written notice to the Contractor if the Contractor fails to perform under or otherwise
breaches any obligation under this Agreement, or upon the occurrence of any event that
may jeopardize the ability of the Contractor to perform any of its obligations under this
Agreement.
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. The Parties do not currently contemplate joint acquisition of property pursuant to
4

SECTION 1 GENERAL PROVISIONS
this Agreement. If, however, property is acquired, upon termination of this
Agreement any such property shall be retained by the party that purchased or
provided it. If property is jointly acquired by the parties, it shall be distributed
equally up termination.
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.
16. 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
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.
17. INDEmIsirrY
Each Party (as "Indemnitor) agrees to indemnify, defend, and hold harmless the other
Party (as "lndemnitee") 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 lndemnitor, 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.
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
5

SECTION1 GENERAL PROVISIONS
'supplying Party that is relevant to this Agreement and to the performance hereunder.
21. NON-DISCRIMINATION
The Contractor, in connection with ahy 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.
22. 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, ef 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) (IRCA");
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,
at seq.).
23. 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.
24, 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
ineligible, or voluntarily excluded from covered transactions by any federal
6

SECTION I GENERAL PROVISIONS
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.
26. E-VERIF1CATION 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.
7

SECTION II SPECIAL PROVISIONS
1. 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:
1. 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,
2. The person administering this Agreement or the Procurement Officer,
as applicable, shall respond in writing to the dispute within fourteen (14)
days.
3. The Contractor may abide by the decision or may appeal the decision
to the Director of the Department within seven (7) days.
This Paragraph shall not apply to claims arising from bodily injury, death, or property
damage.
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
8

SECTION II SPECIAL PROVISIONS
A. If the Contractor expends $500,000 or more in a year in federal awards, the
Contractor shall have a single audit conducted for that year according to the
Single Audit Act of 1984 (Pub. L. No, 98-602) (codified at 31 U.S.C. §§ 7501, et
seq.), and the Single Audit Act Amendments of 1996 (Pub. L. No. 104-156). The
Contractor shall comply with OMB Circulars A-133, A-87, A-102, and A-110, as
applicable. 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 conssideration 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
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:
9

SECTION II SPECIAL PROVISIONS
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, 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
insurance or any decrease in its lines of coverage at least thirty (30) days before
such action takes place.
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 within fifteen (15) days of its effective date.
B. The Contractor shall Include in any subcontracts a provision to the effect that the
subcontractor agrees that the County shall have access to the subcontractor's
facilities and the right to examine any books, documents, and records of the
subcontractor involving transactions related to the subcontract, and that such
books, documents, and records shall not be disposed of except as provided
herein.
7. REPORTING REQUIREMENTS
If requested by the County, the Contractor shall submit monthly, quarterly, and annual
progress reports on or before the third (3rd) day of the month following the end of the
reporting period. In addition, a quarterly expenditure report will be submitted with the
quarterly progress report.
10

SECTION II SPECIAL PROVISIONS
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

WORK STATEMENT
SECTION IV
1. DEFINITIONS:
A. MCDPH refers to Maricopa County Department of Public Health
B. MCOOH FTF refers to Maricopa County Office of Oral Health First Teeth First
C. PUSD refers to Peoria Unified School District
2. SERVICE GOALS
Peoria Unified School District will provide coordination of transportation for preschool
children as indicated in Attachment B, Schedule.
3. SERVICE OBJECTIVES/ACTIVITIES
A. Provide funding to Peoria Unified School District for the cost of the transportation
of children via buses In the First Things First Northwest Maricopa Region to
receive dental education, screenings and fluoride varnish at preschools in the
school district. Additionally, coordinate program at the schools, provide data
entry and report as necessary.
B. • Site Coordinator will provide assistances on the date of services to move the
children from the buses to the location where oral health screenings, fluoride
varnish and education is being provided and the return back to the buses
following services,
C. Data Entry/Reporting personnel enter treatment records into an Excel
spreadsheet for each child following services for reporting purposes to MCDPH,
4, OTHER REQUIREMENTS
MCOOH FTF shall:
A. Provide program information and parental consent forms in advance of
scheduled screening dates, to the site coordinator.
B. Provide licensed dental hygienist and trained bilingual site assistants to conduct
the dental screening and fluoride varnish application at each location.
C, Check State Board of Dental Examiners licensing records on licensed MCDPH
dental providers; conduct background checks of all dental providers.
D. Supply identification badges for dental providers.
E. Furnish/bring necessary dental supplies needed to conduct the basic oral
screening/fluoride varnish activities as the designated PUSD locations.
F. Provide oral health education materials for parents and teachers
G. Maintain all student information according to confidentiality requirements,
12

SECTION IV WORK STATEMENT
PUSD shall:
A. Inform families about participation in the First Teeth First fluoride varnish
program through communication with teachers, school offices and parents.
B. Provide transportation coordination for students from scheduled elementary
schools to the services location on the date of scheduled services.
C. Use all forms, educational materials, protocols and guidelines used in other
MCOOH FrF oral health services delivery locations in the Region.
D. Keep returned consent forms until the date of service and store all consent forms
and treatment records after services have been provided.
E. Provide adequate physical space at each school for dental screening and fluoride
varnish services to be delivered.
F. Provide outreach to parents/guardians with children having urgent dental needs
so that referrals to dental services occur after the initial dental screening,
13

SECTION V COMPENSATION
1, COMPENSATION
A. Subject to the availability of funds, County shall pay the Contractor for the
services described herein for a sum not-to-exceed the Contract Amount listed on
the cover page of this Agreement. In accordance with the budget lines indicated
in Attachment A, Budget. The request for payment must be submitted by the
Contractor,
B. Invoice shall contain the following information on PUSD letterhead:
• Date of invoice
• Breakdown of service dates with each school location, drop off school,
am hours, pm hours and total number of hours.
• Transportation rate per hour for buses.
• Number of scheduling hours (coordinator hours),
• Number of data entry hours (data entry/reporting).
C. The Contractor will send an invoice to the County for payment to the following
address:
Maricopa County Department of Public Health
Office of Oral Health
Attention: Program Manager
1645 E. Roosevelt St, 2" Floor
Phoenix, AZ 85006
2. METHOD OF PAYMENT
A. Contractor shall submit a payment request. This payment request must be on
school letterhead and contain a signature authorizing the request.
B. Subject to the availability of funds, the County will, within thirty (30) working days
from the date of receipt of the fully executed IGA, process and remit, to the
Contractor, a warrant for payment up to the maximum total allowable for services
provided,
C. The Contractor understands and agrees that the County will not honor any claim
for payment submitted six (6) months after the last date of service for each
session. 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 (60) days after the expiration date without approval of the County.
3. NOTICE
Any notice given under this Contract shall be sent to the attention of the following:
14

SECTION V COMPENSATION
Maricopa County Department of Public Health Marlcopa County Department of Public Health
Office of Oral Health Services Grants and Contracts Unit
Maricopa County Department of Public Health Grants and Contracts Administrator
Office of Oral Health 4041 N. Central Avenue, Suite 1400
Attention: Program Manager Phoenix, Arizona 85012
1645 E. Roosevelt St., 2° Floor
Phoenix, AZ 85006
15

ATTACHMENT A BUDGET
_
Expenses
Site Coordination ($25.0D/hr x 100 hours) $2,500
Data Entry/Reporting ($26.00/hr X 100 hours) $2,500
,
Subtotal $5,000
Transportation
Buses ($16.7othr x 160 hours) $2,505
Subtotal $2,505
.. . . .
Grand Total $7,505
16

ATTACHMENT B SCHEDULE
Peoria Unified School District
6330 W Thunderbird Road
Glendale, AZ 65306
Date Location Schools
10/23114 Ira A Murphy Ira Murphy, Desert Palms,
Marshall Ranch
10/28/2014 Alta Loma Alta Loma, Santa Fe, Country
Meadows
11/18/2014 Sky View Sundance, Foothills, Peoria
Elementary
1/29/2016 ' , - Frontier Frontier, Vistancia, Lake
Pleasant
2/10/2015 Sky View Oasis, Desert Harbor, Paseo
Verde
313/2015 Ira A Murphy Ira Murphy, Desert Palms,
Marshall Ranch
4/2/2016 Alta Loma Alta Loma, Santa Fe, Country
Meadows
412312015 Sky View Sundance, Foothills, Peoria
Elementary

APPENDIX D
ACCEPTANCE LETTER
DIGNITY HEALTH
Page 99

APPENDIX D
TIT Maricopa County
Department of Public Health
Administradve Offices WeArePtiblicHealth.org
4041 N Central Ave, #140D • Phoenix, Arizona 85012 twItter.conVM arleopahealth
Phone: (602) 506-6900 • Fax: (602) 506-6885 facebook,com/MCDPH
Sanuaty 20, 2015
Aaron Peace, President
Dignity Health Foundation — East Valley
1727 West Frye ROad, Suite 230
Chandler, AZ 85224
Dear Mr. Peace,
Thank you for your response to our recent Notice of Intent, PH NO I 15-017, Oral Health
Prevention Programs, The evaluation process is now complete and your organization has been
approved to continue collaborative efforts if and when we receive notification of grant funding.
Please note that this is not a guarantee of future funding.
We look forward to working with you. Toby Urvater (602.506.6853) will be contacting you in
regards to setting up a meeting.
-If you have any questions, please do not hesitate to call me. I can be reached at 602.506.6886.
Sincerely,
Cheryl Rentscheler, M.P.A., CPPB
Procurement Officer
cc: Toby Urvater

APPENDIX E
LETTER OF SUPPORT
ARIZONA DEPARTMENT OF HEALTH SERVICES
Page 101

Division of Public Health Services
Office of the Assistant Director
Public Health Prevention Services
Arizona 150 N. 18th Ave, Suite 320 DOUGLAS A. DUCEY, GOVERNOR
Department of Phoenix, Arizona 85007 CORY NELSON • INTERIM DIRECTOR
Health Services (602) 542-1891
(602) 364-1494 FAX
March 20, 2015
Toby Urvater, M.S.W.
Administrator, Community Health Action
Maricopa County Department of Public Health
4041 N Central Avenue
Phoenix, AZ 85012
Dear Ms. Urvater:
The Arizona Department of Health Services Office of Oral Health supports the application from the Maricopa
County Department of Public Health for the Multi-Region Oral Health Strategy RFGA No. FTF-MULTI-16-0519-
00,
The intent of the Oral Health Strategy is to provide best practice approaches that enhance the oral health status of
children, birth through age 5, residing in IVIaricopa County. This is a multi-regional strategy supported by the East
Maricopa, Northwest Maricopa, Southeast Maricopa, Southwest Maricopa, Phoenix North and Phoenix South
regions. The expected results for children are prevention and reduction in prevalence of early childhood tooth decay
and the associated risks for pain and infections that can lead to lifelong complications to health and wellbeing. The
approaches for this strategy include: oral health screening for children and expectant mothers with referrals to oral
health providers for follow up care as needed; fluoride varnishes for children; oral health education for families and
other caregivers; and outreach to families, caregivers and oral health and medical professionals.
If the grant proposal is awarded, the Office of Oral Health is committed to being a partner and working with the
Maricopa County Department of Public Health to support grant activities:
Grant Activities — The Arizona Department of Health Services Office of Oral Health will provide oversight
and administration of submission of dental claims for eligible children who receive fluoride varnish and
oral health services with the First Teeth First program.
The Office of Oral Health supports your grant proposal to improve the oral health of Arizona's children by
preventing and reducing the prevalence of early childhood tooth decay and providing services for underserved
populations.
Sincerely,
Julia Wacloff, RDH, MSPH
Chief, Office of Oral Health
Health and Wellness for All Arizonans

APPENDIX F
TARGET SERVICE UNITS SPREADSHEET
Page 103

Total 25,500 25,500 2,400 9,775 425
Southeast 3,000 3,000 300 1,150 50
SoUthyvest aricopa 3,000 3,000 300 1,150 50
OhOeniX.N.00
F 3,000 3,000 300 1,150 50
Appendix
NorthuVest Maricopa 4,500 4,500 300 1,725 75
Maricopa
East 3,000 3,000 300 1150 50
South
Health Healthcare Phoenix 9,000 9,000 900 3450 150
Oral 0-5
of Dignity Units ages
Office and FTF-Multi-16-0519-00 health expectant oral participating participating
County First Service children oral fluoride applied: receiving screenings:
Teeth of receiving of of of of professionals:
Maricopa First RFGA Target Number screenings: Number varnishes Number mothers health Number adults: Number
yrs