HomeMy WebLinkAboutCOM 0521.061 2002-2004 +tv,w y~,
Harry Kim ~,c Alan R. Parker
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Executive an dgmg
oi'M
Lounty o~ Hawaii
OFFICE OF AGING
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DATE: August 23, 2004
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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
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CHIYOME L FUKINO, M.D. j~ Telephone
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DIRECTOR OF HEALTH (808158fi-0100
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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
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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
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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)
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LINDA LINGLE +E
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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
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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.
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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
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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