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HomeMy WebLinkAboutCOM 0521.061 2002-2004 +tv,w y~, Harry Kim ~,c Alan R. Parker Ngrur Executive an dgmg oi'M Lounty o~ Hawaii OFFICE OF AGING llilo Lagoon Ccntrc. IOI ~upwii Strect, Suitc 342. I lilu. I Lnsai'i 9 6 7 211-4 2 62 I'hunc (%OR)961-8600 • Pas (ROR)9G1-8603 I lanumu Place 7i-i7Uh 6uakini Ilighwav. Suilc 106. ICailua-6une. Ilawai~i 9 6 7 411-1 7 5 1 I'hnnc (HOR) 327-3597 • Pas (ROR) 3273599 ~1 -n r ~ C.: r,, DATE: August 23, 2004 cc TO: James Y. Arakaki Council {~C^"hair and Council Members VIA: Deana ko, ntroller ?.Ik(x/v-r ~n~i-~~ FROM: Alan arker~on Aging RE: NOTIFICATION OF GRANT AWARD Compliance with Ordinance No. 04-74, Section 7(1) Name of Grant Program: Area Plan on Aging Grantor: Dept. of Health, Executive Office of Aging County Grantee Department or Agency: Hawaii County Office of Aging Grant No. (IF KNOWN): HA-2005-1(N) Amount of Grant: $679,975.00 (FY05); $500,922.00 (FY04); 66,456.00 (FY03) Amount of County Match: $120,000.00 County Rev. & Exp. Account Numbers: #3301.04 & #010-411-5411.09 to 10 - $842,653.00 (HCOA) #3301.01 & #010-481-5483.01 to .03 - $301,200.00 (HCNP) #3301.15 8 #010-481-5481.01 to .03 - $103,500.00 (CSE) Grant Period (Commence. & Completion): July 1, 2004 to June 30, 2005 Purpose of Grant: To provide the supportive social services, recreational and cultural programs, congregate and home delivered nutrition services, in- home services, and preventive health services described in the State approved Area Plan for the County of Hawaii. Is final report required by grantor? ~]X Yes ? No Notification attached: ~C] Yes ? No r Comm. No. J • b cc: Parks & Recreation Ref. To: _ Ref. Date ~ i Hoo'~u'i(Tnuvrle nn equal oppurhmtly provider anderrrp[u~~er .Or. bra:I¢rncv nn Aging LINDA LINGLE w" PAT SASAKI GOVERNOR OF HAWAII ,IV,.J ess ,1~~ EXECUTIVE DIRECTOR ~-j,;~ CHIYOME L FUKINO, M.D. j~ Telephone o~~ DIRECTOR OF HEALTH (808158fi-0100 ~.y'n~'y',o~., Faz STATE OF HAWAII leoal seb mes EXECUTIVE OFFICE ON AGING NO. 1 CAPITOL DISTRICT 250 SOUTH HOTEL STREET, SUITE 406 HONOLULU, HAWAII 96813-2831 DATE RECEIVES CIRCl,"1ATE T4 _~l_ , July 7, 2004 r`C7i'"f Tea ~ AC,I~hd BY OA sE f3UE T(7,~ TO: Alan Parker FIDE Executive on Aging Hawaii CounlIty Office of Aging FROM: Pat Sasaki p' O~YS~i~ Executiv`~~.~erector Executive Oflice on Aging SUBJECT: HA-2005-1N Enclosed is your consummated copy of Contract No. HA-2005-IN between the Executive Office on Aging and the Hawaii County Office of Aging. This contract is for the provision of Title III services for FY2005. If you have any questions, please contact Caroline Cadirao at 586-7267. Mahalo. CTGta Encl. O6BOi04 Ii'ED 16:05 FAX 808 580 X185 EXEC OFFICE ON AGING 1~~ HCOA IQ 002 i x` r' ~r STATE OF HAWAII ) SS. COUNTY OF HAWAII ) On this ~G>f? day of ~ , 2004, before me personally appeared DIXIE KAETSU, to me personally known, who, being by me duly sworn, did say that she is the Managing Director of the County of Hawaii, a municipal corporation of the State of Hawaii; that the seal affixed to the foregoing instrument is the corporate seal of said County of Hawaii; that the foregoing instrument was signed and sealed in behalf of the County of Hawaii by authority given to said Mayor of the County of Hawaii by Section 5-1.3(g) of the County Charter, County of Hawaii (2000), as amended, and assigned by the Mayor to the Managing Director pursuant to Section 6-1.3(h) of the County Charter; and said DIXIE KAETSU acknowledged said instrument to be the free act and deed of said County of Hawaii. VIR INIA M, TOLENTINO No ary Public, State of Hawaii My commission expires: 4/22/2005 ~~~~~~~~~ti 7D~ X41..., fps, .i may;. ~y cam` :'~QTaR}'• o i'~j9.. : ~Q.`a~ ''~i~~~tOF 1NP~~~' STATE OF HAWAII AGREEMENT FOR HEALTH AND HUMAN SERVICES: TRANSACTIONS EXEMPT FROM CHAPTER 103F, HRS This Agreement, executed on the respective dates of the signatures of the parties shown hereafter, is effective as of (date) July 1 2004 , between the (agency) Department of Health State of Hawaii (the "STATE"), by its Executive Director Executive Office on Aging (the "DIRECTOR"), whose address is 250 South Hotel Street, Suite 406, Honolulu , and County of Hawaii byand through its County Council and its }~q.~,Maw0'~ Dfrxtor (the"PROVIDER"), a (government entity/corporation/partnership/soleproprietorship/other business form) local government entity whose business address and taxpayer identification number are:Hawaii County Office of Agine 101 Au~uni Street Room 342 Hilo Hawaii 96720 TIN 99-6000567 RECITALS A. This Agreement is for a purchase of health and human services that is exempt from the requirements of Cbapter 103F, HRS, because: ? this Agreement is between or among government agencies as provided in Section ]03F-10](a)(2), HRS; ? this Agreement is to award grants or subsidies of state funds appropriated by the legislature to a specific organization as provided in Section 103F-]Ol(a)(1), HRS, and Section 3-141-503(a)(2), HAR, or to award subawards and subgrants to specific organizations directed by the funding source as provided in Section 3-141-503(a)(1); ® this Agreement is wholly or partly funded from federal sources that conflict with the procedures and requirements established by Chapter 103F, HRS, and its implementing regulations; ? this Agreement is wholly or partly funded from federal sources that (l) identifies a target class of beneficiaries, (2) defines the requirements Tor a provider to he qualified to participate in the federal program, and (3) has the price of the provided health and human services dictated by federal law; EXEMPT TRANSACTIONS Page 1 Form AG3-Exempt(4/99) HA-2005-1(N) ? this Agreement is for an affiliation agreement with hospitals and other health care providers required for University of Hawaii clinical programs; ? this Agreement is for the services of psychiatrist, or psycho?ogists in criminal or civil proceedings as required by a court order or by the rules of the court; ? this Agreement is for a transaction covered by a written exemption from the Chief Procurement Officer for the STATE dated B. The STATE is in need of the health and human services described in this Agreement and its exhibits (the "Required Services"). The PROVIDER is agreeable to providing the Required Services. C. Money has been appropriated for the purchase of the Required Services by: (I) (identify state sources) or (2) (identify federal sources) Older Americans Act Funds ,or both, in the following amounts: State: $ Federal: $ 906.635 D. Pursuant to (legal authority for Agreement) Section 349 - 3 HRS > the STATE is authorized to enter into this Agreement. E. The undersigned representative of the PROVIDER represents, and the STATE relies upon such representation, that he or she has authority to sign this Agreement by virtue of (check any or all that apply): ? corporate resolutions of the PROVIDER or other authorizing documents such as partnership resolutions; ? corporate by-laws of the PROVIDER, or other similar operating documents of the PROVIDER, such as a partnership agreement, or an limited liability company operating agreement; EXEMPT TRANSACTIONS Page 2 Form AG3-Exempt(4/99) HA-2005-1(N) ? the PROVIDER is a sole proprietor and as such does not require any authorizing documents to sign this Agreement; ® the PROVIDER is a government entity, and the undersigned representative of the PROVIDER is duly-authorized to execute contracts on behalf such government entity; ? other evidence of signing authority: F. The PROVIDER has produced, and the STATE has inspected, a certificate of insurance in the amount of N/A DOLLARS ( for bodily injury and property damage liability arising in connection with the PROVIDER'S performance under this Agreement. G. The PROVIDER has produced, and the STATE has inspected, a tax clearance certificate with approval from the State of Hawaii, Department of Taxation, dated N/A , NOW, THEREFORE, in consideration of the promises contained in this Agreement, the STATE and the PROVIDER agree as follows: Scope of Services. The PROVIDER shall, in a proper and satisfactory manner as determined by the STATE, provide the Required Services as set forth in Exhibit "A" to this Agreement, which is attached, and made a part of this Agreement. 2. Term of Agreement. The PROVIDER shall provide the Required Services from (date) July 1 2004 to (date) June 30 , 2007 ,unless this Agreement is sooner terminated. 3. Compensation. The PROVIDER shall be compensated ? in a total amount for all required services not to exceed Nine Hundred Six Thousand Six Hundred Thirty-Five DOLLARS 906,635 including taxes, at the time and in the manner set forth in Exhibit "B" to this Agreement, which is attached, and made a part of this Agreement. ? based upon referrals to the PROVIDER from the STATE, payment EXEMPT TRANSACTIONS Page 3 Form AG3-Exempt (4/99) HA-2005-1(N) for each such referral shall be made according to Exhibit "B" to this Agreement, which is attached, and made a part of this Agreement. The STATE shall provide a minimum of referrals to the PROVIDER. 4. Reporting Requirements. In addition to whatever other reports may be required elsewhere in this Agreement, the PROVIDER shall also submit a Final Project Report, by (date) August 30, 2007 No amendment to the PROVIDER'S Final Project Report shall be considered after (date) September 30, 2007 . 5. Standards of Conduct Declaration. The Standards of Conduct Declaration of the PROVIDER is attached as Exhibit "C", and is made a part of this Agreement. 6. Other Terms and Conditions. The General Conditions for Health and Human Services Contracts (the "General Conditions") are attached as Exhibit "D," and are made a part of this Agreement. If applicable, any Special Conditions are attached as Exhibit "E," and are made a part of this Agreement. In the event of a conflict between the General Conditions and the Special Conditions, the Special Conditions shall control. 7. Notices. Any notice, communication, or information required to be given by any party to this Agreement shall be made in writing, and shall be (a) delivered personally, or (b) sent by United States first class mail, postage prepaid. Notice required to be given to the DIRECTOR shall be sent to the DIRECTOR'S office in Honolulu, Hawaii. Notice to the Agency Procurement Officer shall be sent to: 250 South Hotel Street Suite 406 Honolulu HI 968]3 Notice to the PROVIDER shall be sent to the PROVIDER at the PROVIDER'S address as indicated in this Agreement. Notice to the STATE'S Chief Procurement Officer shall be sent to ll5l Punchbowl Street Rm. 230A, Hon, HI 96813. A notice shall be deemed to have been received three (3) days after mailing or at Che time of actual receipt, whichever is earlier. The PROVIDER is responsible for notifying the STATE in writing of any change of address. EXF,MPT "TRANSACTIONS Page4 FormAG3-Exempt (4/99) HA-2005-1 (N) IN WITNESS WHEREOF, the STATE and the PROVIDER have executed this Agreement effective as of the date first above written. STATE EXECUTIVE OFFICE ON AGING By t Executive Director PROVIDER COUNTY OF HAWAII By Its-A4ager, County of Hawaii ~°i Mmo9tie areefa. RECOMMEND APPROVAL: ~ JUN 15 2004 Hawaii County Office of Bing County Executive APPROVED AS TO FORM AND LEGALITY: Deputy orporation Counsel County of Hawaii APPROVED AS TO FORM: eputy ttorney General State of Hawaii * Evidence of authority of the PROVIDER'S representative to sign this agreement for the PROVIDER must be attached. EXEMPT TRANSACTIONS Page 5 HA-2005-I(N) Form AG3-bxempt PROVIDER'S ACKNOWLEDGMENT Sta of ) SS. County of ) On this day of ,before me personally appeared , to me personally known, who being by me duly sworn, did say that he a is the of t PROVIDER named in the foregoing instrument, and that he/she is authorized to sign said in rument on behalf of the PROVIDER, as provided in Recital E of the foregoing Agreeme and acknowledges that he/she executed said instrument as the free act and deed of the P OVIDER. Notary Public, My commission expires: EXEMPT TRANSACTIONS Page 6 Form AG3-Exempt HA-2005-1(N) SCOPE OF SERVICES (Federal OAA) PROVTDER shall, in a satisfactory and proper manner as detern,i„~~ ~y ,i,c STATE and in accordance with the terns and conditions of this Agreement, use the Older Americans Act (OAA) funds received under this Agreement to provide and implement the following authorized services described in the OAA: Part B: Supportive Services, Pari C: Nutrition Services, including Congregate (C1) and Home Delivered Nutrition Services (C2), Part D: Disease Prevention and Health Promotion Services specifically including activities related to medication management, screening and education to prevent incorrect medication and adverse drug reaction, pursuant to the Consolidation Appropriation Act, 2001 (P.L. 106-554), and Part E: National Family Caregiver Support Program as described in the STATE approved 2004 - 2007 Area Plan for the County of Hawaii which is incorporated herein by reference. PROVIDER shall comply with all regulations and requirements of the expending Federal agency and implement the Older Americans Act of 1965, as amended. Federal guidelines supersede all local policies and must be followed as prescribed or as requested by the state agency. Exhibit "A" Page 1 HA-2005-](N) COMPENSATION AND PAYMENT SCHEDULE (Federal OAA) 1. COMPENSATION. Subject to continuing availability of funds, the STATE agrees to pay PROVIDER, for services satisfactorily performed under this Agreement, a sum not to exceed NINE HUNDRED SIX THOUSAND, SIX HUNDRED AND THIRTY-FNE DOLLARS ( 906 635), provided that PROVIDER shall apportion said sum among the programs/activities set forth in Exhibit "A," Scope of Services. Payment of this sum shall constitute full and complete compensation for all services, materials, supplies, equipment, overhead, taxes, incidentals, and operating expenses that PROVIDER incurs in the performance of this Agreement. It is strictly understood and agreed by PROVIDER that the sum payable under this Agreement shall be paid only upon receipt by the STATE of those federal funds described and provided pursuant to the STATE's Plan on Aging. The STATE shall not pay said amount to PROVIDER out of any funds other than those received from the Department of Health and Human Services (DHHS). 2. METHOD OF PAYMENT. a. The funds awarded to the STATE by the DHHS and appropriated by the state legislature for purposes of this Agreement shall be subject to the allotment system as provided in Chapter 37, Hawaii Revised Statutes. b. Subject to the availability of funds, payments to PROVIDER under this Exhibit `B" Page 1 HA-2005-1(N) Agreement shall be made in accordance with and subject to the provisions of Chapter 7, Request for Payments (Area Agency on Aging Reporting Handbook), and are subject to the following appropriate Federal or State provisions: c. Federal-Older Americans Act Funds (1) The STATE shall use the allocation plan contained in Exhibit B-1 as a basis for paying PROVIDER upon submission by PROVIDER of written request for payment. (2) Program income, and interest or investment income, hereafter referred to as "income," that is collected or earned by PROVIDER or any of its subcontractors as a result of activities supported by funds provided to PROVIDER under this Agreement, shall be retained by PROVIDER or subcontractors earning such income and shall be spent for the expanded level of services prior to using funds provided under this Agreement. Any income in excess of the amount projected in the allocation plan for the expanded level of services shall also be spent prior to using funds provided under this Agreement. (3) All payments shall be made in accordance with and subject to Chapter 40, Hawaii Revised Statutes, which specifies the accounting procedures and controls applicable to pa}nnents out of the Treasury of the State of Hawaii. Exhibit "B" Page 2 HA-2005-1(N) <O Oo r T A W v, t0 N ~I m N A W N O. l T = J T1 -i -1 J N (n 'II ~ N Z ~ T~ O O O T~~ ~ O rn- mo d ° o Q ~ c~ Z 7~ W N p N~~ O O 9I D m ~ m v D 3 m o- ~ cD O d m m m m 0 con n C7 n ? N O In N O o7 O O 11 D N 7 .Z, .3, m C C O O m d o 9t C 0 (/1 O N N OI N 7 C7 o m' T T m m a d m D D D ~1 ~ O = Q n a ~ o ~ d 0 0~ o n n m m ~ d 3 3 p A O N d N N W tD O ~ d > > Z S OJ O ~ C D d p~ ~ !D Z m ~ ~ C L ~ ~ C p~ ~ J - ~ O W a ~ O o f W W~ W~ p O O_ O ~ ~ _ ~ D Co aD v V1 07 ~ O O 01 O f/~ O O W O d N O ~ j N N N N D 4 O O ON V d m AA A w n ~ 3 ~ ~ 0 0 0 0 ~ _ ~ 0 0 0 0 T m v fD ~ O ' W N- S ~ W a (n N ~ W W C 01 Q) J O _ N cn (n A ' - W W O W C> (D (O A N N O O O O O O O O cn _ _ _ 0 J ~l N A A O O ~I N . A A Co 6~ _ y O) Q) A N 0 C O O O O ~ O 0 0 0 3 (D d N N (O W ' 3 (D (O J N ~ ~ _ N ~ W ~ V m ~ O 0 0 0 N O O O O O _ A Qf (O (O O) N O O ~l N T m O W O m (O ~ d (P (T Ui O N O ~ O O O O O O O LINDA LINGLE +E o r,~Hq:~ PAT SASAKI GOVERNOR OF vAVJAn ss `'~.w ExECUTrvE DIRECTOR CNIYOME L PUKING, M.D. 1 ~ Telephone DIRECTOR OF HEALTH tl~ (aOaJ Safi-0t0e ~i....9~ 'vP pad` Fax STATE OF HAWAII leoa) sae-mas EXECUTIVE OFFICE ON AGING NO. 1 CAPITOL DISTRICT 250 SOUTH HOTEL STREET, SUITE 406 HONOLULU, HAWAII 96813-2831 DATE I:ECEIVED p y' June 30, 2004 ~ I ~ FILE TO: Alan Parker Executive on Aging Hawaii County Office of Aging FROM: Pat Sasaki Executive rector Executive Office on Aging SUBJECT: HA-2004-1(I~ Enclosed is your consummated copy of Contract No. HA-2004-1(N), Supplemental Agreement No. 2 between the Executive OPFice on Aging and the Hawaii County Office of Aging. Please retain this as your file copy. The enclosed supplemental contract extended the time of performance and incorporated your approved area plan for the period of October 1, 2004 - September 30, 2007. If you have any questions, please contact Caroline Cadirao at (808) 586-7267. Mahalo. CTGta Encl. STATE OF HAWAII SUPPLEMENTAL AGREEMENT NO. 2 TO AGREEMENT HA-2004-1 (N) (EOA's Primary Contract This Supplemental Agreement No. 2 ,executed on the respective dates indicated below, is effective as of June 30 2004 ,between the Department of Health State of Hawaii (the "STATE"), by its Executive Director Executive Office on Aging , (Insert title of State officer executing agreement) whose address is 250 South Hotel Street Suite 406 Honolulu Hawaii 96813 and County of Hawaii by and through its County Council and its Manaaino Director (the "PROVIDER"), a oovernment entity business address and taxpayer identification number are: Hawaii County Office of A in 101 Au uni St. Room 342 Hilo Hawaii 96720 TIN 99-6000567 RECITALS A. WHEREAS, the STATE and the PROVIDER entered into an Agreement No. HA-2004-1(N) , (Insert agreement number or other identifying information) dated July 1 200 3 ,which was amended by Supplemental Agreement No(s) 1 dated September 30 2003 (hereinafter collectively referred to as "Agreement") whereby the PROVIDER agreed to provide the goods or services described HA-2004-1(N), Supplemental Agreement No. 2 I in the Agreement, and WHEREAS, the parties now desire to amend the Agreement, NOW, THEREFORE, the STATE and the PROVIDER mutually agree to amend the Agreement as follows: (Check applicable box(es)) ® Amend the SCOPE OF SERVICES according to the terms set forth in Exhibit "A", which is attached hereto and is incorporated herein. ® Amend the TIME OF PERFORMANCE according to the terms set forth in Exhibit "C", which is attached hereto and is incorporated herein. ? Amend the COMPENSATION AND PAYMENT SCHEDULE according to the terms set forth in Exhibit "B", which is attached hereto and is incorporated herein. ? Amend the SPECIAL CONDITIONS according to the terms set forth in the Supplemental Special Conditions, which is attached hereto and incorporated herein. A tax clearance certificate from the State of Hawaii ? is ®is not required to be submitted to the STATE prior to commencing any performance under this Supplemental Agreement. A tax clearance certificate from the Internal Revenue Service ? is ®is not required to be submitted to the STATE prior to commencing any performance under this Supplemental Agreement. Unless amended herein, the Agreement shall remain in full force and effect. HA-2004-1(N), Supplemental Agreement No. 2 2 IN VIEW OF THE ABOVE, the STATE and the PROVIDER execute this Supplemental Agreement No. 2 by their signatures below. STATE EXECUTIVE OFFICE ON AGING ~ts Executive Director PROVIDER COUNTY OF HAWAII By ~rie~ 4~ unty of Hawaii APPROVED BY: Hawaii County Office of Aging County Executive APPROVED AS TO FORM AND LEGALITY: Deputy Corporation Council County of Hawaii APPROVED AS TO FORM: ~,2wyr- , Deputy`Attorney General State of Hawaii 'Evidence of Authority of the Provider's representative to sign this Agreement for the Provider must be attached. HA-2004-1(N), Supplemental Agreement No. 2 3 00/'0/04 V1'ED 16:05 FAX 808 586 0185 EXEC OFFICE ON AGING HCOA IAJ 002 + f. X` STATE OF HAWAII ) SS. COUNTY OF HAWAII ) On this /G>f? day of ~ , 2004, before me personally appeared DIXIE KAETSU, to me personally known, who, being by me duly sworn, did say that she is the Managing Director of the County of Hawaii, a municipal corporation of the State of Hawaii; that the seal affixed to the foregoing instrument is the corporate seal of said County of Hawaii; that the foregoing instrument was signed and sealed in behalf of the County of Hawai i by authority given to said Mayor of the County of Hawaii by Section 5-1.3(g) of the County Charter, County of Hawaii (2000), as amended, and assigned by the Mayor to the Managing Director pursuant to Section 6-1.3(h) of the County Charter; and said DIXIE KAETSU acknowledged said instrument to be the free act and deed of said County of Hawaii. VIR INIA M. TOLENTINO No ary public, State of Hawaii My commission expires' 4122/2005 \~~~~~~t~U7D~ ~i~~~~~ ~~ps... ~kl ~o T ~y ~Q ~..o a 'Q. A: G~.~ SCOPE OF SERVICES (Federal OAA) The Scope of Services is amended to as follows: PROVIDER shall, in a satisfactory and proper manner as determined by the STATE and in accordance with the terms and conditions of this Agreement, use the Older Americans Act (OAA) funds received under this Agreement to provide the following authorized services described in the OAA: Part B: Supportive Services, Part C: Nutrition Services, including Congregate (C1) and Home Delivered Nutrition Services (C2), Part D: Disease Prevention and Health Promotion Services specifically including activities related to medication management, screening and education to prevent incorrect medication and adverse drug reaction, pursuant to the Consolidation Appropriation Act, 2001 (P.L. 106-554), and Part E: National Family Caregiver Support Program as described in the STATE approved 2004 - 2007 Area Plan for the County of Hawaii which is incorporated herein by reference. All other provisions in the Scope of Services shall remain unchanged. Exhibit "A" Page 1 HA-2004-1(N), Supplemental Agreement No. 2 TIME OF PERFORMANCE (Federal OAA) The Time of Performance is amended as follows: The PROVIDER shall provide the Required Services from July 1, 2003 to September 30, 2005, unless the agreement is sooner terniinated. EXHIBIT' "C" Page 1 HA-2004-1(N), Supplemental Agreement No. 2