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Intergovernmental Agreement (IGA)
Agreement No.: DI20-002264
Description:
Community Action Services Program
Agreement between the Arizona Department of Economic Security ("ADES") and Maricopa County Administered by it's
Human Services Department ("Contractor").
WHEREAS ADES is duly authorized to execute and administer contracts under A.R.S § 41-1954 and,
The Contractor is duly authorized to execute and administer contracts under _________________________ and,
ADES and the Contractor are authorized by A.R.S. § 11-952 et seq. to enter into agreements for joint or cooperative action to
contract for the services specified in this Agreement.
The term of this Agreement shall begin on July 1, 2020 and shall end on June 30, 2025, unless otherwise amended.
THEREFORE, ADES and Contractor (the “Parties”) agree to abide by all the terms and conditions set forth in this Agreement.
BY SIGNING THIS FORM ON BEHALF OF A PARTY, THE SIGNATORY CERTIFIES POSSESSING THE AUTHORITY TO BIND THE PARTY
TO THIS AGREEMENT.
FOR AND ON BEHALF OF THE ARIZONA
DEPARTMENT OF ECONOMIC SECURITY:
FOR AND ON BEHALF OF THE MARICOPA COUNTY
ADMINISTERED BY IT'S HUMAN SERVICES DEPT:
Procurement Officer Signature
Signature
Printed Name
Printed Name
Title
Title
Date
Date
DI20-002264
ADES Contract Number
Contract Number
IN ACCORDANCE WITH A.R.S. § 11-952, THIS AGREEMENT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND AUTHORITY
GRANTED TO EACH RESPECTIVE PUBLIC BODY.
ARIZONA ATTORNEY GENERAL’S OFFICE
By: __________________________________
By: _________________________________________
Assistant Attorney General
Public Agency Legal Counsel
Date: __________________________________
Date: ________________________________________Attachm ent 2 –
A.R.S. §§ 11-201 and 11-251
Clint Hickman
Chairman, Maricopa County Board of Supervisors
Scope of Work
Agreement No
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Description:
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Intergovernmental Agreement
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Scope of Work
1.
Arizona Department of Economic Security (ADES) Mission and Vision Statement
1.1
ADES Mission: The Arizona Department of Economic Security makes Arizona stronger by helping Arizonans
reach their potential through temporary assistance for those in need, and care for the vulnerable.
1.2
ADES Vision: All Arizonans who qualify receive timely ADES services and achieve their potential.
2.
Purpose of Contract
2.1.
Purpose Statement: To provide broad-ranging programs and services in rural and urban areas that are intended
to pursue the reduction of poverty, the revitalization of low-income communities and the empowerment of low-
income families and individuals to become fully self-sufficient.
2.2.
Legal Authority: A.R.S. § 41-1954(A)(6) provides ADES, hereafter referred to as the Department, the authority
to contract and incur obligations within the general scope of its activities and operations.
2.3.
Funding: Fund sources that support the services include the Community Services Block Grant (CSBG),
Temporary Assistance to Needy Families (TANF), Social Services Block Grant (SSBG), Low Income Home
Energy Assistance Program (LIHEAP), and Neighbors Helping Neighbors (NHN). The use of the funding may
be directed by statute or prescribed by federal requirements and is described in Sections 9 and 10.
3.
Definitions
3.1.
COATES: Community Opportunities, Accountability, Training and Educational Services Act of 1998, Public Law
105-285.
3.2.
CSBG Act: The Community Services Block Grant Act (42 U.S.C. § 9901 et seq.), as amended by Public Law
105-285.
3.3.
Community Action Agency (CAA): A designated eligible entity as described under the federal Community
Services Block Grant Act.
3.4.
Community Action Program Plan: A document submitted by Community Action Agencies to the Division of
Aging and Adult Services in order to receive the funding provided under Section 676 of the Community Services
Block Grant Act.
3.5.
Client: An eligible individual who meets the requirements for a particular service or program as outlined under
state and federal law.
3.6.
Private, non-profit CAAs: A designated Community Action Agency that has been established and maintained
as a 501(c)(3) as recognized by the Internal Revenue Service.
3.7.
Public CAAs: A designated Community Action Agency that is a unit of Local Government such as a
municipality, or a County Government.
3.8.
Results Oriented Management and Accountability (ROMA): A performance management system prescribed
by the federal Department of Health and Human Services for Community Action Agencies.
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3.9.
Self-sufficiency: The ability of an individual or family to sustain a given status without ongoing support from
social service agencies.
3.10. Economic self-sufficiency: Possession of economic resources which are sufficient for ongoing solvency at a
generally acceptable standard of living.
3.11. Personal self-sufficiency: Possession of physical, mental, emotional, and social resources which are
sufficient for ongoing well-being.
3.12. LIHEAP Incentive Plan: A plan which describes the amounts and conditions of LIHEAP payments which
Contractor desires to make available to Clients, apart from and in addition to regular LIHEAP payments, as an
incentive to participate in case management.
3.13. Linguistically Appropriate and Culturally Relevant: Respect and responsiveness to explicit cultural and
linguistic needs of individuals that is reflected in behaviors, attitudes, and policies that form an agency service
system. Such a system enables the agency, to work effectively in cross-cultural situations. The agency will
offer culturally compatible service delivery in taking into account distinct nuances and differing values,
behaviors, expectations, and life skills that are often rooted in varied cultures.
4.
Service Description
4.1.
Arizona Taxonomy Definitions: Community Action Services Program: Services provide assistance and
assess the needs of low-income Clients to determine the incremental steps the Client must take to move toward
economic self-sufficiency. Services available include, but are not limited to: Coordination, Community Services,
Case Management, Utility Assistance and Weatherization.
4.2.
Actual Service Description: Services include Community Services, Case Management, Utility Assistance and
Transportation.
4.2.1.
Coordination and Weatherization services are not provided under this Contract.
5.
Contractor Requirements
The Contractor Shall:
5.1.
Administrative Requirements:
5.1.1.
Provide services that are culturally relevant and linguistically appropriate to the population served.
5.1.2.
Comply with the Community Action section of the DAAS Policy and Procedure Manual, located at:
https://des.az.gov/services/aging-and-adult/partners/daas-policy-and-procedure-manual as may be
amended, and all applicable federal, state, and local laws, rules, and regulations as may be amended,
including but not limited to the following:
5.1.2.1. COATES Human Services Reauthorization Act of 1998;
5.1.2.2. 2 CFR 200 – Uniform Administrative Requirements;
5.1.2.3. Personal Responsibility and Work Opportunity Reconciliation Act of 1996;
5.1.2.4. Stewart B. McKinney Homeless Assistance Act;
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5.1.2.5. ARS §46-241 - Short Term Crisis Services;
5.1.2.6. ARS §46-731 - Utility Assistance;
5.1.2.7. ARS §46-741 - Neighbors Helping Neighbors;
5.1.2.8. ARS §46-140.01 - Verification of identity and citizenship and/or immigration status and
5.1.2.9. ARS §§1-501-1- 502, regarding eligibility for federal and state or local public benefits.
5.2.
Staffing and Security
5.2.1.
Verify and assure that staff members and volunteers do not have conflicts of interest in the provision
of services and management of the programs.
5.2.2.
Provide to all staff and volunteers timely and accurate information and appropriate training for the
services they provide.
5.2.3.
Maintain Client confidential information in a secure location.
5.3.
Equipment
5.3.1.
Access and utilize up-to-date information from ADES, U.S. Department of Health and Human
Services (DHHS) Office of Community Services (OCS), and other web sites.
5.3.2.
Utilize computer back-up and recovery systems and procedures to prevent loss of data required for
ADES reports and any disruption or degradation of services.
5.3.3.
Utilize a computer-based tracking system from which monthly, quarterly, and other reports may be
generated.
5.4.
Service Provision
5.4.1.
Provide services directly, as allowed, or through subcontractors.
5.4.2.
Collect and report required Client data.
5.4.3.
Maintain documentation that key staff has received appropriate training or hold appropriate
certification/licensure in accordance with their job descriptions.
5.4.4.
Maintain permanent facility locations which offer sufficient Client waiting space or waiting rooms,
adequate seating, and restrooms for program applicants.
5.5.
Networking
5.5.1.
Develop partnerships and network with related programs to provide more immediate resolution to
issues and expand resources.
5.5.2.
Form local partnerships with community agencies to address the needs of low-income families and
individuals.
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5.5.3.
Network with social service professionals within the community to expand their means to receive and
disseminate information for each service.
5.5.4.
Facilitate and participate in education, training, and information seminars, workshops, and
conferences.
5.5.5.
Participate in conference calls and attend meetings initiated by ADES to receive training or obtain
information.
5.6.
Service Provisions
5.6.1.
Document all costs associated with provision of Contract services.
5.6.2.
Provide administrative assistance, training and technical assistance to subcontractors in support of
administrative functions as needed or requested by subcontractors.
5.6.3.
Require that subcontractors are in compliance with applicable Federal Regulations, State
Regulations, DAAS Policy and Procedure Manual for Community Services, and all requirements of
this Contract.
5.6.4.
Provide technical assistance to subcontractors through procedural interpretation or by additional
research upon request.
5.6.5.
Develop and present initial and refresher training to subcontractor staff as deemed necessary by the
Contractor, subcontractor or ADES.
5.6.6.
Hold quarterly meetings at a minimum with subcontractors to communicate new developments,
discuss problems, share ideas for improvements and address other identified topic areas.
5.6.7.
Utilize Client grievance procedures in accordance with the community Action section of the DAAS
Policy and Procedure Manual, to respond timely and effectively to customer complaints.
5.6.8.
Identify service gaps among Client populations and develop and implement services or resources to
meet identified needs.
5.6.9.
Address and resolve Client barriers to service.
5.6.10.
Train appropriate personnel in the use and completion of ADES approved written or electronic form(s)
in accordance with DAAS Policy and Procedure Manual Community Services.
5.7.
Monitoring and Evaluation
5.7.1.
Utilize instruments for monitoring and evaluating subcontractors’ performance and compliance with
this Contract.
5.7.2.
Conduct at a minimum, on-site Contract compliance monitoring of subcontractors twice during the
five (5) year term of this Contract, to include, but not limited to, facilities, administrative and financial
operations, and programmatic service delivery.
5.7.3.
Establish and implement a process to improve service and performance of this Contract.
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5.7.4.
Participate in ADES evaluation studies, when required.
6.
General Reporting Requirements/Notices:
The Contractor shall:
6.1.
Input Monthly billing information into the Division of Aging and Adult Reporting System (DAARS) in accordance
with system Guide as may be amended, or as directed by ADES. Note: Mileage will be reimbursed at no greater
than the current federal mileage reimbursement rate. Exceptions may be requested in writing to, and considered
for approval by, the Community Action Program Manager.
6.2.
Send all correspondence regarding this Contract electronically to the assigned DAAS Contract Specialist, or as
directed by ADES.
6.3.
Submit an Annual Cost Allocation Plan, at the beginning of each State Fiscal Year.
6.4.
Complete “Contractor’s Equipment List” (Form FES-1000A), as may be amended, for all proposed equipment
purchases costing $5,000 or more to be purchased in whole or in part with ADES funds (Exhibit A).
6.5.
By June 30 annually, a twelve-month monitoring plan that includes at a minimum: which direct service
subcontractors are to be monitored during the twelve-month period beginning July 1 (of the same year), the
target monitoring start and completion dates.
6.6.
Submit to ADES the Current certificate(s) of insurance within (10) calendar days of award and as required in
the Special Terms and Conditions and maintain a valid certificate of insurance on file with ADES Contract
Specialist.
7.
COMMUNITY SERVICES
7.1.
Arizona Taxonomy Definitions: Community Services: Services that provide a range of activities that have a
measurable, and major impact on causes of poverty.
7.2.
Service Description: Community Services (provided in every county in Arizona) – The primary objectives of this
service are:
7.2.1.
To strengthen community capabilities for planning and coordinating the use of a broad range of
resources related to the elimination of poverty;
7.2.2.
The organization of a range of services so that these services may have a measurable and potentially
major impact on the causes of poverty and help families and individuals become self-sufficient;
7.2.3.
The greater use of innovative and effective community-based approaches to attacking the causes of
poverty and of community breakdown;
7.2.4.
The maximum participation of the poor to empower them to respond to the unique problems and
needs within their communities; and
7.2.5.
The broadening of the resource base of programs directed to the elimination of poverty.
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7.3.
Funding Requirements
7.3.1.
Community Services are funded by the Community Services Block Grant (CSBG).
7.3.2.
CSBG funds must be used to further one or more of the three national goals of Community Action:
7.3.2.1.
Individuals and families with low incomes are stable and achieve economic security;
7.3.2.2.
Communities where people with low incomes live are healthy and offer economic
opportunity;
7.3.2.3.
People with low incomes are engaged and active in building opportunities in communities.
7.3.3.
Specific allowable activities are as follows:
7.3.3.1.
Individual and family stabilization. Stabilization consists of activities which provide
resources to compensate for Clients’ gaps in Self-Sufficiency. Examples include but are
not limited to financial assistance activities and the operation of a food bank.
7.3.3.2.
Individual and family empowerment. Empowerment consists of activities which promote
the attainment of Economic and/or Personal Self-Sufficiency by individuals and families.
Examples include but are not limited to asset-building and mentoring programs.
7.3.3.3.
Community strengthening. Community strengthening consists of activities which improve
the health of or create economic opportunities in communities where people with low
incomes live. Examples include but are not limited to establishing mental health resources
and developing affordable housing units.
7.3.3.4.
Community engagement. Community engagement consists of activities which engage
individuals and/or organizations in working toward one or more of the three national goals
of Community Action. Examples include but are not limited to advocacy, fundraising, and
volunteer recruitment.
7.3.3.5.
Other. With the prior written approval of the ADES, CSBG funding may be used for activities
not described above but which further one or more of the three national goals of Community
Action.
7.4.
Service Requirements
The Contractor Shall:
7.4.1.
Unless exempted by the ADES, maintain (and produce on request) documentation of compliance
with the CSBG Organizational Standards promulgated by the federal Office of Community Services
in Information Memorandum 138.
7.4.2.
Comply with all requirements of Public Law 105-285, including but not limited to the following:
7.4.2.1.
Contractor shall directly or indirectly provide, on an emergency basis, for the provision of
such supplies and services, nutritious foods, and related services, as may be necessary to
counteract conditions of starvation and malnutrition among low-income individuals. Cf. P.L.
105-285 §676(b)(4)
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7.4.2.2.
CSBG funds may not be used for the purchase or improvement of land, or the purchase,
construction, or permanent improvement (other than low-cost residential weatherization or
other energy-related home repairs) of any building or other facility. Cf. P.L. 105-285
§678(F)(a)
7.4.2.3.
Programs funded by CSBG may not be carried out in a manner involving the use of
program funds, the provision of services, or the employment or assignment of personnel in
a manner supporting or resulting in the identification of such programs with any partisan or
nonpartisan political activity or any political activity associated with a candidate, or
contending faction or group, in an election for public or party office; any activity to provide
voters or prospective voters with transportation to the polls or similar assistance with any
such election; or any voter registration activity. Cf. P.L. 105-285 §678(F)(b)(2)
7.4.2.4.
No person may, on the basis of race, color, national origin or sex be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under, any
program or activity funded in whole or in part with CSBG. Any prohibition against
distribution on the basis of age under the Age Discrimination Act of 1975 or with respect to
an otherwise qualified individual with a disability as provided in Section 504 of the
Rehabilitation Act of 1973 shall also apply to any such program or activity. Cf. P.L. 105-
285 §678(F)(c)
7.4.2.5.
Custodial parents in single-parent families that participate in programs, activities, or
services funded by CSBG must be informed of the availability of child support services,
and eligible parents must be referred to the child support offices of State and local
governments. Cf. P.L. 105-285 §678G(b)
7.5.
Tripartite Board Requirements
The Contractor shall:
7.5.1.
Maintain a Tripartite Governing (for private CAAs) or Advisory (for public CAAs) Board that is
structured as follows:
7.5.1.1.
One-third of members are elected public officials currently holding office or such officials’
representatives.
7.5.1.1.1.
If a current elected official (or the representative of one) cannot be identified
to fill a vacancy on this sector of the board within the timeframe specified
Scope of Work Section 7.5.6, a current appointive official (or the
representative of one) may serve instead.
7.5.1.2.
At least one-third of members are low-income representatives, i.e. individuals who are (or
have previously been) low-income, reside in the service area that they represent, and have
been democratically selected by other low-income representatives residing in the same
service area.
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7.5.1.2.1.
If an individual who is (or has previously been) low-income cannot be
identified to fill a vacancy on this sector of the board within the timeframe
specified Scope of Work Section 7.5.6, a non-low-income individual may
serve instead provided that he or she meets the other requirements of Scope
of Work Section 7.5.1.2 and that the Contractor immediately notifies the
Department of the special circumstance.
7.5.1.3.
The remaining members are representatives of major groups and interests in the
community, for example businesses, social service providers, religious organizations, law
enforcement, and educational institutions.
7.5.2.
To the maximum feasible extent, structure the logistics of board meetings so as to enable participation
by low-income individuals despite such challenges as scheduling or transportation.
7.5.3.
Establish and follow written Board procedures and/or bylaws that include at minimum:
7.5.3.1.
A specification of the tripartite structure of the Board
7.5.3.2.
The democratic selection process utilized for low-income representatives
7.5.3.3.
The process by which an individual or organization that considers its organization and/or
low-income individuals to be inadequately represented on the Board may petition for
adequate representation on the Board
7.5.4.
Maintain records of Board membership, bylaws, and meeting minutes.
7.5.5.
Conduct Board meetings at least once per quarter.
7.5.5.1.
For public and quasi-governmental CAAs, meetings must conform to Arizona open meeting
laws.
7.5.6.
Fill Board vacancies as soon as possible and within no more than 240 days of the vacancy occurring.
7.5.7.
Immediately notify the ADES of any Board vacancies that are not filled within 90 days of the vacancy
occurring.
7.6.
Results Oriented Management and Accountability (ROMA) Requirements
The Contractor Shall:
7.6.1.
Implement practices for continuous organizational growth and improvement in accordance with the
ROMA cycle of Assess-Plan-Implement-Achieve-Evaluate. This includes, at a minimum, the
following:
7.6.1.1.
Assess
7.6.1.1.1.
Once every three years, complete a Community Needs Assessment which
contains key findings on the causes and conditions of poverty in the
community(ies) served.
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7.6.1.2.
Plan
7.6.1.2.1.
Once every five years, complete a Strategic Plan which contains goals and
strategies for addressing needs identified in the Community Needs
Assessment
7.6.1.2.2.
Annually, complete a Community Action Program Plan using the ADES
provided template which identifies specific strategies to be implemented that
year toward meeting the goals in the Strategic Plan.
7.6.1.3.
Implement
7.6.1.3.1.
Take action based on the Strategic Plan and Community Action Program
Plan; at least once per year, present updates to the Board on the progress
of each
7.6.1.3.2.
Ensure that adequate systems, electronic or otherwise, are in place to allow
for accurate collection of outcomes data.
7.6.1.4.
Achieve
7.6.1.4.1.
Measure and report results accurately in the ADES provided format.
7.6.1.5.
Evaluate
7.6.1.5.1.
Analyze results and outcomes data to identify successful and unsuccessful
strategies.
7.6.1.5.2.
At least once per year, make recommendations to the Board regarding
action to be taken based on the analysis conducted.
7.7.
Community Services Reporting Requirements
The Contractor shall:
7.7.1.
Submit the following items and all correspondence to the assigned Contract Specialist or as directed
by ADES:
7.7.1.1.
Annual Community Action Program Plan, due July 15 of each year, as may be amended.
7.7.1.2.
Annual CSBG Report, due each August 31, as may be amended.
7.7.1.3.
Schedule of planned Board meetings for the next twelve months, due July 15 of each year.
7.7.1.4.
Annual Organizational Chart, due July 15 of each year.
7.7.1.5.
Current Agency Operations Chart due July 15 of each year.
7.7.1.6.
Copy of complete minutes from Tripartite/Advisory Board meetings within 30 days of Board
approval of minutes.
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8.
CASE MANAGEMENT
8.1.
Arizona Taxonomy Definition: Case Management: A service or process that establishes a relationship with an
individual or family in order to enhance their functioning and/or integration into the community. Appropriate
services and/or benefits are identified, planned, obtained, provided, recorded, monitored, modified when
necessary and/or terminated. This may include assessment to determine their needs and eligibility when
applying for/receiving services, assistance in finding necessary resources in addition to covered services to
meet basic needs, assistance in obtaining entitlements, communication and coordination of care as well as
follow-up of crisis contacts or missed appointments.
8.2.
Service Description:
8.2.1.
Case Management: (provided in every county in Arizona) – This service provides assistance to low-
income families and individuals by providing case management services that are intended to assist
the household in resolving crisis situations and move closer to Self-sufficiency. Components of this
service include Short Term Crisis Services, Utility Assistance Services, and any other program or
service the Contractor deems necessary and appropriate, according to local community needs and
priorities.
8.2.2.
Components of Case Management include:
8.2.2.1.
Utility Assistance, funded by the Low-Income Home Energy Assistance Program (LIHEAP)
Grant and Neighbors Helping Neighbors (NHN);
8.2.2.2.
Short-Term Crisis Services (STCS), funded by the Temporary Assistance to Needy
Families (TANF) Grant; and
8.2.2.3.
Social Services funded by the Social Services Block Grant (SSBG).
8.2.3.
Service Information Specific to Utility Assistance
8.2.3.1.
Utility Assistance services aid low-income households in paying their energy bills, with
specific emphasis on households with the lowest income and highest energy burden.
8.2.3.2.
Allowable Utility Assistance services are as follows:
8.2.3.2.1.
Utility payments or deposits for heating and cooling
8.2.3.2.2.
Temporary emergency shelter (if needed due to energy-related crisis)
8.2.3.2.3.
Payment of water bills related to cooling (May 1 through October 1)
8.2.3.2.4.
Rental assistance where utility payment is included in the rent
8.2.3.2.5.
“Assurance 16” energy education (LIHEAP only—see LIHEAP Section of the
DAAS Policy and Procedure Manual for specific requirements governing
Assurance 16 activities)
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8.2.3.3.
Contractor may not use other federal funding sources such as CSBG or TANF to cover
administrative costs of providing LIHEAP benefits (cf. 42 U.S.C. § 8624(b)(9)). (See the
LIHEAP section of the DAAS Policy and Procedure Manual for definition of administrative
costs.)
8.2.3.4.
With prior written ADES approval of the Contractor LIHEAP Incentive Plan, Contractor may
issue LIHEAP payments to eligible Clients as an incentive to participate in Case
Management services (“LIHEAP incentives”).
8.2.4.
Service Information Specific to STCS
8.2.4.1.
STCS provides temporary assistance to families with children who have an emergent need
that cannot be met immediately with their own income or other resources.
8.2.4.2.
Allowable services are as follows:
8.2.4.2.1.
Temporary shelter at hotels/motels for homeless persons;
8.2.4.2.2.
Housing assistance for rent or mortgage assistance, move-in, and eviction
prevention;
8.2.4.2.3.
Utility assistance for persons with a current or anticipated interruption of
heating and/or cooling services if the person’s health and safety will be put
in danger;
8.2.4.2.4.
Utility repair and replacement; and
8.2.4.2.5.
Special needs to secure or maintain employment.
8.2.5.
Service Information Specific to Social Services
8.2.5.1.
SSBG funds must be used to further one or more of the following goals for eligible
beneficiaries (cf. 42 U.S.C. §1397):
8.2.5.1.1.
Achieve or maintain economic self-support to prevent, reduce, or eliminate;
8.2.5.1.2.
Achieve or maintain Self-sufficiency, including reduction or prevention of
dependency;
8.2.5.1.3.
Prevent or remedy neglect, abuse, or exploitation of children and adults
unable to protect their own interests or preserve, rehabilitate, or reunite
families;
8.2.5.1.4.
Prevent or reduce inappropriate institutional care by providing for
community-based care, home-based care, or other forms of less intensive
care; and
8.2.5.1.5.
Secure referral or admission for institutional care when other forms of care
are not appropriate or providing services to individuals in institutions.
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8.3.
Service Requirements
The Contractor Shall:
8.3.1.
Utilize intake procedures which are responsive to households in crisis situations.
8.3.2.
Utilize intake procedures which accommodate applicants who, by virtue of a disability, cannot access
or use Contractor’s facilities.
8.3.3.
Utilize a ADES-approved Application for Services form(s) in determining program eligibility at all
service locations.
8.3.4.
To the greatest extent feasible while still preserving program integrity and compliance, deliver Utility
Assistance and STCS payments quickly and conveniently for Clients.
8.3.4.1.
With prior written approval of the ADES, Contractor may implement service policies and
methodologies which make provision of Utility Assistance and STCS less quick and
convenient but which the Contractor believes will ultimately be of benefit to Clients.
8.3.5.
Maintain ability to transmit payment to any energy vendor on behalf of an eligible Client.
8.3.6.
Develop consistent internal procedures for making payments to utility companies.
8.3.7.
Maintain documentation that appropriate case management staff has received training on the
requirements of ARS §46-140.01 and ARS §1-501 and 1-502 regarding eligibility for State and local
benefits (this does not apply to tribal entities).
8.4.
Case Management Reporting Requirements
The Contractor shall:
8.4.1.
Submit the following items and all correspondence to the assigned Contract Specialist or as directed
by ADES:
8.4.1.1.
Monthly CAPS Report by the 25th day following the end of the reporting period.
9.
GENERAL TRANSPORTATION
9.1.
Arizona Taxonomy Definition: General Transportation: This service provides or assists in obtaining various
types of transportation for specific needs.
9.2.
Service Description: General Transportation: This service may include various types of transportation for
employment, medical, training, or other supportive services, with the exception of ambulance services. Service
to assist Clients and households with mobility needs for various purposes such as employment, medical and/or
training reasons when they do not have any other means of transportation is also included.
9.3.
Funding Requirements
9.3.1.
Funding: General Transportation is funded by the Social Services Block Grant (SSBG).
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9.4.
Service Information
9.4.1.
The goal of this service is to provide or arrange for transportation for Clients of all ages and abilities
in order to access services or obtain medical care or employment, (e.g., medical appointments or
employment-related training interviews). Case managers typically assist Clients to access
transportation to help increase or maintain Client Self-sufficiency.
9.4.2.
In addition to providing transportation for individual Clients, SSBG funds may be used to develop
transportation programs or infrastructure in communities with unmet transportation needs.
9.4.3.
Use of SSBG funds must adhere to the goals and any requirements specified in the most recent
Arizona SSBG State Plan.
9.5.
Service Requirements
The Contractor shall:
9.5.1.
Contractors that transport Clients shall:
9.5.1.1.
Maintain valid license plates on vehicles used to transport Clients.
9.5.1.2.
Utilize vehicles that meet current federal, state and local safety and maintenance,
standards, including vehicles for individuals with special needs, where applicable.
9.5.1.3.
Keep maintenance logs on all vehicles used for the transportation of Clients.
9.5.1.4.
Utilize paid and/or volunteer drivers that:
9.5.1.4.1.
Have no history of felony convictions;
9.5.1.4.2.
Possess a valid State of Arizona Class D Operators Driver’s License for
vehicles up to fifteen (15) passengers;
9.5.1.4.3.
Possess a valid State of Arizona Class B Commercial Driver’s License with
a passenger endorsement for vehicles over fifteen passengers, such as a
bus;
9.5.1.4.4.
Have a clean driving record with no suspensions within the past year;
9.5.1.4.5.
Are at least eighteen years of age; and
9.5.1.4.6.
Pass a physical prior to providing transportation service to Clients and pass
a physical at least every two years.
9.5.1.5.
Require volunteers who provide transportation to carry a Contractor/Company
Identification Card.
9.5.1.6.
Assist Clients in entering and exiting the vehicle as needed.
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9.5.1.7.
Transport Clients to scheduled appointments on time and safely.
9.5.1.8.
Utilize vehicles that have seat belts for every occupant.
9.5.1.9.
Require drivers to verify all occupants utilize seatbelts during transport.
9.5.1.10. Track the beginning and ending odometer readings of Contractors’ vehicles on days when
used to transport Clients and identify the Clients/households served on each date.
9.5.2.
Contractors that arrange transportation for Clients shall:
9.5.2.1.
Make arrangements for Client transportation through public or private providers.
9.5.2.2.
Make transportation arrangements for Clients to arrive at scheduled appointments on time
and safely.
9.5.3.
Contractors that develop transportation programs or infrastructure shall:
9.5.3.1.
Conduct a needs assessment to verify the nature of the targeted community’s unmet
transportation need.
9.5.3.2.
Collaborate with regional transportation stakeholders to maximize collective impact.
9.6.
General Transportation Reporting Requirements
The Contractor shall:
9.6.1.
Submit the following item and all correspondence to the assigned Contract Specialist or as directed
by ADES:
9.6.1.1.
Monthly Transportation Report by the 25th day following the reporting month to include at
a minimum: the number of Clients served, the number of one-way trips (e.g., from Client’s
home to Client’s work), total number of miles driven to transport Clients, and results of any
Client satisfaction research.
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Description:
Community Action Services Program
Intergovernmental Agreement
Page 17 of 50
Special Terms and Conditions
1.
Definition of Terms
In addition to the Uniform Terms and Conditions, Section 1, the following shall apply:
1.1
“Award Date” The date the Contract is executed by the Department. This may or may not be the same
date as the “Effective Date” which is the date specified on the Offer and Award or Signature Page.
1.2
“Client Specific Referral” Services or activities for which a referral has been made for a client by an
authorized representative of the Department.
1.3
“Department” The Arizona Department of Economic Security (ADES), unless otherwise indicated.
1.4
“Effective Date” The date the Contractor is to start delivering services. The Effective Date is specified on
the Offer and Award or Signature Page.
1.5
“Equipment” All vehicles, furniture, machinery, electronic data processing (EDP) equipment, software and
all other equipment costing $5,000.00 or more, including all normal and necessary expenses incurred to
make the equipment ready for its intended use (e.g., taxes, freight, installation, assembly and testing
charges, etc.), and with a useful life of greater than one (1) year. Equipment as used herein does not
include real property (e.g., land, building, structures, or facilities’ improvements).
1.6
“May” Indicates something that is not mandatory but permissible.
1.7
“Purchase Order” also known as “Purchase Authorization” or “Release Order” is an authorized document
to procure goods or services.
1.8
“Shall, Must” Indicates a mandatory requirement. Failure to meet these mandatory requirements may result
in the rejection of a proposal as non-responsive.
1.9
“Should” Indicates something that is recommended but not mandatory. If the Contractor fails to provide
recommended information, the State may, at its sole option, ask the Contractor to provide the information.
1.10
“Vulnerable adult” An individual who is eighteen (18) years of age or older who is unable to protect himself
from abuse, neglect or exploitation by others because of a physical or mental impairment. Vulnerable adult
includes an incapacitated person as defined in A.R.S. §14-5101.
2.
Advertising, Publishing and Promotion of Contract
In addition to the Uniform Terms and Conditions, Section 3.6, the following shall apply:
2.1
The Contractor shall provide to the Department for review and approval all reports or publications (written,
visual or sound) which are funded or partially funded under this Contract, a minimum of fifteen (15) calendar
days prior to public release. All reports and publications whether written, visual or verbal shall contain the
following statement:
2.1.1
“This program was funded through a contract with the Arizona Department of Economic Security.
Points of view are those of the author and do not necessarily represent the official position or
policies of the Department.”
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Intergovernmental Agreement
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3.
Assignment
In addition to the Uniform Terms and Conditions, Section 5.3, the following shall apply:
3.1
Merger, Reorganization or Change of Ownership
3.1.1
A proposed merger, reorganization or change in ownership of the Contractor shall require prior
written approval of the Department and may require an assignment of the Contract documented by
a Contract Amendment. The Department may terminate this Contract pursuant to the Termination
clauses of the Contract, if the Contractor does not obtain prior written approval or the Department
determines that the change in ownership is not in the best interest of the State.
3.1.2
This Contract is voidable and subject to immediate cancellation by the Department upon the
Contractor becoming insolvent or filing proceedings in bankruptcy or reorganization under the
United States Code or assigning any right(s) or obligations under this Contract without the prior
written consent of the Department.
3.1.3
The Contractor shall submit a detailed merger, reorganization and/or transition of ownership plan
to the Department, for review at least sixty (60) days prior to the effective date of the proposed
change.
4.
Audit
In addition to the Uniform Terms and Conditions, Section 3.3, the following shall apply:
4.1
In compliance with the Federal Single Audit Act (31 U.S.C. § 7501-7506 as may be amended), Contractors
designated as sub-recipients shall comply with the Uniform Administrative Requirements, Cost Principles,
and Audit Requirements for Federal Awards as prescribed in 2 C.F.R. § 200.
4.2
Audits of non-profit corporations receiving Federal or State monies are required pursuant to Federal or
State law and shall be conducted as provided in 31 U.S.C. § 7501-7506, and A.R.S. § 35-181.03, as may
be amended, and any other applicable statutes, rules, regulations, and standards.
4.3
In accordance with A.R.S. § 35-214, the Contractor shall retain and shall contractually require each
subcontractor to retain all data, books and other records (“records”) relating to this Contract for a period of
five (5) years after completion of the Contract, except if subject to Health Insurance Portability &
Accountability Act which is six (6) years. All records shall be subject to inspection and audit by the State at
reasonable times. Upon request, the Contractor shall produce the original of any or all such records.
5.
Authorization for Services
5.1
Authorization for performance of services under this Contract shall be made only upon a duly approved
Itemized Service Budget and the Itemized Service Budget will indicate the Contract number and the dollar
amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount
on the approved Itemized Service Budget. The Department shall not have any legal obligation to pay for
services in excess of the amount indicated on the Itemized Service Budget.
5.2
No further obligation for payment shall exist on behalf of the Department unless change or modification has
been made in accordance with Section 5.1 above.
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Intergovernmental Agreement
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6.
Background Checks for Employment through the Central Registry
If providing direct services to children or vulnerable adults, the following shall apply:
6.1
The provisions of A.R.S. § 8-804 (as may be amended) are hereby incorporated in their entirety as
provisions of this Contract.
6.2
The Department will conduct Central Registry Background Checks and will use the information contained
in the Central Registry as a factor to determine qualifications for positions that provide direct service to
children or vulnerable adults for:
6.2.1
Any person who applies for a contract with this State and that person’s employees;
6.2.2
All employees of a contractor;
6.2.3
A subcontractor of a contractor and the subcontractor’s employees; and
6.2.4
Prospective employees of the contractor or subcontractor at the request of the prospective
employer.
6.3
Volunteers who provide direct services to children or vulnerable adults shall have a Central Registry
Background Check which is to be used as a factor to determine qualifications for volunteer positions.
6.3.1
A person who is disqualified because of a Central Registry Background Check may apply to the
Board of Fingerprinting for a Central Registry exception pursuant to A.R.S. § 41-619.57. A person
who is granted a Central Registry exception pursuant to A.R.S. § 41-619.57 is not entitled to a
contract, employment, licensure, certification or other benefit because the person has been granted
a Central Registry exception.
6.3.2
Before being employed or volunteering in a position that provides direct services to children or
vulnerable adults, persons shall certify on forms that are provided by the Department whether an
allegation of abuse or neglect was made against them and was substantiated. The completed forms
are to be maintained as confidential.
6.4
A person awaiting receipt of the Central Registry Background Check may provide direct services to ADES
clients after completion and submittal of the Direct Service Position certification form if the certification
states:
6.4.1
The person is not currently the subject of an investigation of child abuse or neglect in Arizona or
another state or jurisdiction; and
6.4.2
The person has not been the subject of an investigation of child abuse or neglect in Arizona, or
another state or jurisdiction, which resulted in a substantiated finding.
6.5
If the Central Registry Background Check specifies any disqualifying act and the person does not have a
Central Registry exception, the person shall be prohibited from providing direct services to ADES clients.
6.6
The Contractor shall maintain the Central Registry Background Check results and any related forms or
documents in a confidential file for five (5) years after termination of the Contract.
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Intergovernmental Agreement
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6.7
The Contractor shall require each employee to complete and sign the Direct Service Position form and
retain in a confidential file for five (5) years after termination of the Contract. The Direct Service Position
form can be found at: https://des.az.gov/documents-center
6.7.1
In the Document Center “Filter by Category “Select Aging” and click on “Search”.
6.7.2
Document Number AAA-1344A
7.
Certification of Cost or Pricing Data
By submittal of the offer, the Contractor is certifying that, to the best of the Contractor’s knowledge and belief, any
cost or pricing data submitted is accurate, complete and current as of the date submitted or other mutually agreed
upon date. Furthermore, the price to the State shall be adjusted to exclude any significant amounts by which the
State finds the price was increased because the Contractor-furnished cost or pricing data was inaccurate,
incomplete or not current as of the date of certification. Such adjustment by the State may include overhead, profit
or fees. The certifying of cost or pricing data does not apply when contract rates are set by law or regulation.
8.
Certification Regarding Lobbying
The Contractor agrees by submittal of the Certification Regarding Lobbying form, in compliance with 49 C.F.R. Part
20.
9.
Code of Conduct
The Contractor shall avoid any action that might create or result in the appearance of having:
9.1
Inappropriate use or divulging of information gathered or discovered pursuant to the performance of its
duties under the contract;
9.2
Acted on behalf of the State without appropriate authorization;
9.3
Provided favorable or unfavorable treatment to anyone;
9.4
Made a decision on behalf of the State that exceeded its authority, could result in partiality, or have a
political consequence for the State;
9.5
Misrepresent or otherwise impeded the efficiency, authority, actions, policies, or adversely affect the
confidence of the public or integrity of the State; or
9.6
Loss of impartiality when advising the State.
10.
Competitive Bidding
If the Contractor is authorized to purchase the supplies and equipment itemized in the Contract for utilization in the
delivery of contract services, Contractor shall procure all such supplies and equipment at the lowest practicable
cost and shall purchase all non-expendable items having a useful life of more than one (1) year and an acquisition
cost of $1,000 or more, through generally accepted and reasonable competitive bidding processes. Any
procurement in violation of this provision shall be considered a financial audit exception.
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Community Action Services Program
Intergovernmental Agreement
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11.
Compliance with Applicable Laws
In addition to the Uniform Terms and Conditions, Section 7.6, the following shall apply:
11.1
In accordance with A.R.S. § 36-557 as may be amended (Purchase of community developmental
disabilities services; application; contracts; limitation), as applicable, all recipients of contract services shall
have all of the same specified rights as they would have if enrolled in a service program operated directly
by the State.
11.2
The Contractor shall comply with the requirements related to reporting to a peace officer or child protective
services incidents of crimes against children as specified in A.R.S. §13-3620 as may be amended.
11.3
The Contractor shall comply with P.L. 101-121, Section 319 (31 U.S.C. section 1352) as may be amended,
and 29 C.F.R. Part 93 as may be amended which prohibit the use of federal funds for lobbying and which
state, in part: Except with the express authorization of Congress, the Contractor, its employees or agents,
shall not utilize any federal funds under the terms of this contract to solicit or influence, or to attempt to
solicit or influence, directly or indirectly, any member of Congress regarding pending or prospective
legislation. Indian tribes, tribal organizations and any other Indian organizations are exempt from these
lobbying restrictions with respect to expenditures that are specifically permitted by other federal law.
11.4
The Contractor shall comply with all applicable state and federal statutes and regulations. This shall include
A.R.S. § 23-722.01 as may be amended relating to new hire reporting, A.R.S. § 23-722.02 as may be
amended relating to wage assignment orders to provide child support, and A.R.S. § 25-535 as may be
amended relating to administrative or court-ordered health insurance coverage for children.
11.5
The Contractor shall comply with the Administrative Simplification rules in Title II of the Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-191) and all Federal regulations that are
applicable to the operations of the Contractor by the dates required by the implementing Federal regulations
as well as all subsequent requirements and regulations as published.
12.
Confidentiality
12.1
The Contractor shall observe and abide by all applicable State and federal statutes, rules and regulations
regarding the use or disclosure of information including, but not limited to, information concerning applicants
for and recipients of contract services. To the extent permitted by law, the Contractor shall release
information to the Department and to the Attorney General's Office as required by the terms of this Contract,
by law or upon their request.
12.2
The Contractor shall comply with the requirements of Arizona Address Confidentiality Program, A.R.S. §41-
161 et. seq. The Arizona Department of Economic Security will advise the Contractor as to applicable
policies and procedures the Arizona Department of Economic Security has adopted for such compliance.
13.
Contract Term and Option to Extend
13.1
The term of the resultant Contract shall be effective the date specified on the Signature page and shall
remain in effect for five years or as otherwise specified, unless terminated, cancelled, or extended as
otherwise provided herein.
13.2
The State has no obligation to extend or renew this Contract. However, the State shall have the right, at
its sole option, to renew the Contract in accordance with any extensions the State may receive for
supplemental periods up to a maximum Contract term of five (5) years. In the event that the State exercises
such right, all terms, conditions and provisions of the original Contract shall remain the same and apply
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Intergovernmental Agreement
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during the renewal period with the exception of price. The Contractor shall agree that the price stated in
the original Contract shall apply unless otherwise allowed.
13.3
Any extension or renewal must be made prior to the end of the Contract period specified in this Contract.
13.4
The Contractor shall not provide services prior to Contract term commencing or after the end date of the
Contract. There shall be no billable activity outside of the Contract effective dates.
14.
Cooperation
The Department may undertake or award other contracts for additional work related to the work performed by the
Contractor, and the Contractor shall fully cooperate with such other Contractors and State employees, and carefully
fit its own work to such other Contractors' work. The Contractor shall not commit or permit any act which will interfere
with the performance of work by any other Contractor or by State employees. The Contractor shall cooperate as
the State deems necessary, with the transfer of work, services, case records and files performed or prepared by
the Contractor to other Contractor(s).
15.
Cooperation with the Department’s Investigation
All contractors, providers, vendors and volunteers are to cooperate fully and truthfully with any ADES investigation,
including but not limited to an Investigation by Division or Internal Affairs. Failure to adhere to this policy may result
in ADES taking whatever actions it deems appropriate, from removal of the subject and or witness from working
with ADES clients up to terminating the Contract with ADES.
16.
Data Sharing Agreement
16.1
When determined by the Department that sharing of confidential data will occur with the Contractor, the
Contractor shall complete the ADES Data Sharing Request Agreement and submit the completed
Agreement to the ADES Program Designated Staff prior to any work commencing or data shared. A
separate Data Sharing Request Agreement shall be required between the Contractor and each DES
Program sharing confidential data.
16.2
The Data Sharing Request Agreement is located at: http://des.az.gov/documents-center. In the “Search”
field type “Data Sharing” and click “Apply”. The search will produce the following results:
16.2.1 Document Number J-119-Single (For requests involving a single division or program).
16.2.2 Document Number J-119-Multi (For requests involving multiple divisions or programs).
17.
Equipment
17.1
If the Contractor is authorized to purchase Equipment, it shall be itemized in the Contract for utilization in
the delivery of contract services. If Equipment is purchased as authorized by this Contract, the Contractor
shall maintain complete and up-to-date inventory records for all Equipment purchased hereunder.
Equipment specifically designated within this Contract, to be purchased in whole or part with the
Department funds, shall be reported in accordance with Department inventory policies and procedures. The
Contractor shall report Equipment purchased with contract funds to the Department within thirty (30) days
of purchase, perform an annual inventory of all Equipment purchased with Department funds and submit
the Equipment inventory form to the Department person designated to receive notices.
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Description:
Community Action Services Program
Intergovernmental Agreement
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17.2
The Department shall retain an equitable interest equal to the purchase price paid, or a fair estimate or
appraisal of current market value, whichever is greater, in all Equipment purchased under this Contract.
The Department shall be included as a co-insured on any insurance policy which covers Equipment
purchased under this Contract.
17.3
The Contractor shall not dispose of any Equipment purchased under this Contract without the prior written
consent of the Department during and after the Contract term. Such consent, if given, may include direction
as to the means of disposition and the utilization of proceeds, including any necessary adjustments to the
Contract.
17.4
Upon termination of this Contract, any Equipment purchased under this Contract shall be disposed of as
directed by the Department and, if sold, the Department shall be compensated in the amount of its equitable
interest.
17.5
Under a fixed price contract, Section 17.1 through 17.4 do not apply unless specifically required by federal
or state law.
18.
Evaluation
18.1
The Department may evaluate, and the Contractor shall cooperate in the evaluation of, contract services.
Evaluation may assess the quality and impact of contract services, either in isolation or in comparison with
other similar services and assess the Contractor's progress and/or success in achieving the goals,
objectives and deliverables set forth in this Contract.
18.2
As requested by the Department, the Contractor shall participate in third party evaluations relative to
Contract impact in support of Department goals.
19.
E-Verify
In addition to the Uniform Terms and Conditions, Section 3.10, the following shall apply:
19.1
The Contractor warrants compliance with all Federal immigration laws and regulations relating to
employees and warrants its compliance with Section A.R.S. § 23-214, A, as may be amended. (That
subsection reads: “After December 31, 2007, every employer, after hiring an employee, shall verify the
employment eligibility of the employee through the e-verify program.”)
19.2
A breach of a warrant regarding compliance with immigration laws and regulations shall be deemed a
material breach of the Contract and the Contractor may be subject to penalties up to and including
termination of the Contract.
19.3
Failure to comply with a State audit process to randomly verify the employment records of contractors and
subcontractors shall be deemed a material breach of the Contract and the Contractor may be subject to
penalties up to and including termination of the Contract.
19.4
The Department retains the legal right to inspect the papers of any employee who works on the Contract
to ensure that the Contractor or subcontractor is complying with the warranty above.
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Community Action Services Program
Intergovernmental Agreement
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20.
Fair Hearings and Service Recipients' Grievances
20.1
The Contractor shall advise all applicants for and recipients of contract services of their right, at any time
and for any reason, to present to the Contractor and to the Department any grievances arising from the
delivery of contract services, including, but not limited to, ineligibility determination, reduction of services,
suspension or termination of services, or quality of services. The Department may assert its jurisdiction to
hear the grievance or refer the matter to the appropriate authority.
20.2
The Contractor, whenever authorized by law, shall maintain a formal system acceptable to and approved
by the Department for reviewing and adjudicating grievances by service recipients or subcontractors arising
from this Contract.
21.
Federal Immigration and Nationality Act
In addition to the Uniform Terms and Conditions, Section 3.9, the following shall apply:
21.1
By entering into the Contract, the Contractor warrants compliance with the Federal Immigration and
Nationality Act (FINA) and all other Federal immigration laws and regulations related to the immigration
status of its employees. The Contractor shall obtain statements from its subcontractors certifying
compliance and shall furnish the statements to the Procurement Officer upon request. These warranties
shall remain in effect through the term of the Contract. The Contractor and its subcontractors shall also
maintain Employment Eligibility Verification forms (I-9) as required by the U.S. Department of Labor's
Immigration and Control Act, for all employees performing work under the Contract. I-9 forms are available
for download at USCIS.GOV.
21.2
The State may request verification of compliance for any Contractor or subcontractor performing work under
the Contract.
22.
Fees and Program Income
Unless specifically authorized in the Contract, the Contractor shall impose no fees or charges of any kind upon
recipients for contract services.
23.
Fingerprinting
23.1
Contractor shall comply with, and shall ensure that all of Contractor’s employees, independent contractors,
subcontractors, volunteers and other agents comply with, all applicable (current and future) legal
requirements relating to fingerprinting, fingerprint clearance cards, verification of fingerprint clearance
cards, certifications regarding pending or past criminal matters, and criminal records checks that relate to
contract performance.
23.2
Applicable legal requirements relating to fingerprinting, certification, and criminal background checks may
include, but are not limited, to the following: A.R.S. §§ 36-594.01, 36-3008, 41-1964, and 46-141. All
applicable legal requirements relating to fingerprinting, fingerprint clearance cards, certifications regarding
pending or past criminal matters, and criminal records checks are hereby incorporated in their entirety as
provisions of this Contract. The Contractor is responsible for knowing which legal requirements relating to
fingerprinting, fingerprint clearance cards, certifications regarding pending or past criminal matters, and
criminal records checks relate to contract performance.
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Agreement No.: DI20-002264
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Intergovernmental Agreement
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23.3
To the extent A.R.S. § 46-141 is applicable to contract performance or the services provided under this
Contract, the following provisions apply:
23.3.1 Personnel who are employed by the Contractor, whether paid or not, and who are required or
allowed to provide services directly to juveniles or vulnerable adults shall have a valid fingerprint
clearance card or shall apply for a fingerprint clearance card within seven (7) working days of
employment.
23.3.2 Except as provided in A.R.S. § 46-141, this Contract may be cancelled or terminated immediately
if a person employed by the Contractor and who has contact with juveniles certifies pursuant to the
provisions of A.R.S. § 46-141 (as may be amended) that the person is awaiting trial or has been
convicted of any of the offenses listed therein in this State, or of acts committed in another state
that would be offenses in this State, or if the person does not possess or is denied issuance of a
valid fingerprint clearance card.
23.4
Federally recognized Indian tribes may submit and the Department of Economic Security shall accept
certifications that state that no personnel who are employed or who will be employed during the Contract
term have been convicted of, have admitted committing or are awaiting trial on any offense as described in
A.R.S. § 46-321 (as may be amended).
24.
Health Insurance Portability and Accountability Act of 1996
24.1
The Contractor warrants that it is familiar with the requirements of HIPAA, as amended by the Health
Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 and accompanying
regulations and will comply with all applicable HIPAA requirements in the course of this Contract. Contractor
warrants that it will cooperate with the State in the course of performance of the Contract so that both the
State and Contractor will be in compliance with HIPAA, including cooperation and coordination with the
offices of the Department’s Chief Information Security Officer and Chief Privacy Officer, and other
compliance officials required by HIPAA and its regulations. Contractor will sign the Department’s Business
Associate Agreement.
24.2
The Contractor agrees to sign the Department’s Business Associates Agreement and to abide by the
statements addressing the creation, use and disclosure of confidential information, including information
designated as protected health information and all other confidential or sensitive information as defined in
policy. In addition, if requested, Contractor agrees to either:
24.2.1 Complete the Department’s HIPAA training that is intended to make the Contractor proficient in
HIPAA for purposes of performing the services required, or
24.2.2 Provide the Department with materials that will be utilized for its own training. The Department
reserves the right to review the independent training materials and either approve or reject. If the
training materials are rejected, the Contractor shall complete the Department’s HIPAA training.
25.
Inclusive Contractor
Contractor is encouraged to make every effort to utilize subcontractors that are small, women-owned and/or minority
owned business enterprises. This could include subcontractors for a percentage of the administrative or direct
service being proposed. Contractor who is committing a portion of its work to such subcontractors shall do so by
identifying the type of service and work to be performed by providing detail concerning the Contractor’s utilization
Special Terms and Conditions
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 26 of 50
of small, women-owned and/or minority business enterprises. Emphasis should be placed on specific areas that
are subcontracted and percentage of contract.
26.
Indemnification and Insurance
26.1
Indemnification Clause
Each party (as "Indemnitor") agrees to defend, indemnify, and hold harmless the other party (as
"Indemnitee") from and against any and all claims, losses, liability, costs, or expenses (including reasonable
attorney's fees) (hereinafter collectively referred to as "Claims") arising out of bodily injury of any person
(including death) or property damage, but only to the extent that such Claims which result in
vicarious/derivative liability to the Indemnitee are caused by the act, omission, negligence, misconduct, or
other fault of the Indemnitor, its officers, officials, agents, employees, or volunteers. The State of Arizona,
Department of Economic Security is self-insured per A.R.S. 41-621.
In addition, should Maricopa County Administered by Human Resources Department utilize a contractor(s)
and subcontractor(s) the indemnification clause between Maricopa County Administered by Human
Resources Department and its contractor(s) and subcontractor(s) shall include the following:
To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold harmless the State of
Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and
employees (hereinafter referred to as “Indemnitee”) from and against any and all claims, actions, liabilities,
damages, losses, or expenses (including court costs, attorneys’ fees, and costs of claim processing,
investigation and litigation) (hereinafter referred to as “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 Contractor or any of its owners, officers, directors,
agents, employees or subcontractors. This indemnity includes any claim or amount arising out of, or
recovered under, the Workers’ Compensation Law or arising out of the failure of such Contractor 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 Indemnitee shall, in all instances, except for Claims arising solely from the
negligent or willful acts or omissions of the Indemnitee, be indemnified by Contractor from and against any
and all claims. It is agreed that Contractor will be responsible for primary loss investigation, defense, and
judgment costs where this indemnification is applicable. In consideration of the award of this contract, the
Contractor agrees to waive all rights of subrogation against the State of Arizona, its officers, officials, agents,
and employees for losses arising from the work performed by the Contractor for the State of Arizona.
This indemnity shall not apply if the contractor or sub-contractor(s) is/are an agency, board,
commission or university of the State of Arizona.
26.2
INSURANCE REQUIREMENTS FOR GOVERNMENTAL PARTIES TO AN IGA
26.2.1 None
26.3
INSURANCE REQUIREMENTS FOR ANY CONTRACTORS USED BY A PARTY TO THE INTERGOVERNMENTAL
AGREEMENT
26.3.1 (Note: this applies only to Contractors used by a governmental entity, not to the governmental entity
itself.) The insurance requirements herein are minimum requirements and in no way limit the indemnity
covenants contained in the Intergovernmental agreement. The State of Arizona in no way warrants that
the minimum limits contained herein are sufficient to protect the governmental entity or Contractor from
liabilities that might arise out of the performance of the work under this Contract by the Contractor, his
agents, representatives, employees or subcontractors, and Contractor and the governmental entity are
free to purchase additional insurance.
Special Terms and Conditions
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 27 of 50
26.4
Minimum Scope and Limits of Insurance
Contractor shall provide coverage with limits of liability not less than those stated below.
26.4.1 Commercial General Liability (CGL) – Occurrence Form
Policy shall include bodily injury, property damage 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
26.4.1.1
The policy shall include coverage for Sexual Abuse and Molestation (SAM). This
coverage may be sub-limited to no less than $500,000. The limits may be included
within the General Liability limit or provided by separate endorsement with its own
limits. If you are unable to obtain SAM coverage under your General Liability
because the insurance market will not support it, it should it be included with the
Professional Liability.
26.4.1.2
Contractor must provide the following statement on their Certificate(s) of
Insurance: “Sexual Abuse and Molestation coverage is included” or “Sexual Abuse
and Molestation coverage is not excluded.”
26.4.1.3
The policy shall be endorsed, as required by this written agreement, to include the
State of Arizona, and its departments, agencies, boards, commissions,
universities, officers, officials, agents, and employees as additional insureds with
respect to liability arising out of the activities performed by or on behalf of the
Contractor.
26.4.1.4
Policy shall contain a waiver of subrogation endorsement, as required by this
written agreement, 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 Contractor.
26.4.2 Business Automobile Liability
Bodily Injury and Property Damage for any owned, hired, and/or non- owned automobiles used in
the performance of this Contract.
•
Combined Single Limit (CSL)
$1,000,000
26.4.2.1
Policy shall be endorsed, as required by this written agreement, to include the
State of Arizona, and its departments, agencies, boards, commissions,
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Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 28 of 50
universities, officers, officials, agents, and employees as additional insureds with
respect to liability arising out of the activities performed by, or on behalf of, the
Contractor involving automobiles owned, hired and/or non-owned by the
Contractor.
26.4.2.2
Policy shall contain a waiver of subrogation endorsement as required by this
written agreement 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 Contractor.
26.4.3 Workers’ Compensation and Employers' Liability
•
Workers' Compensation Statutory
•
Employers' Liability
o
Each Accident
$1,000,000
o
Disease – Each Employee
$1,000,000
o
Disease – Policy Limit
$1,000,000
26.4.3.1
Policy shall contain a waiver of subrogation endorsement, as required by this
written agreement, 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 Contractor.
26.4.3.2
This requirement shall not apply to each Contractor or subcontractor that is exempt
under A.R.S. § 23-901, and when such Contractor or subcontractor executes the
appropriate waiver form (Sole Proprietor or Independent Contractor).
26.5
Additional Insurance Requirements
The policies shall include, or be endorsed to include, as required by this written agreement, the following
provisions:
26.5.1 The Contractor's policies, as applicable, shall stipulate that the insurance afforded the Contractor
shall be primary and that any insurance carried by the Department, 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).
26.5.2 Insurance provided by the Contractor shall not limit the Contractor’s liability assumed under the
indemnification provisions of this Contract.
26.6
Notice of Cancellation
Applicable to all insurance policies required within the Insurance Requirements of this Contract,
Contractor’s insurance shall not be permitted to expire, be suspended, be canceled, or be materially
changed for any reason without thirty(30) days prior written notice to the State of Arizona. Within two (2)
business days of receipt, Contractor must provide notice to the State of Arizona if they receive notice of a
policy that has been or will be suspended, canceled, materially changed for any reason, has expired, or will
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Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 29 of 50
be expiring. Such notice shall be sent directly to the Department and shall be mailed, emailed, hand
delivered or sent by facsimile transmission to (State Representative’s Name, Address & Fax Number).
26.7
Acceptability of Insurers
26.7.1 Contractor’s insurance shall be placed with companies licensed in the State of Arizona or 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 Contractor from potential insurer insolvency.
26.7.2 If the Contractor utilizes the Social Service Contractors Indemnity Pool (SSCIP) or other approved
insurance pool for insurance coverage, SSCIP or the other approved insurance pool is exempt for
the A.M. Best’s rating requirements listed in this contract. If the contractor or subcontractor chooses
to use SSCIP or another approved insurance pool as its insurance provider, the
contract/subcontract would be considered in full compliance with the insurance requirements
relating to the A.M. Best rating requirements.
26.8
Verification of Coverage
Contractor shall furnish the State of Arizona with certificates of insurance (valid ACORD form or equivalent
approved by the State of Arizona) evidencing that Contractor has the insurance as required by this Contract.
An authorized representative of the insurer shall sign the certificates.
26.8.1 All such certificates of insurance and policy endorsements must be received by the State before
work commences. The State’s receipt of any certificates of insurance or policy endorsements that
do not comply with this written agreement shall not waive or otherwise affect the requirements of
this agreement.
26.8.2 Each insurance policy required by this Contract must be in effect at, or prior to, commencement of
work under this Contract. Failure to maintain the insurance policies as required by this Contract, or
to provide evidence of renewal, is a material breach of contract.
26.8.3 All certificates required by this Contract shall be sent directly to the Department. The State of
Arizona project/contract number and project 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 Contract at any time.
26.9
Subcontractors
Contractor’s certificate(s) shall include all subcontractors as insureds under its policies or Contractor shall
be responsible for ensuring and/or verifying that all subcontractors have valid and collectable insurance as
evidenced by the certificates of insurance and endorsements for each subcontractor. All coverages for
subcontractors shall be subject to the minimum Insurance Requirements identified above. The Department
reserves the right to require, at any time throughout the life of the Contract, proof from the Contractor that its
subcontractors have the required coverage.
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Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 30 of 50
26.10
Approval and Modifications
The Contracting Agency, in consultation with State Risk, reserves the right to review or make modifications
to the insurance limits, required coverages, or endorsements throughout the life of this contract, as deemed
necessary. Such action will not require a formal Contract amendment but may be made by administrative
action.
26.11
Exceptions
In the event the Contractor or subcontractor(s) is/are a public entity, then the Insurance Requirements shall
not apply. Such public entity shall provide a certificate of self-insurance. If the Contractor or subcontractor(s)
is/are a State of Arizona agency, board, commission, or university, none of the above shall apply.
27.
IT 508 Compliance
Unless specifically authorized in the Contract, any electronic or information technology offered to the State of
Arizona under this Contract shall comply with A.R.S. 41-3531 and 3532 as may be amended and Section 508 of
the Rehabilitation Act of 1973, which requires that employees and members of the public shall have access to and
use of information technology that is comparable to the access and use by employees and members of the public
who are not individuals with disabilities.
28.
Levels of Service
28.1
If the Contractor determines service recipient eligibility, the Contractor shall maintain and regulate the units
or services set forth in this Contract to ensure continuity and availability of services to eligible persons
during the term of this Contract and during any transition to a subsequent contractor.
28.2
The Department makes no guarantee to purchase specific quantities of goods or services, or to refer eligible
persons as may be identified or specified herein. Further, it is understood and agreed that this Contract is
for the sole convenience of the Department and that the Department reserves the right to obtain like goods
or services from other sources when such need is determined necessary by the Department.
28.3
Any administration within the Department may obtain services under this Contract.
28.4
Contract services may be moved or expanded to other site locations within the geographic area awarded
only by a written Contract Amendment.
28.5
The Department makes no guarantee to purchase all of the service units authorized or to provide any
number of referrals. If quantities of units are specified, they are estimates only and the Department may
decrease and/or increase them by providing written notice to the Contractor.
28.6
When the method of compensation for the service is Fixed Price with Price Adjustment, the Contract may
be amended, by mutual agreement, to purchase additional services by increasing the contract itemized
service budget and/or budget summary.
29.
Limited English Proficiency
The Contractor shall ensure that all services provided are culturally relevant and linguistically appropriate to the
population to be served following the ADES Policy, Limited English Proficiency, DES 1-01-34. To ensure
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Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
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compliance, the policy may be obtained at the following location: https://des.az.gov/digital-library/limited-english-
proficiency.
30.
Non-Availability of Funds
In accordance with A.R.S. § 35-154, every payment obligation of the State under the Contract is conditioned upon
the availability of funds appropriated or allocated for payment of such obligation. If funds are not allocated and
available for the continuance of this Contract, this Contract may be terminated by the State at the end of the period
for which funds are available. The Director of the Department shall have the sole and unfettered discretion in
determining the availability of funds. No liability shall accrue to the State in the event this provision is exercised,
and the State shall not be obligated or liable for any future payments or for any damages as a result of termination
under this paragraph.
31.
Non-Discrimination
In addition to the Uniform Terms and Conditions, Section 3.2, the following shall apply:
31.1
Unless exempt under Federal law the Contractor shall comply with Title VII of the Civil Rights Act of 1964
as amended. Contractor shall comply with the Age Discrimination in Employment Act. The Contractor shall
comply with the Rehabilitation Act of 1973, as amended, which prohibits discrimination in the employment
or advancement in employment of qualified persons because of physical or mental handicap. The
Contractor shall comply with the requirements of the Fair Labor Standards Act of 1938, as amended.
31.2
The Contractor shall comply with Title VI of the Civil Rights Act of 1964, which prohibits the denial of benefits
of or participation in contract services on the basis of race, color, or national origin. The Contractor shall
comply with the requirements of Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits
discrimination on the basis of disability in delivering contract services; and with Title II of the Americans
with Disabilities Act, and the Arizona Disability Act, which prohibit discrimination on the basis of physical or
mental disabilities in the provision of contract programs, services and activities.
31.3
If Contractor is an Indian Tribal Government, Contractor shall comply with the Indian Civil Rights Act of
1968. It shall be permissible for an Indian Tribal Contractor to engage in Indian preference in hiring.
31.4
The following shall be included in all publications, forms, flyers, etc. that are distributed to recipients of
contract services:
28.6.1 “Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI and VII) and the Americans with
Disabilities Act of 1990 (ADA) Section 504 of the Rehabilitation Act of 1973 and the Age
Discrimination Act of 1975, (insert Contractor name here) prohibits discrimination in admissions,
programs, services, activities or employment based on race, color, religion, sex, national origin,
age, and disability. The (insert Contractor name here) must make a reasonable accommodation
to allow a person with a disability to take part in a program, service, or activity. Auxiliary aids and
services are available upon request to individuals with disabilities. For example, this means that if
necessary, the (insert Contractor name here) must provide sign language interpreters for people
who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the
(insert Contractor name here) will take any other reasonable action that allows you to take part
in and understand a program or activity, including making reasonable changes to an activity. If you
believe that you will not be able to understand or take part in a program or activity because of your
disability, please let us know of your disability needs in advance if at all possible. To request this
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Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
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document in alternative format or for further information about this policy please contact: (insert
Contractor contact person and phone number here) “Para obtener este documento en otro
formato o obtener información adicional sobre esta política, (insert Contractor contact person
and phone number here).”
32.
Notices
In addition to the Uniform Terms and Conditions, Section 3.5, the following shall apply:
32.1
All notices shall reference the contract number.
32.2
The Contractor shall give written notice to the Department of changes to the following, and a written
amendment to the contract shall not be necessary:
32.2.1 Change of telephone number;
32.2.2 Changes in the name and/or address of the person to whom notices are to be sent;
32.2.3 Changes in contract-related personnel positions of the Contractor which do not affect staffing ratios,
staff qualifications or specific individuals required under this Contract; or
32.3
In a fixed price with price adjustment contract, whenever there is less than a ten percent (10%) increase in
any budget category; any such increase must be offset by an equal value decrease in another budget
category or categories.
33.
Order of Precedence
In addition to the Uniform Terms and Conditions, Section 2.3, the following shall apply:
33.1
In the event of a conflict in the provisions of the Contract, as accepted by the State and as they may be
amended, the following shall prevail in the order set forth below:
33.1.1 ADES Special Terms and Conditions;
33.1.2 Uniform Terms and Conditions;
33.1.3 Scope of Work or Specification;
33.1.4 Attachments that are not included in the Special Terms and Conditions or Uniform Terms and
Conditions;
33.1.5 Exhibits; and
33.1.6 Documents referenced or included in the Contract.
34.
Pandemic Contractual Performance
34.1
The State shall require a written plan that illustrates how the Contractor shall perform up to contractual
standards in the event of a pandemic. The State may require a copy of the plan at any time prior or post
award of a contract. At a minimum, the pandemic performance plan shall include:
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Description:
Community Action Services Program
Intergovernmental Agreement
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34.1.1 Key succession and performance planning if there is a sudden significant decrease in Contractor’s
workforce.
34.1.2 Alternative methods to ensure there are services or products in the supply chain.
34.1.3 An up to date list of company contacts and organizational chart.
34.2
In the event of a pandemic, as declared by the Governor of Arizona, U.S. Government or the World Health
Organization, which makes performance of any term under this Contract impossible or impracticable, the
State shall have the following rights:
34.2.1 After the official declaration of a pandemic, the State may temporally void the Contract(s) in whole
or specific sections if the Contractor cannot perform to the standards agreed upon in the initial
terms.
34.2.2 The State shall not incur any liability if a pandemic is declared and emergency procurements are
authorized by the Director of the Arizona Department of Administration per A.R.S. § 41-2537 as
may be amended of the Arizona Procurement Code.
34.2.3 Once the pandemic is officially declared over and/or the Contractor can demonstrate the ability to
perform, the State, at its sole discretion may reinstate the temporarily voided Contract(s).
35.
Participation In Boycott of Israel
Contractor warrants it is not engaged in a boycott of Israel as defined by A.R.S. § 35-393.01.
36.
Payments
In addition to the Uniform Terms and Conditions, Section 4.1, the following shall apply:
36.1
Payments shall be made according to the type of payment defined as follows:
36.1.1 Fixed Price with Price Adjustment - Reimbursement to the Contractor is in accordance with actual
allowable costs incurred not to exceed the service reimbursement ceiling as stated in the Itemized
Service Budget. The Contractor shall furnish the Department with an accounting of actual costs.
Increases to the service reimbursement ceiling shall be only be made by a Contract Amendment.
36.2
The Department must approve the service reimbursement ceiling. The Contractor shall submit an Itemized
Service Budget reflecting the total amount of the service reimbursement ceiling. The Department will issue
payment based upon actual allowable costs. The Department may negotiate individual budget category,
service code, activity or categories.
36.2.1 Whenever there is less than a ten percent (10%) increase in any budget category, service code, or
activity within a service; any such increase must be offset by an equal value decrease in another
budget category, service code, or activity within a service. A written explanation for the increase
must be submitted to the Department for approval. A new Itemized Service Budget shall not be
required.
36.2.2 Whenever there is a ten percent (10%) or greater increase in any budget category/service
code/activity, any such increase must be offset by an equal value decrease in another budget
category/service code/activity or categories and written justification for the increase must be
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Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
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submitted to the Department for prior approval by the Department. A new Itemized Service Budget
shall be required.
36.2.3 A Contractor shall not exceed ten percent (10%) of the total service reimbursement budget in total
service adjustments within any State fiscal year.
36.3
The Contractor shall report to the Department in the manner prescribed by the "Reporting Requirements"
section of these terms and conditions. Upon receipt of applicable, accurate and complete reports, and
compliance with all requirements, the Department will authorize payment or reimbursement in accordance
with the type of payment indicated by this Contract.
36.4
If the Contractor is in any manner in default in the performance of any obligation under this Contract, or if
audit exceptions are identified, the Department may, at its option and in addition to other available remedies,
either offset the amount or withhold payment up to the amount in dispute or default.
36.5
The Contractor may offer a price reduction adjustment at any time during the term of the Contract. Any
price reduction shall be executed by a contract amendment.
37.
Payment Recoupment
The Contractor shall reimburse the Department upon demand or the Department may deduct from future payments
the following:
37.1
Any amounts received by the Contractor from the Department for contract services which have been
inaccurately reported or are found to be unsubstantiated;
37.2
Any amounts paid by the Contractor to a subcontractor not authorized in writing by the Department;
37.3
Any amount or benefit paid directly or indirectly to an individual or organization not in accordance with the
“Substantial Interest” section of these terms and conditions;
37.4
Any amounts paid by the Department for services which duplicate services covered or reimbursed by other
specific grants, contracts, or payments;
37.5
Any amounts expended for items or purposes determined unallowable by the Department when this
Contract provides for the reimbursement of costs, see the “Unallowable Costs” section of these terms and
conditions;
37.6
Any amounts paid by the Department for which the Contractor’s books, records, and other documents are
not sufficient to clearly substantiate that those amounts were used by the Contractor to perform contract
services;
37.7
Any amounts received by the Contractor from the Department which are identified as a financial audit
exception;
37.8
Any amounts paid or reimbursed in excess of the Contract or service reimbursement ceiling;
37.9
Any amounts paid to the Contractor which are subsequently determined to be defective pursuant to the
“Certification of Cost or Pricing Data” section of these terms and conditions; and
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Description:
Community Action Services Program
Intergovernmental Agreement
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37.10
Any payments made for services rendered before the Contract begin date or after the Contract termination
date.
38.
Personnel
The Contractor's personnel shall satisfy all qualifications, carry out all duties, and work the hours as set forth in this
Contract.
39.
Predecessor and Successor Contracts
The execution or termination of this Contract shall not be considered a waiver by the Department of any rights it
may have for damages suffered through a breach of this or a prior contract with the Contractor.
40.
Professional Standards
The Contractor shall deliver contract services in a humane and respectful manner and in accordance with any and
all applicable professional accreditation standards. Levels of staff qualifications, professionalism, numbers of staff
and individuals identified by name must be maintained as presented in the Contract.
41.
Rate Adjustment
41.1
The Contractor agrees to provide services at the rates as set forth in this Contract. No other costs, rates,
or fees shall be payable to the Contractor. Any requests for rate adjustment(s) shall be submitted in writing
a minimum of forty-five (45) days prior to contract extension and include supportive justification for the
proposed adjustment(s) such as, but not limited to, economic data. Rate adjustment(s) shall only be
considered at time of contract extension. The State will review such request(s) and shall determine whether
an adjustment shall be granted or if an alternative option is in the best interests of the State. Any rate
adjustment, if approved, will be effective and executed via a Contract Amendment.
41.2
Any approved rate adjustment shall be applied to the specific rate(s) in effect prior to the contract extension
period.
41.3
The request shall include the contract number and service description.
41.4
The Contractor shall submit the request for a rate adjustment to:
Procurement Manager
ADES Office of Procurement
1789 West Jefferson, Mail Drop 1222
Phoenix, Arizona, 85007
42.
Records
In addition to the Uniform Terms and Conditions, Section 3.1, the following shall apply:
42.1
Contract service records will be maintained in accordance with this Contract. Records shall, as applicable,
meet the following standards:
42.1.1 Adequately identify the service provided and each service recipient's application for contract and
subcontract activities;
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Intergovernmental Agreement
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42.1.2 Include personnel records which contain applications for employment, job titles and descriptions,
hire and termination dates, a copy of the fingerprint clearance card, wage rates, and effective dates
of personnel actions affecting any of these items;
42.1.3 Include time and attendance records for individual employees to support all salaries and wages
paid;
42.1.4 For Fixed Price with Price Adjustment contracts, include:
42.1.4.1
Records of the source of all receipts and the deposit of all funds received by the
Contractor;
42.1.4.2
Original copies of invoices, statements, sales tickets, billings for services, deposit
slips, etc., and a cash disbursement journal and cancelled checks to reflect all
disbursements applicable to the Contract;
42.1.4.3
A complete general ledger with accounts for the collection of all costs and/or fees
applicable to the Contract; and
42.1.4.4
Copies of lease/rental agreements, mortgages and/or any other agreements which
in any way may affect Contract expenditures.
42.2
Any such records not maintained shall mandate an audit exception in the amount of the inadequately
documented expenditures.
42.2.1 Contractor shall ensure its subcontractor(s), preserve and make available all records for a period
of five (5) years from the date of final payment under this Contract except if subject to Health
Insurance Portability & Accountability Act which is six (6) years from the date of final payment:
42.2.2 If this Contract is completely or partially terminated, the records relating to the work terminated
shall be preserved and made available for a period of five (5) years from the date of any such
termination.
42.2.3 Records which related to disputes, litigation or the settlement of claims arising out of the
performance of this Contract, or costs and expenses of this Contract to which exception has been
taken by the State, shall be retained by the Contractor until such disputes, litigations, claims or
exceptions have been disposed of.
43.
Relationship of Parties
In addition to the Uniform Terms and Conditions, Section 2.4, the following shall apply:
43.1
In the event that the Contractor or its personnel is sued or prosecuted for conduct arising from this Contract,
the Contractor or their personnel will not be represented by the Department of the Attorney General.
43.2
Taxes or Social Security payments will not be withheld from a State payment issued hereunder and the
Contractor shall make arrangements to directly pay such expenses, if any.
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Agreement No.: DI20-002264
Description:
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Intergovernmental Agreement
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44.
Reporting Requirements
44.1
Unless otherwise provided in this Contract, reporting shall adhere to the following schedule: with the
exception of the last month of the Contract term, the Contractor shall submit programmatic and financial
reports to the Department as specified in the Scope of Work no later than the fifteenth (15th) day following
the end of each month during the Contract term. Failure to submit accurate and complete reports by the
fifteenth (15th) day following the end of each month may result, at the option of the Department, in retention
of payment. Failure to provide such report within forty-five (45) days following the end of a month may
result, at the option of the Department, in a forfeiture of such payment.
44.2
Following the end of each contract term, the Contractor shall submit programmatic and financial reports to
the Department in the form set forth in the contract no later than the forty-fifth (45th) day following the end
of each Contract term. The final fiscal report for the Contract term shall include all adjustment to prior
financial reports submitted for the Contract term.
44.3
No later than the forty-fifth (45th) day following the termination or the expiration of this Contract, Contractor
shall submit to the Department a final program and fiscal report. Failure to submit the final program and
fiscal report within the above time period may result, at the option of the Department, in forfeiture of final
payment.
44.4
All report shall reference the contract number and be submitted to the person designated by the
Department.
45.
Responsibility for Payments Indemnification
The Contractor shall be responsible for issuing payment for services performed by the Contractor’s employees,
subcontractors, suppliers, or any other third party incurred in the furtherance of the performance or the arising out
of the Contract and will indemnify and save the Department harmless for all claims whatsoever out of the lawful
demands of such parties. The Contractor shall, at the Department’s request, furnish satisfactory evidence that all
obligations of the nature hereinabove designated have been paid, discharged or waived.
46.
Subcontracts
In addition to the Uniform Terms and Conditions, Section 5.2, the following shall apply:
46.1
The Contractor shall be responsible for any goods and/or services to be provided by the subcontractor and
ensure performance, is in accordance with the requirements of the Contract.
46.2
Prior to adding a subcontractor to the Contract, the Contractor shall submit a formal, written request to the
Procurement Officer. The request shall:
46.2.1 Be on the Contractors company letterhead;
46.2.2 Be signed by an authorized representative of the Contractor; and
46.2.3 Contain the following information:
46.2.3.1
The subcontractor’s name, address, phone number, e-mail and primary point of
contact;
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46.2.3.2
The certifications required of the subcontractor (if any);
46.2.3.3
The subcontractor’s small business status (if applicable);
46.2.3.4
The type of goods and/or services to be provided by the subcontractor;
46.2.3.5
The amount of time or effort (as a percent of total contract performance) that the
subcontractor will perform in relation to total performance of the contract’s
requirements; and
46.2.3.6
A description of the quality assurance measures that the Contractor shall use to
monitor the subcontractor’s performance.
46.2.4 The State reserves the right to request additional information deemed necessary about any
proposed subcontractor. The State reserves the right to approve or disapproved the proposed
subcontractor if in the best interest of the State.
46.3
The Contractor shall provide copies of each contract with a subcontractor relating to the provision of
contract services to the Department within five (5) calendar days of the request.
47.
Substantial Interest Disclosure
47.1
Contractor shall not make any payments, either directly or indirectly, to any person, partnership,
corporation, trust, or any other organization which has a substantial interest in Contractor's organization or
with which Contractor (or one of its directors, officers, owners, trust certificate holders or a relative thereof)
has a substantial interest, unless Contractor has made a full written disclosure of the proposed payments,
including amounts, to the Department.
47.2
Leases or rental agreements or purchase of real property which are covered by Section 48.1 shall be in
writing and accompanied by an independent commercial appraisal of fair market rental, lease, or purchase
value, as appropriate.
47.3
For the purpose of this Section, "relative" shall have the same meaning as in A.R.S. § 38-502 as may be
amended.
48.
Supporting Documents and Information
In addition to any documents, reports or information required by any other section of this Contract, Contractor shall
furnish the Department with any further documents and information deemed necessary by the Department. Upon
receipt of a request for information from ADES, the Contractor shall provide complete and accurate information no
later than fifteen (15) days after the receipt of the request.
49.
Suspension or Debarment
In addition to the Uniform Terms and Conditions, Section 9.3, the Contractor shall submit the Certification Regarding
Debarment, Suspension and Voluntary Exclusion Lower Tier Covered Transactions form.
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50.
Technical Assistance
The Department may, but shall not be obligated to, provide technical assistance to the Contractor in the
administration of contract services, or relating to the terms and conditions, policies and procedures governing this
Contract. Notwithstanding the foregoing, the Contractor shall not be relieved of full responsibility and accountability
for the provision of contract services in accordance with the terms and conditions set forth herein.
51.
Termination for Any Reason
51.1
In the event the Contract is terminated, with or without cause, or expires, the Contractor, whenever
determined appropriate by the Department, shall assist the Department in the transition of services or
eligible persons to other Contractors. Such assistance and coordination shall include, but not be limited to,
the forwarding of program and other records as may be necessary to assure the smoothest possible
transition and continuity of services. The cost of reproducing and forwarding such records and other
materials shall be borne by the Contractor. The Contractor must make provisions for continuing all
management/administrative services until the transition of services or eligible persons is complete and all
other requirements of this Contract are satisfied.
51.2
In the event of termination or suspension of the Contract by the Department, such termination or suspension
shall not affect the obligation of the Contractor to indemnify the Department and the State for any claim by
any other party against the State or Department arising from the Contractor's performance of this Contract
and for which the Contractor would otherwise be liable under this Contract. To the extent such
indemnification is excluded by A.R.S. § 41-621 et seq.as may be amended or an obligation is unauthorized
under A.R.S. § 35-154 as may be amended the provisions of this paragraph shall not apply.
51.3
In the event of early termination for any reason, any funds advanced to the Contractor shall be returned to
the Department within ten (10) days after the date of termination or upon receipt of notice of termination of
the Contract, whichever is earlier.
52.
Termination for Default
In addition to the Uniform Terms and Conditions, Section 9.5, the Department may immediately terminate this
Contract if the Department determines that the health or welfare or safety of service recipients is endangered.
53.
Transfer of Knowledge
The Contractor shall, whenever feasible, share strategies and techniques with Department staff to transfer the skills
and knowledge acquired in the delivery of the contracted service.
54.
Transition of Activities
In the event that a contract is awarded to a new contractor for services similar to those being performed by
Contractor under this Contract, there shall be a transition of services period. During this period, the Contractor under
this Contract shall work closely with the new contractor’s personnel and/or Department staff to ensure a smooth
and complete transfer of duties and responsibilities. The Department’s authorized representative will coordinate all
transition activities. A transition plan will be developed in conjunction with the existing Contractor to assist the new
contractor and/or Department staff to implement the transfer of duties. The Department reserves the right to
determine which projects/service delivery nearing completion will remain with the current Contractor of record.
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55.
Unallowable Costs
The cost principles set forth in the Code of Federal Regulations, 2 C.F.R. § 200, (Issued December 26, 2013),
including later amendments and editions, shall be used to determine the allowability of incurred costs for the
purpose of reimbursing costs under contract provisions that provide for the reimbursement of costs. Costs that are
specifically defined as unallowable therein will not be submitted for reimbursement by the Contractor and may not
be reimbursed with Department funds.
56.
Visitation, Inspection and Copying
Contractor's and/or subcontractor's facilities, services and individuals served, books and records pertaining to the
Contract shall be available for visitation, inspection, monitoring, and copying by the Department and any other
appropriate agent of the State or Federal Government. At the discretion of the Department, visitation, inspection
and copying may be at any time during regular business hours, announced or unannounced. If the Department
deems it to be an emergency situation, it may at any time visit and inspect the Contractor's or subcontractor's
facilities, services and individuals served, as well as inspect and copy their contract-related books and records.
57.
Warranty of Services
The Contractor warrants that all services provided under this Contract shall conform to the requirements stated
herein and any amendments hereto. The Department’s acceptance of services provided by the Contractor shall not
relieve the Contractor from its obligations under this warranty. In addition to its other remedies, the Department
Procurement Officer may, at the Contractor’s expense, require prompt correction of any services failing to meet the
Contractor’s warranty herein. Services corrected by the Contractor shall be subject to all of the provisions of this
Contract in the manner and to the same extent as the services originally furnished.
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Intergovernmental Agreement
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Uniform Terms and Conditions
1.
Definition of Terms
As used in this Solicitation and any resulting Contract, the terms listed below are defined as follows:
1.1.
“Attachment” means any item the Solicitation requires the Offeror to submit as part of the Offer.
1.2.
“Contract” means the combination of the Solicitation, including the Uniform and Special Instructions to Offerors,
the Uniform and Special Terms and Conditions, and the Specifications and Statement or Scope of Work; the
Offer and any Best and Final Offers; and any Solicitation Amendments or Contract Amendments.
1.3.
"Contract Amendment" means a written document signed by the Procurement Officer that is issued for the
purpose of making changes in the Contract.
1.4.
“Contractor” means any person who has a Contract with the State.
1.5.
“Days” means calendar days unless otherwise specified.
1.6.
“Exhibit” means any item labeled as an Exhibit in the Solicitation or placed in the Exhibits section of the
Solicitation.
1.7.
“Gratuity” means a payment, loan, subscription, advance, deposit of money, services, or anything of more than
nominal value, present or promised, unless consideration of substantially equal or greater value is received.
1.8.
“Materials” means all property, including equipment, supplies, printing, insurance and leases of property but
does not include land, a permanent interest in land or real property or leasing space.
1.9.
“Procurement Officer” means the person, or his or her designee, duly authorized by the State to enter into and
administer Contracts and make written determinations with respect to the Contract.
1.10.
“Services” means the furnishing of labor, time or effort by a contractor or subcontractor which does not involve
the delivery of a specific end product other than required reports and performance, but does not include
employment agreements or collective bargaining agreements.
1.11.
“Subcontract” means any Contract, express or implied, between the Contractor and another party or between
a subcontractor and another party delegating or assigning, in whole or in part, the making or furnishing of any
material or any service required for the performance of the Contract.
1.12.
“State” means the State of Arizona and Department or Agency of the State that executes the Contract.
1.13.
“State Fiscal Year” means the period beginning with July 1 and ending June 30.
2.
Contract Interpretation
2.1.
Arizona Law. The Arizona law applies to this Contract including, where applicable, the Uniform Commercial
Code as adopted by the State of Arizona and the Arizona Procurement Code, Arizona Revised Statutes
(A.R.S.) Title 41, Chapter 23, and its implementing rules, Arizona Administrative Code (A.A.C.) Title 2, Chapter
7.
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2.2.
Implied Contract Terms. Each provision of law and any terms required by law to be in this Contract are a part
of this Contract as if fully stated in it.
2.3.
Contract Order of Precedence. In the event of a conflict in the provisions of the Contract, as accepted by the
State and as they may be amended, the following shall prevail in the order set forth below:
2.3.1.
Special Terms and Conditions;
2.3.2.
Uniform Terms and Conditions;
2.3.3.
Statement or Scope of Work;
2.3.4.
Specifications;
2.3.5.
Attachments;
2.3.6.
Exhibits;
2.3.7.
Documents referenced or included in the Solicitation.
2.4.
Relationship of Parties. The Contractor under this Contract is an independent Contractor. Neither party to this
Contract shall be deemed to be the employee or agent of the other party to the Contract.
2.5.
Severability. The provisions of this Contract are severable. Any term or condition deemed illegal or invalid
shall not affect any other term or condition of the Contract.
2.6.
No Parole Evidence. This Contract is intended by the parties as a final and complete expression of their
agreement. No course of prior dealings between the parties and no usage of the trade shall supplement or
explain any terms used in this document and no other understanding either oral or in writing shall be binding.
2.7.
No Waiver. Either party’s failure to insist on strict performance of any term or condition of the Contract shall
not be deemed a waiver of that term or condition even if the party accepting or acquiescing in the
nonconforming performance knows of the nature of the performance and fails to object to it.
3.
Contract Administration and Operation
3.1.
Records. Under A.R.S. § 35-214 and § 35-215, the Contractor shall retain and shall contractually require each
subcontractor to retain all data and other “records” relating to the acquisition and performance of the Contract
for a period of five years after the completion of the Contract. All records shall be subject to inspection and
audit by the State at reasonable times. Upon request, the Contractor shall produce a legible copy of any or all
such records.
3.2.
Non-Discrimination. The Contractor shall comply with State Executive Order No. 2009-09 and all other
applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.
3.3.
Audit. Pursuant to ARS § 35-214, at any time during the term of this Contract and five (5) years thereafter, the
Contractor’s or any subcontractor’s books and records shall be subject to audit by the State and, where
applicable, the Federal Government, to the extent that the books and records relate to the performance of the
Contract or Subcontract.
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Intergovernmental Agreement
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3.4.
Facilities Inspection and Materials Testing. The Contractor agrees to permit access to its facilities,
subcontractor facilities and the Contractor’s processes or services, at reasonable times for inspection of the
facilities or materials covered under this Contract. The State shall also have the right to test, at its own cost,
the materials to be supplied under this Contract. Neither inspection of the Contractor’s facilities nor materials
testing shall constitute final acceptance of the materials or services. If the State determines non-compliance
of the materials, the Contractor shall be responsible for the payment of all costs incurred by the State for testing
and inspection.
3.5.
Notices. Notices to the Contractor required by this Contract shall be made by the State to the person indicated
on the Offer and Acceptance form submitted by the Contractor unless otherwise stated in the Contract. Notices
to the State required by the Contract shall be made by the Contractor to the Solicitation Contact Person
indicated on the Solicitation cover sheet, unless otherwise stated in the Contract. An authorized Procurement
Officer and an authorized Contractor representative may change their respective person to whom notice shall
be given by written notice to the other and an amendment to the Contract shall not be necessary.
3.6.
Advertising, Publishing and Promotion of Contract. The Contractor shall not use, advertise or promote
information for commercial benefit concerning this Contract without the prior written approval of the
Procurement Officer.
3.7.
Property of the State. Any materials, including reports, computer programs and other deliverables, created
under this Contract are the sole property of the State. The Contractor is not entitled to a patent or copyright
on those materials and may not transfer the patent or copyright to anyone else. The Contractor shall not use
or release these materials without the prior written consent of the State.
3.8.
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 contract and any related subcontract (“Intellectual Property”), shall be work made for hire and
the State shall be considered the creator of such Intellectual Property. The agency, department, division,
board or commission of the State of Arizona requesting the issuance of this contract shall own (for and on
behalf of the State) the entire right, title and interest to the Intellectual Property throughout the world.
Contractor shall notify the State, within thirty (30) days, of the creation of any Intellectual Property by it or its
subcontractor(s). Contractor, on behalf of itself and any subcontractor(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 actions 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 contractor or its subcontractor(s) to any
entity not the State without the express written authorization of the agency, department, division, board or
commission of the State of Arizona requesting the issuance of this contract.
3.9.
Federal Immigration and Nationality Act. The contractor shall comply with all federal, state and local
immigration laws and regulations relating to the immigration status of their employees during the term of the
contract. Further, the contractor shall flow down this requirement to all subcontractors utilized during the term
of the contract. The State shall retain the right to perform random audits of contractor and subcontractor
records or to inspect papers of any employee thereof to ensure compliance. Should the State determine that
the contractor and/or any subcontractors be found noncompliant, the State may pursue all remedies allowed
by law, including, but not limited to; suspension of work, termination of the contract for default and suspension
and/or debarment of the contractor.
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Intergovernmental Agreement
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3.10.
E-Verify Requirements. In accordance with A.R.S. § 41-4401, Contractor warrants compliance with all Federal
immigration laws and regulations relating to employees and warrants its compliance with Section A.R.S. § 23-
214, Subsection A.
3.11.
Offshore Performance of Work Prohibited. Any services that are described in the specifications or scope of
work that directly serve the State of Arizona or its clients and involve access to secure or sensitive data or
personal client data shall be performed within the defined territories of the United States. Unless specifically
stated otherwise in the specifications, this paragraph does not apply to indirect or 'overhead' services,
redundant back-up services or services that are incidental to the performance of the contract. This provision
applies to work performed by subcontractors at all tiers.
4.
Costs and Payments
4.1.
Payments. Payments shall comply with the requirements of A.R.S. Titles 35 and 41, Net 30 days. Upon
receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate invoice for
payment from the State within thirty (30) days.
4.2.
Delivery. Unless stated otherwise in the Contract, all prices shall be F.O.B. Destination and shall include all
freight delivery and unloading at the destination.
4.3.
Applicable Taxes.
4.3.1.
Payment of Taxes. The Contractor shall be responsible for paying all applicable taxes.
4.3.2.
State and Local Transaction Privilege Taxes. The State of Arizona is subject to all applicable state
and local transaction privilege taxes. Transaction privilege taxes apply to the sale and are the
responsibility of the seller to remit. Failure to collect such taxes from the buyer does not relieve the
seller from its obligation to remit taxes.
4.3.3.
Tax Indemnification. Contractor and all subcontractors shall pay all Federal, state and local taxes
applicable to its operation and any persons employed by the Contractor. Contractor shall, and
require all subcontractors to hold the State harmless from any responsibility for taxes, damages and
interest, if applicable, contributions required under Federal, and/or state and local laws and
regulations and any other costs including transaction privilege taxes, unemployment compensation
insurance, Social Security and Worker’s Compensation.
4.3.4.
IRS W9 Form. In order to receive payment the Contractor shall have a current I.R.S. W9 Form on
file with the State of Arizona, unless not required by law.
4.4.
Availability of Funds for the Next State fiscal year. Funds may not presently be available for performance
under this Contract beyond the current state fiscal year. No legal liability on the part of the State for any
payment may arise under this Contract beyond the current state fiscal year until funds are made available for
performance of this Contract.
4.5.
Availability of Funds for the current State fiscal year. Should the State Legislature enter back into session and
reduce the appropriations or for any reason and these goods or services are not funded, the State may take
any of the following actions:
4.5.1.
Accept a decrease in price offered by the contractor;
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4.5.2.
Cancel the Contract; or
4.5.3.
Cancel the contract and re-solicit the requirements.
5.
Contract Changes
5.1.
Amendments. This Contract is issued under the authority of the Procurement Officer who signed this Contract.
The Contract may be modified only through a Contract Amendment within the scope of the Contract. Changes
to the Contract, including the addition of work or materials, the revision of payment terms, or the substitution
of work or materials, directed by a person who is not specifically authorized by the procurement officer in
writing or made unilaterally by the Contractor are violations of the Contract and of applicable law. Such
changes, including unauthorized written Contract Amendments shall be void and without effect, and the
Contractor shall not be entitled to any claim under this Contract based on those changes.
5.2.
Subcontracts. The Contractor shall not enter into any Subcontract under this Contract for the performance of
this contract without the advance written approval of the Procurement Officer. The Contractor shall clearly list
any proposed subcontractors and the subcontractor’s proposed responsibilities. The Subcontract shall
incorporate by reference the terms and conditions of this Contract.
5.3.
Assignment and Delegation. The Contractor shall not assign any right nor delegate any duty under this
Contract without the prior written approval of the Procurement Officer. The State shall not unreasonably
withhold approval.
6.
Risk and Liability
6.1.
Risk of Loss: The Contractor shall bear all loss of conforming material covered under this Contract until
received by authorized personnel at the location designated in the purchase order or Contract. Mere receipt
does not constitute final acceptance. The risk of loss for nonconforming materials shall remain with the
Contractor regardless of receipt.
6.2.
Indemnification
6.2.1.
Contractor/Vendor Indemnification (Not Public Agency) The parties to this contract agree that the
State of Arizona, its departments, agencies, boards and commissions shall be indemnified and held
harmless by the contractor for the vicarious liability of the State as a result of entering into this
contract. However, the parties further agree that the State of Arizona, its departments, agencies,
boards and commissions shall be responsible for its own negligence. Each party to this contract is
responsible for its own negligence.
6.2.2.
Public Agency Language Only Each party (as 'indemnitor') agrees to indemnify, defend, and hold
harmless the other party (as 'indemnitee') from and against any and all claims, losses, liability, costs,
or expenses (including reasonable attorney's fees) (hereinafter collectively referred to as 'claims')
arising out of bodily injury of any person (including death) or property damage but only to the extent
that such claims which result in vicarious/derivative liability to the indemnitee, are caused by the act,
omission, negligence, misconduct, or other fault of the indemnitor, its officers, officials, agents,
employees, or volunteers."
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Intergovernmental Agreement
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6.3.
Indemnification - Patent and Copyright. The Contractor 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 Contract performance or use by the State of materials furnished or work performed under this Contract. The
State shall reasonably notify the Contractor of any claim for which it may be liable under this paragraph. If the
contractor is insured pursuant to A.R.S. § 41-621 and § 35-154, this section shall not apply.
6.4.
Force Majeure.
6.4.1.
Except for payment of sums due, neither party shall be liable to the other nor deemed in default
under this Contract if and to the extent that such party’s performance of this Contract is prevented
by reason of force majeure. The term “force majeure” means an occurrence that is beyond the
control of the party affected and occurs without its fault or negligence. Without limiting the foregoing,
force majeure includes acts of God; acts of the public enemy; war; riots; strikes; mobilization; labor
disputes; civil disorders; fire; flood; lockouts; injunctions-intervention-acts; or failures or refusals to
act by government authority; and other similar occurrences beyond the control of the party declaring
force majeure which such party is unable to prevent by exercising reasonable diligence.
6.4.2.
Force Majeure shall not include the following occurrences:
6.4.2.1.
Late delivery of equipment or materials caused by congestion at a manufacturer’s plant
or elsewhere, or an oversold condition of the market;
6.4.2.2.
Late performance by a subcontractor unless the delay arises out of a force majeure
occurrence in accordance with this force majeure term and condition; or
6.4.2.3.
Inability of either the Contractor or any subcontractor to acquire or maintain any
required insurance, bonds, licenses or permits.
6.4.3.
If either party is delayed at any time in the progress of the work by force majeure, the delayed party
shall notify the other party in writing of such delay, as soon as is practicable and no later than the
following working day, of the commencement thereof and shall specify the causes of such delay in
such notice. Such notice shall be delivered or mailed certified-return receipt and shall make a
specific reference to this article, thereby invoking its provisions. The delayed party shall cause such
delay to cease as soon as practicable and shall notify the other party in writing when it has done so.
The time of completion shall be extended by Contract Amendment for a period of time equal to the
time that results or effects of such delay prevent the delayed party from performing in accordance
with this Contract.
6.4.4.
Any delay or failure in performance by either party hereto shall not constitute default hereunder or
give rise to any claim for damages or loss of anticipated profits if, and to the extent that such delay
or failure is caused by force majeure.
6.5.
Third Party Antitrust Violations. The Contractor assigns to the State any claim for overcharges resulting from
antitrust violations to the extent that those violations concern materials or services supplied by third parties to
the Contractor, toward fulfillment of this Contract.
7.
Warranties
7.1.
Liens. The Contractor warrants that the materials supplied under this Contract are free of liens and shall
remain free of liens.
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7.2.
Quality. Unless otherwise modified elsewhere in these terms and conditions, the Contractor warrants that, for
one year after acceptance by the State of the materials, they shall be:
7.2.1.
Of a quality to pass without objection in the trade under the Contract description;
7.2.2.
Fit for the intended purposes for which the materials are used;
7.2.3.
Within the variations permitted by the Contract and are of even kind, quantity, and quality within
each unit and among all units;
7.2.4.
Adequately contained, packaged and marked as the Contract may require; and
7.2.5.
Conform to the written promises or affirmations of fact made by the Contractor.
7.3.
Fitness. The Contractor warrants that any material supplied to the State shall fully conform to all requirements
of the Contract and all representations of the Contractor, and shall be fit for all purposes and uses required by
the Contract.
7.4.
Inspection/Testing. The warranties set forth in subparagraphs 7.1 through 7.3 of this paragraph are not affected
by inspection or testing of or payment for the materials by the State.
7.5.
Compliance With Applicable Laws. The materials and services supplied under this Contract shall comply with
all applicable Federal, state and local laws, and the Contractor shall maintain all applicable license and permit
requirements.
7.6.
Survival of Rights and Obligations after Contract Expiration or Termination.
7.6.1.
Contractor's Representations and Warranties. All representations and warranties made by the
Contractor under this Contract shall survive the expiration or termination hereof. In addition, the
parties hereto acknowledge that pursuant to A.R.S. § 12-510, except as provided in A.R.S. § 12-
529, the State is not subject to or barred by any limitations of actions prescribed in A.R.S., Title 12,
Chapter 5.
7.6.2.
Purchase Orders. The Contractor shall, in accordance with all terms and conditions of the Contract,
fully perform and shall be obligated to comply with all purchase orders received by the Contractor
prior to the expiration or termination hereof, unless otherwise directed in writing by the Procurement
Officer, including, without limitation, all purchase orders received prior to but not fully performed and
satisfied at the expiration or termination of this Contract.
8.
State's Contractual Remedies
8.1.
Right to Assurance. If the State in good faith has reason to believe that the Contractor does not intend to, or
is unable to perform or continue performing under this Contract, the Procurement Officer may demand in
writing that the Contractor give a written assurance of intent to perform. Failure by the Contractor to provide
written assurance within the number of Days specified in the demand may, at the State’s option, be the basis
for terminating the Contract under the Uniform Terms and Conditions or other rights and remedies available
by law or provided by the contract.
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8.2.
Stop Work Order.
8.2.1.
The State may, at any time, by written order to the Contractor, require the Contractor to stop all or
any part, of the work called for by this Contract for period(s) of days indicated by the State after the
order is delivered to the Contractor. The order shall be specifically identified as a stop work order
issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with
its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work
covered by the order during the period of work stoppage.
8.2.2.
If a stop work order issued under this clause is canceled or the period of the order or any extension
expires, the Contractor shall resume work. The Procurement Officer shall make an equitable
adjustment in the delivery schedule or Contract price, or both, and the Contract shall be amended
in writing accordingly.
8.3.
Non-exclusive Remedies. The rights and the remedies of the State under this Contract are not exclusive.
8.4.
Nonconforming Tender. Materials or services supplied under this Contract shall fully comply with the Contract.
The delivery of materials or services or a portion of the materials or services that do not fully comply constitutes
a breach of contract. On delivery of nonconforming materials or services, the State may terminate the Contract
for default under applicable termination clauses in the Contract, exercise any of its rights and remedies under
the Uniform Commercial Code, or pursue any other right or remedy available to it.
8.5.
Right of Offset. The State shall be entitled to offset against any sums due the Contractor, any expenses or
costs incurred by the State, or damages assessed by the State concerning the Contractor’s non-conforming
performance or failure to perform the Contract, including expenses, costs and damages described in the
Uniform Terms and Conditions.
9.
Contract Termination
9.1.
Cancellation for Conflict of Interest. Pursuant to A.R.S. § 38-511, the State may cancel this Contract within
three (3) years after Contract execution without penalty or further obligation if any person significantly involved
in initiating, negotiating, securing, drafting or creating the Contract on behalf of the State is or becomes at any
time while the Contract or an extension of the Contract is in effect an employee of or a consultant to any other
party to this Contract with respect to the subject matter of the Contract. The cancellation shall be effective
when the Contractor receives written notice of the cancellation unless the notice specifies a later time. If the
Contractor is a political subdivision of the State, it may also cancel this Contract as provided in A.R.S. § 38-
511.
9.2.
Gratuities. The State may, by written notice, terminate this Contract, in whole or in part, if the State determines
that employment or a Gratuity was offered or made by the Contractor or a representative of the Contractor to
any officer or employee of the State for the purpose of influencing the outcome of the procurement or securing
the Contract, an amendment to the Contract, or favorable treatment concerning the Contract, including the
making of any determination or decision about contract performance. The State, in addition to any other rights
or remedies, shall be entitled to recover exemplary damages in the amount of three times the value of the
Gratuity offered by the Contractor.
9.3.
Suspension or Debarment. The State may, by written notice to the Contractor, immediately terminate this
Contract if the State determines that the Contractor has been debarred, suspended or otherwise lawfully
prohibited from participating in any public procurement activity, including but not limited to, being disapproved
as a subcontractor of any public procurement unit or other governmental body. Submittal of an offer or
Uniform Terms and Conditions
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 49 of 50
execution of a contract shall attest that the contractor is not currently suspended or debarred. If the contractor
becomes suspended or debarred, the contractor shall immediately notify the State.
9.4.
Termination for Convenience. The State reserves the right to terminate the Contract, in whole or in part at any
time when in the best interest of the State, without penalty or recourse. Upon receipt of the written notice, the
Contractor shall stop all work, as directed in the notice, notify all subcontractors of the effective date of the
termination and minimize all further costs to the State. In the event of termination under this paragraph, all
documents, data and reports prepared by the Contractor under the Contract shall become the property of and
be delivered to the State upon demand. The Contractor shall be entitled to receive just and equitable
compensation for work in progress, work completed and materials accepted before the effective date of the
termination. The cost principles and procedures provided in A.A.C. R2-7-701 shall apply.
9.5.
Termination for Default.
9.5.1.
In addition to the rights reserved in the contract, the State may terminate the Contract in whole or in
part due to the failure of the Contractor to comply with any term or condition of the Contract, to
acquire and maintain all required insurance policies, bonds, licenses and permits, or to make
satisfactory progress in performing the Contract. The Procurement Officer shall provide written
notice of the termination and the reasons for it to the Contractor.
9.5.2.
Upon termination under this paragraph, all goods, materials, documents, data and reports prepared
by the Contractor under the Contract shall become the property of and be delivered to the State on
demand.
9.5.3.
The State may, upon termination of this Contract, procure, on terms and in the manner that it deems
appropriate, materials or services to replace those under this Contract. The Contractor shall be
liable to the State for any excess costs incurred by the State in procuring materials or services in
substitution for those due from the Contractor.
9.6.
Continuation of Performance Through Termination. The Contractor shall continue to perform, in accordance
with the requirements of the Contract, up to the date of termination, as directed in the termination notice.
10. Contract Claims
All contract claims or controversies under this Contract shall be resolved according to A.R.S. Title 41, Chapter 23,
Article 9, and rules adopted thereunder.
11. Arbitration
The parties to this Contract agree to resolve all disputes arising out of or relating to this contract through arbitration,
after exhausting applicable administrative review, to the extent required by A.R.S. § 12-1518, except as may be
required by other applicable statutes (Title 41).
12. Comments Welcome
The State Procurement Office periodically reviews the Uniform Terms and Conditions and welcomes any comments
you may have. Please submit your comments to: State Procurement Administrator, State Procurement Office, 100
North 15th Avenue, Suite 201, Phoenix, Arizona, 85007.
1
Maricopa County Human Services Department
Administrative Methodology – Attachment 2
1. One to two paragraphs describing how culturally relevant and linguistically appropriate
services will be provided and indicate how clients will have ready access to services
considering their diverse languages, cultures and geographic locations.
Maricopa County Human Services Department (MCHSD), Community Services Division (CSD)
requires all contract providers to ensure that services are delivered in a manner that does not
preclude an individual’s ability to apply for services based upon language or cultural barriers.
Contract Terms and conditions require that subcontractors:
o Offers and provide language assistance services, including bilingual staff and interpreter
services at no cost to the program applicant/participant;
o Inform program applicant/participant of their right to receive language assistance
services at no cost;
o Make available easily understood program-related materials and post signage in the
languages of the commonly encountered groups and / or groups represented in the
service area.
Subcontractors are encouraged to recruit, retain and promote and diverse staff and leadership
that are characteristic of the service area, and to maintain current demographic and cultural
profiles of the community. We also encourage our service provides to accurately plan for and
implement services members at all levels receive training in culturally and linguistically
appropriate service delivery, and in cultural sensitivity.
Services are made available throughout the geographic service area using and infrastructure of
service providers in local communities. Rural areas of the county are covered through itinerate
site location and schedules. In the event that transportation is a barrier to accessing program
services or applicants are homebound due to illness or disability. Subcontractors are also
encouraged to conduct outreach activities or community initiative to advertise available services
in geographically remote location, so as to promote program awareness.
2. One or two paragraphs describing the Applicant’s organizational structure, including key staff
members.
The MCHSD is the designated Community Action Agency (CAA) servicing Maricopa County,
exclusive of Phoenix, Mesa and Glendale. The MCHSD is comprised of five distinct program
Divisions to include:
•
Early Education Division
•
Workforce Development Division
2
•
Community Development Division
•
Senior and Adult Services Division
•
Community Services Division
The MCHSD maintains responsibility for all Community Action Programs and administers
services to over 25 local cities and towns through an infrastructure of subcontractors who
operationalize programmatic functions. MCHSD maintains Intergovernmental Agreements
(IGAs) or contracts with variety of governmental agencies or private, non-private, non-profit
community-based organizations, who work to ensure services are provided according to the
unique needs of the local communities.
As an administrative entity, MCHSD provides programs oversight, on-site monitoring, quality
assurance, vendor payments, financial management and training or technical assistance to
subcontractors when necessary or appropriate. MCHSD also acts as a direct service
provider for specific service areas throughout the county and coordinates anti-poverty
efforts with other programs including but not limited to the Eviction Prevention Program,
through partnerships with the Arizona Department of Housing.
Key MCHSD staff members include:
•
The Assistant Director
This position acts as the CAA Director and provides overall administrative and program
direction for Community Services Division. The Assistant Director represents MCHSD at
intergovernmental, interagency community and professional meeting, task forces and
committees, and also provides support to the federal CSBG required tri-partite board,
the advisory Maricopa County Community Services Commission, to ensure compliance
with federal law. This position also establishes, and monitors management systems and
controls for administrative, program and fiscal procedures, set and adjust priorities and
policies, provides technical assistance to key staff members, and interfaces with the
state and other revenue sources on funding and contract compliance.
•
The Community Action Program Manager
This Position provides oversight and daily supervision for staff engaged in the case
management activities for various services and administered by the CSD, including the
Low-Income Home Energy Assistance Program, Short Term Crisis Services Program,
Family Self-Sufficiency Program, and the DOH Eviction Prevention Program. The
position plans, assigns and directs the work of staff engaged in making eligibility
determinations, implements program policies and procedures, manages the CSD
telephone intake process, selects and trains subordinated staff and responds to client
complaints or inquiries from the general public. The position is also responsible for the
design and implementation of data collection tools.
•
The Community Services Commission Liaison
This Position coordinates and supports high level and broad-ranging efforts of the CSD
including the implementation of legislative requirements outlined under the Community
3
Services Block Grant (CSBG) Act for designated CAAs. This includes acting as the
programmatic lead for all strategic planning efforts including Results Oriented
Management and Accountability (ROMA), Community Action Board development and
training, developing and implementing new programs or services which address the
causes of poverty in local communities, and serves as the CSD liaison for Community
Action Program compliance.
•
The Community Services Division Administrative Services Supervisor
This position is responsible for the preparation and management of the CSD Division
budget, in addition to the administration of CSD’s contract compliance efforts. The
position develops and coordinates the release of Request for Proposals, leads the
evaluation process and subsequent contract negotiations. The position also develops
intergovernmental Agreements (IGAs) and manages subcontract awards through
desktop and on-site monitoring efforts.
•
The Eviction Prevention/Special Projects Program Coordinator
This position develops, implements, and coordinates a variety of eviction prevention
programs and other special projects and services. This includes coordinating eviction
prevention and mortgage assistance programs for households at risk of experience
homelessness. In addition, this position manages inter-departmental strategies in
coordinating utility services for the Senior Utility Assistance Program, the Head Start
Utility Assistance Program, and the Categorical Utility Assistance Program for the
Weatherization Program.
2. One or two paragraphs describing how client/recipient confidential information will be
maintained.
MCHSD requires all contract providers to assure that all efforts are made to maintain
appropriate confidentiality in creating, storing, transferring and disposing of client records.
Contract terms and conditions require that subcontractors:
•
Ensure that client records are kept in a secure location such as locked file cabinet or
locked file rooms;
•
Ensure that only authorized persons have access to records;
•
Utilize encrypted email technology when communicating client information;
•
Utilize encrypted passwords, and electronic security levels, authorizing access to
electronic client files and to any database containing confidential client information;
•
Utilize secure FTP site for submitting program reports and client information; and
•
Ensure that case manages obtain written permission from clients to disclose or
transfer records to third parties.
3. One or two paragraphs describing the Applicant’s Information Technology equipment and
capabilities, consistent with the requirements of the Scope of Work.
MCHSD has developed and utilizes HSD Online, a web-based computer application developed
specifically for client demographic and payment tracking. This system allows subcontractors to
4
screen program applications for prior assistance, determine program eligibility, and complete
data entry at the time of applications. This county-wide system eliminates the duplications of
program services and serves as the primary data collection tool used by the Maricopa
Community Action Agency in serving the specific geographic service areas in Maricopa County.
MCHSD administrative offices and subcontractor locations maintain the capability to
communicate electronically through email, convey Microsoft-based text and spreadsheet
documentation, and have access to the internet. The MCHSD, Office of Information Systems, has
backup/recovery systems in place to preserve electronics files and the information needed to
meet all program and funder audit standards or reporting requirements.
MCHSD has implemented an IT Disaster Recovery Plan, and a Continuity of Operations Plan
(COOP). These plans work together to protect technology assets, and to ensure minimal
disruption or degradation of services. MCHSD uses HSD Online and Microsoft Office Software to
track monthly, quarterly and annual reports, and maintains the ability to draw ad-hoc reports
when necessary.
4. One or two paragraphs describing the Applicant’s competitive bidding procedures including
time frames used to select subcontractors.
Maricopa County contracts with cities and towns for the provision of Community Action
Program services for respective communities and service areas, through an Intergovernmental
Agreement (IGA). When the County is unable to enter in an IGA for specific geographic service
areas, the Maricopa County’s Office of Procurement Services (OPS) initiates the release of a
Request for Proposal (RFP), in accordance to Article 3 of the Maricopa County Procurement
Code.
OPS use a web-based government bid notification database, BidSync, for the release and
notification of RFPs. BidSync provides instructions and information to Respondents concerning
proposal submission requirements, including the period that the solicitation will remain open,
time and date set for closing, and any other special information.
Solicitation are typically open for a two-week period. Subsequent proposal evaluations and
contract negotiations are completed within 3-4 weeks. Contract awards are finalized prior to the
effective date of the contract.
5. One or two paragraphs describing the process used to ensure that direct service
subcontractors are in compliance with contractual requirements and CAP policies, including
specifically how and when on-site monitoring will be conducted (if direct services are
subcontracted for all or part of a service(s).
MCHSD uses a variety of methods to ensure subcontractors are in compliance with the
contractual and program requirements to include the following:
•
Contractual require CAP subcontractors to utilize the Maricopa Community Action
Agency Policy & Procedure Manual and provide training to new hires. The Manual
provides detailed guidance and instruction regarding intake procedures, service
description, eligibility criteria, and confidentiality requirements.
5
•
MCHSD holds quarterly meeting with CAP subcontractors to discuss expenditure
patterns, policy/procedure changes, program performance, and information on
available community resources/events.
•
MCHSD provides annual CAP training to subcontractor staff, focusing on
policy/procedure changes, database changes, and common application errors/ finding,
•
MCHSD conducts desktop monitoring for all CAP subcontractors. MCHSD performs a
monthly desktop review of CAP application taken in the most recent month, pulling a
random 10% sample size from each subcontractor. The desktop review includes a
review of applicant’s eligibility information in comparison with fund source and
payment amount. Any findings are communicated immediately to the CAP
subcontractor, including needed action to resolve the finding/discrepancy.
•
MCHSD conducts on-site monitoring once every other year, for each CAP subcontractor.
The on-site monitoring includes the review of documentation supporting the agency’s
administrative, fiscal, and programmatic operations, in addition to the observance of
operations in accordance with contract requirements and pertinent federal, state, and
local laws/ordinances.
6. A monitoring plan for the period beginning July 1, 2020 through June 30, 2025 to include: the
on- site monitoring, scope (administrative, fiscal, and/or programmatic) of monitoring, the
specific service(s) to be monitored, and the target monitoring start and completion dates.
MCHSD conducts on-site monitoring visits for each subcontractor on a biennial basis, once every
other year. The timeframe for the on-site monitoring visit typically takes one day. The
monitoring visit begins with an entrance interview, during which time introductions are made,
the scope of the monitoring visit is shared, and subcontractors are provided the opportunity to
ask questions, if needed. MCHSD staff uses monitoring tools specific to each component of the
on-site monitoring visit
During the on-site monitoring, MCHSD staff conducts the following reviews:
•
Fiscal Management Review
The MCHSD Grants Accountant monitoring subcontractor’s compliance with the
requirements set forth in 2CFR part 200: Financial Management, Internal Controls,
Payment and Financial Reporting, Insurance Coverage, Records Retention,
Compensation-Personal Services & Audit Requirements.
•
Contract Compliance Review
The CSD Administrative Services Supervisor conducts the Contract Compliance Review
to include inspection of the facility where services are delivered along with the review of
policies and procedures related to the agency’s management, personnel, and service
delivery.
•
Program/Case Management File Review
6
The Case Management Review included a sample review of client applications and
corresponding client files
At the conclusion of the review process, an exit interview is conducted with subcontractor staff
to discuss findings/recommendations and highlight subcontractor’s best practices. A written
monitoring report is distributed to the subcontractor within 90 days from the date of the visit.
Any findings, corrective actions, or disallowed expenditures will be noted on the report. If the
subcontractor needs training or technical assistance, MCHSD will provide the needed assistance
in a timely manner to ensure quality of service and contract compliance.
The MCHSD SFY21 & SFY22 on-site monitoring schedule, as follows:
SFY2021 Projected Monitoring Plan
Subcontractor
Community
Service
Area (CSA)
Type
Service
Monitoring Date
*TBD
Southeast
CSA
On-Site
Administrative
Programmatic
Fiscal
September 2020
SCOTTSDALE
Scottsdale
CSA
On-Site
Administrative
Programmatic
Fiscal
October 2020
*TBD
Wickenburg
CSA
On-Site
Administrative
Programmatic
Fiscal
November 2020
SURPRISE
Surprise/ El
Mirage CSA
On-Site
Administrative
Programmatic
Fiscal
January 2021
Avondale
Avondale
CSA
On-Site
Administrative
Programmatic
Fiscal
February 2021
TBD
Northwest
CSA
On-Site
Administrative
Programmatic
Fiscal
March 2021
SFY2022 Projected Monitoring Plan
Subcontractor
Community
Service
Area (CSA)
Type
Service
Monitoring Date
TOLLESON
Central
West CSA
On-Site
Administrative
Programmatic
Fiscal
September 2021
GUADALUPE
Guadalupe
CSA
On-Site
Administrative
Programmatic
Fiscal
October 2021
7
*TBD
Central East
CSA
On-Site
Administrative
Programmatic
Fiscal
November 2021
*TBD
Buckeye
CSA
On-site
Administrative
Programmatic
Fiscal
January 2022
GILA BEND
Gila Bend
CSA
On-Site
Administrative
Programmatic
Fiscal
February 2022
*TBD
North
CSA
On-Site
Administrative
Programmatic
Fiscal
March 2022
*MCHSD is presently procuring service providers for identified geographic service areas
8
Service Methodology – Attachment 3
1.0 Community Service Methodology
1.1 No more than one page describing the procedures used by the Applicant to develop and
maintain a Tripartite Governing Board (for Private, Non-Profit Agencies), or an Advisory
Board (for Public Agencies).
MCHSD is the designated public CAA and consequently administers Community Action
Programs and Services and related activities through a Tripartite Advisory Board as required
under Federal law. The Maricopa County Community Services Commission (Commission) was
established pursuant to a resolution adopted by the Maricopa County Board of Supervisors on
February 24, 1970.
Commission Bylaws require that members of the Commission be residents of the Community
Action service area within Maricopa County (excluding City of Phoenix, City of Mesa and City
of Glendale). The commission consist of no less than nine (9), nor more than fifteen (15)
persons. Commission membership is delineated as follows:
•
Consumer Sector
A minimum of one third (1/3) of the Commission members will be representatives of
low-income individuals and families who reside in the low-income target area that they
are selected to represent. The membership belongs to the individual.
•
Public Official Sector
One third (1/3) of the Commission members shall be elected public officials, currently
holding office. The membership belongs to the individual.
•
Private Sector
The remainder of the members of the Commission will be representative of public
agencies, business, industry, labor, religious, education, law enforcement, or other
private groups and interests in the community. The membership belongs to the
organization represented.
Commission members are recruited using requests from local cities or towns for elected
public official sector, for the Consumer Sector a customer satisfaction surveys has an option
for low income applicants who wish to represent the Consumer sector to leave contact
information and recommendations from local service providers are also considered for
nomination, finally for the Private Sector members are recruited through partnerships with
public agencies, businesses, or other organizations that have a stake in the community.
Commissioners fulfill their advisory roles through policy development, approval of monthly
financial expenditure reports, quarterly reports and annual audit reports. The Commission
also advises on the alignment of service areas, funding formula development, input for the
CSD Community Action Plan. Commission members receive training to ensure they
understand the roles and responsibilities of CAA advisory boards. This is accomplished
through Commission orientation and ongoing training opportunities provided by MCHSD
9
Staff, and partner organizations including Wildfire and the National Community Action
Partnership.
The Commission complies with governing legislation set by the Community Services Block
Grant (CSBG) as well as Open Meeting Laws. Notices of meetings are posted in the lobby of
the MCHSD administrative offices, the MCHSD website and emailed to partner agency
stakeholders.
1.2 One or two paragraphs describing the democratic selection process used to ensure Board
participation from representatives of low-income neighborhoods.
One or more of the following methods may be used to select consumer sector representatives
to provide low-income persons equal access to participate and be represented.
•
The Commission shall designate a democratic selection committee from an existing
organization or community group whose membership is predominantly composed of
low-income persons. The organization/community group, through a majority vote, may
choose a representative from among their elected officers/board members; or shall
select representative(s) from a pool of applicants.
•
Applicants shall be selected by low-income members through a petition process
requiring a minimum of 25 signatures from community residents that are at least 18
years of age and self-identify as low-income individuals.
•
Community elections can be held where nominees are placed on a ballot and eligible
voters complete a ballot at the election site. Eligible voters must be at least 18 years of
age and self-identify as a low-income individual and live in the service area that will be
represented. The nominee that receives the majority of the votes shall be the
designated consumer sector representative.
1.3 One or two paragraphs describing the Applicant’s maximum feasible efforts to promote
participation of low-income individuals on the board.
Efforts to promote participation of low-income individuals by are made by ensuring adequate
public view of Commission meetings. Notice is posted on the Maricopa County Human
Services Department (MCHSD) website, Community Action Program (CAP) offices and the
main lobby of MCHSD’s office. Board meetings are held after business hours, starting at 6PM,
to allow working low-income board members the flexibility of attending meetings without
needing to miss work. The option to participate remotely via teleconference is also available,
and low-income representatives who don’t have access to childcare are able to participate
while caring for their children.
1.4 A narrative of no more than one page describing how the Applicant ensures that the Board
fully participates in the development, planning, implementation, and evaluation of the
programs and services to serve low-income communities.
10
Development – Commission members are primary sources of information and insight
regarding the conditions in their neighborhoods and communities, and as a result help to
develop agency outreach and communication strategies. They bring critical information and
perspective to the needs assessment process and assist in the development of new programs,
resource identification, and help to inform CSD staff about the changing needs of low-income
households in each unique geographic area served.
Planning – Commission members provide information and advice on how to reduce poverty
within the geographic area they represent and participate in strategic planning initiatives
which feed into the CSD Community Action Plan. Commission members help CSD staff to
identify goals, objectives and performance outcomes for individual programs and review the
Results Oriented Management and Accountability (ROMA) reports submitted to ADES.
Commission members also participate in annual program planning at the start of each year
and help establish milestones, or intermediate steps towards achieving program results.
Implementation – Commission members are kept informed of agency programs and activities
throughout the year and receive periodic reports from CSD staff regarding service delivery and
fund expenditure patterns. Commission members carry out their implementation
responsibilities through the following activities:
•
Regular attendance at board and committee meetings;
•
Familiarity with agency information such as Commission bylaws, sources of funding,
agency goals and programs, and federal CSBG legislation;
•
Careful review of materials and reports related to CSD activities;
•
Full participation in their advisory capacity and any decision-making process;
•
Knowledge of all major actions taken by the agency.
1.5 A roster of Board members demonstrating which segment of the community each
represents, i.e., public elected official, low-income representative, members of business,
industry, labor, religious, etc.
1.
Bonnie Temme:
Salt River Project, Private Sector, SE Region
2.
Jayson Matthews:
Corporation for Supportive Housing, Private Sector, N Region
3.
Adonis Deniz:
Mercy Care, Private Sector, SW Region
4.
Lauriane Hanson:
Equality Health, Private Sector W Region
5.
Councilman John Carnero:
Public Elected Official, Tolleson, SW Region
11
6.
Councilman Ricardo Vital:
Public Elected Official, Guadalupe, SE Region
7.
Vice Mayor Roland Winters:
Public Elected Official, Surprise, W Region
8.
Vacant, Public Sector, N Region
9.
Pam DiPietro:
Low-Income Representative, N Region
10.
Vacant, Low-Income Representative, SE Region
11.
Jessica Gonzalez:
Low-Income Representative, SW Region
12. Vacant, Low-Income Representative, W Region
1.6 A schedule of planned Board meetings for the first contract year.
Maricopa County Community Services Commission
SFY 2021 Schedule of Meetings
Year
Month/Date
2020
July 20th
2020
September 21st
2020
November 16th
2021
January 25th
2021
March 22nd
2021
May 24th
12
2.0 Case Management Methodology
2.1. A narrative describing the Applicant’s client intake procedures including:
2.1.1. A description of how the Applicant accommodates clients at the primary location and
alternative sites, if applicable, that cannot make an appointment during regular
business hours, including home visits.
Subcontractors are contractually required to make reasonable accommodations for
those clients who are unable to appear for an appointment during regular business
hours. Such accommodations include early or late day/evening appointments, home
visits, seeing clients during the client’s lunch hour, or assessing other household
members for a possible applicant who is available during regular business hours.
2.1.2. A description of how clients access services when staff is away during off-site
meetings and trainings.
Clients may access services in a variety of ways if staff is away during off-site meeting.
This includes cross-training other staff members (such as a receptionist or accounting
technician) to conduct preliminary screening and payment guarantees until regular
case management staff return to the site location. Subcontractors normally do not
experience accessibility issues as interviews are normally scheduled during per-
determined weekdays (such as Tuesday & Fridays), allowing the subcontractor to
attend off-site meeting during other days. CSD training events are offered in split
sessions and on separate dates to allow for flexibility and office coverage.
2.1.3. A description of the process used for scheduling client appointments at all locations.
Subcontractors determine the best process for scheduling client appointments based on
the needs of the local community. Agencies utilize a combination of several approaches
to schedule client appointments. Each subcontractor has a phone line that informs
callers of the agency’s appointment process; indicating if individuals will need to leave a
message for an appointment, option for walk-in appointments, and applications pick-
up/drop off process.
Subcontractors offers extended hours to accommodate clients requiring an
appointment outside of regular business hours. Contractors also schedule home visits,
as requested, for individuals that are disabled or homebound. Contractors provide hard
copies of the applications and other needed documentation for signature. Contractors
use portable scanners/printers to ensure that documentation is properly copied for
client file.
2.1.4. A description of the process used to immediately assist people in crisis situations at all
locations.
Each subcontractor has defined a process to immediately assist people in crisis
situations, per their contract, which states “Crisis assistance is provided within 48
hours after a household applies, if the household is eligible for such benefits. Crisis
13
assistance is provided within 18 hours after a household applies, if a life threating
situation exists, and the household is eligible for such benefits.
A guarantee of utility payment to local utility vendors meets this assurance. For those
eligible for utility assistance, and to avoid utility shut off, each subcontractor ensures
that a guarantee of assistance is faxed to the utility company or guaranteed via the
utility company website, for which the assistance will be provide.
2.1.5. A description of the process used to assist clients when STCS and/or Utility Assistance
Funds have been depleted.
Each subcontractor has defined a process to assist clients when STCS and/or utility
assistance funds have been depleted. All subcontractors leverage private and/or local
funds which can be used in situations when funds have been depleted, or when an
applicant does not qualify or does not have the required documents for STCS or Utility
Assistance. Agencies maintain partnerships with local agencies, such as the Salvation
Army, St. Vincent de Paul, and other community-based organizations. Leveraging
community resources, benefits residents who are in need of additional services in order
to move forward with their plans for employment or other activities helping them
achieve self-sufficiency. Subcontractors provide the following services either directly or
through referral process: utility and rent assistance, shelter food, bus tickets,
workforce/employment assistance, and enrollment in other programs such as SNAP,
AHCCCS, WIC, and other health programs.
2.1.6. A description of how the Applicant provides information, referral assistance in
response to walk-in clients requesting assistance.
Each subcontractor has a unique process for addressing walk-in requests for services.
All applicants are provided information regarding the contractors’ scheduling process.
Some agencies accept walk-ins daily, while others accept walk-ins only on specific days.
Generally, at each intake appointment, referrals are provided for other services that are
not available directly from the subcontracted agency. These referrals are coded and
recorded in HSD Online. Referral information may also be provided in-person and on
the phone for residents who are not applying for services available through the
subcontracted agency.
2.1.7. A description of how the Applicant provides services at alternative sites.
Services are made available throughout the geographic service area using an
infrastructure of service providers in local communities. Rural areas of the county are
covered through itinerate site location and schedules. In the event that transportation
is a barrier to accessing program services or applicants are homebound due to illness or
disability, subcontractors may conduct home visits or identify alternative locations for
service delivery. Subcontractors are also encouraged to conduct outreach activities or
community initiatives to advertise available services in geographically remote locations
to promote program awareness.
2.1.8. The procedures used to advise clients of their rights and responsibilities.
14
Applicants are provided a “Clients Rights and Responsibilities” form for their review and
signature. The applicant or client is provided a copy of the signed document. The
original of the signed document is retained in the client file. The application for services
“Applicant’s Statement of Truth and the client “Notice of Approval/Denial/Appeal for
Services” also serve to advise clients of their rights and responsibilities. Staffs review
the statement on both of documents with clients during the interview process. Copies of
these documents are retained in the clients file.
2.1.9. A description of how clients that are missing documentation are handled.
Subcontractors each have a unique process for handling clients that are missing
documentation. Some allow the clients to return later in the day with the
documentation or reschedule the appointment for a later date to allow the client to
obtain the documents. In some cases, subcontractors assist the client in obtaining the
documentation (i.e. applying for a copy of a birth certificate).
2.2. A description of no more than two pages describing the Applicant’s case management model
including:
2.2.1.
The methods in place to engage clients in the development of a case plan.
Clients are engaged in crisis case management services at the time of their request for
financial assistance with rent/mortgage and/or utility assistance. Subcontractors
implement a client-drive approach to address the short- term emergent needs of the
household.
If long-term case management services are determined appropriate for a household,
subcontractors will identify and plan an appropriate combination of services/benefits,
in partnership with the client. Subcontractors will use various resources, including
multiple LIHEAP payment, to incentivize client’s participation, engagement, and
progress with case plan.
2.2.2.
The steps taken in developing and monitoring the case plan.
Subcontractors conduct an initial assessment following the intake process, to assess
for immediate needs and determine if the family is in a crisis. Crisis case management
and financial assistance services are provided to stabilize the emergent needs of the
family. All services and referrals are documented in HSD Online.
For households that are identified for long-term case management services,
subcontractors conduct the HSD Self-Sufficiency Matrix to assess the household’s
needs as it relates income, employment, shelter, nutrition, and energy. This
information is used to coordinate and plan services that will assist the family in
meeting their short term and long-term goals in obtaining self-sufficiency.
Subcontractors maintain ongoing, regular communication to assess the client’s
15
progress with the services identified in the case plan. Subcontractors establish a
relationship with the individual or family to include regular scheduled meetings,
phone calls or check-ins, for a minimum of three (3) consecutive months with an
option to extend, at the discretion of the CAP Office and the individual/family.
2.2.3.
The steps taken to effect closure of the case plan.
The stabilization of client’s immediate needs through the delivery of crisis case
management and financial assistance services, demonstrates the client’s attainment of
short-term goals. The delivery of crisis case management and financial assistance
services are recorded in HSD Online.
For households that are receiving long-term case management services, subcontractors
conduct a post assessment using the HSD Self-Sufficiency Matrix to determine the
household’s progress in attaining their self-sufficiency goals, as identified in their case
plan. Client’s progress and attainment of goals are documented in the case notes and
recorded in HSD Online.
2.2.4.
The process for referring clients to outside resources and methods used to follow-up
on the outcomes of referrals.
Subcontractors provide referrals to various community organizations to assist the client
in accessing services that are not readily available through the contractor. If needed,
subcontractors will call the referral agency on the client’s behalf to assist in scheduling
an appointment or determine eligibility. Subcontractors also provide written material/
brochures for available community resources. All referrals are documented in HSD
Online. During subsequent contact with the client, subcontractors will review the
referrals that were made to determine if the client followed through and if services
were received.
2.2.5.
The process used to evaluate the effectiveness of case management services, and how
evaluation results were used for program planning
The client’s attainment of short-term goals, as it relates to the stabilization of emergent/
crisis needs is used to determine the effectiveness of crisis case management services.
For long-term case management services, subcontractors use the HSD Self-Sufficiency
Matrix to determine the household’s progress in achieving self-sufficiency related goals
as identified in their case plan. Dependent on the household’s progress and challenges,
adjustments are made to the case plan and subsequent service delivery. Outcomes are
recorded and documented in HSD Online.
HSD Online provides reporting capabilities that allows MCHSD to analyze aggregated
program data on a subcontractor level and agency level. This information is used to
determine overall program success and identify needed adjustments to services
delivery.
16
2.3. Case management tools to be used in the completion of an individual household assessment
of needs, case planning, monitoring, and final closure of the household case plan
Subcontractors use the HSD Self-Sufficiency Matrix to assess the households needs and track
progress towards client drive goals as it relates to self-sufficiency. Subcontractors maintain
regular communication with clients to assess progress with case plan and determine needed
adjustments. Subcontractors utilize the HSD Online database to 1) access to the HSD Self-
Sufficiency Matrix to record pre and post assessment results; 2) document case notes regarding
client’s progress; 3) record delivered services and referrals; and 4) pull reports to determine
program outputs and outcomes.
2.4. A client satisfaction survey/tool to be used, and a description of how and when it will be
used.
Subcontractors conduct the MCHSD Customer Satisfaction Survey with program clients, in
accordance to the MCHSD Policy & Procedure Manual. Subcontractors send out surveys once a
month (at the beginning of the month), which remain open to clients to take anytime during the
program year. Survey data is collected and analyzed by MCHSD on a monthly basis to identify
program trends, best practices, service gaps, and needed adjustments to intake/ service delivery
processes.
2.5. A description of how the Utility Assistance Program and the STCS Program services will be
available to serve clients on an on-going basis, throughout the entire contract period.
Each subcontractor completes a direct service expenditure plan to include monthly expenditure
projections for LIHEAP and STCS/TANF funds for a twelve-month period. In addition,
subcontractors indicate the projected number of households to be served and include the
amount of local funds that will be used to supplement the rental and utility assistance in their
local service area. MCHSD reviews subcontractor’s expenditure levels in comparison to their
direct service expenditure plan on a monthly basis to determine if subcontractor is on target
with expenditures.
2.6. Client grievance policy and procedures and a description of how clients are made aware of
their right to appeal decisions made by the Applicant.
Each subcontracted agency is contractually required to establish a client grievance or problem
solving procedure. The grievance procedure is required to include provisions for notifying the
applicants / recipients of their eligibility for service, denial of service in total or partial denial,
and their right to appeal to DES/DAAS if the individual is not satisfied with the response
received from MCHSD.
At initial assessment, each applicant/client is provided a “Client Rights and Responsibilities for
their review and signature. The applicant or client is provided a copy of the signed document.
The original of the signed document is retained in the client file.
MCHSD requires subcontractors to provide each applicant/client of direct financial services an
“MCHSD Approval/Denial/Appeal for Services” Form, and to retain a copy of that form in the
client’s file.
17
2.7. A narrative describing how Client Satisfaction Survey data is shared with the
tripartite/advisory board and how it will be used in program planning.
Client satisfaction data is shared with the Commission at every meeting. Data will be used to
help inform strategic planning initiatives, subcontractor training needs, and identify unmet
service needs in the geographic area served.
Attachment 6
Facility Location Chart
Agreement No.: DI20-002264
Description:
Community Action Services Program
Facility Location Chart
a) Organization
(Contractor/Subcontractor)
b) Sub
c) Service
d) Days and Hours
of Operation
e) Geographic Area
to be Served
Administrative Offices:
Maricopa County Human Services
Department
234 North Central Ave., Suite 300
Phoenix, AZ 85004
Community Services Division
(602) 506-4206 Phone
(602) 506-4749 Fax
Community Services
8:00am – 5:00pm
Monday – Friday
Maricopa County excluding
the city limits of Glendale,
Mesa, and Phoenix
MCHSD Itinerate Site Office
Foothills Food Bank & Resource Center
6038 E Hidden Valley Dr.
Cave Creek, AZ 85331
480.488.1145
Case Management
Walk-ins
8:30am – 3:30pm
Anthem, Carefree, Cave
Creek and New River
AZCEND
345 S. California St.
Chandler, AZ 85225
480-963-1423
480-892-5331
X
Case Management
Call/Walk-in
7:30 am – 4:00pm
Monday – Friday
Southeast: Chandler, Queen
Creek, Sun Lakes, Gilbert
and Higley
City of Avondale
1007 S. 3rd Street
Avondale, AZ 85323
(623) 333-2700 Phone
(623) 333-2703 Phone
(623) 333-0270 Fax
Avondale Resource Center
328 W. Western Ave.
Avondale, AZ 85323
(623) 333-2703 Phone
X
Case Management
Call/Walk-in
8:00am – 5:00pm
Monday- Thursday
9:00am-5:00pm
Friday
Central West: Avondale,
Goodyear and Litchfield
Park
City of Scottsdale -Val Del Camino
7700 E. Roosevelt St
Scottsdale, AZ 85257
480-312-2323
X
Case Management
Call/Walk-in
8:00am – 5:00pm
Monday – Friday
Scottsdale
City of Surprise
12425 W. Bell Road
Surprise, AZ 85378
623-222-HOPE (4673)
X
Case Management
Walk-in
8:00am – 5:00pm
Monday – Friday
El Mirage and Surprise
City of Tolleson
9555 W Van Buren St
Tolleson, AZ 85353
623-936-2760
X
Case Management
Call/Walk-in
7:30am – 5:00pm
Monday – Friday
Tolleson
Foundation for Senior Living - Peoria
8335 W. Jefferson St.
Peoria, AZ 85345
623.979.3911 Ext.405 For appointments
X
Case Management
Call
8:00am-5:00pm
Monday – Friday
Walk-in
8:00am -5:00pm
Wednesday
Peoria, Waddell,
Youngtown, Sun City and
Sun City West
Foundation for Senior Living- Wickenburg
466 W Wickenburg Way
Wickenburg, AZ 85390
928-684-7894
X
Case Management
Walk-in
8:00am-5:00pm
Monday - Friday
Wickenburg and
surrounding area
Tempe Community Action Agency
2146 E. Apache Blvd.
Tempe, AZ 85281
480-422-8922
X
Case Management
Walk-in
8:00am-5:00pm
Monday - Friday
Tempe and Fountain Hills
Town of Gila Bend -CAP Office
303 E. Pima St.
Gila Bend, AZ 85337
928-683-6502
X
Case Management
Call/Walk in
12:00p m– 4:00pm
Mon – Wed, Friday
8:00 am -12:00pm
Thursday
Gila Bend and surrounding
area
Town of Guadalupe
9241 S. Avenida Del Yaqui
Guadalupe, AZ 85283
480-730-3093
X
Case Management
Call
8:00am – 5:00pm
Monday – Friday
Guadalupe
f)
[ X ] New Year’s Day
[
] Good Friday
[ X]
President’s Day
[
] Yom Kippur
[ ] Washington’s Birthday
[ X ] Martin Luther King Jr’s
[ X] Memorial Day
[
] Rosh Hashanah
[ X ] Columbus Day
[ X] Labor Day
[
] Lincoln’s Birthday
[ X] Independence Day
[ X ] Christmas
[ X ] Veteran’s Day
[ X] Thanksgiving Day
[
] Other (specify)
* Use additional pages if needed
Facility Location Chart (Instructions)
Complete the Facility Location and Staffing Chart form indicating each Office where the Offeror proposes to administer services. Include
Subcontractor information as is appropriate. Complete the chart as follows:
a. Organization: Name of Facility, Physical Address, Mailing Address, Phone and Fax Numbers where service(s) will be provided: List
the name, physical address, mailing address if it is different than the physical address, phone and fax number of each facility at which
the service will be provided. Do not use Post Office boxes to indicate the facility location. The name and address of any subcontractor
facility where services will be provided must also be included in this listing.
b. Sub: Designate any subcontractor facility by placing a check mark in the "SUB" column alongside the subcontractor facility name.
c. Service: Indicate the type of service the organization will be providing.
d. Days and Hours of Operation: List the days and hours during which service is available at each facility location. (for Applicant and
subcontractors).
e. Geographic Area: List the geographic area(s) in which the service will be provided, (e.g., Pima County, Maricopa County).
f.
The facility(s) listed above will not be open on those holidays marked (insert an X for applicable holidays)
234 N. Central Ave.
3rd Floor
Phoenix, AZ 85004
Phone: 602-506-5911
Fax: 602-506-8789
www.hsd.maricopa.gov
Maricopa County
Human Services Department
April 15, 2020
Arizona Department of Economic Security
Division of Aging & Adult Services
1789 West Jefferson, Site Code 950A
Phoenix, Arizona 85007
Re: DES Request for Application – Letter of Assurance
The Maricopa County Human Services Department (MCHSD) submits this Attachment 7 - Letter of
Assurance as required for the generation of a new contract for Community Action Program
Services.
As the Maricopa County Human Services Department Director, I submit to the following
assurances:
1.
Assurance that sufficient funds are available to meet financial obligations in a timely
manner, while awaiting payment reimbursement from the Arizona Department of
Economic Security.
2.
Assurance that Maricopa County, as a government entity is self-insured. Assurance
that the County will require all subcontractors meet the insurance requirements
imposed by the Terms and Conditions of the new contract.
3.
Assurance that MCHSD will comply with the requirements relating to fingerprinting,
certification, and criminal background checks, including but not limited to the following:
A.R.S. §§ 36-594.01, 36-3008, 41-1964 and 46-141. MCHSD will require all
subcontractors to comply with all applicable legal requirements listed above.
The point of contact for any notices is listed below:
Sandra Mendez, Assistant Director
Maricopa County Human Services Department
Community Services Division
234 N. Central Avenue, Suite 3000
Phoenix, Arizona 85004
Office: (602) 506-2316
Email: Sandra.Mendez@maricopa.gov
We look forward to receiving the new contract for Community Action Program Services.
Sincerely,
Bruce Liggett,
Director
Attachment 7 - Letter of Assurances
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Attachment 8
Certification Regarding Lobbying
Agreement No.:
D120-002264
I) E I';\ 11 T .II EN T 01'
ECONOMIC SECURITY"
-
Description:
Community Action Services Program
four f'.u1na for :I .\1mn9u Arlh.ma
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making
of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards
at all tiers (including subcontracts, subgrants, and contracts under grabts, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance
was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31,
U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
APPLICANT'S ORGANIZATION
Clint Hickman, Chairman, Maricopa County Board of Supervisors
* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
Prefix:
*Last Namthckc
* First Name(]Ut'\-J-
Middle Name:
Suffix:
* Title: f✓#-ffi --
* SIGNATURE:
APR O 8 2020
cie&fuesoanj(J'
Intergovernmental Agreement
Page 1 of 1
APR O 8 2020
* DATE:
i)J_- o-o
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Attachment 9
Certification Regarding: Debarment, Suspension,
Ineligibility and Voluntary Exclusion
Agreement No.:
D120-002264
I> E I' ,I I\ TM E N T 01'
E
ONOMIC SECURITY
Description:
Community Action Services Program
1;--,.,, ra,tnu IUr A .t11on9uA,uon,1
Certification Regarding: Debarment, Suspension, Ineligibility and Voluntary
Exclusion Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549-Debarment and Suspension, 29 CFR
Part 98, Section 98.510, Participant's responsibilities. The regulations were published as Part VII of the May 26, 1988
Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ ATTACHED INSTRUCTIONS WHICH ARE AN INTEGRAL PART OF
THE CERTIFICATION)
(1)
The prospective recipient of federal assistance funds certifies, by submission of this proposal, that neither it nor
its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by a federal department or agency.
(2)
Where the prospective recipient of federal assistance funds is unable to certify any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.
Maricopa County
Name of Agency / Organization
Clint Hickman, Chairman, Maricopa County Board of Supervisors
Name and Title of Authorized Representative
Signa(!PL_
Date
APR O 8 2020
APR082020
CIGt1( of the Board
Intergovernmental Agreement
Page 1 of 2
C --t1';}.--JJ) -
..
.,-
Oti-\o 3 (JD
-
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Attachment 10
Participation in Boycott of Israel
Agreement No.: D120-002264
D E l' A I\ T t\l E N T OF
E
ONOM IC SE
U RITY
-
Description:
Community Action Services Program
four f'.1rtnu for :f S1mn9t''t Arlldnt1
Participation in Boycott of Israel
Please note that if any of the following apply to this Solicitation, then the Offeror shall select the "Exempt
Solicitation, Contract, or Contractor" option below:
•
The Solicitation or Contract has an estimated value of less than $100,000;
•
Contractor is a sole proprietorship;
•
Contractor has fewer than ten (10) employees; OR
•
Contractor is a non-profit organization.
Pursuant to A.R.S. §35-393.01, public entities are prohibited from entering into contracts "unless the contract
includes a written certification that the company is not currently engaged in, and agrees for the duration of the
contract to not engage in, a boycott of goods or services from Israel."
Under A.R.S. §35-393:
1. "Boycott" means engaging in a refusal to deal, terminating business activities or performing other actions that are intended
to limit commercial relations with entities doing business in Israel or in territories controlled by Israel, if those actions are
taken either:
(a) Based in part on the fact that the entity does business in Israel or in territories controlled by Israel.
(b) In a manner that discriminates on the basis of nationality, national origin or religion and that is not based on a valid
business reason.
2. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability
partnership, limited liability company or other entity or business association, including a wholly owned subsidiary,
majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full
time employees.
5."Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this
state or a political subdivision of this State.
The certification below does not include boycotts prohibited by 50 United States Code Section 4842 or a regulation issued
pursuant to that section. See A.R.S. §35-393.03.
In compliance with A.R.S. §§35-393 et seq., all offerors must select one of the following:
□
The Company submitting this Offer does not participate in, and agrees not to participate in during the term of the
contract, a boycott of Israel in. accordance with A.R.S. §§35-393 et seq. I understand that my entire response will
become public record in accordance with A.AC. R2-7-C317.
□
The Company submitting this Offer does participate in a boycott of Israel as described in A.R.S. §§35-393 et seq.
/J Exempt Solicitation, Contract, or Contractor.
Indicate which of the following statements applies to this Contract:
□Solicitation or Contract has an estimated value of less than $100,000;
□Contractor is a sole proprietorship;
D Contractor has fewer than ten (10) employees; and/or
}("Contractor is a non-profit organization.
Maricopa County
Company Name
301 W. Jefferson 10th Floor
Clint Hickman
Printed Name
Phoenix
Address
AZ
85003
Chairman, Maricopa County Board of Supervisors
City
State
Zip
Title
Intergovernmental AgreemeG
&O· 8
Page 1 of 1
Clerk of the Board
2020
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 20 of 31
Attachment 14 – Business Associates Agreement
HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT OF 1996 HIPAA AND HEALTH INFORMATION
TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT OF 2009 - HITECH
The Arizona Department of Economic Security (DES) or on behalf of a DES Division or Program (“DES Covered Component”),
and undersigned Business Associate hereby enter into this Business Associate Agreement (“BAA” or “Agreement”).
This BAA has the same effective date as the Contract, Intergovernmental Agreement, Memorandum of Understanding or
Interagency Service Agreement to which it is appended (“Related Contract” or “Contract”), or the date of the last signature,
whichever is later. If there is no Related Contract, the effective date of this BAA is the date of the last signature to this Agreement.
This Agreement supplements any Contract between a DES Covered Component and the Business Associate which involves
the disclosure of Protected Health Information (“PHI”) as defined in HIPAA. In the event of conflicting terms or conditions, this
Agreement’s terms shall supersede the provisions of the Related Contract to which it is appended.
The DES Covered Component and the Business Associate agree to comply with applicable Privacy and Security Standards of
HIPAA and HITECH, and with other applicable federal and state laws, in order to protect the privacy of PHI in any form and to
safeguard the confidentiality, integrity, and availability of any Electronic PHI (“ePHI’) related to this Agreement.
1.0
DEFINITIONS. Capitalized terms not otherwise defined in this Agreement shall have the same meanings as those terms
in the Privacy Rule and HITECH.
1.1. Breach shall have the meaning given to such term under the HITECH Act (42 U.S.C. § 17921).
1.2. Business Associate shall have the meaning given to such term under the Privacy Rule, the Security Rule, and the
HITECH Act (45 C.F.R. § 160.103 and 42 U.S.C. §17938).
1.3. Covered Component shall have the meaning given to such term under the Privacy Rule and the Security Rule (45 C.F.R
§160.103).
1.4. Data Aggregation shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §164.501).
1.5. Designated Record Set shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §164.501).
1.6. Electronic Health Record shall have the meaning given to such term in the HITECH Act (42 C.F.R. § 17921).
1.7. Electronic Protected Health Information shall have the meaning given to such term under the Privacy Rule (45 CFR
§164.501and §106.103)
1.8. Health Care Operations shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §164.501).
1.9. Individual shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §160.103) and shall include a
person who qualifies as a personal representative (45 C.F.R. §164.502(g)).
1.10. Privacy Rule shall mean the Standards for Privacy of Individually Identifiable Health Information codified at 45 C.F.R.
Parts 160 and 164, Subparts A and E.
1.11. Protected Health Information shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §164.501).
Protected Health Information includes Electronic Protected Health Information (C.F.R. §160.103 and §164.501).
1.12. Protected Information shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §164.501).
Protected Information includes Electronic Protected Information (C.F.R. §160.103 and §164.501).
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 21 of 31
1.13. Required By Law shall have the meaning given to such term under the Privacy Rule (45 C.F.R. §164.512).
1.14. Secretary shall mean the Secretary of the U.S. Department of Health and Human Services or his designee.
1.15. Security Rule shall mean the HIPAA Regulation that is codified at 45 C.F.R. Parts 160 and 164, Subparts A and C.
1.16. Unsecured PHI shall have the meaning given to such term under the HITECH Act and any guidance issued pursuant to
such Act ( 42 U.S.C. §17932(h)).
2.0
PERMITTED USES AND DISCLOSURES OF PHI. The Business Associate will use and disclose PHI only for those
purposes necessary to perform functions, activities, or services for, or on behalf of, the DES Covered Component as
specified in the underlying Contract, this BAA , or as Required By Law. Any use or disclosure by the Business Associate
shall not violate applicable Privacy Rule provisions, the terms of this BAA, or the DES Covered Component policies and
procedures for using or disclosing only the Minimum Necessary PHI.
2.1. Prohibited Use and Disclosures. The Business Associate shall not use or disclose Protected Information for fundraising
or marketing purposes. The Business Associate shall not disclose Protected Information to a health plan for payment or
health care operations purposes if the patient has requested a restriction and has paid out of pocket in full for health care
items or services to which the PHI solely related as described in 42 U.S.C. §17935(a). The Business Associate shall not
directly or indirectly receive remuneration in exchange for Protected Information, except with the prior written consent of
the Covered Component and as permitted by the HITECH Act, 42 U.S.C. §17935(d) (2); however, this prohibition shall
not affect payment by the Covered Component to the Business Associate for services provided pursuant to the Contract.
Disclosure for research is prohibited without the Covered Component’s permission prior to such disclosure.
2.2. Business Activities of Business Associate. The Business Associate may use PHI for the necessary management and
administration of the Business Associate, or to carry out the legal responsibilities of the Business Associate if:
1.
The disclosure is Required By Law; or
2.
The Business Associate obtains reasonable written assurances from a third party receiving the PHI that the third party
will:
i.
Maintain the confidentiality of the PHI;
ii.
Use or disclose the PHI only as Required By Law or for the purpose for which the PHI was disclosed to the person;
iii.
Notify the Business Associate within 1 business day of any discovered breach of confidentiality of the Protected
Information (42 U.S.C. §17932; 45 C.F.R. §164.504(e)(2)(ii)(D)) and comply in writing with paragraphs 3.1, 3.2,
3.3, 3.4, 3.5 and 3.6; and
iv.
Ensure that any third party to whom it provides Protected Information receives from, or created or received by the
Business Associate on behalf of the Covered Component, agrees to the same restrictions and conditions that
apply to the Business Associate with respect to such information (45 C.F.R. §164.504 (e)(2)(ii)(D)).
2.3. Aggregation of PHI. The Business Associate shall provide data aggregation services with regard to PHI created or
received from or on behalf of the DES Covered Component, if requested to do so by the DES Covered Component. (45
C.F.R. §164.504(e)(2)(i)(B)).
2.4. De-Identification of PHI. Under 45 C.F.R. §164.502(d) (2), de-identified information does not constitute PHI and is not
subject to the terms of this Agreement. The Business Associate may de-identify any and all PHI, provided
1.
The de-identification conforms to the requirements of 45 C.F.R. §164.514(b),
2.
The Business Associate maintains the documentation required by 45 C.F.R. §164.514(b), and
3.
The Business Associate gives written assurance to the DES Covered Component that the Business Associate
appropriately maintains the documentation required by 45 C.F.R. §164.514(b).
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 22 of 31
3.0
OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE.
3.1. Safeguards. The Business Associate shall implement appropriate safeguards as are necessary to prevent the use or
disclosure of Protected information otherwise that as permitted by the Contract and the Business Associate Agreement,
including, but not limited to, administrative, physical, and technical safeguards that reasonably and appropriately protect
the confidentiality, integrity and availability of the Protected Information, in accordance with 45 C.F.R §164.308, §164.310,
and §164.312. The Business Associate shall comply with the policies, procedures, and documentation requirements of
the HIPAA Security Rule, including but not limited to 42 U.S.C. §17931 and 45 C.F.R. §164.316.
3.2. Reporting Impermissible Use or Disclosure and Security Incidents. The Business Associate agrees to report to the
DES Covered Component in writing of any access, use or disclosure of Protected Information not permitted by the contract
or the Business Associate Agreement, and any breach of Unsecured PHI of which it becomes aware of as described in
42 U.S.C. §17921 and 45 C.F.R. §164.308(b) and §164.504(e)(2)(ii)(C), within 1 business day after discovery. The
Business Associate shall:
1.
Promptly take corrective action to secure any such deficiencies; and
2.
Grant prompt and immediate access to DES Covered Component and other individuals from DES or the State of
Arizona authorized by DES to participate in the incident investigation, mitigation, resolution, or breach notification;
and
3.
Contact the DES Chief Privacy Officer if DES Covered Component cannot be notified within 1 business day after
discovery of incident; and
4.
Secure and preserve all records pertinent to the incident; and
5.
Promptly require within 1 business day of incident discovery applicable subcontractors and agents to secure and
preserve all records pertinent to the incident; and
6.
Any action pertaining to such unauthorized disclosure required by applicable federal and state statutes and
regulations.
3.3. Mitigation. The Business Associate agrees to mitigate, to the extent practicable, any harmful effects that are known to
the Business Associate of a use or disclosure of PHI by the Business Associate or its agents or subcontractors in violation
of the requirements of this Agreement ( 45 C.F.R §164.530(f)).
3.4. Agents and Subcontractors. The Business Associate agrees to the following:
1.
Ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by
the Business Associate on behalf of the DES Covered Component, agrees in writing to the same restrictions and
conditions that apply to the Business Associate through this Agreement with respect to such PHI and implementing
the safeguards required by paragraph 2.1 above with respect to Protected Information (45 C.F.R. §164.308(b) and
§164.504(e)(2)(ii)(D)).
2.
It shall implement and maintain sanctions against agents and subcontractors that violate such restrictions and
conditions and shall mitigate the effects of any such violations as described in 45 C.F.R. §164.530(e)(l) and 164.530(f).
3.5. Personnel. The Business Associate shall appropriately inform all of its employees, agents, representatives, and members
of its workforce (“Personnel”), whose services may be used to satisfy the Business Associate’s obligations under this
Agreement and the Related Contract, of the terms of this Agreement. The Business Associate represents and warrants
that the Personnel are under sufficient legal obligations to the Business Associate for the Business Associate to fully
comply with the provisions of this Agreement. The Business Associate agrees to train its workforce on the HIPAA Rule
and keep appropriate records of the training as prescribed in 45 C.F.R. §164.530(b)(1)(2).
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 23 of 31
3.6. Access to Protected Information. The Business Associate shall make Protected Information maintained by the Business
Associate or its agents or subcontractors in Designated Record Sets available to the DES Covered Component for
inspection and copying within 10 business days of a request by the DES Covered Component to enable the DES Covered
Component to fulfill its obligations under the Privacy Rule, including, but not limited to, 45 C.F.R. §164.524. If the Business
Associate maintains an Electronic Health Record, the Business Associate shall provide such information in electronic
format to enable the DES Covered Component to fulfill its obligations under the HITECH Act, including, but not limited to,
42 U.S.C. §17935(e).
3.7. Individual Access to PHI. If an Individual requests direct access to PHI in possession of the Business Associate which
is maintained under its contract with DES, prior to disclosure of any PHI the Business Associate shall first consult in writing
with the DES Covered Component’s Privacy Officer or the DES Chief Privacy Officer. The Business Associate shall grant
or deny access pursuant to written instructions from the DES Covered Component which are consistent with 45 C.F.R.
§164.524 or other applicable law. Within 5 business days, the Business Associate shall notify the DES Covered
Component’s Privacy Officer or the DES Chief Privacy Officer in writing of the actions it has taken pursuant to the request
for access and DES Covered Component’s authorization.
3.8. Amendment of PHI. The Business Associate agrees to make any amendment(s) to PHI in a Designated Record Set
within 5 business days after the Business Associate receives from the DES Covered Component instructions to amend
PHI. Such instructions generally follow an Individual’s request to the DES Covered Component to amend the Individual’s
PHI held by the DES Covered Component or its Business Associates in a Designated Record Set. If the DES Covered
Component declines an Individual’s request to amend that Individual’s PHI, the DES Covered Component shall provide
to its Business Associate, who shall promptly incorporate into the Individual’s Designated Record Set, any statements of
disagreement and/or rebuttals supplied by the Individual, as required by 45 C.F.R. § 164.526.
3.9. Individual Amendment of PHI. If an individual requests an amendment of PHI directly from the Business Associate or its
agents or subcontractors on behalf of the DES Covered Component, the Business Associate must notify the DES Covered
Component in writing within 5 business days of the request. Any approval or denial of amendment to Protected Information
maintained by the Business Associate or its agents or subcontractors shall be the responsibility of the DES Covered
Component, which shall notify the Business Associate of its decision in writing.
3.10. Documentation of Disclosure. The Business Associate agrees to document all disclosures of PHI made by the Business
Associate and information related to such disclosures as would be required by the DES Covered Component to respond
to a request by an Individual for an accounting of disclosures of PHI according to 45 C.F.R. §164.528. At a minimum, the
documentation related to the Business Associate’s disclosure of PHI shall include:
1.
The date of disclosure;
2.
The name of the PHI recipient and, if known, the address of the PHI recipient;
3.
A brief description of the PHI disclosed; and
4.
A brief statement of the purpose of the disclosure that reasonably informs the Individual of the basis for the disclosure,
or instead of such statement, a copy of the written request for disclosure by the Secretary or under 45 C.F.R. §164.512.
3.11. Accounting of Disclosures. Within 10 business days after receipt of notice from the DES Covered Component to the
Business Associate that the DES Covered Component has received a request for an accounting of disclosures of an
Individual’s PHI, the Business Associate agrees to provide the DES Covered Component with the disclosure information
requested by the Individual and as required in paragraph 3.10 above. If an individual requests an accounting of disclosures
directly from the Business Associate, the Business Associate shall, within sixty (60) business days, provide or deny an
accounting according to 45 C.F.R §164.528. Unless otherwise directed by the DES Covered Component, the Business
Associate shall notify the DES Covered Component of the action it has taken and shall do so in writing within five (5)
business days after the action. The accounting of disclosure shall include all PHI disclosures for the time period the
Individual requested, but not for a date earlier than six years prior to the date of creation or last entry, which ever occurred
last. If the Business Associate is unable to provide the accounting of disclosure within the allowed time frame, the Business
Associate shall provide the DES Covered Component with a written statement of the reason for delay and the date the
Business Associate will provide the accounting.
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 24 of 31
3.12. Government Access to Records. For the purpose of determining the DES Covered Component compliance with the
Privacy Rule, as well as the Business Associate’s compliance with this BAA, the Business Associate agrees to make
available to the DES Covered Component or its authorized agent, or to the Secretary, in the time and manner designated:
1.
The Business Associate’s internal practices, books, and records, including policies and procedures, relating to the use
and disclosure of PHI received from, or created or received by the Business Associate on behalf of the DES Covered
Component; and
2.
All PHI received by the Business Associate from the DES Covered Component or created or received by the Business
Associate on behalf of the DES Covered Component.
3.13. Minimum Necessary. The Business Associate and its agents and subcontractors shall request, use, and disclose only
the minimum amount of Protected Information necessary to accomplish the purpose of the request, use or disclosure as
described in 42 U.S.C. § 17935(b); 45 C. F. R. § 164.502(b)(1) and 164.514(d).
3.14. Data Ownership. The Business Associate acknowledges that the Business Associate has no ownership rights with
respect to the Protected Information.
3.15. Transaction Standards Regulation. If the Business Associate conducts in whole or part Standard Transactions for or on
behalf of the DES Covered Component, the Business Associate agrees to comply with the Electronic Data Transaction
Standards and Code Sets, 45 C.F.R. Part 162 (I – R). The Business Associate agrees to require any subcontractor or
agent involved in conducting Standard Transactions for or on behalf of the DES Covered Component, to comply with the
Transaction Standards and Code Sets. The Business Associate and its subcontractors or agents shall not engage in any
practice or enter into any agreement related to conducting in whole or in part Standard Transactions for or on behalf of
the DES Covered Component that:
1.
Changes the definition, Data Condition, or use of a Data Element or Segment in a Standard Transaction;
2.
Adds a Data Element or Segments to the maximum defined Data Set;
3.
Uses any code or Data Element that is marked “not used” in the Standard Transaction’s implementation specification
or that is not in the Standard Transaction’s implementation specification; or
4.
Changes the meaning or intent of the Standard transaction implementation specification.
3.16. Retention of Records. All records containing PHI created or received by the Business Associate from or on behalf of the
DES Covered Component will be retained for six years from the date of creation (e.g., PHI) or the date when it last was
in effect (e.g., a policy or form), whichever is later.
3.17. Violations of Law. The Business Associate may use PHI to report violations of law to appropriate Federal and State
authorities, consistent with 45 C.F.R. §164.502(j).
3.18. Audits, Inspection and Enforcement.
1.
Within 10 business days of a written request by the DES Covered Component, the Business Associate and its agents
or subcontractors shall allow the DES Covered Component to conduct a reasonable inspection of the facilities,
systems, books, records, agreements, and policies and procedures relating to the use, acquisition, or disclosure of
Protected Information pursuant to this Agreement for the purpose of determining whether the Business Associate has
complied with this Agreement; provided, however that:
i.
The Business Associate and the DES Covered Component shall mutually agree in advance upon the scope, timing
and location of such inspection. If an agreement can not be concluded, then DES will decide; and
ii.
To the extent allowed by law, the DES Covered Component shall safeguard all trade secret information of the
Business Associate to which the DES Covered Component has access during the course of such inspection; and
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 25 of 31
2.
The fact that the DES Covered Component inspects, fails to inspect, or has the right to inspect the Business
Associate’s facilities, systems, books, records, agreements, and polices and procedures does not relieve the Business
Associate of its responsibilities to comply with this Agreement. The following acts by the DES Covered Component
do not constitute acceptance of such practices or waive the DES Covered Entity’s enforcement rights under the
contract or Agreement.
i.
Failure to detect; or
ii.
Detection, but failure to notify the Business Associate; or
iii.
Requiring the Business Associate to correct any unsatisfactory practices.
3.
The Business Associate shall notify the DES Covered Component in writing within 1 business day of learning that the
Business Associate has become the subject of an audit, compliance review, or complaint investigation by the Office
for Civil Rights.
4.
Notwithstanding paragraph 3.18.1, pursuant to paragraphs 3.1 through 3.4 and in compliance with 42 U.S.C. §17921
and 45 C.F.R. §164.308(b) and §164.504(e)(2)(ii)(C), Business Associate, its subcontractors and agents shall permit
prompt and immediate access to the Covered Component to all physical locations and business records, including
electronic records and all relevant data files, under the control or maintained by the Business Associate, its
subcontractors and agents on behalf of Covered Component, for the purpose of mitigating a data breach, conducting
a risk analysis and obtaining information which will identify individuals affected.
4.0
OBLIGATIONS OF DES COVERED COMPONENT
4.1. Notice of Privacy Practices. The DES Covered Component shall notify the Business Associate of any changes or
limitation(s) in the DES Covered Component’s Notice of Privacy Practices according to 45 C.F.R. §164.520, to the extent
that such changes or limitation(s) may effect the Business Associate’s use or disclosure of PHI.
4.2. Changes in Permission by Individual. The DES Covered Component shall notify the Business Associate of any
changes in, or revocation of, an Individual’s permission to use or disclose PHI, to the extent that such changes may affect
the Business Associate’s use or disclosure of PHI.
4.3. Restriction on PHI. The DES Covered Component shall notify the Business Associate of any restriction on PHI uses and
disclosures that the DES Covered Component has agreed to in accordance with 45 C.F.R. §164.522, to the extent that
such restriction may affect the Business Associate’s use or disclosure of PHI.
4.4. Permissible Requests by DES Covered Component. The DES Covered Component shall not request the Business
Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by the DES
Covered Component.
5.0
TERM AND TERMINATION
5.1. Term. The term of this Agreement is specified on page one (1) of this Agreement or in the Contract to which it is appended
and shall terminate when all PHI provided by the DES Covered Component to the Business Associate, or created or
received by the Business Associate on behalf of the DES Covered Component, is destroyed or returned to the DES
Covered Component. If it is not feasible for the Business Associate to return to the DES Covered Component or destroy
all PHI when this Agreement terminates under the Contract or is terminated early, protections agreed to by the Business
Associate are extended to such information, whether PHI is held or controlled by the Business Associate or its agents or
subcontractors.
Attachment 15
Business Associates Agreement
Agreement No.: DI20-002264
Description:
Community Action Services Program
Intergovernmental Agreement
Page 26 of 31
5.2. Effect of Termination.
1.
Except as provided in subparagraph 3 of this paragraph, upon termination of this Agreement for any reason, the
Business Associate shall return or destroy all PHI received from the DES Covered Component, or created or received
by the Business Associate on behalf of the DES Covered Component. No copies or data repositories can be retained
as to this information.
2.
This provision shall apply to PHI in the possession or under the control of subcontractors or agents of the Business
Associate. The Business Associate and its subcontractors and agents shall retain no copies or data repositories of
any type of returned or destroyed PHI unless ordered to do so by a court of law.
3.
If the Business Associate determines that returning or destroying PHI is not feasible, the Business Associate shall
provide to the DES Covered Component notification of the conditions making the return or destruction not feasible.
The Business Associate shall extend the protections of this Agreement to the PHI and shall limit further uses and
disclosures of the PHI to the purpose that make the return or destruction not feasible, for so long as the Business
Associate maintains the PHI. If it is not feasible for the Business Associate to recover from a subcontractor or agent
any PHI, the Business Associate shall provide a written explanation to the DES Covered Component. The Business
Associate shall require the subcontractor or agent to agree:
i.
To extend the protections of this Agreement to the PHI in subcontractor or agent; and
ii.
To limit further uses or disclosures of the PHI to the purpose that makes the return or destruction not feasible, for
so long as the subcontractor or agent maintains the PHI.
5.3. Termination for Cause.
1.
Breach. Upon the DES Covered Component’s knowledge of a material breach by the Business Associate of the terms
of this Agreement, the DES Covered Component shall take one or more of the following actions:
i.
Provide an opportunity for the Business Associate to cure the breach within a specified timeframe;
ii.
Terminate this Agreement and the underlying Contract if the Business Associate does not cure the breach or end
the violation within the time specified by the DES Covered Component, or if a cure of the breach is not possible;
iii.
Immediately terminate this Agreement and the underlying contract; or
iv.
Report the violation to the Secretary, if neither termination nor cure is feasible.
2.
Judicial or Administrative Proceedings. The DES Covered Component may terminate the Agreement if;
i.
The Business Associate is named as a defendant in a criminal proceeding for a violation of HIPAA, the HITECH
Act, the HIPAA Regulations or other security or privacy laws; or
ii.
There is a governmental agency or tribunal finding or stipulation that the Business Associate has violated any
standard or requirement of HIPAA, the HITECH Act, the HIPAA regulations or other security or privacy laws.
6.0
MISCELLANEOUS
6.1. HIPAA Reference. A reference in this Agreement to HIPAA or the Privacy Rule means the regulation including the HITECH
Act of 2009, as in effect on the effective date or as subsequently amended, and for which compliance is required. (45
C.F.R. § 160, §162, and §164 and 42 U.S.C. §17938).
6.2. Amendment. The parties agree to take the action necessary to amend this Agreement from time to time so that the DES
Covered Component may comply with the requirements of HIPAA, HITECH, court decisions and any regulatory changes.
6.3. Interpretation. Any ambiguity in this Agreement shall be resolved to permit the DES Covered Component to comply with
the HIPAA and HITECH Rules.
4/28/2020
Maricopa BAA - Signed.jpeg
https://mail.google.com/mail/u/0/#inbox?projector=1&messagePartId=0.2
1/1
Attachment 16
CONTRACT SERVICE:
Case Management - Intake Costs (CMG-CAP-INT)
Agency:
Maricopa County
DI20-002264
1.
PERSONNEL
TOTAL
96%
1%
2%
1%
Number of
FTE
Total Salary for the
DES service
LIHEAP
SSBG
TANF
NHN
Positions
Level
Position Title
Contract Period
COST
COST
COST
Cost
Cost
Total FTE:
TOTAL PERSONNEL
$0.00
$0.00
$0.00
$0.00
$0.00
2.
BASIS
TOTAL
96%
1%
2%
1%
DES service
LIHEAP
SSBG
TANF
NHN
COST
COST
COST
Cost
Cost
$0
$0
$0
$0
TOTAL EMPLOYEE RELATED EXPENSES
.
$0.00
$0.00
$0.00
$0.00
$0.00
3.
TOTAL
LIHEAP
SSBG
TANF
NHN
COST
COST
COST
Cost
Cost
$0
$0
TOTAL PROFESSIONAL AND OUTSIDE SERVICES
$0.00
$0.00
$0.00
$0.00
$0.00
4.
TRAVEL
.
TOTAL
LIHEAP
SSBG
TANF
NHN
ITEM
COST
COST
COST
Cost
Cost
$0
$0
TOTAL TRAVEL
$0.00
$0.00
$0.00
$0.00
$0.00
5.
SPACE
TOTAL
LIHEAP
SSBG
TANF
NHN
ITEM
COST
COST
COST
Cost
Cost
TOTAL SPACE
$0.00
$0.00
$0.00
$0.00
$0.00
6.
EQUIPMENT
TOTAL
LIHEAP
SSBG
TANF
NHN
ITEM
COST
COST
COST
Cost
Cost
TOTAL EQUIPMENT
$0.00
$0.00
$0.00
$0.00
$0.00
7.
TOTAL
LIHEAP
SSBG
TANF
NHN
ITEM
COST
COST
COST
Cost
Cost
TOTAL MATERIALS AND SUPPLIES
$0.00
$0.00
$0.00
$0.00
$0.00
BASIS
EMPLOYEE RELATED EXPENSES
MATERIALS AND SUPPLIES
ITEM
BASIS
BASIS
ITEMIZED SERVICE BUDGET
Contract Period: 07/01/2020 - 06/30/2021
BASIS
BASIS
PROFESSIONAL AND OUTSIDE SERVICES
8.
TOTAL
LIHEAP
SSBG
TANF
NHN
ITEM
COST
COST
COST
Cost
Cost
$0.00
$0.00
TOTAL OPERATING EXPENSES
$0.00
$0.00
$0.00
$0.00
$0.00
9
INDIRECT COSTS
TOTAL
LIHEAP
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
Cost
Cost
TOTAL INDIRECT COSTS
$0.00
$0.00
$0.00
$0.00
$0.00
10
SUBTOTAL VOUCHER COST
$0.00
$0.00
$0.00
$0.00
$0.00
11.
VOUCHERS
TOTAL
DES service
LIHEAP
SSBG
TANF
NHN
COST
COST
COST
Cost
Cost
LIHEAP Program Coordinator = 1FTE
$56,243.00
$56,243.00
$23,943.00
$23,943.00
$5,000.00
$5,000.00
$5,000.00
$5,000.00
$656,030
$596,987
$0
$59,043
TOTAL VOUCHERS
$746,216.00
$687,173.00
$0.00
$59,043.00
$0.00
12.
TOTAL SERVICE COST/DES TOTAL COST:
$746,216.00
$687,173.00
$0.00
$59,043.00
$0.00
REVENUE SOURCES:
DES - DAAS
$746,216.00
$687,173.00
$0.00
$59,043.00
$0.00
TOTAL REVENUE:
$746,216.00
$687,173.00
$0.00
$59,043.00
$0.00
BASIS
ITEM
OPERATING SERVICES
ERE = ($12,768 x 1 FTE) + ($56,243 X 19.87%)
Travel/Mileage = $417 x 12 months
Office Supplies = $417 x 12 months
Sub-contracted providers for crisis case management and financial assistance services
CONTRACT SERVICE:
Case Management
Agency:
Maricopa County
DI20-002264
1.
PERSONNEL
Number of
FTE
Total Salary for the
Total
TOTAL
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
Service
DES service
CMG-CAP-LIH
CMG-CAP-A16
CMG-CAP-SBG
CMG-CAP-TNF
CMG-CAP-NHN
Positions
Level
Position Title
Contract Period
COST
COST
COST
COST
COST
Cost
Cost
1
0.45
Assistant Director
$97,760
$43,992.00
$43,992.00
$24,440.00
$14,664.00
$4,888.00
$0.00
1
0.70
Admin Services Supervisor
$71,492
$50,045.00
$50,045.00
$17,873.00
$28,597.00
$3,575.00
$0.00
1
0.90
CAA Prg Mgr
$80,163
$72,146.00
$72,146.00
$28,057.00
$36,073.00
$8,016.00
$0.00
1
0.25
CSBG Program Coordinator
$51,272
$12,818.00
$12,818.00
$0.00
$12,818.00
$0.00
$0.00
1
0.65
Management Assist
$48,632
$31,611.00
$31,611.00
$12,158.00
$12,158.00
$7,295.00
$0.00
1
0.55
Management Analyst
$54,600
$30,030.00
$30,030.00
$10,920.00
$16,380.00
$2,730.00
$0.00
1
0.30
Prog Coordinator- Evict Prevent
$68,017
$20,405.00
$20,405.00
$10,202.00
$3,401.00
$6,802.00
$0.00
1
1.00
Program Specialist
$39,584
$39,584.00
$39,584.00
$23,750.00
$9,896.00
$5,938.00
$0.00
1
0.80
Prog Coordinator- Utility Assist
$42,911
$34,329.00
$34,329.00
$19,310.00
$9,870.00
$5,149.00
$0.00
1
0.50
Grant Accountant
$66,976
$33,488.00
$33,488.00
$0.00
$33,488.00
$0.00
$0.00
Total FTE:
6.10
4% Cost of Living
$14,738.00
$14,738.00
$5,868.00
$7,094.00
$1,776.00
TOTAL PERSONNEL
$383,186.00
$383,186.00
$152,578.00
$0.00
$184,439.00
$46,169.00
$0.00
2.
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
FICA
$383,186
$77,885.00
$77,885.00
$31,921.00
$36,133.00
$9,831.00
$0.00
Unemployment Insurance
X19.87%
$76,139.00
$76,139.00
$30,317.00
$36,648.00
$9,174.00
Health Benefits
$76,139.00
Life Insurance
Retirement
$12,768
etc…
X 6.10FTEs
Unemployment & Workers Comp
$77,885.00
$0.00
TOTAL EMPLOYEE RELATED EXPENSES
.
$154,024.00
$154,024.00
$62,238.00
$0.00
$72,781.00
$19,005.00
$0.00
3.
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
BASIS
COST
COST
COST
COST
COST
COST
COST
$0
$0
$0
$0
$0
$0
Crisis Case Mgt & Financial Asst Services
$0
$0
$0
$0
$0
$0
Community Needs Assessment
$1,689
$1,689
$0
$1,689
TOTAL PROFESSIONAL AND OUTSIDE SERVICES
$1,689.00
$1,689.00
$0.00
$0.00
$1,689.00
$0.00
$0.00
4.
TRAVEL
Total
.
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
Conference and Training
Related Lodging/Travel
$6,990
$6,990
$1,048
$5,000
$942
$0
Staff Mileage
$7,572
$7,572
$1,000
$3,572
$3,000
$0
TOTAL TRAVEL
$14,562.00
$14,562.00
$2,048.00
$0.00
$8,572.00
$3,942.00
$0.00
5.
SPACE
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
Office Space
$0
$0
$0
$0
$0
$0
$0
TOTAL SPACE
$0
$0
$0
$0
$0
$0
$0
6.
EQUIPMENT
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
ITEMIZED SERVICE BUDGET
Contract Period: 07/01/2020 - 06/30/2021
EMPLOYEE RELATED EXPENSES
PROFESSIONAL AND OUTSIDE SERVICES
ITEM
Sub-Contracted Providers of
TOTAL EQUIPMENT
$0
$0
$0
$0
$0
$0
$0
7.
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
$16,000.00
$16,000.00
$5,000.00
$5,000.00
$6,000.00
$0.00
$0
TOTAL MATERIALS AND SUPPLIES
$16,000.00
$16,000.00
$5,000.00
$0.00
$5,000.00
$6,000.00
$0.00
8.
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
Records Management (Storage & Destruction)
$708.00
$708.00
$0.00
$0.00
$708.00
$0.00
$0.00
Reprographics
$1,000.00
$1,000.00
$0.00
$0.00
$1,000.00
$0.00
$0.00
Staff Parking Fees
$7,500.00
$7,500.00
$0.00
$0.00
$7,500.00
$0.00
$0.00
Fingerprint Clearance Card
$100.00
$100.00
$0.00
$0.00
$100.00
$0.00
$0.00
Saff Training -Regist. Fees
$6,250.00
$6,250.00
$0.00
$0.00
$6,250.00
$0.00
$0.00
Memberships
$2,350.00
$2,350.00
$0.00
$0.00
$2,350.00
$0.00
$0.00
Advisory Board/Community Meetings
$650.00
$650.00
$0.00
$0.00
$650.00
$0.00
$0.00
Parking Validation Tickets
$1,500.00
$1,500.00
$0.00
$0.00
$1,500.00
$0.00
$0.00
Telecommunication
$4,000.00
$4,000.00
$0.00
$0.00
$4,000.00
$0.00
$0.00
HSD Online Database
$2,639.00
$2,639.00
$0.00
$0.00
$2,639.00
$0.00
$0.00
TOTAL OPERATING EXPENSES
$26,697.00
$26,697.00
$0.00
$0.00
$26,697.00
$0.00
$0.00
9
INDIRECT COSTS
Total
Service
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
ITEM
BASIS
COST
COST
COST
COST
COST
COST
COST
Maricopa County Human Services
$0
$131,505.00
$131,505.00
$62,835.00
$54,788.00
$13,882.00
$0.00
Provisional indirect cost rate is 21.3%
Personnel and ERE only
TOTAL INDIRECT COSTS
$131,505.00
$131,505.00
$62,835.00
$0.00
$54,788.00
$13,882.00
$0
10
SUBTOTAL ADMIN COST
$727,663.00
$727,663.00
$284,699.00
$0.00
$353,966.00
$88,998.00
$0
11.
VOUCHERS
TOTAL
TOTAL DES
LIHEAP
LIHEAP A16
SSBG
TANF
NHN
COST
COST
COST
COST
COST
COST
COST
$445,283.00
$445,283.00
$445,283.00
$3,045,589.00
$3,045,589.00
$3,045,589.00
NHN
$6,910.00
$6,910.00
$6,910.00
TOTAL VOUCHERS
$3,497,782.00
$3,497,782.00
$3,045,589.00
$0.00
$0.00
$445,283.00
$6,910.00
12.
TOTAL SERVICE COST/DES TOTAL COST:
$4,225,445.00
$3,330,288.00
$0.00
$353,966.00
$534,281.00
$6,910.00
REVENUE SOURCES:
DES - DAAS
$4,225,445.00
$3,330,288.00
$0.00
$353,966.00
$534,281.00
$6,910.00
TOTAL REVENUE:
$4,225,445.00
$3,330,288.00
$0.00
$353,966.00
$534,281.00
$6,910.00
MATERIALS AND SUPPLIES
General office supplies
Avg. $1,333 Mo X 12 Months
OPERATING SERVICES
LIHEAP
ITEM
TANF
CONTRACT SERVICE:
Community Services
Agency:
Maricopa County
DI20-002264
1.
PERSONNEL
Total
TOTAL
100%
0%
0%
Number of
FTE
Total Salary for the
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
Positions
Level
Position Title
Contract Period
COST
COST
COST
COST
Cost
1
0.55
Assistant Director
$97,760
53,768.00
53,768.00
53,768.00
0.00
0.00
1
0.30
Admin Services Supervisor
$71,493
21,448.00
21,448.00
21,448.00
1
0.10
CAA Prog Manager
$80,162
8,016.00
8,016.00
8,016.00
0.00
0.00
1
0.75
CSBG Prog Coordinator
$51,272
38,454.00
38,454.00
38,454.00
0.00
0.00
1
0.35
Mgmt. Assistant
$48,632
17,021.00
17,021.00
17,021.00
0.00
0.00
1
0.45
Mgmt. Analyst
$54,600
24,570.00
24,570.00
24,570.00
0.00
0.00
1
0.70
Prog. Coordinator-Evict Prevent/Spec
$68,017
47,611.00
47,611.00
47,611.00
0.00
0.00
1
0.20
Prog. Coordinator Utility Assist
$42,911
8,582.00
8,582.00
8,582.00
0.00
0.00
1
0.25
Surpise WDD Specialist
$49,982
12,496.00
12,496.00
12,496.00
0.00
0.00
1
0.50
Scottsdale/Tempe WDD Specilist
$55,120
27,560.00
27,560.00
27,560.00
0.00
0.00
1
0.50
Grant Accountant
$66,976
33,488.00
33,488.00
33,488.00
0.00
0.00
Total FTEs
4.65
4% Cost of Living Increase
11,721.00
11,721.00
11,721.00
0.00
0.00
TOTAL PERSONNEL
304,735.00
304,735.00
304,735.00
0.00
0.00
2.
EMPLOYEE RELATED EXPENSES
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
$304,735
59,371.00
59,371.00
59,371.00
-
-
Unemployment Insurance
19.87%
60,551.00
60,551.00
60,551.00
-
-
Health Benefits
$60,551
Life Insurance
Ritirement
$12,768
Unemploymrnet & Workers Comp
X 4.65 FTEs
$59,371
TOTAL EMPLOYEE RELATED EXPENSES
.
$119,922.00
$119,922.00
$119,922.00
-
-
3.
PROFESSIONAL AND OUTSIDE SERVICES
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
Check Writing Fees/Insurance
$20,000
$20,000
$20,000
$0
$0
Needs Assessment
$20,255
$20,255
$20,255
$0
$0
Community Initiatives CAP Contracts
$200,000
$200,000
$200,000
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
TOTAL PROFESSIONAL AND OUTSIDE SERVICES
$240,255.00
$240,255.00
$240,255.00
$0
$0
4.
TRAVEL
Total
.
.
.
ITEMIZED SERVICE BUDGET
Contract Period: 07/01/2020 - 06/30/2021
FICA
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
Staff and Advisory Board Conference
$5,000
$5,000
$5,000
$0
$0
and Training Related Lodging/Travel
Staff Mileage
$6,000
$6,000
$6,000
$0
$0
TOTAL TRAVEL
$11,000.00
$11,000.00
$11,000.00
$0
$0
5.
SPACE
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
Office Space
50% of $10,000 x 12 months
$0.00
$0
$0
$0
$0
TOTAL SPACE
$0
$0
$0
$0
$0
6.
EQUIPMENT
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
TOTAL EQUIPMENT
$0
$0
$0
$0
$0
7.
MATERIALS AND SUPPLIES
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
General Office Supplies
$3,000
$3,000
$3,000
$0
$0
Avg. $250 Month X 12 Months
Postage, forms, Business Cards, Calendars, Misc.
$700
$700
$700
$0
$0
$0
$0
$0
$0
TOTAL MATERIALS AND SUPPLIES
$3,700.00
$3,700.00
$3,700.00
$0
$0
8.
OPERATING SERVICES
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
Records Mgmt & Storage
$708
$708
$708
$0
$0
Reporgraphics (coping, printint, ets.)
$1,000
$1,000
$1,000
$0
$0
Staff Monthly Parking Fees
$7,500
$7,500
$7,500
$0
$0
Fingerprint Clearance Cards
$100
$100
$100
$0
$0
Staff Training - Registration Fees
$7,500
$7,500
$7,500
$0
$0
Memberships
$2,350
$2,350
$2,350
$0
$0
Advisory Board/Community Mtgs
Estimated $260 X 5 Events
$1,300
$1,300
$1,300
$0
$0
Parking Validation
Visitor, Parking Stamps
$1,500
$1,500
$1,500
$0
$0
Telecommunications
$4,000
$4,000
$4,000
$0
$0
HSD Online Database
$2,639
$2,639
$2,639
$0
$0
TOTAL OPERATING EXPENSES
$28,597.00
$28,597.00
$28,597.00
$0.00
$0.00
9
INDIRECT COSTS
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
BASIS
COST
COST
COST
COST
Cost
Maricopa County Human Services
21.30%
$90,452
$90,452
$90,452
$0
$0
provisinal indirect cost rate is 22.2% of
Personnel and ERE only
TOTAL INDIRECT COSTS
$90,452.00
$90,452.00
$90,452.00
$0.00
$0.00
10
SUBTOTAL ADMIN COST
$798,661.00
$798,661.00
$798,661.00
$0.00
$0.00
11.
Program Costs
Total
Service
DES service
CSBG
CSBG-DSC
CSBG-EMG
ITEM
COST
COST
COST
COST
Cost
$100,000.00
$100,000.00
$100,000.00
$0.00
$0.00
TOTAL program cost
$100,000.00
$100,000.00
$100,000.00
$0.00
$0.00
$0
$0
12.
TOTAL SERVICE COST/DES TOTA $898,661.00
$898,661.00
$0
$0
REVENUE SOURCES:
DES - DAAS
$898,661.00
$898,661.00
$0
$0
TOTAL REVENUE:
$898,661.00
$898,661.00
$0
$0
vouchers
FES-1000AFORFF (1-16)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Contract Inception
Annual Inventory
End-of-Contract Inventory
CONTRACTOR’S EQUIPMENT LIST
(Capital and Stewardship Equipment Items)
Page ______ of ______
CONTRACTOR’S NAME (Legal name and DBA “doing business as” name)
FEI/SSN
MAILING ADDRESS (P.O. Box or No., Street, City, State, ZIP)
PHONE NO.
DES CONTRACT NO.
CONTRACT BEGIN DATE
CONTRACT END DATE
INVENTORY DATE
Item Description
Manufacturer
Serial No.
Acqu.
Date
Physical Location
Total
Item Cost
DES
Contract Cost
CONTRACTOR’S NAME (Printed)
TITLE
CONTRACTOR’S SIGNATURE
DATE SIGNED
DES CONTRACT NOTICES PERSON’S NAME (Printed)
DES CONTRACT NOTICES PERSON’S SIGNATURE
PHONE NO.
DES PROGRAM
MAIL DROP
DATE SIGNED
See reverse for EOE/ADA/LEP/GINA disclosures.
Exhibit A
Completion Instructions for FES-1000AFORFF
CONTRACTOR’S EQUIPMENT LIST
(Capital and Stewardship Equipment Items)
A. Purpose.
To facilitate the inventory control of capital and stewardship equipment purchased with Department contract funds.
B. Completion.
The following sections must be completed by the contractor within 30 days of acquisition of equipment purchased with contract funds and annually thereafter
until the contract’s termination. At the contract’s conclusion date, an end-of-contract inventory is completed. ALL INFORMATION IS TO BE TYPED.
All items are self-explanatory except:
CONTRACTOR’S NAME. Enter legal name and DBA (doing business as) name.
FEI OR SSN. Enter the federal employer identification number or social security number as applicable.
DES CONTRACT NO. Enter the contract number through which the equipment was purchased or acquired.
INVENTORY DATE. Enter the date form is prepared.
ITEM DESCRIPTION. Enter the type of item and model number.
ACQUISITION DATE. Enter the acquisition date of purchased equipment item.
PHYSICAL LOCATION. Enter the address where the equipment is located. Do not use a “P.O. Box” designation.
TOTAL ITEM COST. Enter the total cost of the equipment item.
DES CONTRACT COST. Enter the amount of contract funds used to acquire the item.
CONTRACTOR’S SIGNATURE. The individual delegated authority for the inventory control must sign the form.
Shaded area is to be completed by DES staff.
C. Routing.
The contractor submits the form to the DES Program Division/Administration Contract Unit within 30 days of the acquisition of the item and annually
thereafter.
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section
504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department
prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The
Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the
Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will
take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you
will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request
this document in alternative format or for further information about this policy, contact your local office; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is
available upon request. • Ayuda gratuita con traducciones relacionadas con los servicios del DES está disponible a solicitud del cliente.