HomeMy WebLinkAboutCOM 0082.078 2004-2006 t'r.w
Harry Kim it ~ Alan R. Parker
Mayor Executive on Aging
? ..o'r':rii'rJ
County of Hawaii
OFFICE OF AGING
Hilo lagoon Centre, 101 Aupuni Street, Suite 342, Hilo, Hawaii 96720-4262
Phone (808) 961-8600 Fax (808) 961-8603
Hanama Place, 75-5706 Kuakini Hi~way, Suite 106, Kailua-Kona, Hawaii 96740-I,~TaI
Phone (808) 327-3597 ~ Fax (808) 327-3599 ~ r1 ~
C.,'.: ~
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X
DATE: September 19, 2006
-:7
TO: Stacy K. Higa, Council Chair and Council Members ~
ca ;
VIA: Deanna S o~r ~ r-, -
:.cs
FROM: Alan Parker, ecutive on Aging
RE: NOTIFICATION OF GRANT AWARD
Compliance with Ordinance No. 06-79, Section 7(1)
Name of Grant Program: Kupuna Care Services
Grantor: Department of Health, Executive Office on Aging
County Grantee Department or Agency: Hawaii County Office of Aging
Grant No. (IF KNOWN): HA-2006/2007-2 (A)
Amount of Grant: $1,336,808 = $690,230 for FY 2006 + $646,578 for FY 2007
Amount of County Match: $101,000.00
County Rev. & Exp. Account Numbers: #3304.06 & #010-411-5411.09 to 10 - $584,419 (HCOA)
(For 7/1/06-6/30/07) #3304.04 & #010-481-5483.01 to 03 - $62,159(HCNP)County
Grant Period (Commence. & Completion): July 1, 2006 to June 30, 2007
Purpose of Grant: To enable Hawaii's "Na Kupuna" to have access to affordable and
quality home-and -community based services that are client-centered
and family-supportive, allowing them to live with independence and
dignity. Services are Adult Day Care, Attendant Care, Case
Management, Chore, Homemaker/Housekeeper, Personal Care,
Assisted Transportation, and Home Delivered Meals.
Is final report required by grantor? ®Yes ? No
Notification attached: ®Yes ? No
bji
cc: Parks 8 Recreation ~ ~~g
x:omm. fdo,
Ref. Tot
Ref. Cote OCT 3 0 200
Hawaii County is an equal opportunity provider and employer. An Area Agency on Aging
n..~.,._.. _ _ _
LINDA LINGLE e ° ° x PAT SASAKI
GOVERNOR OF HAWAII 4~~e~gl i EXECUTIVE DIRECTOR
CHIYOME L. FUKINO, M.D. Telephone
DIRECTOR OF HEALTH ~ (808) 586-0100
'4.e.v~.wass~
Fax
(808)5860185
STATE OF HAWAII
EXECUTIVE OFFICE ON AGING
NO. 1 CAPITOL DISTRICT
250 SOUTH HOTEL STREET, SUITE 406
HONOLULU, HAWAII 96813-2831
DATE RECEIVED
CIRCULATE TO Al' g~
September 11, 2006 COPY TO
ACTION BY
DATE DUE _
TO
TO: Alan Parker FILE
o County Executive
Hawaii County Office on Aging
FROM: Pat Sasak~
Executiv irector
Executive Office on Aging
SUBJECT: HA-2006/2007-2(A)
Enclosed is your file copy of the consummated supplemental agreement #3 to HA-
2006/2007-2(A). The supplemental agreement is for the transfer of funds among services
for state fiscal year 2007.
If you have any questions regarding this agreement, please contact Caroline Cadirao at
(808) 586-7267. Mahalo.
CTC
Encl.
STATE OF HAWAII
SUPPLEMENTAL AGREEMENT NO. 3
TO AGREEMENT HA-2006/2007-2(A)
(EOA's Primary Contract
This Supplemental Agreement No. 3 ~ executed on the respective dates indicated
below, is effective as of August 30, 2006, 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 the County of Hawaii (the "PROVIDER"),
a government entity whose business address
and taxpayer identification number are: Hawaii County Office of Aging, 101 Aupuni
Street Room 342.-Hilo, Hawaii 96720 Federal Tax I.D. # 99-6000567
RECITALS
A. WHEREAS, the STATE and the PROVIDER entered into an Agreement No.
HA-2006/2007-2A
(Insert agreement number or other identifying information)
dated July 1 , 200 5 ,which was amended by Supplemental Agreement No(s). _
1 ,dated September 6. 2005 and Supplemental Agreement No(s) 2 dated
June 1, 2006 (hereinafter collectively referred to as Agreement"}whereby the
PROVIDER agreed to provide the goods or services described in the Agreement, and
HA-2006(2007-2A, Supplemental Agreement No. 3
1
B. 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 O 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 D 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-2006/2007-2A, Supplemental Agreement No. 3
2
IN VIEW OF THE ABOVE, the STATE and PROVIDER execute this SUPPLEMENTAL
AGREEMENT No. 3 by their signatures below.
STATE: EXECUTIVE OFFICE ON AGING
By:
Its Executive Director
PROVIDER
COUNTY OF HAWAII
By \`~I~~Y
County of Hawaii
RECOMMEND APPROVAL:
C,~Q~,,,,, J pd.r~~
Hawaii County Office of Aging
County Executive
APPROVED AS TO FORM AND LEGALITY:
Deput rporation Counsel
County of Hawaii
APPROVED AS TO FORM:
Deputy ttorney eneral
State of Hawaii
'Evidence of authority of the Provider's representative to sign this Agreement for the Provider must be attached.
HA-200612007-2A, Supplemental Agreement No. 3
3
STATE OF HAWAII )
SS.
COUNTY OF HAWAII )
On this 5th day of September 2006, 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.
P1N~'''~ ~'~''R.~Fi
~
~ O~ ~ CAT T. CORREIA
Not Public, State of Hawaii
~t pU gt.~`~ My commission expires: 10/13/06
~~~OF
H~~*``
PROVIDER'S ACKNOWLEDGMENT
to of )
SS.
County of )
On is day of 200, before me personally
appeared , to me personally
known, who being me duly sworn, did say that he/she is the
of
the
PROVIDER named in the foregoi instrument, and that he/she is authorized to
sign said instrument on behalf of the OVIDER, and acknowledges that he/she
executed said instrument as the free act a deed of the PROVIDER.
Printe ame
Notary Pu is
My commissio expires:
~1
HA-2006/2007-2A, Supplemental Agreement No. 3
4
STATE OF HAWAII
COMPENSATION AND PAYMENT SCHEDULE
The Compensation and Payment Schedule, Exhibit "B," in section 2. METHOD
OF PAYMENT, Section 2.2.1 of contract HA-2006/2007-2(A) is amended as
follows:
The STATE shall use the amended allocation plan contained in Exhibit B-1 as a
basis of paying PROVIDER upon submission of PROVIDER of a written request
for payment.
All other provisions in the Compensation and Payment Schedule shall remain
unchanged.
HA-2006/2007-2(A), Supplemental Agreement No. 3
EXHIBIT B
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