HomeMy WebLinkAboutCOM 0048.038 2006-2008Or~• 08-7$
Harry Kim
Mayor
Alan R. Parker
Executive on Aging
COUNTY O~ HAWAII
OFFICE OF AGING
Hilo Lagoon Centre, 101 Aupuni Street, Suite 342, Hilo, Hawaii 96720-4262
Phone (808) 961-8600: Fax (808) 961-8603: email: hcoa@hawaiiantel.net
Hanama Place, 75-5706 Kuakini Highway, Suite 106, Kailua-Kona, Hawaii 96740-1751
Phone (808) 327-3597 •'v Fax (808) 327-3599: email: hcoakona@hawaiiantel.net
MEMORANDUM
DATE: July 1, 2008
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TO: eter Hoffman, Council Chair and Council Members . ~ ; ~., r-- _;.~
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VIA: eanna S ko, ntroller ''"
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FROM: Alan Parker, xecutive on Aging - ~
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RE: NOTIFICATION OF GRANT AWARD ~ ""
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Compliance with Ordinance No. 08-78, Section 7(1) cn
Name of Grant Program:
Grantor:
County Grantee Department or Agency:
Grant No. (IF KNOWN):
Amount of Grant:
Amount of County Match:
County Revenue Account Numbers:
County Expenditure Account Numbers:
Grant Period (Commence. & Completion):
Purpose of Grant:
Is final report required by grantor?
Notification attached:
bji/Ima
cc: Parks & Recreation
CSE Chore Services
State of Hawaii, Department of Human Services
Hawaii County Office of Aging
DHS-06-POS-3139
$69,126.00
$ -0-
#3304.50
#010-481-5481.01 to 5481.02
July 1, 2008 to June 30, 2009
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.
® Yes ~ No
®Yes ~ No
u
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Older Americans Alondi 2008
An Equal Employment Opportunity Provider and Employer
comma. Na ~ g. ~8
Ref. To: ~-~
Ref. Date - -
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Z E O ~ M, ~Y
~'~ ~~ ~~ STATE OF HAWAII-
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:®
-.o-e~ SUPPLEMENTAL CONTRACT N0.3
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TO CONTRACT DHS-06-POS-3139
(Insert contract number or other identif}ping information)
This Supplemental Contract No. 3 ,executed on the respective dates
indicated below, is effective as of July 1 2008 ,between the
Department of Human Services ,State of Hawaii
(Insert name ojstate department, agency, board or cornrnission)
("STATE"), by its Director ,
(Insert title ojstate o~eer executing contract)
(hereafter also referred to as the HEAD OF THE PURCHASING AGENCY or designee ("HOPA")), ,
whose address is 1390 Miller Street, Room 209, Honolulu,. Hawaii 96813 ,and
Hawaii County Office of Aging ("CONTRACTOR"),
a Government Entity
(/nsert corporation, partnership, joint venture, sole proprielorshtp. or other legal form ojthe CONTRACTOR)
under the laws of the State of Hawaii ,whose business address and federal
and state taxpayer identification numbers are as follows: 101 Aupuni Street, 6A
Hilo,- Hawaii 96720 Federal ID#99-600567
RECITALS
A. WHEREAS, the STATE and the CONTRACTOR entered into Contract
DHS-06-POS-3139
(Insert contract numberor other idemifj~ing i~jormation)
dated October 1 ._2005 ,which was amended by Supplemental Contract No(s). - 1
dated July 1 2006 which was amended by Supplemental Contract No(s). 2
dated July 1, 2007 which was amended by Supplemental Contract No{s).
dated , (hereafter collectively referred to as "Contract").whereby the
CONTRACTOR agreed to provide the goods or services, or both, described in the Contract; and
B. WHEREAS, -the parties .now desire to amend the Contact.
NOW, THEREFORE, the. STATE and the CONTRACTOR mutually agree to
amend the Contract as follows: (Check Applicable box(es))
^ Amend the SCOPE OF SERVICES according to the terms set forth in Attachment-Si,
Which is made a part of the Contract.
^ Amend the COMPENSATION AND PAYMENT SCHEDULE according to the terms
set forth in Attachment-S2, which is made a part of the Contract.
® Amend the TIME OF PERFORMANCE according to the terms set forth in
Attachment-S3, which is made a part of the Contract.
^ Amend the SPECIAL CONDITIONS according to the ternls set forth in
Attachment-S6 SUPPLEMENTAL SPECIAL CONDITIONS, which is made a part of
the Contract. •
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 Contract.
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 Contract.
The entire Contract, as amended herein, shall remain in full force and effect. .
IN VIEW OF THE ABOVE, the parties execute this Contract by their signatures, on the dates
below, to be effective as of the date first above written.
STATE
'~~~1
(Signature)
Lillian B. Koller
(Print Name)
Director
(Print Tide1
05 ) a~6~g
(Date)
CONTRACTOR •
(Name ojContractor)
(Signature)
~~~~ ~~
(Print Name)
~r°~~:~~gis~g ~Fe~EC~or
(Print Title)
(Dare)
APPROVED AS TO FORM:
Certification Attached
Deputy Attorney General
APPROVED AS TO
FORM AND LEGALITY:
DEPUTY CORPO~TION COUNSEL
COUNTY OF HAWAII
Date ~ ~
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APR 2~ 8~M2Q08 f
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Evidence of authority of the CONTRACTOR'S representative to sign this Contract for the CONTRACTOR must be attached.
2
t60c ly,
r ~ , „5p * ;; Attachment - S2
~ STATE OF HAWAII
~~~~.,,,,~.,%~ COMPENSATION AND PAYMENT SCHEDULE.
~.,.~.~~
1. This Supplemental Agreement provides for a change in funding for fiscal years:
2009, 2010, 2011
Accordingly, Paragraphs 1 and 10
of the Compensation-and Payment Schedule shall be amended, where applicable, as follows:
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, a sum based on
the payment rate per unit of service set forth below multiplied by the number of units
delivered, provided that the total sum shall not exceed:
Three Hundred Eighty Five Thousand, Nine Hundred Fifty Six And No/100
Dollars {$385, 956.00)
This sum shall be allocated as follows for the specified fiscal years:
FY 2006 FY 2007 FY 2008 FY 2009 FY 2010' FY 2011
State Funds $40,326.00 $69,126.00 $69,126.00 $69,126.00 $69,.126.00 $69,126.00
Federal Funds =0- -0- ~ -0- -0- -0- -0-
(CFDA #) N/A N/A N/A N/A N/A N/A
Contract Total $40,326.00 $69,126.00 $69,126.00 $69,126.00 $69,126.00 $69,126.00
PROVIDER shall equally distribute the total funding for fiscal years 2006 through 2011
between the East Hawaii and West Hawaii locations.
12 Payment Rate and Service Capacity
The annual number of Service Units and the monthly service unit Ca aci which must be
maintained for each- fiscal year of the contract are as follows:
ANNUALLY FOR FYs
2007 THROUGH 2011
Annual Service Units: 3,456
Monthly Capacity: 288
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.
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STATE OF
STATE OF HAWAII
CONTRACTOR'S ACKNOWLEDGMENT
COUNTY OF
SS.
On this day before me appeared
.and , to me
known, to be the person(s) described,in and, who, being me duly sworn, did say that he/she/they is/are
and of
,the
CONTRACTOR named iii the foregoing instrument, and th he/she/they is/are authorized to sign said
instrument on behalf of the .CONTRACTOR, and ackno ledges that he/she/they executed said
instrument as the free act and deed of the CONTRACTOR.
(Signnture)
(Print Name)
Notary Public, State of
My commission expires:
4-
AG-009 Rev 1 I/15/200> 1
STATE OF HAWAII )
SS.
COUNTY OF HAWAII )
On May 1, 2008, before me personally appeared DIXIE IG4ETSU, to me
personally known, whoa. being by me duly sworn, did say that DIXIE KAETSU 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 (ERNES
Notary Public, State of Hawaii
My commission expires: 11/1/2009
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``~"~F ~" STATE OF HAWAII
~jt~a ~ ~ CONTRACTOR'S
~~-~__-eo-e STANDARDS OF CONDUCT DECLARATION
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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; 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 fifty per cent (50%):
"Employee" means any nominated, appointed, or elected officer or employee, of the State,
including members of boards, conunissions, 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. (Section 84-3, HRS).
On behalf of Hawaii County Office of Aging ~ ,CONTRACTOR, the
undersigned does declare as follows:
1. CONTRACTOR [] is* ®is not a legislator or an employee or a business in which a legislator
or an employee has a controlling interest. (Section 84-15(a), HRS). .
2. CONTRACTOR has not been represented or assisted personally in the matter by an individual
who has been an employee of the agency awarding this Contract within the preceding .two years
and who participated while so employed in the matter with which the Contract. is directly
concerned. (Section 84-15(b), HRS).
3. CONTRACTOR has not been assisted or represented by a legislator or employee for a fee or other
compensation to obtain this Contract and will not be assisted or represented by a legislator or
employee fora fee or other compensation in the performance of this Contract, if the legislator or
employee had been involved in the development or award of the Contract.. (Section 84-14 (d),
HRS).
4. CONTRACTOR has not been represented on matters related to this Contract; 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, and participated while an employee or
legislator on matters related to this Contract. (Sections 84-18(b) and' (c), HRS).
CONTRACTOR understands that the Contract to which this document is attached is voidable on behalf
of the STATE if this Contract was entered into in violation of any provision of chapter 84, Hawaii
Revised Statutes, 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 profit received by any
person as a result of a violation of the Code of Ethics may be recovered by the STATE. .
CONTRAC
By
(SignaarreJ
Print Name Dixie Kaetsu
Print Title Managing Director
Name of Contractor Hawaii Office of Aging
Date ~ ~~ ~; " ~1 -
FReminder to A~ency: If the "is" block is checked and if the Contract involves goods or services of a value in excess of
$10,000, the Contract must be awarded by competitive sealed bidding under section 103D-302, HRS, or a competitive sealed
proposal under section ]03D-303, HRS. Otherwise, the Agency may not award the Contract unless it posts a notice of its intent
to award it and files a copy of the notice with the State Ethics Commission. (Section 84-15(a), HRS).
AG-010 Rev 11/15/?005
OF y
,~~,i'~'S`9 ~ Attachment - S3
' ~ ~".~~~. ~. STATE OF HAWAII
f ~~~ . ~
~., ~ ~~,o-~ TIME OF PERFORMANCE
The time performance is extended from the current termination date of:
June 30, 2008
to the new termination date of:
June 30, 2009
as allowed in the document (s) checked below:
X Section 2 of the Request for Proposals.
X Exhibit "E" of the original contract.
§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. .
t6 O c M, Attachment - S4
,~',.-~~,95a,• ~ STATE OF HAWAII
~. ~~ -
t e
e~ CERTIFICATE OF EXEMPTION
~~~~~~~~ FROM CIVIL SERVICE
1. By Heads of Departments Delegated by the Director of the Department of Human Resource
Development ("DHRD").*
Pursuant to a delegation of the authority by the Director of DHRD, I certify that the services to
be provided under this Contract, and the person(s) providing the services under this Contract are exempt
from the civil service, pursuant to § 76-16, Hawaii Revised Statutes (HRS).
(Signature) (Date)
Lillian B. Koller
{Print Name)
Director
(Print Title)
* This part of the form may be used by all department heads and the heads of attached agencies to whom the Director
of DHRD expressly 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. If an exemption is based on
§ 76-16(b)(IS), the contract must meet the following conditions:
(1) It involves the delivery of completed work or product by or during a specific time;
(2) There is no employee-employer relationship; and
(3) The authorized funding for the service is from other than the "A" or personal services cost element.
NOTE: Not all attached agencies have received. a delegation under § 76-16(b)(15). If in doubt, attached agencies should
check with the. Director of DHRD prior to certifying an exemption under § 76-16(b)(15). Authority to certify :exemptions
under §§76-16(b)(2), and 76-16(b)(12),-HRS, has not been delegated; only the Director of DHRD may certify §§ 76-16(b)(2),
and
76-16(b)(12) exemptions.
2. By the Director of DHRD, State of Hawaii.
I certify that the services to be provided under this Contract, and the person(s) providing the
services under this Contract are exempt from the civil service, pursuant to §76-16, HRS.
(Signature) (Date)
(Print
(Print Title, if designee of the Director of DHRD)
AG-014 Rev 6/26/2006
~ ~.
Adult Chore Services; Hawaii Office of Aging
r Contract #: DHS-06-POS-3139 Supplernerlt #3
CERTIFICATION OF CHAPTER 103F AGREEMENT WHEN
NEW AGREEMENT IS SUBSTANTIALLY SIMILAR TO PRIOR AGREEMENT
The undersigned agency officer or employee declares:
1. The agency has had. during the immediately preceding year a Chapter 103E agreement 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 why the new agreement should not be entered into with the
provider or recipient; as the case may be.
3. The General Conditions within the new agreement are substantially the same as those of the
earlier agreement.
4. The Special Conditions within the new agreement are substantially the same as those of the earlier
agreement.
5. The Scope of Services of the new agreement will not conflict with or vary any material term of the
proposal received from the recipient or provider for this agreement.
6. The earlier agreement was approved as to form by a deputy attorney general or preapproved
pursuant to the terms in this Interdepartmental Memorandum.
DATED: Honolulu, Hawaii; ~;AY - 6 200$
AGENCY: Department of Human Services
BY:
(Certifying Signat
Marquis Miyauchi
(Print or Type Name of Certifying Signature)
ITS: Support Services Office Administrator
(Title of Certifying Signature)
The completion of this certificate in compliance with the 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.
SD-POS Certification Form (Revised 7/07)