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HomeMy WebLinkAboutCOM 0454.000 2004-2006 ~MiV of N,~' I-lorry I<im William Takaba U6r;9} Vqi ar - lJ,rc'clni' Nancy E. Creiwford ~i Depu~' D,rrclur 1F~ Ci ~Mri~ I County of Hawaii Finance Department, 25 Aupum Stet, Koom I I8 • Hdn. I Inw~ii 96720 ~SIlRl 961-8'31 . Pax I80819h I-824H September 21, 2005 Stacy K. Higa, Chairperson and Members of the Hawaii County Council Hawaii County Council 25 Aupuni Street Hilo, Hawaii 96720 Re: Operating Budget The Department of Human Services will be awarding the Chore Services Contract (Purchase of Services) to the County of Hawaii for the period 07/01/05 - 06/30/06, with the Department of Parks and Recreation's Coordinated Services for the Elderly (CSE) Division receiving this funding via the Office of Aging. This will enable Coordinated Services staff to provide in-home chore services (routine housecleaning, laundry, meal preparation, marketing, shopping assistance, personal care, errand and escort services) to seniors. For the past 30+ years, the County had been providing these services to the seniors on the Big Island. However, the Department of Human Services decided to give another provider the Chore Services Contract for fiscal year 2005-06. When the new provider withdrew their application, the DHS negotiated with the Office of Aging to have CSE continue to provide the CHORE Services. An extension to the original contract was granted to December 15, 2005, with another contract being drafted up now to take it to the end of June 2006. The total Chore funds for the entire fiscal year will not exceed $69,127. Enclosed is a resolution to authorize the Mayor to enter into an agreement with the State of Hawaii Department of Human Services for the Adult Chores Services Grant. Also enclosed is a bill for an ordinance amending the Operating Budget by appropriating this Adult Chores Services Grant. If there are any questions, please do not hesitate to call the Office of Aging and the Department of Parks and Recreation. Comm. ~o• WilliamlTakaba Director of Finance Ref. To: Ref. Dote "~'~j ~ n'Sg ~ Hawai'i County is an Equal Opportunity Provider and Employer Stacy K. Higa Page 2 September 21, 2005 APPROVED: Harry Kim Mayor Enc. cc: Parks & Recreation, Aging DEPARTMENT OF FINANCE REQUEST FOR COUNCIL ACTION DEPARTMENT: Ofice of Akins DATE: 9/20/05 STAFE CONTACT: Dennis Shiaeta PHONE: 961-8600 A. REQUEST: 7b enter into agreement with Department of Human Services to provide Chore Services to the Elderly on the Island of Hawaii, July 1, ?005 to .tune 30.2006. B. BACKGROUND AND.IUS"fIFICATION (Uscadditional sheets as neededl: The Department of Human Services (DIIS) originally decided to give another provider the Chore contract effective July 1, 2005. Ilowcver, DIIS was not able to finalize the contract so they asked Coordinated Services (CSE) to continue providing Chore Services after July 1, 2005 on an extension contract (attached) through December 15. 2005. The new provider has since withdrawn their application so DHS has negotiated with the Office of Aging to have CSI' continue to provide Chore Services for the rest of Use fiscal year. The contract after the extension period is cw~rently being drafted by DHS. The total Chore funds for the fiscal year will not exceed $69,127.00. SIGNED: ~ 1~~ DATE: 9/20/05 Department Head GRANT SUMMARY (Supplement to B-52, Request for Council Action) t e of Grant A ro riation bein * re nested: (New or an additional a ro riation) ® New (tor this fiscal year period). OR ? Additional appropriation (to an existing grant); is a drat[ a~~reemenl anached? Ha,r the ori~>incd Krun! no~ificcilion been Transmitted to ® l'es ? Nn Comicil? ? Yes ? No Name of Grant Program: Adult Chore Services -East Hawaii & West Hawaii Grantor: State of HI, Department of Human Services, Social Services Division, Support Service Office County Grantee Department or Agency: Office of Aging County Grantee Contact Person: Dennis Shigeta Phone Number: 9G1-8600 Amount of Grant $69,127.00 Grant Period (Commencement & Completion): July 1, 2005 to June 30, 2006 Purpose of Grant To provide Chore services to the elderly. County Match required?: ? Yes ®No ff yes, Matching Amount'? Budgeted in account# In-kind? Explain: Explanation: County's personnel requirements: Amount of new position(s)? Qty: Permanent: ? Temporary: Duration: Dull-time: ? Part-time: Time Element: Qty: Contractual: ? Explain: Explanation: Additional Comments about Grant: R-5? (iran~ Summary Fonn STATE OF HAWAII ' SUPPLEMENTAL AGREEMENT NO. 2 TO AGREEMENT DHS-o2-P05-1207 pnrn.~.m.m «w~».fa.r~tllyr~p,Mwm.oay This Supplemental Agreement No. 2 ,executed on the respective dates indicated below, is effective as of June 1 , 200 5 ;between the Department of Human Services State (NUM nm. o/ tfw ap.~vn.nl..w~.r. Bond «mmrsvonJ of Hawaii ,'hereinafter'STATE~, by its Director rx,:.n oi.cuo.ip whose addresslS 1390 Miller Street, Room 209, Honolulu, Aawaii 96813 -,and Hawaii County Office of Aging (hereinafter 'CONTRACTOR'), a non-profit organization (MSnt 'coryo~6on,' ywiezAp.' 7ri'r rsnt,n.' •doN popwMrpAp,' «aMr MON bn d IM G~otaJ under the laws of the State of Hawaii ,whose business address and taxpayer identification number are as follows: 101 Aupuni Street #6A, Hilo, Hawaii 96720 Federal ID# 99-6000-567 State ID# 30016002 RECITALS A. WHEREAS, the STATE and the CONTRACTOR entered into an Agreement DHS-02-POS-1207 (MSM pnomsM nwnDoi «otlNr id~ntlryrp iMiorms9D/y . Adult Chore Services -East Hawaii 2001 dated July 1 , which was amended by Supplemental Agreement No(s). AG-Sapp (11!96) i ,dated January i, 2002 (hereinafter collectively referred to as "Agreement") whereby the CONTRACTOR agreed to provide the goods or services described in the Agreement, and 6. WHEREAS, the parties now desire to amend the Agreement, NOW, THEREFORE, the STATE, and the CONTRACTOR mutually agree to amend the Agreement as follows: (Check applicable box(es)) O Amend the SCOPE OF SERVICES according to the terms set forth in Attachment S1, which is attached hereto and is incorporated herein. Amend the TIME OF PERFORMANCEaccording to the terms set forth iq Attachme/nt S2, which is attached hereto and is incorporated herein. ~J Amend the COMPENSATION AND PAYMENT SCHEDULE according to the terms set forth in Attachment S3, which is attached hereto and is incorporated herein. O 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 certficate from the State of Hawaii O is l9'"~s not required to lie submitted to the STATE prior to commencing any performance under this Supplemental Agreement. A tax clearance certificate from the Internal Revenue Servit:e O 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. 2 Ro-s,~ ti ~fvq IN VIEW OF THE ABOVE, the STATE and the CONTRACTOR execute this Supplemental Agreement No. 2 by their signatures on the dates below. STATE: By Print Name Lillian B. Ko11Pr_ Fcn Title Director Date AUG Q 3 ~uU~ FUNDING AGENCY (to be signed by Head wlundup agency tl oNSr Nan Ne Confrdeturg AgsnryJ By _ Print Name - - ~ 'True / ~~s e~ Date APPROVED AS TO CONT CJ FORM AND LEG-,AIILITY: By c U~'`~' Print Name c~x.E K,~,ers~s r,~P C:CJftP6RA'TIpN ~©uNS~I Co Nrr ~~~A~'~~ 2005 Title Ddr®----- - Date b ~IS ~OS •eawne. d ~utlwn?y d 1M cww.aora ~p.s.M.N.. ro sipn lAi~ Supp~.m.nrr Api.rnnf mwf b NbrJrd APPROVED AS TO FORM: Certification Attached Deputy Ariomey General 3 AGSvpy f 111^a8J STATE OF HAWAII ) SS. COUNTY OF HAWAII ) k+, On this ~S day of 'S~- , 2005, 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. JEAN IERNES Notary Public, State of Hawaii My commission expires: 11/1/2005 CONTRACTOR'S ACKNOWLEDGMENT . State of SS. County of ) On this day o 199_, before me personally appeared to me personally known, who being by me duly swo did say that he/she is the of the CONTRACTOR named in the foregoing ins ent, and that he/she is authorized to sign said instrument on behalf of the CONTRACTOR, andacknowledges that he/she executed said instrument as the free act and deed of the C NTRACTOR. Notary P blic, My commi sion expires: U AG-Sapp (11/91) ~ STANDARDS OF CONDUCT DECLARATION For the purposes of this declaration: . "Agency" means and inGucies the State, the legislature and its committees, all executive departments, boards, commissions, committees, bureaus, offices, the University~of Hawaii, and all independent commissions and other establishments of the state government but excluding the courts. "Controlling interest means an interest in a business or other undertaking which is sufficient in fad to control, whether the interest is greater or less than fifty per cent (50%). "Employee" means any nominated, appointed, or elected officer or employee of the State, including members of boards, commissions, and committees, and employees under contrail to the State or of the constftutional convention, but exGuaing legislators, delegates to the constitutional convention, justices, and judges. On behalf Of Hawaii County Office of T~ging ,CONTRACTOR, the undersigned does declare as follows: 1. CONTRACTOR O is is not a legislator or an employee or a business in which a legislator or an employee has a controlling interest' I 2. CONTRACTOR has not been assisted or represented by a legislator or employee for a tee or other compensation to obtain this Supplemental Agreement and will not be assisted or represented by a legislator or employee for a fee or other compensation in the performance of the Supplemental Agreement, if the legislator or employee had been involved in the development or award of the Supplemental Agreement 3. CONTRACTOR has not been assisted or represented for a fee or other compensation in the award of this Supplemental Agreement by an Agenq employee or. in the case of the Legislature, by a legislator. 4. CONTRACTOR has not been represented or assisted personally on matters related to the Supplemental Agreement by a person who has been an employee of the Agency within the preceding two (2) years and who participated while in state office or -employment on the matter with which the Supplemental Agreement is directly concerned. 5_ CONTRACTOR has not been represented or assisted on matters relates to this Supplemental Agreement, for a fee or other consideration by an i~idividuafvrho; within- the past twelve (12) months, has been an Agency employee, or in the case of the Legislature, a legislator. 6. CONTRACTOR has not been represented or assisted in the award of this Supplemental Agreement for a fee or other consideration by an individual who, a) within AG-S~ryp (I 1 N!) the past twelve (12) months, served as an Agency employee or in the case of the Legislature, a legislator, and b) participated while an employee or legislator on matters related to this Supplemental Agreement. CONTRACTOR understands that the Supplemental Agreement to which this document is attached is voidable on behalf of the STATE if this Supplemental Agreement was entered into in violation of any provision of chapter 84, HRS, commonly referred to as the Code of Ethics, including the provisions which are the source of the declarations above. Additionally, any fee, compensation, gift, or profd received by any person as a result of a violation of the Code of Ethics may be recovered by the STATE. DATED: ~ .Hawaii, 19'~S. CONTRACTOR et' Title ~ 'Reminder to Agency: If 'is' is checked, the Agency is required, under section 84-15, HRS, to file with the State Ethics Commission, ten (10) days before the Supplemental-Agreement is entered into, a written justification as to why the Supplemental Agreement was not required to be competitively bid. AG-Supt' (11J9~ CERTlF7CATE OF EXEMPTION FROM CIVIL SERVICE , f By Heads of Departments or Agencies as Delegated by the Director of Human Resources Development (a.) Pursuant to a delegation of the authority by the Director of Human Resources Development, I certify that the services provided under this Contract, and the person(s). providing the service's. under this Contract are exempt from the civil service, pursuant to §76-16, Hawaii Revised Statutes (}IRS). (SignaNn) Lillian B. Koller, Eso. (Prior Name) Director ' (Print Title) AUG 0 3 ~uU~ (Date) a. This page of this two-paged certificate may be used by all department heads and others to whom the Director of Human Resources Development has delegated authority to certify §76-16, HRS, civil service exemptions. The specific paragraph(s) of §76-16, HRS, upon . which an exemption is based should be noted in the contract file. NOTE: If authority to certify exemptions under §§76-16(2), 76-16(3), 76-16(12), and 76-16(15), HRS, has not been delegated, only the Director of DHRD may certify §§76- ]6(2), 76-16(3), 76-16(12), and 76-16(15) exemptions. AG/SP~ FORM-K(Ix10/Ol) Attachment S2 Supplemental Agreement No. 2 TIME OF PERFORMANCE The time of performance is extended from the current termination date of: July 1, 2005 to the new termination date of: December 15, 2005 or sooner as determined by the Department based on when a replacement contract has been executed, which ever occurs first. as allowed in the document(s) checked below: Section 2 of the Request for Proposals. X Exhibit "E" of the original contract. X §3-149-301 of Hawaii Administrative Rules regarding the extension of existing contracts during a procurement process under Chapter 103F, HRS. §3-141-503(a)(2) of Hawaii Administrative Rules regarding exemptions from procurement procedures for grants and subsidies. • Attachment S3 Supplemental Agreement No. 2 Contract No. DHS-02-POS-1207 COMPENSATION AND PAYMENT SCHEDULE 1. This Supplemental Agreement provides for a change in funding for fiscal year(s): 2006 Accordingly, Paragraphs 1, 7, and 13 of the Compensation and Payment Schedule shall be amended, where applicable, as follows: 1 Sum Not to Exceed. Subject to continuing availability of State and federal funds, STATE agrees to pay PROVIDER for services satisfactorily performed under this Agreement, the total sum not to exceed: ONE HUNDRED EIGHTY-THREE THOUSAND, EIGHT HUNDRED SEVENTY-TWO AND 59/100 DOLLARS ($183,872.591 This sum shall be allocated as follows for the specified fiscal year(s): FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 State Funds $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 Federal Funds 0 0 0 0 0 (CFDA N/A N/A N/A N/A N/A Contract Total $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 In-Kind N/A N/A N/A N/A N/A Grand Total $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 7 Manner or Method of Payment. Where the State has agreed to pay the PROVIDER according to an approved budget for expenditures actually and appropriately incurred in the performance of this Agreement, the PROVIDER shall submit for approval of the STATE a revised budget for those fiscal years in which funding has changed. 3 Paymeut Rate and Service Capacity The quarterly payment rate is revised as follows for those fiscal years in which the funding has changed: 1. Attachment 53 Supplemental Agreement No. 2 Contract No. DHS-02-POS-1207 COMPENSATION AND PAYMENT SCHEDULE 1. This Supplemental Agreement provides for a change in funding for fiscal year(s): 2006 Accordingly, Paragraphs _ 1, 7, and 13 of the Compensation and Payment Schedule shall be amended, where applicable, as follows: I Sum Not to Exceed. Subject to continuing availability of State and federal funds, STATE agrees to pay PROVIDER for services satisfactorily performed under this Agreement, the total sum not to exceed: ONE HUNDRED EIGHTY-THREE THOUSAND. EIGHT HUNDRED SEVENTY-TWO AND 59/100 DOLLARS ($183.872.59 This sum shall be allocated as follows for the specified fiscal year(s): FY 2002 FY 2003 FY 2004 FI' 2005 FI' 2006 State Funds $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 Federal Funds 0 0 0 0 0 (CFDA N/A N/A N/A N/A N/A Contract Total $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 In-Kind N/A N/A N/A N/A N/A Grand Total $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 7 Manner or Method of Payment. Where the State has agreed to pay the PROVIDER according to an approved budget for expenditures actually and appropriately incurred in the performance of this Agreement, the PROVIDER shall submit for approval of the STATE a revised budget for those fiscal years in which funding has changed. 13 Payment Rate and Service Capacity The quarterly payment rate is revised as follows for those fiscal years in which the funding has changed: 1. Attachment S3 Supplemental Agreement No. 2 Contract No. DHS-02-POS-1207 QUARTERLY PAYMENT RATE TABLES FY 06 STATE $ FEDERAL $ OTHER $ TOTAL 151 Qtr $8,640.87 N/A N/A $8,640.87 2„n Qtr $7,200.72 N/A N/A $7,200.72 3`d Qtr N/A N/A N/A N/A 4`n Qtr N/A N/A N/A N/A TOTAL $15,841.59 N/A N/A $15,841.59 Unless otherwise agreed the annual number of service units expected for those fiscal years in which the funding has changed will equal the approved budget for those fiscal years, including approved can-yover, divided by the unit rate as applicable. Unless otherwise agreed the average monthly service unit capacity which must be maintained for those fiscal years in which the funding has changed will equal the annual number of service units for each of those fiscal years divided by twelve (12). 2. All other terms and conditions of the Compensation and Payment Schedule, including the paragraphs amended pursuant to this Supplemental Agreement, shall remain valid and enforceable unless otherwise contradictory to this Supplemental Agreement. 2. Adult Chore Services - E. HI DHS-02-POS-1207 Supplement #2 CERTIFICATION OF CHAPTER ] 03F AGREEMENT WI~~N NEW AGREEMENT IS SUBSTANTIALLY SI1vIII,.AR TO PRIOR AGREI~NT The undersigned agency officer or employee declares: ~ . 1. The agency has had during the immediately preceding year a Chapter 103E agramera with the same recipient or provider, the scope of services and other terms and wnditiotu of which are substantially the same as those of the new agreement. 2. I am not txtrrently aware of any rtslsson why the new agreement should not be entered into with the provider or retapiettt, ~ the case maybe. 3. Unless deleted or modified by the earlier agreement, all of tha General Conditions for Neahh and Human Services Contracts, Form A(33 HIiS(3C (4J99~ will apply to the new a~ecment. 4. No new Special Conditions will apply to the new agreement. 5. The Scope of Services of the never agreement will not conflict with or vary arty material term of the proposal received from the recipient or provider for the agreernetrt. 6. The earlier ttgreemeut was apptoved as to form by a deputy attorney general or preapproved pursuant to the terms set forth in this Interdepartmental Memorandum. DATED: Honolulu, Hawaii, JUL 1 3 ~u~5 AGENCY: Department of Human Suvices B}~~ . g Signahue) Marquis Miyauchi (Print or Type Namb ~ Certifying Signature) Its: Support Services Office Administrator (fiUe of Certifying Signattrrs) The completion of this certificate in compliance with ATTORNEY GENERAL'S INTERDEPARTMENTAL MEMORANDUM NO. 1999-OS constitutes approval as to the form of the attached convect by the Department of the Attorney General without further review. STATE OF HAWAII ' SUPPLEMENTAL AGREEMENT NO. 2 TO AGREEMENT DHS-02-POS-1208 Ibwrt pnan~~r nn~wr a orMr iangywp This Supplemental Agreement No. 2 ,executed on the respective dates indicated below, is effective as of June 1 , 200 5 ;between the Department of Human Services State fwu«r mnr M aW d~p~abnML ap~nry, eor4 a mnmatieiy of Hawaii (hereinafter `STATE7, by its nirector Irusn a+~+~q whose address i5 1390 Miller Street, Roam 209, Honolulu, Aawaii 96813 ,ate Hawaii County Office of Aging (hereinafter `CONTRACTOR7, a non-profit organization (Ins~rl ' ~e'v4' ywrisAip.' 7oin1 rMlu~.' IoM proyrirlorsl~.' or eNrr I~pd Ibm~ a tlr Co++u~e~oQ under the laws of the State of Hawaii ,whose business address and taxpayer identification number are es follows: 101 Aupuni Street #6A, Hilo, Hawaii 96720 Federal ID# 99-6000-567 'State ID# 30016002 RECITALS. A. WHEREAS, the STATE and the CONTRACTOR entered into an Agreement DHS-02-POS-1208 (ln»rt prMmsiN nurn0ar a ofl»~ ldm~yinp irdanrrliory Adult Chore Services -West Hawaii 2001 dated July 1 , 199_, which was amended by Supplemental Agreement No(s~ AG-Sapp p INf) 1 ,dated January 1, 2002 (hereinafter collectively referred to as "Agreement") whereby the CONTRACTOR agreed to provide the goods or services described in the Agreement, and g. WHEREAS, the parties now desire to amend the Agreement, NOW, THEREFORE, the STATE, and the CONTRACTOR mutually agree to amend the Agreement as follows: (Check applicable box(es)) ? Amend the SCOPE OF SERVICES according to the terms set forth in Attachment S1, which is attached hereto and is incorporated herein. l~ Amend the TIME OF PERFORMANCE-according to the terms set forth iq Attachment S2, which is attached hereto and is incorporated herein. Amend the COMPENSATION AND PAYMENT SCHEDULE according to the terms set forth in Attachment S3, 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 O is l~ not required to be submitted to the STATE prior to commencing any pertormance under this Supplemental Agreement. A tax clearance certificate from the Internal Revenue Service O is not required to be submitted to the STATE prior to wmmencing any perfomnance under this Supplemental Agreement. Unless amended herein, the Agreement shall remain in lull force and effect. 2 ~o-s~ a inn) IN VIEW OF THE ABOVE, the STATE and the CONTRACTOR execute this Supplemental Agreement No. 2 by their signatures on the dates below. STATE: By Print Name Li 11 i an B. Kol 1 er, Esq. Title Director Date AUG 0 3 [uu5 FUNDING AGENCY (ro ee signed Dy need o1 /undinp _ u.._y,._.._ I agency d other then tlro Confrddulg AgenoY) S / i ff{ B f ! y ` - ~ Print Name i ~ ; (c~~~~OS Title Date APPROVED AS TO CON CT R: FORM AND LEGpA~LITY: gy ~~~U~~ v~^----~ Print Name D~~~' ~ ~ ~ ~ DE CORPORATION COUNSEL TIUe • ~;~tc€ CO TY OF W II Dpt® JU~I ~ 4 2005 _ Date ~ ~ Is los ~Evidrna d suthorey d Ws ConD7doh np~asrMeOre ro sipn ew Suppl~m~~fd Apis~mny muq b NbtlNQ APPROVED AS TO FORM: Certification Attached Deputy Attorney General ~ AU-SvFDfl l/9m) STATE OF HAWAII ) SS. COUNTY OF HAWAII ) On this (S day of 5.,~,,.x.. , 2005, 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. 4t-~- V ~-e ~~r~ JEAN IERNES Notary Public, State of Hawaii My commission expires: 11/1/2005 C TRACTOR'S ACKNOWLEDGMENT . State of ' SS. County of ) On this day of 199_, before me personally appeared , to me personally known, who being by me duly sworn, did ay that he/she is the of the CONTRACTOR named in the foregoing instrume t, and that he/she is authorized to sign said instrument on behalf of the CONTRACTOR, an acknowledges that he/she executed said instrument as the free act and deed of the CON CTOR. Notary Publi , My commiss' expires: AGdupp (1 IN8) STANDARDS OF CONDUCT DECLARATION For the purposes of this declaration: "Agency" means and includes the State, the legislature and its committees, all executive departments, boards, commissions, committees, bureaus, offices, the University-of Hawau, and all independent commissions and other establishments of the state government but excluding the courts. "Controlling interest means an interest in a business or other undertaking which is sufficient in fad to control, whether the interest is greater or Tess than frfty per cent (50°kj. "Employee' means any nominated, appointed, or elected officer or employee of the State, including members of boards, commissions, and committees, and employees under contract to the State or of the constftutional convention, but excluding legislators, delegates to the constitutional conventidn, justices, and judges. On behalf Of Hawaii County Office of Aging ,CONTRACTOR, the undersigned does declare as follows: 1. CONTRACTOR O is Is not a legislator or an employee or a business in which a legislator or an employee has a controlling interest' I 2. CONTRACTOR has not been assisted or represented by a legislator or employee for a fee or other compensation to obtain this Supplemental Agreement and will not be assisted or represented by a legislator or employee for a fee or other compensation in the performance of the Supplemental Agreement,rf the legislator or employee had been involved in the development or award of the Supplemental Agreement: 3. CONTRACTOR has not been assisied or represented for a fee or other compensation in the award of this Supplemental Agreement by an Agency employee or. in the case of the Legislature, by a legislator. 4. .CONTRACTOR has not been represented or assisted personally on matters related to the Supplemental Agreement by a person why has been an employee of the Agency within the preceding two (2) years and who participated while in state office or -employment on the matter with which the Supplemental Agreement is directly concerned. 5_ CONTRACTOR has not been represented or assisted on matters relates to this Supplemental Agreement, for a fee or other consideration by an individoatwlto; within- the past twelve (12) months, has been an Agency employee, or in the case of the Legislature, a legislator. 6. CONTRACTOR has not been represented or assisted in the award of this Supplemental Agreement for a fee or other consideration by an individual who, a) within AGSupp (l l ry!} the past twelve (f2) months, served as an Agency employee or in the case of the Legislature, a legislator, and b) participated while an employee or legislator on matters related to this Supplemental Agreement. CONTRACTOR understands that the Supplemental Agreement to which this document is attached is voidable on behalf of the STATE K this Supplemental Agreement was entered into in violation of any provision of chapter 84, HRS, commonly referred to as the Code of Ethics, including the provisions which are the source of the declarations above. Additionally, any fee, compensation, gift, or profrt received by any person as a result of a violation of the Code of Ethics may be recovered by the STATE. ~u.rc. lS ,Hawaii, 4~~~5. DATED: CONTRA TOR ey Title ' 'Reminder to Agency: If "is' is checked; the Agency is required, under section 84-15, HRS, to file with the State Ethics Commission, ten (10) days before the Supplemental Agreemerrt is entered into, a written justification as to why the Supplemental Agreement was not required to be competkivety bid. AG-Sapp (11/91) CERTIFICATE OF EXEMPTION FROM CIVIL SERVICE 1 By Heads of Departments or Agencies as Delegated by the Director of Human Resources Development (a.) Pursuant to a delegation of the authority by the Director of Human Resources Development, I certify that the scrviccs provided under this Contract, and the person(s)providing the servica. under this Contract are exempt from the civil service, pursuant to §7(x16, Hawaii Revised Statutes (7iRS). ae 4 ,~Q~~t (Signature) Lillian B. Koller.,'_fsq. (Print Name) Director (Print Tide) AUG ~ 3 2uU5 (Date) a. This page of this two-paged certificate maybe used by all department heads and others to whom the Director of Numan Resources Development has delegated authority to certify §76-] 6, HRS, civil service exemptions. The specific paragraph(s) of §76-16, HRS, upon which an exemption is based should be noted in the contract file. ]VOTE: If authority to certify exemptions under §§7(x16(2), 76-16(3), 76-16(12), and 76-1605), HRS, has not been delegated, only the Director of DHRD may certify §§76- 16(2), 76-16(3), 76-1602), and 76-16(15) exemptions. AGISPD FORM-K(Ixtl?/0!) Attachment 52 Supplemental Agreement No. 2 TIME OF PERFORMANCE The time of performance is extended from the current termination date of: July 1, 2005 to the new termination date of: December 15, 2005 or sooner as determined by the Department based on when a replacement contract has been executed, which ever occurs first. as allowed in the document(s) checked below: Section 2 of the Request for Proposals. X Exhibit "E" of the original contract. X §3-149-301 of Hawaii Administrative Rules regarding the extension of existing contracts during a procurement process under Chapter 103F, HRS. §3-141-503(a)(2) of Hawaii Administrative Rules regarding exemptions from procurement procedures for grants and subsidies. Attachment 53 Supplemental Agreement No. 2 Contract No. DHS-02-PO5-1208 COMPENSATION AND PAYMENT SCHEDULE 1. This Supplemental Agreement provides for a change in funding for fiscal year(s): 2006 Accordingly, Paragraphs 1, 7, and 13 of the Compensation and Payment Schedule shall be amended, where applicable, as follows: 1 Sum Not to Exceed. Subject to continuing availability of State and federal funds, STATE agrees to pay PROVIDER for services satisfactorily performed under this Agreement, the total sum not to exceed: ONE HiJNDRED EIGHTY-THREE THOUSAND. EIGHT HUNDRED SEVENTY-TWO AND 59/100 DOLLARS ($183.872.59) This sum shall be allocated as follows for the specified fiscal year(s): FY 2002 FY 2003 FY 2004 Fl' 2005 Fl' 2006 State Funds $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 Federal Funds 0 0 0 0 0 (CFDA N/A N/A N/A N/A N/A Contract Total $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 In-Kind N/A NlA NfA NIA N/A Grand Total $38,133.50 $42,628.50 $52,705.50 $34,563.50 $15,841.59 7 Manner or Method of Payment. Where the State has agreed to pay the PROVIDER according to an approved budget for expenditures actually and appropriately incurred in the performance of this Agreement, the PROVIDER shall submit for approval of the STATE a revised budget for those fiscal years in which funding has changed. 13 Payment Rate and Service Capacity The quarterly payment rate is revised as follows for those fiscal years in which the funding has changed: 1. Attachment S3 Supplemental Agreement No. 2 Contract No. DHS-02-POS-1208 QUARTERLY PAYMENT RATE TABLES FY 06 STATE $ FEDERAL $ OTHER $ TOTAL 15f Qtr $8,640.87 N/A N/A $8,640.87 2"d Qtr $7,200.72 N/A N/A $7,200.72 3rd Qtr N/A N/A N/A N/A 4`~ Qtr N/A N/A N/A N/A TOTAL $15,841.59 N/A N1A $15,841.54 Unless otherwise agreed the annual number of service units expected for those fiscal years in which the funding has changed will equal the approved budget for those fiscal years, including approved carryover, divided by the unit rate as applicable. Unless otherwise agreed the average monthly service unit capacity which must be maintained for those fiscal years in which the funding has changed will equal the annual number of service units for each of those fiscal years divided by twelve (12). 2. All other terms and conditions of the Compensation and Payment Schedule, including the paragraphs amended pursuant to this Supplemental Agreement, shall remain valid and enforceable unless otherwise contradictory to this Supplemental Agreement. 2. Adult Chore Services- West Hawa DHS-02-POS-1208 Supplement #2 CERTIFICATION OF CHAPTER 103F AGREEMENT V1rFIDV NEW AGREEMENT IS SUBSTANTIALLY SD~ID.AR TO PRIOR AGREEM>~T1T The undersigned agency officer or employee declares: 1. The agency has had during the immediately preceding year a Chapter 103F agreement with the same recipient ~ provider. the scope of services and other terms and condition of which are substantially the same as those of the new agreematt. 2. I stn not wrrerttly aware of any reason why the new agreement should not be entered into with the provider or recipient, as the case maybe. 3. Unless deleted or modified by the earlier agreement, all of the General Conditions for Heahh and Human Services Contracts, Form Afi3-HHSGC (4/99, wt71 apply to the new a~xmeru. 4. No new Special Conditions will apply to the new agreement. S. The Scope of Services of the new agrecmeru will not conflict with or vary arty material term of the proposal received from the recipient or provider for the agreement 6. The earlier agreement was approved as to form by a deputy attorney general or preapproved pursuant to the terms set forth in this Interdepartmental Memorandum. DATED: Honolulu, Hawaii, JUI. 1 3 2u`J5 AGENCY: Department of Human Services (~tit)'iag Si ) Marquis Miyauchi (Print or Type Name ~ Certifying Signature) Its: Support Services Office Administrator (Title of Certifying Signature) The comp)etion of this certificate in compliance with ATTORNEY GENERAL'S INTERDEPARTMENTAL MEMORANDUM NO. 1999-OS constitutes approval as to the form of the attached contract by the Department of the Attorney General without further review. Form B-52 7/18/91 DEPARTMENT OF FINANCE REQUEST FOR COUNCIL ACTION DEPARTMENT: PARKS AND RECREATION DATE: 09/20/05 STAFF CONTACT: SIDNEY KANNO PHONE: 961-8777/322-1812 A. REQUEST: To increase revenue account: 3304.50 COORD SERV PORCH OF SERV by $69,127 To appropriate the $69,127 to expend funds as follows: 010.481.5481.01.099 $ 782.00 010.481.5481.02.102 $ 990.00 010.481.5481.02.109 $4,155.00 010.481.5481.02.112 $1,200.00 010.481.5481.02.218 $42,000.00 010.481.5481.02.341 $20,000.00 B. BACKGROUND AND JUSTIFICATION (USE ADDITIONAL SHEETS AS NEEDED): Council action is needed to amend the Coordinated Services Operating Budget to accommodate the receipt of State Funds. The Department of Human Services will be awarding the Chore Contract (Purchase of Services) to the County of Hawaii for the period 7/1/05 - 6/30/06. The Coordinated Services for the Elderly will be receiving this funding via the Office of Aging. This will enable Coordinated Services staff to provide in-home chore services (routine housecleaning, laundry, meal preparation, marketing, shopping assistance, personal care, errand and escort services) to seniors. ` ~y i X~~ DATE: SIGNED: `.-_Dep ent Head GRANT SUMMARY (Supplement to B-52, Request for Council Action) T e of Grant A ro riation bein re uested: (New or an additional a ro riation ® New (for this fiscal year period). OR ? Additional appropriation (to an existing grant); Is a draft agreement attached`? Has the original grant notiftcatdon heen transmitted to ? Yes ®No Council? ? Yes ? No Name of Grant Program: Purchase of Service -State Chore Agreement Grantor: State of Hawaii -Department of Human Services County Grantee Department or Agency: Coordinated Services via Hawaii County Office of Aging County Grantee Contact Person: Sidney Kanno Phone Number: 322-1812 Amount of Grant: $69,127 Grant Period (Commencement & Completion): 7/1/05 - 6/30/06 Purpose of Grant: To provide in-home chore services (routine house cleaning, laundry, meal preparation, marketing, shopping assistance, personal care, errand and escort services) to disabled/older adults County Match required?: ? Yes ®No If yes, Matching Amount? Budgeted in account# In-kind? Explain: Explanation: County's personnel requirements: Amount of new position(s)? Qty: _ Permanent: ? Temporary: Duration: Full-time: ? Part-time: Time Element: Qty: Contractual: ? Explain: Explanation: Additional Comments about Grant: B-52 Grant Summary Form