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HomeMy WebLinkAboutCOM 0041.003 2008-2010+tV OI N,I '. %-. 4~'r4 ' 1~Cy: Alan R. Parker William P. Kenai Mayor Lzecu(ive on Aging ~i'•. _~ 1IE Oi'M~~` County of Hawaii OFFICE OF AGING Aging and Disability Resource Center, 1055 Kino'ole Street, Suite 101, Hilo, 1{awai'i 967203872 Phone (808) 961-8600 • Fax (808) 961-8603 • Hmail: hcoa~hawaiiantel.net Hanama Place, 75-5706 Kuakini Highway, Sui[e 106, Kailua-Kona, Hawaii 96740-1751 Phone (808) 327-3597 • Pax (808) 327-3599 • BmaiL hcoakona©hawaiian[el.ne[ DATE: July 1, 2009 rr~ t-~ TO: J Yoshimoto, Council Chairman and ~-~ °° Council Members <"~ c-~~-. .-,-, C ~ `, I- ~- -- VIA: Kay Oshiro, Acting C ntroller~ - ~: ' FROM: Alan Parker, Exe tive on Aging ' ~ ~~ ~ ~_ _L. ~ ~ i CJ RE: NOTIFICATION OF GRANT AWARD %~ .,~ `" Compliance with Ordinance No. 09-64, Section 7(1) = W Name of Grant Program: Elder Abuse Awareness and Prevention Grantor: Dept. of Health, Executive Office on Aging County Grantee Department or Agency: Hawaii County Office of Aging Grant No. (IF KNOWN): HA.EAb.FB10-11.A Amount of Grant: $50,360.00 Amount of County Match: N/A County Revenue & Expenditure Account Numbers: 3304.06 and 010.411.5411.10.115 Grant Period (Commencement & Completion): July 1, 2009 to June 30, 2011 Purpose of Grant: Elder abuse awareness and prevention services for individuals 60 years or older and their caregivers. Is final report required by grantor? ®Yes ^ No Notification attached: ®Yes ^ No, because Please direct any questions to Vicki R. Belluomini at 961-8600 (~ ~ ?~ +iomm. No. -1 Ref. Tai '~' Ref. Dore .Illl 1 7 2009 a ~; Hmrai i Coenry fs an equal oppornmip~ provider mid enip(oyer. An Area Agency on Aging STATE OF HAWAII AGREEMENT FOR HEALTH AND HUMAN SERVICES: TRANSACTIONS EXEMPT FROM CHAPTER 103F, HRS This Agreement, executed on the respective dates of the signatures of the parties shown hereafter, is effective as of (date) July 1 2009 between the (agency) Department of Health State of Hawaii (the "STATE"), by its Director, Executive Office on AginE (the "DIRECTOR"), whose address is 250 South Hotel Street, Suite 406, Honolulu, Hawaii 96813, and County of Hawaii, Hawaii County Office of A~ine (the "PROVIDER"), a (government entity/corporation/partnership/sole proprietorship/ other business form) government entity whose business address and taxpayer identification number are: Hawaii County Office of Aeine.1055 Kino'ole Street, Suite 101, Hilo, Hawaii 96720 Federal Tax I.D. #99-6000567 State Tax I.D. #W40893544-O1 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 and subgrants to specific organizations directed by the funding source as provided in Section 3-141-503(a)(1); ^ this Agreement is wholly or partly funded from federal sources that conflict with the procedures and requirements established by Chapter 103F, HRS, and its implementing regulations; ^ this Agreement is wholly or partly funded from federal sources that (1) 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 HA.EAb.FB10-11.A 1 Form AG3-Exempt(4/99) ^ this Agreement is for an af£liation 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 or by the rules of the court; - ^ this Agreement is for a transaction covered by a written exemption from the Chief Procurement Officer for the STATE dated B. The STATE is in need of the health and human services described in this Agreement and its exhibits (the "Required Services"). The PROVIDER is agreeable to Providing the Required Services. C. Money has been appropriated for the purchase of the Required Services by: (1) (identify state sources) Item ,ACT , 2009 HSL , or (2) (identify federal sources) or both, in the following amounts: State: $ 50,360.00 Federal: $ -0- D. Pursuant to (legal authority for Agreement) Section 349-3, HRS the STATE is authorized to enter into this Agreement. E. The undersigned representative of the PROVIDER represents, and the STATE relies upon such representation, that he or she has authority to sign this Agreement By virtue of (check any of all that apply): corporate resolutions of the PROVIDER or other authorizing documents such as partnership resolutions; corporate by-laws of the PROVIDER, or other similar operating documents of the PROVIDER, such as a partnership agreement, or an limited liability company operating agreement; EXEMPT TRANSACTIONS HA.EAb.FB10-11.A ~ Form AG3-Exempt(4/99) ^ the PROVIDER is a sole proprietor and as such does not require any authorizing documents to sign this Agreement; ^D the PROVIDER is a government entity, and the undersigned representative of the PROVIDER is duly-authorized to execute contracts on behalf such government entity; ^ other evidence of signing authority: F. The PROVIDER has produced, and the STATE has inspected, a certificate of insurance in the amount of n/a DOLLARS ( n/a ), for bodily injury and property damage liability arising in connection with the PROVIDER's performance under this Agreement. G. The PROVIDER has produced; and the STATE has inspected, a tax clearance certificate with approval from the State of Hawaii, Department of Taxation, dated n/a , NOW, THEREFORE, in consideration of the promises contained in this Agreement, the STATE and the PROVIDER agree as follows: 1. Scone of Services. The PROVIDER shall, in a proper and satisfactory manner as determined by the STATE, provide the Required Services as set forth in Exhibit "A" to this Agreement, which is attached, and made a part of this Agreement. 2. Term of Agreement. The PROVIDER shall provide the Required Services from (date) July 1 2009 , to (date) June 30 2011 unless this Agreement is sooner terminated. 3. Compensation. The PROVIDER shall be compensated: D in a total amount for all required services not to exceed FIFTY THOUSAND THREE HUNDRED SIXTY AND NO/100 DOLLARS ($50,360.00), including taxes, at the time and in the manner set forth in Exhibit "B" to this Agreement, which is attached, and made a part of this Agreement. based upon referrals to the PROVIDER from the STATE, payment EXEMPT TRANSACTIONS HA.EAb.FB10-11.A 3 Form AG3-Exempt(4/99) for each such referral shall be made according to Exhibit "B" to this Agreement, which is attached, and made a part of this Agreement. The STATE shall provide a minimum of n/a referrals to the PROVIDER. 4. Reporting Requirements. In addition to whatever other reports may be required elsewhere in this Agreement, the PROVIDER shall also submit a Final Project Report, by (date) August 30 2011 No amendment to the PROVIDER'S Final Project Report shall be considered after (date) September 30 2011 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 DHtECTOR shall be senf to the DIRECTOR'S office in Honolulu, Hawaii. Notice to the Agency Procurement Officer shall be sent to: Executive Office on Acing, 250 South Hotel Street, Suite 406, Honolulu, Hawaii 96813 .Notice to the PROVIDER shall be sent to the PROVIDER at the PROVIDER'S address as indicated in this Agreement. Notice to the STATE'S Chief Procurement Officer shall be sent to State Procurement Office, 1151 Punchbowl Street, Room 230A, Honolulu, Hawaii 96813. A notice shall be deemed to have been received three (3) days after mailing or at the time of actual receipt, whichever is earlier. The PROVIDER is responsible for notifying the STATE in writing of any change of address. EXEMPT TRANSACTIONS HA.EAb.FB10-11.A 4 Form AG3-Exempt(4/99) 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 EXECUT OFF`I O AGING By uec„° , Print Name Noemi Pendleton Title Director Date June 26, 2009 PROVIDER COU~ N~T~?Y OF HAWAII By ~`C" ~' Print Name Title WILLIAM P. KENOI MAYOR -- Date GUN 15 209 RECOMMEND APPROVAL: cLate JUN 0 5 2009 Hawaii County Office of Aging County Executive APPROVED AS TO FORM AND LEGALITY: Deputy C rpor on Counsel County of Hawaii APPROVED AS TO FORM: D t Attorney Genet State of Hawaii EXEMPT TRANSACTIONS Page 5 HA.EAb.FB10-11.A AG3-Exempt (4/99) CONTRACT NO. PROVIDER'S ACKNOWLEDGMENT ATE OF ~ ~~- ) COUNTY OF ~- ) On this / ay of ~~,..1- me appeared ~~~L~4•- Yy~.. ~ ~~-Z~~~/ 20 ~~_ ,before and , to me lmown, to be the person(s) de/scribed in and, who, being by me duly sworn, did say th t~/she/the} fi /are the ~"/ i9- ~O /2_~ and of the PROVIDER named in the foregoing instrument, and that he/she/they is/are authorized to sign said instrument on behalf of the PROVIDER, and aclmowledges that he/she/they executed said instrument as the free act and deed of the PROVIDER. G~ (Notary Seal) /Gfr~ e ~ ~AT~Ie '~"" oG~ Print Name Date F Notary Public, State of GC.C~~ My coimnission expires: ~~17/~0 Doc. Date: ~~ Notary e: PAT CIA A, KAG~ ~~~~ Circuit r 0 OQ- ~ lLK /!~~ ~~G'`- JUN 15 2009 No Signature ate NOTARY CERTIFICATION HA.EAb.FB10-11.A with ~ without attachments (Notary Stamp or Seal) ~~ AG Form 103F (10/08)