REVISED IMMUNIZATION AGREEMENT - MASTER (00).PDF
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PARTNERHSIP AGREEMENT
between
MARICOPA COUNTY
by and through the
DEPARTMENT OF PUBLIC HEALTH
and
___________________
Background
These rather unusual times necessitate a pre-emptive and creative effort with rural and urban communities
to ensure students are vaccinated and ready for when school resumes. Due to recent events, COVID-19,
there has been a significant decrease nationally in children receiving their recommended childhood
vaccines. The collaboration between Maricopa County Department of Public Health (MCDPH) and the
school districts or school organizations will assist families in accessing necessary childhood vaccines in
order to attend school and prevent vaccine preventable diseases. Although we encourage parents and
guardians to contact their child’s pediatrician to schedule well visits and needed vaccines, we know this
may not be easily attainable.
Federal Vaccine funding changes will affect the way that immunizations are provided in the public sector.
County Health Departments and all public VFC (Vaccines for Children) providers, such as several fire
departments, school programs, and other public clinics may no longer use public vaccine for privately
insured children. Privately insured children may fall through the cracks if turned away by private
providers and sent to county health departments or other public providers only to be bounced back to
private practice. To assure that children receive the needed vaccines to attend school Maricopa County
Department of Public Health wishes to enter into an agreement with the District school district to provide
vaccines to children who are eligible for Vaccine for Children vaccines and to children who have private
insurance with a plan that is contracted with Maricopa County Department of Public Health.
This AGREEMENT is hereby made and entered into by Maricopa County through the MCDPH and the
____________ School District, hereinafter referred to as District.
A.
PURPOSE
The purpose of this Agreement is to develop a framework of cooperation between MCDPH and
District to provide childhood and the seasonal influenza vaccines to students who are uninsured
and insured and the seasonal influenza vaccine for adults who are uninsured and insured.
B.
STATEMENT OF MUTUAL BENEFIT AND INTERESTS
The mutual benefit for both parties is to assure eligible children receive age appropriate
immunization to prevent the spread of vaccine preventable diseases.
C.
MCDPH SHALL:
1. Maintain COVID-19 precautions as set forth by the CDC recommendations and State of
Arizona
2. Supply MCDPH nurses, staff and volunteers for the event
3. Coordinate event with district/organization’s person of contact (POC)
4. Provide district/organization with flyers and language to assist them with their school
community outreach
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5. Supply all vaccine, supplies and paperwork
6. Enter all client consent forms into the Arizona State Immunization Information System
(ASIIS)
7. Bill all AHCCCS and privately insured clients for whom Maricopa County has been
contracted with.
8. Screen and document all patients for the appropriate VFC categories:
a. Native American or Alaskan Native
b. Enrolled in the Arizona Health Care Cost Containment System (AHCCCS)
c. Has no health insurance
d. Has health insurance that does not pay for vaccines
e. Has health insurance that pays for vaccines
9. For children enrolled in AHCCCS and that have health insurance that pays for vaccines, a
copy of the health insurance card must be copied, the front and the back, and attached to the
Immunization Consent Form (Attachment A). All client’s insurance status must be verified
using the supplied web portal.
10. Screen all patients for each vaccine using the guidelines set by the Advisory Committee on
Immunization Practices (ACIP).
11. Administer all vaccines based on the ACIP guidelines.
12. Comply with the appropriate immunization schedule, dosage and contraindications
established by the ACIP unless (a) in the medical judgment and in accordance with accepted
medical practice, the provider deems such compliance to be medically inappropriate, or (b)
the particular requirements contradict the laws in Arizona pertaining to religious or other
exemptions.
13. Administer VFC vaccine to the following children:
a. Native American or Alaskan Native
b. Enrolled in the Arizona Health Care Cost Containment System (AHCCCS)
c. Has no health insurance
d. Has health insurance that does not pay for vaccines
14. Administer MCDPH purchased vaccine to the following children:
a. Has health insurance that pays for vaccines
b. Has commercial health insurance that is contracted with Maricopa County
15. Distribute current Vaccine Information Statements (VIS).
16. Report all clinically significant adverse events to the Vaccine Adverse Event Reporting
System and MCDPH Immunization Program.
17. Not impose a charge for the cost of the VFC vaccine. MCDPH will not hold party responsible
for denied PPV claims.
18. Comply with all Arizona Immunization statutes and rules regarding childcare and school
immunizations.
D.
DISTRICT SHALL:
1. Provide location on a school campus or district office adequate to maintain COVID-19
precautions.
2. Provide electric and air-conditioning accessibility.
3. Provide tables and chairs for the events
4. Provide at least one staff member who can represent the school district or organization to
support their community’s district or organizations needs.
5. Conduct school community outreach for the purpose of the events.
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E.
IT IS MUTUALLY UNDERSTOOD AND AGREED BY AND BETWEEN THE PARTIES
THAT:
1. MODIFICATION OR AMENDMENT
Modifications within the scope of the instrument shall be made by mutual consent of the
parties, by the issuance of a written modification or amendment, signed and dated by all
parties, prior to any changes being enacted.
2.
TERM & TERMINATION
The term of this Agreement becomes effective on the date both parties have signed and
automatically renews annually from this date. Either party may terminate this Agreement
at any time by giving 90 days written notice to the other party.
3.
APPLICABLE LAW
This Agreement shall be governed by and construed in accordance with the laws of the
State of Arizona.
4.
CANCELLATION
This Agreement is subject to cancellation pursuant to the terms of A.R.S. §38-511.
5.
CLIENT CONFIDENTIALITY
Both parties understand and concur that this agreement is subject to all State and Federal
laws protecting client confidentiality. Client/patient confidentiality will be maintained
equally for all individuals presenting for services whether being provided by District or
MCDPH. The use or disclosure by either party of any information concerning an eligible
individual served under this agreement is directly limited to the fulfillment of this
agreement.
5.
NON-DISCRIMINATION
Both parties shall comply with Executive Order 75-5 as modified by Executive Order 2009-
09, which mandates that all persons regardless of race, color, religion, sex, age, national
origin or political affiliation, shall have equal access to employment opportunities, and all
other applicable State and Federal employment laws, rules and regulations, including the
Americans with Disabilities Act. All parties shall take affirmative action to ensure that
applicants for employment and employees are not discriminated against due to race, creed,
color, religion, sex, national origin or disability.
6.
LAWS, RULES AND REGULATIONS
Both parties understand and concur that this agreement is subject to all State and Federal
laws, rules and regulations that pertain hereto.
7.
PARTICIPATION IN SIMILAR ACTIVITIES
This agreement in no way restricts MCDPH or District from participating in similar
activities with other public or private agencies, organizations, and individuals.
8.
NON-LIABILITY
Neither MCDPH, District, nor their respective officers and employees shall be liable for
any act or omission by the other party or other party’s subcontractor, employee, officer,
agent, or representative occurring in the fulfillment of this agreement.
9.
INDEMNITY
MCDPH agrees to indemnify, hold harmless, and defend District, its officers and
employees from and against any and all claims, damages, suits and proceedings, from
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liability, punitive damages, costs or expense of every type, all or any part thereof arising
out of or in connection with or by reason of any negligent act or omission of MCDPH.
MCDPH and its subcontractors shall reimburse District for its costs, including attorney’s
fees for defense of any litigation arising from such claim. MCDPH shall include a clause
to this effect in all subcontracts inuring to the benefit of District.
Similarly, District agrees to indemnify, hold harmless, and defend MCDPH, its officers
and employees from and against any and all claims, damages, suits and proceedings,
regardless of the merits, from liability, punitive damages, costs or expense of every type,
all or any part thereof arising out of or in connection with or by reason of any negligent act
or omission of District or any subcontractors or anyone directly or indirectly employed by
either District or any subcontractors in the performance of this MOU. District and its
subcontractors shall reimburse MCDPH for its costs, including attorney’s fees for defense
of any litigation arising from such claim. District shall include a clause to this effect in all
subcontracts inuring to the benefit of MCDPH and Maricopa County.
10.
INSURANCE
MCDPH shall maintain a self-insurance program under the Revised Restated Declaration
of Trust for Maricopa County, Arizona Self-Insured Risk Trust Fund during the term of
this Agreement.
District shall maintain during the term of this Agreement insurance policies described
below issued by companies licensed in the State of Arizona with a current AM Best, Inc.
rating of A- VII or better. In the alternative, District may submit required coverage under
a self-insured program. At the signing of this Agreement, District shall furnish MCDPH
with Certificates of Insurance or Self-Insurance evidencing the required coverage
conditions and limits required by this Agreement.
In the event any insurance policies required by this Agreement are written on a “claims
made” basis, coverage shall extend for two years past expiration of the Agreement and
must be evidenced by annual Certificates of Insurance upon request from MCDPH.
10.1.
Commercial General Liability insurance with a limit of not less than $2,000,000
per occurrence and $4,000,000 aggregate for bodily injury, property damage, personal
injury, products and completed operations, and blanket contractual coverage, including but
not limited to, the liability assumed under the indemnification provisions of this
Agreement;
10.2.
Automobile Liability insurance with a combined single limit for bodily injury and
property damage of not less than $1,000,000 each occurrence with respect to owned, hired,
and non-owned vehicles;
10.3.
Workers’ Compensation insurance with limits statutorily required by any Federal
or state law and Employer’s Liability insurance of not less than $1,000,000 for each
accident, $1,000,000 disease for each employee, and $1,000,000 disease policy limit; and
11.
COMMUNICATION
Each party agrees to notify the other, in writing, of changes in policy which may affect
this agreement. Notification is to be made to the attention of the principal contacts
identified in Section 12 below.
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12.
PRINCIPAL CONTACTS
The principal contacts for this agreement are:
Maricopa County Department of Public Health:
Immunization Program
4041 N Central Avenue, Suite 600
Phoenix, AZ 85012
Phone: 602-506-8365
FAX: 602-506-5506
Grants/Contracts Unit
4041 N. Central Avenue, Suite 1400
Phoenix, AZ 85012
Phone: 602-372-0674
FAX: 602-506-6885
District:
Name
Address
Phone-email
Contact
-Signature Page Follows-
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IN WITNESS WHEREOF, the parties agree to the changes indicated herein:
FOR AND ON BEHALF OF
FOR AND ON BEHALF OF
MARICOPA COUNTY
SCHOOL DISTRICT (TBD)
By ___________________________
By ____________________________
Chairman, Board of Supervisors
_______________________________
________________________________
Date
Date
ATTEST:
________________________________
Clerk of the Board
________________________________
Date
APPROVED AS TO FORM
APPROVED AS TO FORM
________________________________
_____________________________
Attorney for Maricopa County
Signature
DATE: __________________________
DATE: _________________________