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HomeMy WebLinkAboutCOM 0041.008 2008-2010 Qr'd . oif -~ll . o o William P. Kenoi Mayor Alan R. Parker Executive on Aging County ot Hawai'i OFFICE OF AGING lOSS Kinoole Street, Suite 101, Hilo, Hawai'i 96720-3872 Phone (808) 961-8600 . Fax (808) 961-8603 Hanama Place, 75-5706 Kuakini Highway, Suite 106, Kailua-Kona, Hawai'i 96740-1751 Phone (808) 327-3597 . Fax (808) 327-3599 ~, c;:;:. c.-::> c.:o DATE: August 12, 2009 ..:-) .'.~ \_/ C. -'7 '........... L."-:-- ::D c::: G"'"J t- .'~; TO: J Yoshimoto, Council Chairman and Council Members 1"\) C() FROM: Kay os~contro r ~~ Alan Parker, Ex utive on Aging \ \,'" ::D :3 VIA: . ',"\ \ ' I CD . , ,~. ,....';.,. t-.J W RE: NOTIFICATION OF GRANT AWARD Compliance with Ordinance No. 09-64, Section 7(1) Name of Grant Program: Grantor: Kupuna Care Services Department of Health, Executive Office on Aging Hawaii County Office of Aging County Grantee Department or Agency: Grant No. (IF KNOWN): Amount of Grant: HA.KC.FB10-11.A $1,293,156.00 = $646,578 for FY2010 + $646,578 for FY2011 $101,000.00 #3304.06 & #010.411.5411.09 to 10 - $584,419 (HCOA) #3304.04 & #101.481.5483.01 to 03 - $62,159 (HCNP) County Grant Period (Commencement & Completion): July 1, 2009 to June 30, 2011 Purpose of Grant: To enable Hawai'j'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 include: Adult Day Care, Case Management, Chore, Homemaker, Personal Care, Assisted Transportation, and Home Delivered Meals. Amount of County Match: County Revenue Account Numbers: Is final report required by grantor? Notification attached: ~Yes D No ~ Yes D No, because /dw Comm. No. 4'.~ Ref. To: Ref. Date AUG 2 8 2009 Hawai'i County is an equal opportunity provider and employer. o LINDA LINGLE GOVERNOR OF HAWAII CHIYOME L. FUKINO, M.D. DIRECTOR OF HEALTH STATE OF HAWAII EXECUTIVE OFFICE ON AGING NO.1 CAPITOL DISTRICT 250 SOUTH HOTEL STREET, SUITE 406 HONOLULU, HAWAII 96813-2831 June 29, 2009 TO: Alan Parker County Executive Hawa~i County O;Lfice of gi~ Noeml Pendleton . ;Jj /J () ~ Director ~ /~~ '-- Executive Office on Aging FROM: SUBJECT: HA.KC.FB 1 O-II.A cory o NOEMI PENDLETON DIRECTOR Telephone (808) 586-0100 Fax (808) 586-0185 DATE RECEIVE'D \0 - 30 - 01 CIRCULATE TO N COpy TO n~! B.L (~ S.:J ) ACTION BY DATE DUE TO ,.- FILE i e- Enclosed is your file copy of contract HA.KC.FB 1 O-II.A. This contract for KUPUNA CARE extends from July 1,2009 through June 30, 2011. If you have any questions, please contact Nancy Moser toll-free at 974-4000,67309#. Mahala. NM:jI Enclosure c: Ernest Reid h o o STATE OF HA WAPI 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) Julv 1 , 2009 between the (agency) Department of Health State of Hawai'i (the "STATE"), by its Director. Executive Office on A2:in2: (the "DIRECTOR"), whose address is 250 South Hotel Street. Suite 406. Honolulu-L- Hawaii 96813, and- -County of Hawaii. Hawaii County Office of A2:in2: (the "PROVIDER"), a (government entity/corporation/partnership/sole proprietorship/ other business form) 2:overnment entity whose business address and taxpayer identification number are: Hawaii County Office of A2:in2:. 1055 Kino'ole Street. Suite 101. HUo. Hawaii 96720 Federal Tax I.D. #99-6000567 State Tax I.D. #W40793866-01 RECITALS A. This Agreement is for a purchase of health and human services that is exempt from the requirements of Chapter 103F, HRS, because: IXJ this Agreement is between or among government agencies as provided in Section 103F-I0l(a)(2), HRS; D' 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); lJ this Agreement is wholly or partly funded from federal sourc'~s that . ~ conflict with the procedures and requirements established by Chapter 103F, HRS, and its implementing regulations; o 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; HA.KC.FB lO-l1.A EXEMPT TRANSACTIONS 1 Form AG3-Exempt(4/99) I, I. o o o . this Agreement is for an affiliation agreement with hospitals and other health care providers required for University of Hawaii clinical programs; o 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; o 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: $ 1,293,156.00 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): o corporate resolutions of the PROVIDER or other authorizing documents such as partnership resolutions; o 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; HA.KC.FBlO-l1.A EXEMPT TRANSACTIONS 2 Form AG3-Exempt(4/99) r o o o the PROVIDER is a sole proprietor and as such does not require any authorizing documents to sign this Agreement; !2S] the PROVIDER is a government entity, and the undersigned . representative of the PROVIDER is duly-authorized to exe<:ute contracts on behalf such government entity; o other evidence of signing authority: F. The PROVIDER has produced, and the STATE has inspected, a certificate of insurance in the amount of nla DOLLARS ( nla ), 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 Hawai'i, Department of Taxation, dated nla 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 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) Julv 1, 2009, to (date) June 30, 2011, unless this Agreement is sooner terminated. 3. Compensation. The PROVIDER shall be compensated: l&J in a total amount for all required services not to exceed ONE MILLION TWO HUNDRED NINETY-THREE THOUSAND ONE HUNDRED FIFTY-SIX AND NOI100 DOLLARS 0.293.156.00), 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. o based upon referrals to the PROVIDER from the STATE, payment HA.KC.FB 1 0-11.A EXEMPT TRANSACTIONS 3 Form AG3-Exempt(4/99) " I' o o 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 nla referrals to the PROVIDER. 4. Reportin2: 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) AU2:ust 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 DIRECTOR shall be sent to the DIRECTOR's office in Honolulu, Hawaii. Notice to the Agency Procurement Officer shall be sent to: Executive Office on A2:in2:, 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. HA.KC.FB 1 0-11.A EXEMPT TRANSACTIONS 4 Form AG3-Exempt(4/99) 1- o o 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 . . . . ~~c~j;:~7l.:'~ Print Name Noemi Pendleton Title Director Date June 29, 2009 PROVIDER COUNTY OF HAW All By WILLIAMP..KENOI Print Name . MAYOR Title Date JUN 1 B 2009 RECOMMEND APPROVAL: ~ ~~te JUN 0 1 2009. HawmiCounty lceofA~ng County Executive APPROVED AS TO FORM AND LEGALITY: D~CounSe1 County of Hawaii De u y Attorney Gener State of Hawaii EXEMPT TRANSACTIONS Page 5 HA.KC.FB lO-ll.A AG3-Exempt (4/99) .0 0 STATE OF HAWAI'I ) ) SS: COUNTYOFHAWAI'I ) On June 18, 2009 , before me personally appeared WILLIAM P. KENOl, to me personally known, who, being by me duly sworn, did say that WILLIAM P. KENOl is the Mayor of the County ofHawai'i, a municipal corporation of the State of Hawai'i; that the seal affixed to the foregoing instrument is the corporate seal of the said County of Hawai'i; that the foregoing instrument was signed and sealed in behalf of the County of Hawai'i by authority given to said Mayor of the County ofHawai'i by Section 5-1.3(g) of the County Charter, County of Hawai 'i (2000), as amended; and said WILLIAM P. KENOl acknowledged said instrument to be the free act and deed of said County of Hawai'i. ~\,.~-~ GUILLERMA G. SUMERA Notary Public, State ofHawai'i My commission expires: 9/22/09 Doc. Date:' July 1,2009 No. of Pages: 39 Notary Name: Guillerma G. Sumera Third Judicial Circuit Doc. Description: Agreement for Health and Human Services - State DOH Executive Office on Aging WUU<4 \t.. ~~ Notary Signature 6/18/09 Date .