HomeMy WebLinkAboutCOM 0082.056 2004-2006
H Kim c,°~~~ ~
~'Y ~ Alan R. Parker
Mayor
a; • e Executive on Aging
®~'~oo
C'ourity o~ Hawaii
OFFICE OF AGING
Hilo Lagoon Centre, 101 Aupuni Street, Suite 342, Hilo, Hawaii 46720-4262
Phone (808)961-8600 • Fax (808)961-8603
Hanama Place, 75-5706 Kuakini Highway, Suite 106, Kailua-Kona, Hawaii 96740-1751
Phone (808) 327-3597 • Fax (808) 327-3599
DATE: February 3, 2006
TO: Stacy K. Higa, Council Chair and Council Members
VIA: Deanna S o, C ntroller
FROM: Alan Parker, ecutlve on Aging
RE: NOTIFICATION OF GRANT AWARD
Compliance with Ordinance No. 05-86, Section 7(1)
Name of Grant Program: CSE Chore Services
Grantor: State of Hawaii, Department of Human Services
County Grantee Department or Agency: Hawaii County Office of Aging
Grant No. (IF KNOWN): DHS-02-POS-1207 /DHS-02-POS-1208 /DHS-06-POS-3139
Amount of Grant: $15,841.59 / $15,841.59 / $40,326.00
Amount of County Match: $ -0-
County Revenue Account Numbers: #3304.50
County Expenditure Account Numbers: #010-481-5481.01 to 5481.02
Grant Period (Commence. & Completion): July 1, 2005 to June 30, 2006
Purpose of Grant: To provide chore services to adults eighteen years of age or
older who are unable to perform chore activities because of
physical or mental disabilities.
Is final report required by grantor? LX~Yes ? No
Notification attached: ®Yes ? No
bj i
cc: Parks & Recreation
Cow. No. •
Ref. T®a
R~#. U+~t~ It1
Haivai'i County is an equal opportunity provider and employer. An Area Agency on Aging
f.
STATE OF HAWAII '
SUPPLEMENTAL AGREEMENT NO. 2
TO AGREEMENT DHS-02-POS-1207
(Irwrtap/ts/MnlnumwraWMriOantilyirginh>.ma0bn)
This Supplemental Agreement tVo. 2 ,executed on the respective dates
indicated below, is effective as of June 1 , 200 5 ;between the Department
of Numan Services StatB
(/n7M Mme dJno~ wpawMnt, ayanry. marQ or oonmsriny
of Hawaii (hereinafter `STATE7, by its Director
(u,san a:~cuanp aprw
WhOSe addre55I5_1390 Miller Street, Room 209, Honolulu, Rawaii 96813
s and Hawaii County Office of Aging
(hereinafter `CONTRACTOR`),
a non-profit organization
(Inssrr co~a~+. "pw~.rsrw.' 70%+ r.mu.." sow v~a~~sl.v.' or am rw arm d m. co~xr.aoy
under the laws of the State of Hawaii ,-whose
business address and taxpayer identification number are as follows:
101 Aupuni Street #6A, H.ilo, 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
1lnsart epiasmonl numDar a other idanOiryirp in/omationl
Adult Chore Services -East Hawaii
2001
dated July 1 , which was amended by Supplemental Agreement No(s).
AG-Sapp 111/98)
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
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))
? Amend the SCOPE OF SERVICES according to the terms set forth in
Attachment S1, which is attached hereto and is incorporated herein.
p~ Amend the TIME OF PERFORMANCE-according to the terms set forth irk
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_
? -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 Dis 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 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 Rc-s,my c i asst
IN VIEW OF THE ABOVE, the STATE and the CONTRACTOR execute this
Supplemental Agreement No. 2 by their• signatures on the dates below.
STATE:
Print Name Lillian B. Koller_ F¢n_
Title Director
Date AUG 0 3 [UU5
FUNDING AGENCY (to be signed by heed o1 funding
- agency it other than fhe Contracting Ageney)
l j By
Print Name
- - ~
. _ ~ Title
~/~3
fDu~_ - Date
APPROVED AS TO CONT C
FORM AND LEGALITY: Ety
Print Name DIXIE Kr6ETSl5
DFP ~ORP~7~A~'IA~
tV~ C)UNS~I
Nrr ~~~~~I 2005 Title y .
Date Date b ~IS(oS
'EriC.nas d.uthaNy d tlr t:w~o-.aors npesenfetirr
ro spn Nis Su~pplsrr»dr1 Ap's.mM must M Ndc?Md.
APPROVED AS TO FORM:
Certification Attached
Deputy Attorney General
3 aa-s~ t1 v>a~
~ i.
STATE OF HAWAII )
SS.
COUNTY OF HAWAII )
On this ~S day of `r~-c_ , 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 seated 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 (ERNES
Notary Public, State of Hawaii
My commission expires: 11/1/2005
i
F
f %
i
r
i'
CONTRACTOR'S ACKNOWLEDGMENT
State of
SS.
Jy County of
On this day o 199_,. befog 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, and-acknowledges 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 (11/35)
~
~ 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 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 frfty 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
contract to the State or of the constitutional convention, but excluding legislators,
delegates to the constitutional convention, 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'
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 Agreemerri, if the legislator or empbyee 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 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 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.
S_ CONTRACTOR has not been represented or assisted on matters related to
this Supplemental Agreement, for a fee or other consideration by an individual~who; within-
the past twelve (12) months, has been an Agency employee, or in the case of the
Legislature, a legislator.
6. CONTRACTOR has nct been represented or assisted in the award of this
Supplemental Agreement for a-fee or other consideration by an individual who, a) within
AG-Supp (I I /96)
i
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 profrt received by any person as a
result of a violation of the Code of Ethics may be recovered by the STATE-
DATED: `j"-'^~ ~ ,Hawaii, t~~5. q.~
CONTRACTOR 9
By r
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 competFtively bid:
ac-s~v 1 i ~~st
( 1
CERTIF]CATE OF EXEMPTION FROM CIVIL SERVICE ,
1 By Heads of Departments or Agencies as Delegated by 1heDirector of Human Resources
Development (a.)
Pursuant to a delegation of the authority by the Director of Human Resources Development, l
certify that the services provided under this Contract, and the pcrson(s).providing the services.
under this Contract are exempt from the civil suvice, pursuant to §76-Ib, Hawaii Revised
Statutes (]iRS).
ti
(Signaan)
Lillian B. Koller, Esa.
. (Print Nomtj
Director
(Print Titk)
AUG 0 3 tuu5
(Date)
a. This page of this two-paged certificate maybe used by all departrnent heads and othess 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-)b, HR.S, upon
which an exemption is based should be noted in the contract file.
NOTE: If authority to certify exemptions under §§76-1b(2), 76-Ib(3), 76-1G(12), and
76-16(15), HRS, has not been delegated, orily the Director of DHRD may certify §§76-
lb(2), 7b-lb(3), 76-1b(]2), and 76-16(IS) exemptions.
~
• Attachment S2
Supplemental Agreement No. 2
TIME OF PERFORMANCE
The time of performance is extended from the current termination date of:
3uly 1, 2005
to khe 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 §3-144-301 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 ($183,872.59
This sum shall be allocated as follows for the specified fiscal year(s):
FY 2002 FY 2003 F'Y 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 Payment Rate and Service Capacity
The quarterly payment rate is revised as follows for those fiscal years in which
the funding has changed:
i
( ~
Attachment S3
Supplemental Agreement No. 2
Contract No. DHS-02-POS-1207
QUARTERLY PAYMENT RATE TABLES
FY 06
STATE $ FEDERAL $ OTHER $ TOTAL
ls` Qtr $8,640.87 NJA NJA $8,640.87
Z"d Qtr $7,200.72 N/A N/A $7,200.72
3ra Qtr N!A NJA NJA N!A
4`h Qtr N/A N/A N/A N/A
ToTnL $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 carryover, divided by the unit rate as
applicable.
Unless otherwise agreed the average monthly service unit capacity which must
be maintained for those fiscal yeazs 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.
i Adult Chore Services _ E. HI
~ DHS-02-POS-1207
' -Supplement #2
CERTffICATION OF CHAPTER ]03F AGREEMENT WIN '
NEW AGREEMENT IS SUBSTANTIALLY SIMILAR TO PRIOR AGREEMENT
The undersigned agency officer or employee dxlares: '
1. The agency has had during the immediately preceding year s Chapter 103E agreement
with the same recipient or provides the scope of services and other terms and
conditions ofwhich are substantially the same ss those ofth neW agreement
2. I am not arrently aware of any rwon why the new agreement should not be entered
into with the provider or recapiertt, 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 AC33-HHSGC (4/99, will apply to the
new agreement.
4. No new Spedal Conditions will apply to the new agreement.
5. The Scope of Services of the new agrecment will not conflict with or vary any material
term of the propgsal 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, ~ JUL 1 3 a7D5
AGENCY: Department ofH~man Services
Bye
' g Signature)
Marquis Miyauchi
(Print or Type Namb of Certifying Signature)
Its: Support Services Office Administrator
(Title of Certifying Signature)
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 contract by the Department of the Attorney General without further
review.
i ~
STATE OF HAWAII '
SUPPLEMENTAL AGREEMENT NO. 2
TO AGREEMENT DHS-02-POS-1208
(awrl prsnrmnt rranDaf a uMf io.norytip in/o~miEOn!
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
(NUYI gIIM d tbb d~prorrn4 p~nry. DOHA. W m11anRTiOIV ~ ,
of Hawaii~(hereinafter'STATE7, by ifs Director
(assn .a.wDno w~
whose addresslS 1390 Miller Street, Room Z09, Honolulu, Hawaii 96813
and Hawaii County Office of Aging
(hereinafter 'CONTRACTOR',
a non-profit organization
(InsN( cnfpof~Deq • yarmwsh'p,' ~eir,+iuua.' ^svM popiNwsAip.' n oNrr Ipr loon a dr Conuaewq
under the laws of the State of Hawaii ,whose
business address and taxpayer identification number are as follows:
101 Aupuni Street #6A, Hd•lo, Hawaii 96720
Federal ID# 99-6000-567 'State ID# 30016002
~CITALS
A. WHEREAS, the STATE and the CONTRACTOR entered into an Agreemenrt
DHS-02-POS-1208
(In3!/i lyM/Mnl I111I1101f q DIIMf 1dllla/yYlp inlorrnsDOn/
Adult Chore Services -West Hawaii
2001
dated July i , 199_, which was amended by Supplemental Agreement No(s).
~c-s~~~ Inq
( l
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
B. 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.
Amend the TIME OF PERFORMANCE-according to the terms set forth iri
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 ~ 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 commencing any perfom~ance under this
Supplemental Agreement.
Unless amended herein, the Agreement shall remain in full force and effeG.
z wG-supp t~~~se)
~
IN VIEW OF THE ABOVE, the STATE and the CONTRACTOR execute this
Supplements{ Agreement No. 2 by their signatures on the dates below.
STATE:
gY
Print Name Li 11 i an B. Koller, Esg_
Title Director
Date AUG 0 3 CUUh
I i:i~:~/7 s~, r py:,~;:
J,~/r1 ~ i FUNDING AGENCY (to be signed by head o//unding
agency t/ other than fha Contracting Ageney)
s
B
a,. _ ' y
~ ` .Prnnt Name
~ 05'- ~
- ; a: ~ I 'rile
-
1__..____.._
Date
APPROVED AS TO CON CT R-
FORM AND LEGpA~L~ITY: gy ~~~~y~,Q,~
L+u•C ~~G~------ Print Name ~1~«
DEfj T1 CORPORATION COUNSEL T,~e ryL;:~ y:;;15, r;;r"roe
CO N OF W II
Dare JU~. r 4 2005 _ Date ro ~ is los
~E»tl~np d •ufAorByd tl» Con67a0/s npessrM~We
ro apn tAs Supplsrr»nrd Apn»nwK must b Mbawd
APPROVED AS TO FORM:
Certification Attached
Deputy Attorney General
~ AQ'iSuCp (11/9N)
~ ~
C TRACTOR'S ACKNOWLEDGMENT _
State of '
SS.
County of )
On this day of 199_, before me personally
to me personally
appeared
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 zcknowledges that he/she executed
said instrument as the free act and deed of the CON CTOR.
Notary Publi ,
My commiss" expires:
AG-Supp (t IN8)
' I ~ .
STANDARDS OF CONDUCT DECLARATION
i
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 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 fact to control, whether the interest is greater or less than frfty per cent (50°k).
"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 constitutional convention, but excluding legislators,
delegates to the constitutional convention, justices, and judges.
On behalf of Hawaii County Office of Aging ,CONTRACTOR, the
undersigned does declare as follows: /
t, CONTRACTOR O is ~s not a legislator or an employee or a business in
which a legislator or an employee has a controlling interest'
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 Agneement, ff the legislator or empbyee 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 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 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.
b_ CONTRACTOR has not been represented or assisted on matters related to
this Supplemental Agreement, for a fee or other consideration by an mdividuafwho; within-
the past twelve (12) months, has been an Agency employee, or in the case of the
t_egislature, 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
~cs~,pv 1 ~ ~~i
~
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 t34, 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.
DATED: i~' ,Hawaii, '1-~~~s.
CONTRACTORII
pp 00~~~/
By `~"'L1L
Title ";r.~
'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:
CERTIF]CATE OF EXEMPTION FROM CIVIL SERVICE
1 By Neads of Departments or Agencies as Delegated by the Director of Humao Resources
Development (a.)
Pursuant to a delegation of the authority by the Director of Human Rcsourocs Development, I
certify that the services provided under this Contract, and the persons}providing the services.
under this Contract are exempt from the civil service, pursuant to §76-16, Hawaii Revised
Statutes (}IRS).
(Signanrn)
Lillian B. Koller.,_E~sg. .
(Prior Name)
Director
(Print Title)
AUG 0 3 2UU5
(Dale)
a. This page of this two-paged ccriificaie maybe used by all department heads end others to
whom the Director of Human Resources Developmrnt 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.
NOTE: If authority to certify exemptions under §§76-16(2), 76-16(3), 76-16(12), and
76-16(]5), HRS, has not been delegated, only the Director of DHRD may certify §§76-
16(2), 76-16(3), 76-]6(12), and 76-16(15) exemptions.
AG/SPD FORM-K(rxt0/Ot)
. ~
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 ofthe 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.
~ l
Attachment S3
Supplemental Agreement No. 2
Contract No. DHS-OZ-POS-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 ender 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 NIA NIA NIA 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.
( 1
Attachment S3
Supplemental Agreement No. 2
Contract No. DHS-02-POS-1208
QUARTERLY PAYMENT RATE TABLES
FY 06
STATE $ FEDERAL $ OTHER $ TOTAL
ls` Qtr $8,640,87 N/A N/A $8,640.87
2"d Qtr $7,200.72 N/A N/A $7,200.72
3`d Qtr N/A N/A N/A N/A
4m Qtt 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 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 teens 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 H
~ DHS-02-POS-1208
Supplement #2
CERTIFICATION OF CHAPTER 103E AGREEMENT WI~~N
NEW AGREEMENT IS SUBSTANTIALLY SA~.AR TO PRIOR AGRF-EMENT
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 or provider, the scope of services and other terms and
conditions ofwhic6 are substantially the same ss those ofthe new agreement.
2. I am not aurently aware of any reason why the near agreement should not be entered
into with the provider or redpiertt, u the cane maybe.
3. Unless dddtti or modified by the earlier agreement, all of the General Conditions for
He.ahh 'and Human Services Contracts, Form Aff3 HHSGC (4J99), will apply to the
new agrceme~.
4. No new Spcdal Conditions will apply to the new agreement.
5. The Scope of Services of the new ageemerrt will not conflict will[ or vary arty material
term of the proposal received from the recipient or provider for the ageement
6. The earlier agxment 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, JUL 1 3 2005
AGENCY: Department ofFluman Services
By:
(Certifying Si lure) .
Marquis Miyauchi
(Print or Type Name of Certifying Signature)
Its: Support Services Office-Administrator
(fide of Certifying Signature)
The completion of this certificate in compliance with ATTORNEY GENERAL'S
INTERDEPARTMENTAL MEMORANDUM NO. 1999-05 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 PURCH 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.
SIGNED: DATE: llGn~~ "S
p ent Head
~ i
GRANT SUMMARY
(Su lement to B-52, Re uest for Council Action)
T e of Grant A ro riation being 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 notification been 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!1105 - 6130106
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: ? Temporazy: Duration:
Full-time: ? Part-time: Time Element:
Qty: Contractual: ? Explain:
Explanation:
Additional Comments about Grant:
B-52 Grant Summary Form
~
40,~`YY Oi ~1~k
l~- 1!
~~~~i/per,
COUNTY OF HAWAII STATE OF HAWAII
Sri or•k~'"
RESOLUTION NO.
RESOLUTION AUTHORIZING THE OFFICE OF THE MAYOR TO ENTER INTO AN
AGREEMENT WITH THE STATE OF HAWAII DEPARTMENT OF HUMAN
SERVICES, PURSUANT TO HRS 46-7, FOR THE ADULT CHORE SERVICES
GRANT
WHEREAS, the State of Hawaii Department of Human Services has authorized funding to the
Hawaii County's Office of Aging to provide Adult Chore Services to the Elderly on the Island of
Hawaii; and
WHEREAS, these funds will be passed on to the Department of Parks and Recreation's
Coordinated Services Program for the Elderly Division; and
WHEREAS, Adult Chore Services include routine housecleaning, laundry, meal
assistance/planning, marketing, shopping assistance, personal care, running errands and escort
services for any disabled/older adult in need of assistance to achieve, restore, or maintain
independent living and self-direction; and
WHEREAS, Hawaii Revised Statutes, Section 46-7, requires that county departments obtain
the consent of the council to enter into agreements with the federal or state governments respecting
action to be taken pursuant to any of the powers granted by law to furnish, expend, and receive any
funds or other assistance in connection with projects being or to be undertaken pursuant to those
powers.
NOW, THEREFORE, BE IT RESOLVED BY THE COUNCIL OF THE COUNTY OF HAWAII,
in accordance with section 46-7, Hawaii Revised Statutes, that the Mayor of the County of Hawaii is
authorized to execute, on behalf of the County, an agreement and/or related documents with the
State of Hawaii Department of Human Services to enable the County to implement the Adult Chore
Services to the Elderly Program.
BE IT FURTHER RESOLVED that the County Clerk of the County of Hawaii shall transmit
copies of this resolution to the Office of the Mayor, the Department of Finance, and the Office of
Aging.
Dated at ,Hawaii, this day of , 2005.
INTRODUCED BY:
COUNCIL MEMBER, COUNTY OF HAWAII
COUNTY COUNC[L ROLL CALL VOTE
County of Hawaii
Hilo, Hawaii AYES NOES ABS EX
ARAKAKI
I hereby certify that the foregoing RESOLUTION was by the RIGA
vote indicated to the right hereof adopted by the COUNCIL of HOFFMANN
the County of Hawaii on HGLSCHUH
IKEDA
ATTEST
ISBELL
JACOBSON
PILAGO
SAFARIK
Reference
COUNTY CLERK CHAIRMAN 3c PRESIDING OFFICER RESOLUTION NO.
~
tI`.' Lam. H
1d~i;
COUNTY OF HAWAII ~ ~ STATE OF HAWAII
\7~( _OF ~NF'~~
- BILL NO.
ORDINANCE NO.
AN ORDINANCE TO AMEND ORDINANCE NO. OS-86, AS AMENDED, THE OPERATING BUDGET FOR
THE COUNTY OF HAWAII FOR THE FISCAL YEAR ENDING .IIJNE 30, 2006.
BE IT ORDAINED BY THE COUNCIL OF THE COUNTY OF HAWAII:
SECTION I. Ordinance No. OS-86, as amended, is hereby further amended by appropriating revenues in the
following amount(s) to the fund(s) as set forth in Section 2.
3304.50 State Grants -Coordinated Services -Purchase of Services General $ 69,127
Total $ 69,127
SECTION 2. The foregoing amount(s) as specified in Section 1 hereof is/are hereby appropriated to the following
fund(s) and expenditure account(s) as set forth herein below:
Account No. Function and Activity Fund Amount
O 10-48 l -5481.02 Coordinated Services - OCE General $ 69,127
Total $ 69,127
SECTION 3. A final report, or the final report required by the grantor, shall be submitted to the
Council upon completion of the grant program(s).
SECTION 4. This ordinance shall take effect upon its approval.
Introduced By:
Council Member, County of Hawaii
Hawai i
Date of Introduction:
Date of Ist Reading:
Date of 2nd Reading:
Effective Date:
`I
LINDA LINGLE ~ o e „ LILIAN B. KDLLER, ESD.
GOVERNOR M1~ ,o`o
~ ~ DIRECTOR
d • ~I//~
HENRY OLIVA
DEPUTY DIRECTOR
STATE OF HAWAII
DEPARTMENT OF HUMAN SERVICES
Social Services Division
Support Services Office
Federal Revenue & Program Support Staff
Purchase of Service & Grant Management
810 Richards Street, Suite 501
Honolulu, Hawaii 96813
DATE RECEIVED f
December 28, 2005 CIRCULATE TO
COPY TO
ACTION BY
Mr. Dennis Shigeta DATE DUE TO
Hawaii County Office of Aging
Hilo Lagoon Center FILE
101 Aupuni Street, Suite 342
Hilo, Hawaii 96720-4262
Dear Mr. Shigeta:
Re: Adult Chore Services -Big Island
Contract #DHS-06-POS-3139
Please find enclosed your fully executed copy of the above referenced contract
between Hawaii County Office of Aging and the Department of Human Services.
Should you have any questions concerning this contract, please contact POS
Program Specialist, Mr. Rex Shilo at (808) 586-5673.
Sincerely,
Purchase of Service & Grant Management Office
Enclosure
AN EQUAL OPPORTUNITY AGENCY
Adul. shore Services -Big Island
Hawaii County Office, of Aging
DHS-06-POs-3139
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) December 1, 2005
between the (agency) Department of Human.Services
State of Hawaii (the "STATE"), by its Director
(the "DIRECTOR"), whose address is 1390 Miller Street. #207. Honolulu. HI 96813
and Hawaii County Office of Aging
(the "PROVIDER"), a (government entity/corporation/partnership/sole proprietorship/other
business form) go~ternment entity
whose business address and taxpayer identification number are: 101 Aupuni Street, 6A,
Hilo, HI 96720 Federal ID# 99-6000667 StateIdD# 30016002
RECITALS
A. This Agreement is for a purchase of health and human services that is exempt
from the requirements of Chapter 103F, HRS, because:
this Agreement is between or among government agencies as provided
in Section 103F-101(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-101(a)(1), HRS, and Section 3-141-503(a)(2), HAR,
or to award subawards end 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 ~ t ~
identifies a target class of beneficiaries;•(2) defines the requirements
for a provider to be 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-Exem~ 1
.
? 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 psychologists in
criminal or civil proceedings as required by a court order of 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:
(1) (identify state sources) Act 236, SLH 2005 , or
(2) (identify federal sources) N/A . or both,
in the following amounts:
State: $ 40,326.00 (FY 06) $69,126.00 (FY 07)
Federal: $ N/A
D. Pursuant to (legal authority for Agreement) Chapter 346-63 ,
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 authorizin,_
documents such as partnership resolutions;
? corporate by-laws of the PROVIDER, or other similar oper:ttin_~
documents of the PROVIDER, such as a partnership agreement, or .~~t
limited liability company operating agreement;
EXEMPT TRANSACTIONS
Page 2 Form AG3-Exenu
? the PROVIDER is a sole proprietor and az 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;
l~ other evidence of signing authority: Providers Acknowledoement
F. The PROVIDER has produced, and the STATE has inspected, a certificate
of insurance in the amount of One Million and no/100 DOLLARS
($1 000.000.00 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 haz 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:
1. Scope of Services. The PROVIDER shall, in a proper and satisfactory manner
az determined by the STATE, provide the Required Services az 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) December 1, 2005 .to (date) ,tune 30. 2nnfi
. unless this Agreement is sooner terminated. See Exhibit "E" for option to
3. C-o/mpensation. The PROVIDER shall be wmpensated extend.
LJ in a total amount for all required services not to exceed Forty thousand
three hundred twenty six and. no/100 DOLLARS ($40,326.00 1,
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. subject to Exhibit "E"•paragraph 17 and Exhibit "A"
Attachment 2.
' ? based upon referrals to the PROVIDER from the STATE, payment
EXEMPT TRANSACTIONS
Page 3 FormAG3-Exem~1vv~
1
for each such referral shall be made according to Exhibit "13" 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. Re~orting_ 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) July 30, 2008 No amendment to the
PROVIDER's Final Project Report shall be considered after (date) .October 30, 2008 .
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:
Bepartment of Human Services, Social Services Division Administrator .
810 Ribhar!ds Street, Suite 400. Honolulu. HI 9fiR1~ ohce 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
Department of Accounting and General S~r~brt~ shall be deemed to have been recen ~ .l
1151 Ptlnchbowl St., # 30A Honto~~lu HI f968~
three ()days after m g or a e time o ac al receipt, whichever is earlier. I I~.
PROVIDER is responsible for notifying the STATE in writing of any change of addn~~-
EXEMPT TRANSACTIONS
Page 4 Form AG3-Ezcn:
IN VIEW OF THE ABOVE, the parties execute this Agreement by their signatures,
on the dates below, to be effective as of the date first above written.
STATE M ~
BY
Print Name Lillian B. Koller, Eso.
Title Director
Date Q ~ Q cQQ~----
_ PROVIDER
_ COUNTY OF HAiIAl
^rCC)nt.',~rSD ~>s~ :'3Vn~_~~ By
f
1 11
{ ~
I ~Z,y,i(_ _ ~ Print Name Diaie Raecsu
t`j'Fx/ec. or.~a.,y~+-n,; ¢ Title Managing Director
~ _s_._. DEC 0 1 2005
Date
APPROVED AS TO FORM:
APPROVED AS TO
Certification FORM AND LEGALITY:
Deputy Attorney General u.C
DEP TY ORPORATION COUNSEL
CO . OF HAWAII
Date OCT - 5 2005
EXEMPT TRANSACTIONS
. Page 5 FocmAG3-Eaem(1.N`+i
PROVIDER'S ACKNOWLEDGMENT
Stat 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 a/she is the of
he PROVIDER named in the foregoing instrument, and that
he/she is authorized to.sign sai 'nstrument on behalf of the PROVIDER, as provided in
Recital E of the foregoing Agree ent, and acknowledges that he/she executed said
instrument as the free act and deed of a PROVIDER.
Notary Pub 'c,
My commissio expires:
EXEMPT TRANSACTTONS
Page 6 Form AG3-Exem~ 1
Ad I Chore Services - BigiIsland
~ Hawaii County Office of Aging
CERTIFICATION OF CHAPTER ] 03F AGREEMENT WHEN
NEW AGREEMENT IS SUBSTANTIALLY S]MII.AR TO PRIOR AGREIIKENT
The undersigned agency officer or employee declares: .
1. The agency has had during the immediately preceding year .a Chapter 103F agrexmera
with the same recipient or provider, the scope of services and, other terms and
conditions of which are substantially the same as those of the new agreement.
2. I am not. currently aware of any reason wlfy the new agreement should not be emexed
into with the provider or retipiertt, as the case may be.
3. Unless deleted or modified by the earlier agreement, all of the General Condition for
Health and Human Services Contracts, Form A(33 HHSGC (4/99 will apply to the
new agt~eemeat. .
4. No ne;w Speaal Conditions will apply to the new agree.mertt.
5: The Scope of Sexviees of the new agrexmeM will not oonflitx with or vary arty matexial
term of the proposal received from the rexipiextt e><provider for then agreeyttenL
6. ~7te earlier agreement was apptovsd as to form :by a deputy attorney general or .
preapproved pursuant to the terms set forth in this Interdepartmental Memorandum.
DATED: Honolulu, Hawaii, ~ DEC 13 2005
AGENCY: Department of Human Services
By:
(Certifying Signature)
Marquis Miyauchi
.(Print or 7~pe Name: of Certifying Signatwe)
Its: Support Services Office Administrator
(title of Certifying Si®oatme)
The completion of this certificate in compliance with ATTORNEY GENERAL'S
INTERDEPARTMENTAL MEMORANDUM NO. 1999-05 constitutes approval as to the
form, of the attached contract by the Department of the Attorney General without further
review.