Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Resolutions - 2010.06.09 - 10159
MISCELLANEOUS RESOLUTION f10137 June 9, 2010 BY: General Government Committee, Christine Long, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2010 MICHIGAN DEPARTMENT OF HUMAN SERVICES ZERO TO THREE SECONDARY PREVENTION GRANT AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Human Services has awarded the Oakland County Department of Health and Human Services/Health Division a grant award in the total amount of $1,146,251 for the Zero to Three Secondary Prevention Program for the period of May 1, 2010 through September 30, 2012; and WHEREAS these funds will be used to reimburse expenses associated with this program designed to prevent child abuse and neglect of Pontiac children ages birth to three years of age utilizing ;he evidence-based Nurse Family Partnership home visitation model; and WHEREAS it is estimated that 100 families in the City of Pontiac will be assisted each year by this program; and WHEREAS no new positions will be utilized for this initiative; and WHEREAS a grant match of $341,314 will be utilized from MU Block Grant and in-kind sources; and WHEREAS this agreement has been submitted through the County Executive Review Process and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby accepts the Michigan Department of Human Services Zero to Three Secondary Prevention Program Grant Agreement. BE IT FURTHER RESOLVED that the future level of service be contingent upon the level of funding for this program. BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute this agreement, any changes and extensionS to the agreement not to exceed fifteen percent (15%), which is consistent with the agreement as originally approved. Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing resolution. GENERAL GOVERNMENT COMMITTEE a GENERAL GOVERNMENT COMMITTEE Motion carried unanimously on a roll call vote with Schwartz absent. Dr. Tom Fackler From: Fournier, Nancy (fourniern@oakgov.corni Sent: Friday, May 21, 2010 5:06 PM To: 'Fockler, Dr, Tom '; forzleyk@oakgov.com ; 'Pearson, Linda'; 'Smith, Laverne' Cc: Gala ', 'Soave, Tim' Subject: Grant Sigri Off: Health lIvision - 2010 Zero to Three Secondary Prevention - Grant Acceptance Attachments: SKMBT_42010052112140.pdf GRANT REVIEW SIGN OFF — Health Division GRANT NAME: Health Division - 2010 Zero to Three Secondary Prevention - Grant Acceptance FUNDING AGENCY: Michigan Department of Human Services DEPARTMENT CONTACT PERSON: Tom Pockler 2-2151 STATUS: Grant Acceptance DATE: May 21, 2010 Pursuant to Misc. Resolution #01320, please be advised the captioned grant materials have completed internal grant review. Below are the returned comments. The captioned grant materials and grant acceptance package (which should include the Board of Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal Note, and this Sign Off email containing grant review comments) may be requested to be placed on the appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution, DEPARTMENT REVIEW Department of Management and Budget: Approved. — Laurie Van Pelt (5/17/2010) Department of Human Resources: Approved. — Cathy Shallal (5/i 8/2010) Risk Management and Safety: Approved by Risk Management, — Andrea Plotkowski (5/21(2010) Corporation Counsel: Approved. — Bradley G. Berm (5/21/2010) COMPLIANCE The grant agreement references a number of specific federal and state regulations. Below is a list of these specifically cited compliance related documents for this grant, Federal Office of Management and Budget (OMB) Circular No. A-87, A-102, and A-133 http://www.whitellouse ,gov/omb/circulars/index,h.tml Michigan Elliott-Larsen Civil Rights Act — "Act 453 of 1976" bttpJlegt1ai.tre 1111. go yi ge IonrjSz.55z2 ui ileg.aspx2page=ggAthjec t objec In a me ----n_ic I -Ac t- 453-of-1976&queryith--14718540 5/21/2010 • Page 2 of 2 Michigan State Contracts with Certain Employers Prohibited — Mt 278 of 1980 http://y,.ww.leoislaturedintawliMulacipluncl , ___-110s21355))/mileg.spx?pagetObject&objcoName ---mcl- Act-278-of-1980 Nancy Fournier, Fiscal Services Chief, an behalf of &ma V. Piir Grants Compliance and Programs Coordinator Oakland CoL,nty Fiscal Services Division Phone (248) 858-1037 Fax (248) 858-9724 piirg@oakgov.com 5/21/2010 Contract No: County: Total Grant Amount: 1st Year Amount 2nd Year Amount: 3rd Year Amount: Method of Payment: ZTT-10-63001 Oakland $1,146,251 $200,257 $472,997 $472,997 Actual Cost GRANT AGREEMENT between Michigan Department of Human (hereinafter referred to as aDHS") 235 South Grand Avenue P.O. Box 30037 Lansing, Michigan 48909 Services & Oakland County Health Division (hereinafter referred to as "Grantee") 1200 N. Telegraph, Dept 34E Pontiac, MI 48341 This Agreement is effective from May 1, 2010 through September 30, 2012. I. GRANTEE RESPONSIBILITIES Geographic Area The Grantee shall provide services described herein in the following geographic area: Oakland County. B. Location of Facilities The Grantee shall provide services described herein at the following location(s): 1200 N. Telegraph Rd., Dept. 34 -E, Pontiac, ML, 48341. In client homes Location which is mutually agreed upon between the client and Grantee C. Tar et PoL_g -g_Vaer iteri 1. DHS referred families, families with expectant mothers or families with children up to age three (3) who have been identified as at risk and do not have an open Children's Protective Services (CPS) case with a Category I or RI disposition. A family shall be deemed at risk when they possess three (3) or more of the following risk factors: • Family history of child abuse and/or neglect • Family who is homeless CM-F157 (Rev. 10-09) Previous edition obsolete. MS Word SYJ4.29.10 A. • Parent with negative or ambivalent attitude regarding pregnancy or parenting • Parent with destructive temperament who has unrealistice expectations of the child and/or views harsh punishment as appropriate • Parent with substance abuse or addiction • Family who is isolated with inadequate support system • Parent with diagnosed mental/physical condition that interferes with parenting ability • Family history of delinquency • Teen parent • Family with incarcerated parent • Child with long-tern chronic illness • Child with diagnosed handicapped condition • Child with diagnosed mental health condition or documented behavioral issue CPS Category Definitions: Category IV: Cases in which a preponderance of evidence of child abuse or neglect is not found. DHS assists the child's family in voluntarily participating in community based services commensurate with the risk level determined by the DHS risk assessment, Category Ill: Cases in which DHS determines that there is a preponderance of evidence of child abuse or neglect and the risk assessment indicated a low or moderate risk. Category II:Cases in which OHS determines that there is a preponderance of evidence of child abuse or neglect and the risk assessment indicates a high or intensive risk. Category I: Cases in which 01-IS determines that there is a preponderance of evidence of child abuse or neglect and a court petition is needed and/or required. 2. Determination of Eligibility DHS and the Grantee shall determine eligibility. DHS referrals shall receive priority, D. Credentials The Grantee shall assure that appropriately credentialed or trained staff shall -2- CM-P 157 ;Rev. 10-D9) Previous edition obsolete. MS Word SYJ4.25.10 perform functions under this Agreement. The public health nurse shall possess at a minimum a Bachelors Degree in Nursing from an accredited college or university and be licensed by the Michigan Board of Nursing. The public health nurse must be registered as a professional nurse in the State of Michigan and possess at least three (3) years of full time experience in public health nursing. The Public Health Nurse Supervisor shall possess at a minimum a Bachelors Degree in Nursing from an accredited college or university and be licensed by the Michigan Board of Nursing. In addition the Supervisor must be registered as a professional nurse in the State of Michigan and possess at least three (3) years of full time experience in public health nursing one of which involving program evaluation or functional supervision of an education or preventive program. E. Services to be Delivered Service # 1 of 1: HOME VISITATION SERVICES 1. Activities the Grantee shall perform: The Grantee shall: a. Provide the Nurse-Family Partnership (NFP) program to OHS referred and qualified first time pregnant mothers. b. Adhere to the Nurse-Family Partnership model of service. c. Provide a team of four (4) full-time registered public health nurses (RN) to perform direct services for the Nurse-Family Partnership program. Each nurse shall be assigned a maximum of 25 clients. The public health nurses duties shall include the following: 1) Initiate contact with the client within three (3) business days of receiving a written referral to: • Thoroughly explain the program • Determine willingness to voluntarily participate with services. • Verify program eligibility • Schedule a date for initial home visit Meet with the client within seven (7) business days of initial contact, to complete the NFP Prenatal Visit Health Checklist and -3- CM-F157 (Rev. 10-09) Previous edition otsolete. MS Word SYJ-0.29.10 the NFP Maternal Health assessment. The nurse shall identify client strengths and needs. 3) Develop a written service plan jointly with the client by the second visit. The service plan shalt include at a minimum: • A statement of goals • Identification of client needs • A list of activities to be performed by the client, family (as appropriate) and nurse 4) Conduct home visits according to the following schedule: • Pregnancy: Weekly during the first month of initial client enrollment, then every other week until the baby is born. • Postpartum: Weekly for the first six weeks after the child's birth • Newborn: Every other week from 6 weeks of the child's birth until the child is 20 months of age. • Toddler. Monthly from the child's 21st month of age until the child is 24 months of age. 5) Conduct home visits according to a seven (7) segment home visit organization as follows: • Client greeting • Discussion of client issues and concerns • Review of previous visits outlined activity assignment(s) • Assessment of client's current status • Clients structured selection of the next visit's topic • Goal setting • Schedule next appointment 6) Follow up each missed appointment with the client by a phone call, reminder card or personal visit. 7) Assist the client/family in utilizing community resources. With written consent of the client, make appropriate referrals to agencies and resources that address needs identified in the service plan. Coordinate service planning with agencies involved. -4- CM-F157 (Rev. 13-09) Previous editiei obsolce. MS Word SYJ4.29.10 8) Provide health education targeted at nutrition, signs and symptoms of preterm labor, parenting skills, smoking cessation, alcohol and drug abuse avoidance. 9) Provide life skills guidance for domain areas of education, employment, housing, and regular medical care. 10) Teach/model coping skills, problem resolution, stress reduction techniques, appropriate discipline and growth and realistic developmental expectations of children. 11) Conduct risk assessments of mother and child at each visit as appropriate. Appropriate tools of assessment will be used for pregnancy, postpartum and for children after birth. The assessment tools used are: • NFP Prenatal Visit Health Checklist • NFP Postpartum Visit Checklist • NFP Infant/Toddler Checklist • NFP Maternal Health Assessment 12) Provide referral and follow up to mental health services for positive screening of depression and/or domestic violence. 13) Provide specc assistance to families that will promote achievement of goals such as learning aids, safety devices, and bus fare up to $100 per client. 14) Participate in monthly case conferences with the NFP supervisor to encourage collaboration and problem-solving. 15) Maintain close and consistent contacts with Child Protective Services (CPS) workers and work in conjunction with CPS on the plan of intervention/recommendations for any Category III or IV families. 16) Administer a satisfaction survey with each family when service provision ends. 17) Close cases and terminate services when the youngest eligible child reaches his or her second birthday. 18) Refer families to other home-based preventative services when the family's case is closed. -5- CM-F107 (Rev. 10-09) Previous edition obsolete. MS WO.-cl SY,J4.29.10 2. Volume of Service a. Clients - The estimated number of clients to be served annually shall be: 100 b. Unit Definitions: Length of Service: One unit equals one (1) family completing at least 50% of the prescribed period of the evidenced-based model. Outcome Achievement: One unit equals one (1) family completing at least 80% of the service outcomes outlined in the service plan. c. Number of units: The estimated number of units to be provided during the following period shall be: Length of Service: Fiscal Year estimated Number of Units May 1, 2010 through September 30, 2010 35 October 1, 2010 through September 30, 2011 75 October 1, 2011 through September 30, 2012 75 Outcome Achievement: Fiscal Year Estimated Number of Units May 1, 2010 through September 30, 2010 30 October 1, 2010 through September 30, 2011 65 October 1, 2011 through September 30, 2012 65 F. Evaluation Reporting Requirements The Grantee shall submit to DHS reports that indicate the status and effectiveness of activities performed under this Agreement as indicated: 1. Comply with all program reporting procedures as are or may hereinafter be established by DHS. a. Submit an annual evaluation detailing 0-3 Secondary Prevention activities, outcomes, challenges, etc., for each fiscal year of the three (3) year grant. The annual evaluation must be received by December 20 of each year of the Agreement. -6- CM-F57 (Rev. 10-09) Prey c.,us edition obIet MS Wo.-ci SYJ4.29.10 Federal Program Title I TANF CFDA # 93.558 100% FFP°./0 b. Submit all materials to: Jeff Sadler, Bureau of Child Welfare Suite 1411, Grand Tower Building 235 S. Grand Ave. Lansing, MI 48933 G. Audit Requirements Subrecipient Relationshie This Agreement constitutes a subrecipient relationship with OHS. The Grantee is required to comply with all federal regulations that related to the accounting and auditing of the federal award used to fund this Agreement. This includes, but it not limited to, compliance with OMB Circular A-133. Regulations applicable to funding sources are included in the Catalog of Federal Domestic Assistance (CFDA). The Federal Program Title, CFDA number, and federal finandal participation (FFP) rate DHS will use for this Agreement are: However, OHS may change the CFDA number and/or FFP rate during the course of this Agreement. CFDA numbers and FFP rates for this Agreement shall be posted monthly on the OHS web site. The Grantee is required to check the web site to obtain up to date information regarding the CFDA numbers. The Grantee shall consult the following website address to obtain CFDA numbers, payments, program updates, and other audit information: http://www. m ichigan.gov/dhs/0.1607,7-124-5455_7199_8380 —,00. htm I OHS agrees to participate in audit cost related to the audit as described in other sections of this Agreement. Reporting Requirements The Grantee must immediately report to the DI--iS Office of Monitoring and Internal Control accounting irregularities including noncompliance with provisions of this Agreement. -7- CM-F 157 (Rev. 10-39) Previous edition bsoiete. MS Word SY44.29 10 If the Grantee is required per OMB Circular A-133 to have a Single Audit performed, the Grantee must submit the Reporting Package and an Audit Transmittal Letter to the DHS Office of Monitoring and Internal Control at the address that follows and in accordance with the time frame established in the Circular. Reporting Package includes: 1. Financial statements and schedule of expenditures of Federal awards 2. Summary schedule of prior audit findings 3. Auditor's report(s) 4. Corrective action plan, if applicable Audit Transmittal Letter The Grantee is responsible to identify in the Audit Transmittal Letter all organizations it operates that administer DHS subrecipient programs and the different names the Grantee may use to contract with DHS. The Grantee is responsible for proper completion and submission of the Audit Transmittal Letter. This letter, to be accurately processed by DHS, must include the following information: 1. Grantee's name as reported in the DHS contract(s) 2. Grantee's Federal Identification number(s) as reported in the DHS contract(s) 3. Grantee's fiscal year end 4. Identify other name(s) and other Federal Identification number(s) used by the Grantee If a Single Audit is not required per OMB Circular A-133, the Grantee must still submit an Audit Transmittal Letter stating why a Single Audit was not required arid the Grantee's fiscal year to which the letter pertains. The Audit Transmittal Letter should include items stated in the section, 'Audit Transmittal Letter," described above. The letter may be mailed to the address below or FAX to (517) 373-8771. Mailing address for all information: Michigan Department of Human Services Office of Monitoring and Internal Control Grand Tower Suite 1112 PO Box 30037 Lansing, MI 48909 -8- CM-F157 (Rev. 10-09) Previous edition obsolete. MS Word SY.A.2.9.10 If the Grantee is a subrecipient of DHS, but asserts it is not required to have a Single Audit performed, the Grantee shall submit an audit transmittal letter to the OHS Office of Monitoring and Internal Control stating the reason the Single Audit is not required. Failure by the Grantee to submit the transmittal letter shall result in invoking the same sanctions on the Grantee as failure to submit the Single Audit report. Audit Cost Cost of the Single Audit can only be charged to this Agreement if there is a provision within this Agreement that allows payment for the Single Audit cost. No audit cost may be charged tot his Agreement if the Grantee is not required by federal requirements to have a Single Audit No audit costs may be charged to OHS when audits required by this Agreement have not been performed or have not been performed in accordance with OMB Circular A-133 requirements. Late submission (as defined in OMB Circular A-133) of the Single Audit report and/or Audit Transmittal Letter is considered non- compliance with this section and may be grounds to impose sanctions. Sanctions OHS may impose sanctions if the Grantee fails to adhere to any of the audit requirements in this Agreement, including the audit transmittal letter. In cases of continued inability or unwillingness on the part of the Grantee to comply with audit requirements, OHS may impose sanctions such as: 1. Withholding a percentage of Federal Awards until the audit is completed satisfactorily; 2. Withholding or disallowing overhead costs; 3. Suspending Federal awards until the audit is conducted; 4. Terminating the Federal award; or 5. Recouping all federal payments made to the Contractor under this or any other agreements between OHS and the Contractor. H. Match The Grantee shall provide a minimum match (cash and in-kind combined) of 25% of the grant. The cash match must be at least 15% of the grant. The amounts and types of match are subject to approval by OHS. The sources of match must be verifiable. CM-F157 (Rev. 10-09) Prev.ous editor, obsoiele. MS Wore SYJ4.29.10 1. Participation in Surveys The Grantee shall complete all surveys conducted by DHS or funding agencies and return them in a timely manner. If a program had concerns with any information contained in the survey, the concern shall be expressed in writing and an exception to the policy may be provided. J. Fiscal Requirements The Grantee shall install and maintain an accounting system to identify and support all expenditures billed to DHS under this Agreement. The accounting system must record all income and expenses for the Grantee's total program of which services provided under this Agreement are a part. The accounting system, as a minimum, shall consist of a chart of accounts, cash receipts journal, cash disbursements journal, and general ledger. All expenditures and income must be supported by vouchers and receipts that detail the reason for the transaction. The Grantee shall maintain, within the accounting system, salary and fringe benefits accounts that break out positions, hospitalization, retirement, workmen's compensation and other fringe benefits. The Grantee shall establish and maintain payroll records for all employees. The Grantee shall maintain payroll records to support amounts billed to OHS in accordance with the federal timekeeping requirements described in the applicable OMB Circular A-122, or OMB Circular A-87, or as codified in the Code of Federal Regulations. K. Billing Method As used in this Agreement, "Cost Documentation" refers to the CM-468-ex Total Program Budget Summary, and the Contract Budget Statement Detail sheets attached hereto. The Actual Cost Reimbursement Method shall be used in claiming reimbursement under this Agreement. The Cost Documentation is hereby made a part of this Agreement, The Grantee certifies that this budget has been prepared in accordance with the Budget Completion Instructions provided by DHS. This document details the amount and object of expenditures for which the Grantee shall use funds paid under this Agreement. The Grantee is authorized to expend funds only for those resources indicated in the budget that are allowable, properly allocated and reasonable as defined in the Budget Completion Instructions_ Where the approved budget, and/or supporting detail sheets and/or the Grantee's proposal submitted in response to the OHS Invitation to Bid issued for this -10- CM-F157 (Rev, 10.-09) Previous eciton obsoete. MS Word SYJ4 29 10 Agreement includes provision for voluntary contributions on the part of the Grantee, the Grantee shall provide the contributions in the proportion indicated for each dollar expended for the identified cost item. The Grantee shall follow and adhere to the budget. However, expenditures up to a 10% increase or $1,000, whichever is greater above the direct cost line item budget categories are permissible provided the sum of all expenditures does not exceed the total amount of the Agreement. The Grantee shall not be reimbursed for any expenditures incurred in budget line items that do not include dollar amounts. The Grantee must obtain prior written approval from DHS to increase any line item by more than 10% or $1,000, whichever is greater. The DHS representative authorized to approve budget revisions is the Director, Division of Contracts and Rate Setting. The Grantee's request for DHS approval must contain sufficient information to allow DHS to identify which budget line items are to be increased and which line items are to be decreased, staying within the originally approved budget total. For travel costs, including mileage, meals, and lodging, incurred related to services provided under this Agreement, the Grantee may bill DHS the premium state rate, or Grantee 's usual reimbursement rate for employees, whichever is less. State of Michigan travel rates may be found at the following website: http://www.michigan.govidmb/0,1607,7-150-9141_13132 —,00.html The Grantee cannot charge DI-IS more for a provision of service than is charged to other entities for whom the Grantee provides services. L. Billing Procedure In Fiscal Year 2010, the Grantee shall submit a monthly "Statement of Expenditures" (DNS-3469) to DHS. This Statement of Expenditures shall indicate actual expenditures incurred broken out by category of expense in the performance of this Agreement for the period being billed and the units of service delivered. This Statement shall be submitted to DHS within thirty days from the end of the monthly billing period. For the month of September, billings shall be submitted as reasonably directed by the contract administrator to meet fiscal year end closing deadlines. In each subsequent year of this Agreement, the Grantee shall submit a quarterly DHS-3469 to DHS by January 20, April 20, July 20, and in October as reasonably directed by the grant administrator to meet fiscal year end closing deadlines. Do not report match dollars on the DHS-3469. -11- CM-F157 (Rev. 1 o•09) Previous edilion obsolete. MS Word SYJ4.29.10 With each DHS-3469, the Grantee shall submit the 0-3 Report of Expenditures. All match (cash and in-kind) expenditures, as well as grant expenditures are itemized in this format. Payment is dependent upon timely submission and completion of all reports. In no event shall DHS make payment to the Grantee for billings submitted more than 90 days after the end of a billing period. Obligations incurred prior to or after the period covered by this Agreement shall be excluded from the Grantee's invoices. M. Epriprni nt ticielinas for Use of Community-Based Child Abuse Prevention Grant This Agreement is subject to the following terms, conditions, and provisions: 1. Applicable program standards include Title IV-A of the Social Security Act, Title IV of PRWORA of 1996, as amended (8 U.S.C. 1611 et seq.), and the TANF regulations at 45 CFR Parts 260 to 284. Administrative requirements are identified below. 2. The following regulations from Title 45 of the Code of Federal Regulations (CFR) apply: • 45 CFR Part 16 — Procedures of the Departmental Grant Appeals Board; • 45 CFR Part 76 — Debarment and Suspension from Eligibility for Financial Assistance (Nonprocurement); • 45 CFR Part 80— Nondiscrimination Under Programs Receiving Federal Assistance through the Department of Health and Human Services, Effectuation of Title VI of the Civil Rights Act of 1964; • 45 CFR Part 81 — Practice and Procedure for Hearings Under Part 80 of this Title; • 45 CFR Part 84 — Nondiscrimination on the Basis of Handicap in Programs and Activities Receiving or Benefiting from Federal Financial Assistance; • 45 CFR Part 86 — Nondiscrimination on the Basis of Sex in Education Programs and Activities Receiving or Benefiting from Federal Financial Assistance; • 45 CFR Part 91 — Nondiscrimination on the Basis of Age in HHS Programs or Activities Receiving Federal Financial Assistance; • 45 CFR Part 92 — Uniform Administrative Requirements for Grants and Cooperative Agreements to State, and Local, and Tribal Governments • 45 CFR Part 93— New Restrictions on Lobbying -12- CM-L 1 57 ;Rev. I 0-09) Previous edition obsolete. MS Word SY..14.2 91 D • 45 CFR Part 95 — General Administration — Grants Programs (Public Assistance, Medical Assistance and State Children's Health insurance Programs) 3. in accordance with Public Law 103-333, the "Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1995," the following provisions are applicable to this Agreement: Section 507: "Purchase of American-Made Equipment and Products — It is the sense of the Congress that, to the greatest extent practicable, all equipment and products purchased with funds made available in this Act should be American-made." 4. In accordance with Part C of Public Law 103-227, the "Pro-Children Act of 1994," smoking may not be permitted in any portion of any indoor facility owned or regularly used for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs whether directly or through State or local governments. Federal programs include grants, cooperative agreements, loans and loan guarantees, and contracts. The law does not apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug and alcohol treatment. The above language must be included in any subawards that contain provisions for children's services and that all subgrantees shall certify compliance accordingly. Failure to comply with the provisions of Public Law 103-227 may result in the imposition of a civil monetary penalty of up to $1 1 000 per day. M Criminal Backoround Check As a condition of this Agreement, the Contractor certifies that the Contractor shall, prior to any individual performing work under this Agreement, conduct or cause to be conducted for each new employee, employee, subcontractor, subcontractor employee or volunteer who works directly with: 1. clients under this Agreement, or who has access to client information, an Internet Criminal History Access Tool (ICHAT) check and a National and State Sex Offender Registry check. Information about ICHAT can be found at http://mmapps.michigan.goviichat. -13- CM-Fl 57 (Rev. 10-0e) Previous edition obsolete. MS Word SYJ4.29.10 The Michigan Public Sex Offender Registry web address is http://www.mispsoestate.mi.us . The National Sex Offender Public Website address is http://wvvw.nsopw.gov . 2. children under this Agreement, a Central Registry (CR) check. Information about CR can be found at http:www.mi.govidhs/0,1607,7-124- 5452_7119_48330-180331—,00.html. The Contractor shall require each employee, subcontractor, subcontractor employee, or volunteer who works directly with clients or who has access to client information under this Agreement to notify the Contractor in writing of criminal convictions (felony or misdemeanor) and/or pending felony charges or placement on the Central Registry as a perpetrator at hire or within 10 days of the event after hiring. Additionally, the Contractor shall require each new employee, employee, subcontractor, subcontractor employee or volunteer who works directly with clients under this Agreement or who has access to client information and who has not resided or lived in Michigan for each of the previous ten (10) years to sign a waiver attesting to the fact that they have never been convicted of a felony or identified as a perpetrator, or if they have, the nature and recency of the felony. The Contractor further certifies that the Contractor shall not submit claims for or assign duties under this Agreement to. any employee, subcontractor, subcontractor employee, or volunteer based on a determination by the Contractor that the results of a positive ICHAT and/or a CR response or reported criminal felony conviction or perpetrator identification make the individual ineligible to provide the services. The Contractor must have a written policy describing the criteria on which its determinations shall be made and must document the basis for each determination. The Contractor may consider the recency and type of crime when making a determination. Failure to comply with this provision may be cause for immediate cancellation of this Agreement. In addition, the Contractor must further have a written policy regarding acceptable screening practices of new staff members and volunteers who have direct access to clients and/or client's personal information, which serve to protect the organization and its clients that is clearly defined. The Contractor must also assure that any subcontractors have both of these written policies. If DHS determines that an individual provided services under this Agreement for any period prior to completion of the required checks as -14- CM-F 157 (Rev. 10-09)P7evious edition 00solete. MS 'Nord SYJ4.29.10 described above, DHS may require repayment of that individual's salary, fringe benefits, and all related costs of employment for the period that the required checks had not been completed. II. DHS RESPONSIBILITIES A. Payment DHS shall make payments to the Grantee within forty-five (45) days after receipt by DHS of the Grantee's "Statement of Expenditures" detailing program related budgeting expenditures as set forth in Cost Documentation attached to this Agreement. B. Maximum Amount of Agreement DHS hereby agrees to pay the Grantee an amount not to exceed One Million One Hundred Forty Six Thousand Two Hundred Fifty One and 001100 dollars ($1,146,251) for services performed in accordance with the terms of this Agreement exclusively during the period May 1, 2010 through September 30, 2012. From the total amount, the maximum that may be expended during the following period is: Fiscal Year Amount May 1,2010 through September 30, 2010 $200,257 October 1, 2010 through September 30, 2011 $472,997 October 1, 2011 through September 30, 2012 $472,997 If a monthly (in Fiscal Year 2010) or quarterly (in subsequent Fiscal Years) report is not submitted by the Grantee by the due date, at its discretion, DHS reserves the right to withhold payment until the report is received. If the Grantee does not meet the match requirement by September 30 of each period of this Agreement, OHS shall withhold payment from the final billing and recoup any remaining unmet match requirement. If at any time during the period of this Agreement OHS makes a determination that the amount of match funds provided by the Grantee at any point in time is insufficient to justify continued DHS funding, DHS can decrease the Grantee's funding under this Agreement in proportion to the amount of deficient match requirements. C. Initial Payments -15- CM-Fl 57 (Rev. 10-0'9) Previo,is edition obsmete. MS Wcrd SYJ4.29.10 DHS shall make an initial payment in the amount of Sixteen Thousand Six Hundred Eighty Eight and 00/100 dollars ($16,688.00) to the Grantee within approximately forty-five (45) days after full execution of this Agreement. OHS shall make an initial payment in the amount of One Hundred Eighteen Thousand Two Hundred Forty Nine and 25/100 dollars ($118 1249.25) to the Grantee at the beginning of each subsequent annual period as identified in Section II, Part B. Subsequent monthly payments in Fiscal Year 2010 and quarterly payments in subsequent Fiscal Years, shall be adjusted in consideration of the initial payment, to prevent total payments from exceeding the lesser of total actual expenditures or the amount of this Agreement for the fiscal period in which the initial payment is made. Recovery of the initial payment shall be made through deductions from each monthly (in Fiscal Year 2010) or quarterly (in subsequent Fiscal Years) payment to the Contractor, The monthly or quarterly deduction shall be the percentage of the initial payment that the current bill is of the total Agreement. Recovery may be accelerated if the Agreement is cancelled or terminated. At any point that DHS determines that expenditures are much less than anticipated, DHS retains the option of reducing billings by the entire outstanding initial payment until the advance has been recovered. D. Evaluation Criteria The services provided by the Grantee under this Agreement shall be evaluated by OHS on the basis of the following criteria: 1. The Grantee shall be required to annually review and evaluate services provided under this Agreement. This evaluation process must include identification of measurable performance objectives and results. 2. The Grantee shall participate in and assist in all DHS research and evaluation efforts as determined by OHS. Data collected/compiled and reports on such efforts may be available to the Grantee for their use. 3. Home visitor programs funded by this Agreement are required to participate in the Adult and Adolescent Parenting Inventory (on-line) and submit accurate outcomes using the OHS Data Collection Form (DCF) and narrative report with the submission of each quarterly report. 4. The Grantee shall participate in a semiannual and/or annual site visit. -18- CM-F157 (Rev. DO-09) Previous edition obsolete. MS Word SYJ4.29:10 Ill. GENERAL PROVISIONS—PUBLIC A. Conclusion. Termination, and Cancellation Terms 1. DHS' Source of Funds-Terminatcn OHS' payment of Federal or State funds for purposes of this Agreement is subject to and conditional upon the availability of those funds for such purposes. No commitment is made by DHS to continue or expand activities covered by this Agreement. Funding for services to be provided beyond the end of the initial State fiscal year is dependent on legislative appropriation. DHS may terminate this Agreement immediately upon written notice to the Contractor at any time prior to the completion of this Agreement if, in the sole discretion of DHS, funding becomes unavailable for this service or such funds are restricted. 2. Cancellation of Agreement DHS may cancel this Agreement upon thirty days written notice if DHS determines that the Contractor, its agent, or its representative has offered or given a gratuity, kickback, money, gift, or anything of value to an officer, official, or employee of the State to obtain a contract or favorable treatment under a contract. By signing this Agreement, the Contractor hereby certifies that no funds have been given to any state officer, official, or state employee for influencing or attempting to influence such officer, official, or employee of the State. Except as indicated below, OHS may cancel this Agreement without further liability to DHS or its employees by giving the Contractor written notice of such cancellation thirty days prior to the date of cancellation. The Contractor may terminate this Agreement upon thirty days written notice to OHS at any time prior to the completion of the Agreement period. In case of default by the Contractor, OHS may immediately cancel this Agreement without further liability to DHS or its employees, and procure the services from other sources. In addition, DI-IS may immediately cancel this Agreement without further liability to DHS or its employees if the Contractor, an officer of the Contractor, or an owner of a 25% or greater share of the Contractor is convicted of a criminal offense incident to the application for or performance of a State, public, or private contract or subcontract; or convicted of a criminal offense including but not limited to any of the following: -1 7- CM-F157 (Rev. 10-09) PreViCILI5 edition obsolete. MS Word SYJ4.29.10 embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property, attempting to influence a pubfic employee to breach the ethical conduct standards for State of Michigan employees; convicted under State or Federal antitrust statutes; or convicted of any other criminal offense which, in the sole discretion of DHS, reflects on the Contractor's business integrity. 3. Stop Work Orders DHS may, at any time, by written stop work order to the Contractor, require that the Contractor stop all, or any part, of the work called for by the Agreement for a period of up to ninety (90) calendar days after the stop work order is delivered to the Contractor, and for any further period to which the parities may agree. The stop work order shall be specifically identified as such and shall indicate that it is issued under this section of the Agreement. Upon receipt of the stop work order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the stop work order during the period of work stoppage. If a stop work order issued under this section of the Agreement is canceled or the period of the stop work order or any extension thereof expires, the Contractor shall resume work. The parties shall agree upon an equitable adjustment in the services to be delivered, the Agreement price, or both, and the Agreement shall be modified, in writing, accordingly, if: (a) the stop work order results in an increase in the time required for, or in the Contractor's cost properly allocable to the performance of any part of this Agreement; and (b) the Contractor asserts its right to an equitable adjustment within thirty (30) calendar days after the end of the period of work stoppage, provided that, if OHS decides the facts justify the action, DHS may receive and act upon a Contractor billing submitted at any time before final payment under the Agreement. B. Closeout Responsibilities 1. Closeout When this Agreement is concluded or terminated, for any reason, the Contractor shall provide OHS, within thirty (30) days of conclusion or termination, with all financial, performance and other reports required as a condition of this Agreement. DHS shall within the limit of this Agreement reimburse the Contactor for allowable costs not previously reimbursed. The Contractor shall immediately refund to DHS any payments or funds advanced to the Contractor in excess of allowable reimbursable expenditures. -18- CM-F157 (Rev. ' 0-39) Previous edition obsolete. MS Word SYJ4.29.1 2. Fixed Assets DHS reserves the right to obtain or transfer title to all fixed assets, real or personal, included in the approved budget of this Agreement, billed in full or in part to DHS by the Contractor, and not fully utilized at the conclusion of the Agreement. Fixed asset costs billed to DHS shall be limited to straight- line determination or a use charge pre-approved by DHS and shall be used only for the performance of the Agreement unless another use is authorized in writing by DHS. At least sixty (50) days prior to the end date of this Agreement (which includes cancellation of the Agreement) the Contractor shall report to DHS the book value of all fixed assets and non-consumables purchased with DHS funds and not fully utilized by the end of the Agreement. The Contractor shall request written instructions regarding the disposal of these fixed assets and consumable and/or non-consumable supplies that have been acquired with funds under this Agreement. Any gain on the sale or disposition of fixed assets before completion of this Agreement must be immediately reported and refunded to DHS. No disposal, sale or transfer of fixed assets obtained under this Agreement in whole or part, may occur without the express written consent of DI-IS. 3. Continuing Responsibilities Termination, conclusion, or cancellation of this Agreement shall not be construed as terminating the ongoing responsibilities of the Contractor or rights of DHS contained in Section III, Examination and Maintenance of Records" and Section III, "Closeout of this Agreement. C. Compliance with Rules and Regulations 1. Compliance with Federal and State Requirements The Contractor shall comply with all Federal, State and local statutes, regulations and administrative rules, and any dIIIIIUIlII Itb tliereto, as they may apply to the performance of this Agreement. This shall include, but shall not be limited to, those laws and regulations that could have a material effect on the Federal program. In addition, the Contractor shall comply with all federal grant agreements, provisions stated within the Catalog of Federal Financial Assistance, and state and federal laws and other rules and regulations related to this funding source. -1 9- CM-F157 (Rev. 10 0) Previous edition obsolete. MS Word SYJ4.29.10 The Contractor shall comply with all Federal Office of Management and Budget circulars, which apply to the federal funding provided under this Agreement which include but are not limited to: • A-133 for audit requirements . A-102 for administrative requirements - A-87 Cost Principles for Government • Special Federal Grant Provisions The Contractor shall keep informed of federal, state, and local laws, ordinances, rules, regulations, orders, and decrees of bodies or tribunals having any jurisdiction/authority that in any manner affects those engaged in or employed on the work done under this Agreement or that in any manner affects the conduct of the work done under this Agreement. 2. Civil Service Rules and Reeulations The State of Michigan is obligated to comply with Article XI, Section 5, of the Michigan Constitution and applicable civil service rules and regulations. Other provisions of this Agreement notwithstanding, the State personnel director is authorized to disapprove contractual disbursements for personal services if the State personnel director determines that this Agreement violates Article Xl, Section 5 of the Michigan Constitution or applicable civil service rules and regulations. 3. Compliance with Civil Rights, Other Laws The Contractor shall not discriminate against any employee or applicant for employment with respect to hire, tenure, terms, conditions, or privileges of employment, or a matter directly or indirectly related to employment, because of race, color, religion, national origin, age, sex, height, weight or marital status pursuant to 1976 Public Act 453, Section 209. The Contractor shall also comply with the provisions of the Michigan Persons with Disabilities Civil Rights Act, 1976 Public Act 220, as amended (M.C.L. 37.1101 et. seq.) and Section 504 of the Federal Rehabilitation Act of 1973, P.L. 93-112, 87 Stat. 355, which states that no employee or client or otherwise qualified handicapped individual shall, solely by reason of this handicap, be excluded from participation, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. Further, the Contractor shall comply with the Americans with Disabilities Act of 1990 (ADA), P.L. 101-336, 104 Stat. 327, which prohibits discrimination against individuals with disabilities and provides enforcement standards. The Contractor shall comply with all other Federal, State or local laws, regulations and standards, and any -20- CM-F15? (Rev. 10 ,09) Previous edition obsoiete. MS Ward SY,14.Z9.13 amendments thereto, as they may apply to the performance of this Agreement. 4. Freedom of Information Act All information in this Agreement is subject to the provisions of the Freedom of Information Act. 1976 Public Act 442, as amended, MCL 15.231, et seq. 5. Prohibition aeainst Using Funds to Support Religious Activities The Contractor shall not use financial funds administered by the State or Federal government to support inherently religious activities, such as worship, religious instruction, or proselytization. If the Contractor engages in such activities, it must offer them separately, in time or location, from the programs or services funded with State or Federal assistance, and participation must be voluntary for the beneficiaries of the State or Federally funded programs or services. The Contractor shall strictly adhere to provisions of federal law and regulation, including those found in 42 U.S.C. 604a. D. Fees and Other Sources of Funding The Contractor guarantees that any claims made to DI-IS under this Agreement shall not be financed by any source other than DHS under the terms of this Agreement If funding is received through any other source, the Contractor agrees to deduct from the amount billed to OHS the greater of either the fee amounts, or the actual costs of the services provided. The Contractor may not accept reimbursement from a client unless the Agreement specifically authorizes such reimbursement in the "Contractor Responsibility" section. In such case, a detailed -fere-scale-and criteria for charging the fee must be included. If the Contractor accepts reimbursement from a client in accordance with the terms of the Agreement, the Contractor shall deduct these fees from billings to OHS. Other third party funding sources, e.g., insurance companies, may be billed for contracted client services. Third party reimbursement shall be considered payment in full unless the third party fund source requires a co-pay, in which case DHS may be billed for the amount of the co-pay. No supplemental billing is allowed. E. Confidentiality -21- CM-F157 (Rev. 10-09) Previous editon obsoiete. MS Word 5Y-14.29.10 1. The Contractor and the State of Michigan (hereinafter referred to as the State) each acknowledge that the other possesses and will continue to possess confidential information that has been developed or received by it. As used in this Section, "Confidential Information" of the Contractor must mean all non-public proprietary information of the Contractor (other than Confidential Information of the State as defined below) which is marked confidential, restricted, proprietary or with a similar designation. "Confidential Information" of the State must mean any information which is retained in confidence by the State (or otherwise required to be held in confidence by the State under applicable federal, state and local laws and regulations) or which, in the case of tangible materials provided to the Contractor by the State under its performance under this Agreement, is marked as confidential, proprietary or with a similar designation by the State. "Confidential Information" excludes any information (including this Agreement) that is publicly available under the Michigan Freedom Of Information Act. 2. The State and the Contractor will each use at least the same -degree-of-care to prevent disclosing to third parties the Confidential Information of the other as it employs to avoid unauthorized disclosure, publication or dissemination of its own confidential information of like character, but in no event less than reasonable care. Neither the Contractor nor the State will (i) make any use of the Confidential Information of the other except as contemplated by this Agreement, (ii) acquire any right in or assert any lien against the Confidential Information of the other, or (iii) if requested to do so, refuse for any reason to promptly return the other party's Confidential Information to the other party. Each party will limit disclosure of the other party's Confidential Information to employees and Subcontractors who must have access to fulfill the purposes of this Agreement. Disclosure to, and use by, a Subcontractor is permissible where (A) use of a Subcontractor is authorized under this Agreement, (B) the disclosure is necessary or otherwise naturally occurs in connection with work that is within the Subcontractors scope of responsibility, and (C) the Contractor obligates the Subcontractor in a written Contract to maintain the State's Confidential Information in confidence. At the State's request, any employee of the Contractor and of any Subcontractor having access or continued access to the State's Confidential Information may be required to execute an acknowledgement that the employee has been advised of the Contractor's and the Subcontractor's obligations under this Section and of the employee's obligation to the Contractor or Subcontractor, as the case may be, to protect the Confidential Information from unauthorized use or disclosure. Promptly upon termination or cancellation of this Agreement for any reason, the Contractor must certify to the State that the Contractor has destroyed all State Confidential information. -22- C hil-F157 (Rev. 10--9) Previous edition obsolete. MS Word SYJ4.29.10 F. Examination and Maintenance of Records The Contractor shall permit DHS or any of its authorized agents access to the facilities being utilized at any reasonable time to observe the operation of the program. Further, the Contractor shall retain all books, records or other documents relevant to this Agreement for six years after final payment, at the Contractor's cost. Federal auditors and any persons duly authorized by DHS shall have full access to and the right to examine and audit any of said material during said period. If an audit is initiated prior to the expiration of the six-year period and extends past that period, all documents shall be maintained until the audit is completed. DHS shall provide findings and recommendations of audits to the Contractor. DHS shall adjust future payments or final payment if the findings of an audit indicate over payment to the Contractor in any period prior to the audit If no payments are due and owing the Contractor, the Contractor shall refund all amounts which may be due DHS within sixty (60) days notice by OHS. The Contractor shall assure, as a condition of any sale or transfer of ownership of the Contractor agency, that the new purchasers or owner maintains the above- described books, records or other documents for any unexpired portion of the six- year period after final payment under this Agreement or the Contractor shall otherwise maintain said records as DHS may direct. If busii lUbb opt' dliur lb uwabe, the Contractor shall maintain records as DHS may direct. The Contractor shall notify DHS when and if the Contractor operations cease during the six-year period after final payments and provide for appropriate storage of records at the Contractor's expense. The Contractor shall, as a provision of the Agreement between the Contractor and the auditor, assure that DHS may make reasonable inquiries of the auditor relating to audit workpapers and, furthermore, that DHS may review the auditor's workpapers in support of the audit. G. Reporting and Monitoring 1. Reporting The Contractor shall comply with all program and fiscal reporting procedures as are or may hereinafter be established by DHS. The Contractor shall also comply with all reporting procedures established by DHS in completion of progress reports at time intervals, on forms, in formats, and by means specified by OHS. In particular, reports or billing documents denoting event dates shall record month, day and year as specified by DHS. In all electronic filings, four digits shall be used to designate century. Any additional reports as deemed necessary by OHS shall be made and submitted by the Contractor upon request. -23- CM-F1 57 (Rev. 1U-09) Previous edition obwlete. MS Word SYJ4.29.10 2. Monitoring Requirements [}HS reserves the right to perform scheduled and unscheduled on-site visits during normal business hours, to monitor the Contractor's activities under this Agreement at any time, either during the term, or within three (3) years after termination of the Agreement. The Contractor shall cooperate with DHS during the monitoring process by making available all records, facilities, and other resources necessary to perform the review. If DHS detects noncompliance with this Agreement, and/or questioned costs during the course of its review, these items shall be identified and conveyed to the Contractor in an exit conference. DHS shall provide the Contractor with a detailed written report of these findings within sixty (60) days of the exit conference. The Contractor is required to address each item in OHS' report by providing a Corrective Action Plan (CAP) to eliminate or correct each issue of noncompliance. The Contractor shall submit the Corrective action plan to OHS within sixty (60) days from issuance of DHS' report. If OHS identifies questioned costs that cannot be substantiated, OHS may, at its discretion, and after consultation with the Contractor, require the Contractor to submit a revised DHS-3469, "Statement of Expenditures" to reflect adjustment for disallowed costs. Submission of revised billings to DHS shall be made within a time schedule established by DHS and the Contractor. If the Contractor fails to comply with monitoring requirements as set forth in this Agreement, and within allotted time frames mutually established, OHS may, at its discretion, invoke sanctions on the Contractor, which may include, but are not limited to, actions to collect disallowed costs and/or cancellation of the Agreements. 3. AuditReoorts that Contain a Goino Concern Statement If an audit firm conducts an audit of the Contractor and issues an audit report with a finding of a Going Concern, the Contractor must submit this audit report to the OHS Office of IVIonitoring and Internal Control within 10 days from the date of the audit report. The submission of this audit report to DHS is required regardless of whether an audit is required under this Agreement. A Contractor receiving a Going Concern must submit a financial plan to the DHS Office of Monitoring and Internal Control no later than 25 days from the date of the audit report issued by the audit firm. The financial plan must be approved by DHS. Failure of the Contractor to either timely submit the audit report with the Going Concern, or timely submit a financial plan, or OHS' -24- Crvl-F157 (Rev. 10-09) Previous edition obsolete. MS Word SY.:4.29.10 rejection of the Contractors financial plan, are grounds for immediately terminating this Agreement. Mailing address for all audit information: Michigan Department of Human Services Office of Monitoring and Internal Control Grand Tower, Suite 1112 PO Box 30037 Lansing, MI 48909 1-I. Recoupment of Funding and Repayment of Debts. 1. Recouement of Funding If the Contractor fails to comply with monitoring requirements as set forth in this Agreement, or fails to submit a revised DHS-3469, "Statement of Expenditures" within allotted time frames established by DHS in consultation with the Contractor, DHS may, at its discretion, recoup or require the Contractor to reimburse payments made under this Agreement which DI-IS has determined that the Contractor has been overpaid. The Contractor is liable for any cost incurred by OHS in the recouprnent of any funding. Upon notification by DHS that repayment is required, the Contractor shall make payment directly to OHS within 30 days or DHS may withhold current or future payments made under this or any other agreements, current or future, between DHS and the Contractor. If the Contractor fails to: (1) correct noncompliance activities identified by DHS, (2) submit revised billings as requested as part of a Corrective Action Plan when required; or (3) remit overpayments or make arrangements to have the overpayments deducted from future payments within 30 days, such failure shall constitute grounds to terminate immediately any or all of DHS agreements with the Contractor. OHS shall also report noncompliance of the Contractor to Michigan's Department of Management and Budget. Such report may result in the Contractor's debarment from further contracts with the State of Michigan. 2. Repayment of Debts and Other Amounts due DHS By entering into this Agreement, the Contractor agrees to honor all prior repayment agreements established by DHS with the Contractor or Contractors predecessors. If the Contractor has an outstanding debt due to OHS but does not have a repay agreement, the Contractor agrees to make -25- CM-F57 (Rev. 10-09) Previous edition obsolete. MS Word 5Y-14.29.10 monthly payments to DHS at an amount not less than 5% of any outstanding balance and to begin on the date this Agreement is executed. If the Contractor fails to honor prior repayment agreements, or the Contractor fails to begin repayment on an obligation due DHS that is not subject to a repayment agreement, DHS will initiate the administrative process to reduce payments to the Contractor under this Agreement to recoup the debt. The payment reduction will be made at the amount originally established in the repayment agreement or at an amount not less than 5% of any outstanding balance effective on the date this Agreement is executed. I. Publication - Approval and Copyright The State of Michigan shall have copyright, property and publication rights in all written or visual material or other work products developed in connection with this Agreement. The Contractor shall not publish or distribute any printed or visual material relating to the services provided under this Agreement without prior written permission of the State of Michigan. If the Contractor or an agent of the Contractor creates and/or reproduces under this Agreement materials which are developed for consumption by the general public or as a general information tool and which are funded in whole or in part with State of Michigan funds, the Contractor or its agent must include one of the statements referenced below, as they apply: • This program is funded by the State of Michigan or • This program is funded in part by the State of Michigan News releases (including promotional literature and commercial advertisements) pertaining to this Agreement shall not be made without prior written DHS approval, and then only in accordance with the explicit written instructions from DHS. No results of the activities associated with the Agreement are to be released without prior written approval of DHS and then only to persons designated. J. Subcontracts The Contractor shall not assign this Agreement or subcontract this Agreement to other parties without obtaining prior written approval of the DHS Division of Contracts and Rate Setting. DHS, as a condition of granting such approval, shall require that such assignees or subcontractors shall be subject to all conditions and provisions of this Agreement including Criminal Record and Central Registry background checks when applicable. The Contractor shall be responsible for the performance of all assignees or subcontractors. -26- CM-F157 (Rev. 10-•9) R-evious edltion obsolete. MS Word SY..14 29 10 If subcontracting, the Contractor must obligate the subcontractors to maintain the confidentiality of OHS' client information in conformance with State and Federal requirements. At DHS' request, any employee of the Contractor and of any subcontractor having access or continued access to DHS' confidential information may be required to execute an acknowledgment that the employee has been advised of the Contractors and the subcontractor's obligations under this section and of the employee's obligation to DHS, the Contractor or subcontractor, as the case may be, to protect such confidential information from unauthorized use or disclosure. K. Disputes The Contractor shall notify DHS in writing of intent to pursue a claim against DHS for breach of any terms of this Agreement. No suit may be commenced by the Contractor for breach of this Agreement prior to the expiration of ninety (90) days from the date of such notification. Within this ninety (90) day period, the Contractor, at the request of OHS, must meet with the Director of DHS or designee for the purpose of attempting resolution of the dispute. L. Agreement Inclusiveness This Agreement contains all the terms and conditions agreed upon by the parties. No other understanding, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. M. Reporting of Retiree Employment All other provisions of this Agreement notwithstanding, no reimbursement may be claimed under this Agreement for salary or subcontracting expense for any employee who retired from the State of Michigan using the early retirement program authorized by 2002 Public Act 93. The Contractor shall provide written notification within fifteen (15) days of hiring to OHS Division of Contracts and Rate Setting (DCRS) the name, social security number, and work site of any employee who retired from the State of Michigan using the early retirement program authorized by 2002 Public Act 93. Failure to notify the DCRS within the allotted time period may result in the disallowance of all costs related to this Agreement up to the time the proper notification is received by DCRS. N, Certifications Regarding Lobbying -27- CM-F17 (Rev. 10-09) PrevioLs edition obsolete. MS Word SYJ4.29.10 au--12aciar.dicue_Eleharoaer aension. and a nsibili 0. (X) Res ther As required by section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69, the Contractor certifies that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any persons influencing or attempting to influence an officer or employee of an department, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any department, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard form — LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including sub-grants, contracts under grants and cooperative agreements, and subcontracts) and that all sub-recipients shall certify and disclose accordingly. Matters The Contractor certifies that they and their principals: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal or State department or agency. 2. Have not within a three-year period preceding this Agreement been convicted of or had civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or focal) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. -28- CM-F" 57 (Rev. 10-09} Previous edition obsolete. MS Word SY.J4,29. JO 3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in 28 CFR 67, et sec. 4. Have not within a three-year period preceding this Agreement had one or more public transactions (Federal, State or local) terminated for cause and default. Where the parties are unable to certify to any of the statements in this certification, the Contractor shall attach an explanation to this Agreement. The Contractor shall promptly notify DHS of any criminal litigation, investigations or proceeding which may have arisen or may arise involving the Contractor or any of the Contractor's subcontractors, or any of the foregoing entities' then current officers or directors during the term of this Agreement and three years thereafter. All notices shall be provided in wilting to DHS within fifteen business days after the Contractor learns about any such criminal or civil investigations and within fifteen days after the commencement of any proceeding, litigation, or arbitration, as otherwise applicable. Details of settlements, which are prevented from disclosure by the terms of the settlement, shall be annotated as such. However, the Contractor shall disclose if any terms of such settlement would impede the Contractor's performance of this Agreement. The Contractor may rely on similar good faith certifications of its subcontractors, which certification shall be available for inspection at the option of DHS. The Contractor certifies to the best of its knowledge that within the past three (3) years, the Contractor has not; 1. Failed to substantially perform a state contract or subcontract according to its terms, conditions, and specifications within specified time limits. 2. Refused to provide information or documents required by a contract including, but not limited to information or documents necessary for monitoring contract performance. 3. Failed to respond to requests for information regarding contract compliance, or accumulated repeated substantiated complaints regarding performance of a contract. Failed to perform a state contract or subcontract in a manner consistent with any applicable state or federal law, rule, regulation, order, or decree. -29- CM-Fl 57 (Rev 10-09) Previous editton obsolete. MS Word SYJ4.29.10 The Contractor shall include Section O. (Certification Regarding Debarment, Suspension, and Other Responsibility Matters) language as written above in all subcontracts with other parties. The Contractor shall require each primary subcontractor, whose subcontract will exceed $25,000, to disclose to the Contractor, in writing, whether at of the time of the award of the subcontract, the subcontractor, or its principals, is or is not debarred, suspended, or proposed for debarment by the State of Michigan. The Contractor shall then inform DHS of the subcontractor's status and reasons for the Contractor's decision to use such subcontractor, if the Contractor so decides. If it is determined that the Contractor knowingly rendered an erroneous certification under this provision, in addition to the other remedies available to the state, DHS may immediately terminate this Agreement. If the state finds that grounds to debar exist, it shall send notice to the Contractor of proposed debarment indicating the grounds for proposed debarment and the procedures for requesting a hearing. If the Contractor does not respond with a written request for a hearing within twenty (20) calendar days, the state shall issue the decision to debar without a hearing. The debarment period may be of any length up to eight (8) years. After the debarment period expires, the Contractor may reapply for inclusion on bidder lists through the regular application process by authority of Executive Order 2003-1. P. Governing Law This Agreement shall in all respects be governed by, and construed in accordance with, the laws of the State of Michigan. Any dispute arising herein shall be resolved in the State of Michigan, 0. Severability Each provision of this Agreement shall be deemed to be severable from all other provisions of this Agreement and, if one or more of the provisions of this Agreement shall be declared invalid, the remaining provisions of this Agreement shall remain in full force and effect. R. Amendment 1. Federal or State Laws or Regulations The Contractor shall, upon request of OHS and receipt of a proposed amendment, amend this Agreement, if and when required in the opinion of OHS, due to the revision of Federal or State laws or regulations. If the -30- CM-F157 (Rev. 10-09) PrevioJs edition otwtte. MS Word Contractor refuses to sign such amendment within fifteen (15) days after receipt, this Agreement shall terminate upon such refusal. This Agreement may otherwise be amended only by the written consent of all the parties hereto. 2. Change Requests The State reserves the right to request from time to time any changes to the requirements and specifications of this Agreement and the work to be performed by the Contractor under this Agreement During the course of ordinary business, it may become necessary for the State to discontinue certain business practices or create Additional Services/Deliverables. At a minimum, to the extent applicable, the State will require the Contractor to provide a detailed outline of all work to be done, including tasks necessary to accomplish the services/deliverables, timeframes, listing of key personnel assigned, estimated hours for each individual per task, and a complete and detailed cost justification. If the Contractor does not so notify the State, the Contractor has no right to claim thereafter that it is entitled to additional compensation for performing that service or providing that deliverable. Change Requests: a. By giving Contractor written notice within a reasonable time, the State must be entitled to accept a Contractor proposal for change, to reject it, or to reach another agreement with Contactor. Should the parties agree on carrying out a change, a written amendment must be prepared and issued under this Agreement, describing the change and its effects on the services and any affected components of this Agreement. b. No proposed change must be performed until the proposed change has been specified in a duly executed amendment issued by DHS. c. If the State requests or directs the Contractor to perform any activities that Contractor believes constitute a change, the Contractor must notify the State that it believes the requested activities are a change before beginning to work on the requested activities. If the Contractor fails to notify the State before beginning to work on the requested activities, then the Contractor waives any right to assert any claim for additional compensation or time for performing the requested activities. If the Contractor commences performing work outside the scope of this Agreement and then ceases performing that work, the Contractor must, -31- CM-F157 (Rev. 70-09) Previous edition obsolete. MS Word SYJ4.29.10 at the request of the State, retract any out-of-scope work that would adversely affect this Agreement. S. Options to Renew At the discretion of DHS, an awarded contract may be renewed in writing by an amendment not less than 30 days before its expiration. The contract may be renewed for up to one additional year period. -32- CM-F157 (Rev. 10-00) Previous ecli*con obsolete. M.S Word SYJ4.29:10 By: -33- IN WITNESS WHEREOF, the DHS and the Grantee have caused this Agreement to be executed by their respective officers duly authorized to do so. The Undersigned has the lawful authority to bind the Grantee to the terms set forth in this Agreement. Dated at , Michigan Oakland County Health Division (Grantee) this day of By: Witness: DEPARTMENT OF HUMAN SERVICES Dated at , Michigan this day of Director Witness: Grant #: ZTT-10-63001 CM-F157 (Rev, 10-09) Previous edition obsolete. MS Word SYA.29.10 Contractor's Legal Name: Mailing Address: Fount> of Ottkl‘tral MI 1200 N. retegraph Depi 34E Ponliac MI 4I•1711 Contract Number: Contract Amount: Budget Period: zrr-10-63001 $200,257 FY.2010 (5 months) TOTAL PROGRAM BUDGET SUMMARY 1 OTAL DHS MATC11 or (A) SERVICE (B) SERVICE (C) SERV ICE (D) SERVICE LINE ITEM P BUDGET ROGRAM CONTRACT INK IND AMOUNT CATEGORY CATEGORY CATEGORY CATEGORY BUDGET (If Applicable) SALARIES 138,657 5 111,207 $ 27,450 $ 138,657 5 - - S - FICINGE BENEFITS 5 75,594 5 59,931 5 15,663 $ 75,594 $ - $ - s - OCCUPANCY 4,117 $ 1,256 $ 2,861 5 4,117 S - $ $ - COMMUNKA I ION S ,624 $ 1.624 5 - $ 1,624 $ - $ - S - SUPPLIES S :577 $ 573 $ - 5 573 5 - S - $ - EQUIPMENT $ - $ - S - $ - $ - $ - $ _ TRANSPOR IA atuni S 4,877 $ 2,464 5 2,413 $ 4,877 S - $ - $ - _ CONTRACT ED SERVICES $ 1,470 $ 1,470 $ - 5 1,470 $ - $ - $ - Sea,CIFIC ASSISTANCE $ L496 5 1,496 5 - S 1,496 5 - $ - $ - TO INDIVLIJUALS MISCELLANEOUS $ 31,184 5 20,236 $ 10,948 S 31,184 5 - $ - $ - TOTALS: $ 259,593 $ 200,257 5 59,335 5 259,593 $ - $ - $ , NUNIEIER OF UNITS 10 BE PROVIDED: 42.0 0.0 0.0 0.0 EtAlf E PER UN IT OF SERVICE: S 6,1E0.79 #DIV/01 #DIVIO #DIWO. Service Category (A) Service Category (CO; Service Category (13): Service Category (c): Deaartmani of Humeri Services ( HS) will not macrimmate against any Individual or group beceuse of rack religion, age, Authority: PA. no of 193E netionst ongln, color. height. vierght marital statut, 3E%, sexing orientation, gender Identity or expression political beliefs or Completion: Mandatory disability, if you need help smith res Ping. writing, hearing. etc., under The Americans with Dieebeelee Mt, you ere in2ea to make Penalty: Contract Invalid your reeds known to a OHS office In your area, CM-468 EX (Rev I2-E6) Previous edition obsolete. MS Excel Budget Summery 04,19,2010 You may enter additional comments on this sheet or attach supplemental materials to your CM-468. Out of State Travel - A requirement of agencies adopting the Nurse-Family Partnership model is for direct service workers (Nurse Home Visitors) and supervisors to attend a 4 day training in Denver CO (on rare occasions these classes may be held in another location). Our supervisor and two nurses for this project have already been training and do not need to travel, However, to have a full team (4 nurses). two additional nurses will need to be hired for this project and must attend NFP required training. THESE CHARGES NOW SHOW AS MATCH DOLLARS. Indirect Costs - OaWand County has an established indirect cost rate. Our federal cognizent agency does not issue indirect cost rate agreements to local/county governments because it is not required. We would be happy to provide a copy of our cost ailocation plan that is prepared by MaKmus. It is 333 pages and too large to include in this application. Attached is a copy of our Certification by the Responsible County Official. DETAILED INFORMATION WAS E-MAILED FOR REVIEW AND SUBMITTED BY SHARENE JOHNSON TO FISCAL FOR APPROVAL. Required Fringe Benefits - Workers Comp - The County calculates the average rate for this benefit at 1.19%. Because this cell on the worksheet calculates at "Cents per $100 of", the rate is shown as 11.9 in order to get it to calculate correctly. Specific Assistance - Teaching/Child Safety - This line item has been pro-rated to show the total $10,000 allocated over the 2 1/2 years of the grant ($1,600 yr 1. $4.200 yr 2. $4,200 yr 3). Bus Fare - Based On past experience, we do not anticipate that all clients will need assistance with transportation expenses. Therefore, this line does not reflect a proration for all 100. Contracted Services - Translation & Interpretation - this is calculated at .99 per minute of usage. CM-465-EX (Rev. 12-08) Prevdms ed:tion cbsolete. MS Excel Corrreits CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES DEFINITION: Gross compensation paid to employees in the form of cash, products, or services including vacations, holidays, sick leave and leaves of absence. Paid absences must be reimbursed tmifonnly for both employees paid under this contract as well as employees not paid under this ecntract but performing similar work. INSTRUCTIONS: List each position below including total yearly salary or wages, how many weeks employed yearly, how many hours worked per week, percent of time spent on Total Program, percent of salary/wages charged to DI-IS Contract Program. Provide additional detail budget sheets, as needed. Example on Help_Salaries, METHOD OF ALLOCATION OF COST: Determine the DHS percentage of the cost of each salary position using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% of the contractlIdentify below the method used to determine the percentage shown in Column 3. Options include: a) Number of DK clients served divided by Total Program clients served X 100%. b) Direct service staff hours serving DHS clients divided by total direct staff program hrs. r fitIlruf irirntifv1 Cost allocation method: b and match (Use Comment page if rot one of the above methods) 1 4, DHS 5. . 1. C COST ITEM TOTAL 3. DHS % ONTRACT Match or lnkind (TOTAL COST) PROGRAM PORTION Portion (Of Total Frog.) (if Applicable) PROGRAM POSITIONS-ADMINISTRATIVE Position Title: — Yearly Salary! Weeks/Year: 0.0 Hours/Week: 0.0 U., of Time Snent on Total Proemin: 0.00% Salary Charged to Total Program: $ - 0.0% $ - $ - Position Title: Yearly Salary: Weeks/Year: 0.0 Hours/Week: 0.0 "A of Time Snent on Total ProQram: 0.00% Salary Charged to Total Program: $ - 0.0% $ - $ . Position Tole: Yearly Salary: $ - .Weeks/Year: (1.0 hours/Week: 0.0 % of Time Snent on Tata: Proeram: 0.00% Salary Charged to Total Program: $ 0.0% $ - $ - SUBTOTA.L:f $ - I S . i $ - SALARY TOTAL:l S 138,657 $ 111,207 27,450 CM-168-EX (R.ev. 12-08) Previous edition obsolete. MS Excel Salaries and Wages C425,'2C10 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: 'b and Match 4. DHS 5. 2, 1. TOTAL 3, DHS , CONTRACT Match or Inkind COST ITEM (TOTAL COST) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE ----- Position Title: Health Program Coordinator Yearly Salary: , $ 27,450.00 Weeks/Year: 22.0 Hours/Week: 40,0 3/4 of Time Spent on Total Program: 100,00%' Salary Charged to Total Program: S 27,450 0.0% $ _ $ 27,450 Position Title: Office Assistant II Yearly Salary: 7,079.00 Weeks/Year 22.0 Hours/Week: 19.2 1% of Time Spent on Total Program: 100.00% Salary Charged to Total Program: 5 7,079 100,0% $ 7,079 $ - Posit:on Title: Public Health Nurse III Yearly Salary: $ 26.03100 ‘4reeks/Year; 22,0 Hours/Week: 40.0 % of Time Spent on Total Program: 100.00% Salary Charged to Total Program: $ 26,032 100.0% $ 26,032 $ . 1 !Position Title: Public Health Nurse III Yearly Salary: $ 26,032.00 Weeks/Year: 21 .0, Hours."Week: 40,0 1 % of Time Spent on Total Program: 100.00% Salary Charged to Total Program: 5 26,032 100.0% $ 26,032 5 - Pos':tion Title, Public Health Nurse ill Yearly Salary: $ 26,032.00 Week.s/Year: 22.0 Hours/Week: % or Time Spent on Thal Program: 100.00% Saar y Charged to Total Program: S 26,032 100.0% $ 26,032 S - SUBTOTAL: $ 112,625 85,175 27,4.50 CM•455 EX .Rev. 12-M Prevics editor' onsolete MS Excel Salaries end Wages Sheet 2 1, COST ITEM (TOTAL COST) 2. TOTAL 3. DHS 1/4 PROGRAM 4. DHS 5. CONTRACT Match or Inkind PORTION Portion DI-Tots! Pray AIME 0.0 0.0 0.0 0.0 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES fContinued) Cost allocation method: PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE Position Tit:e. Yearly Salary: W eeks/Year: Hours/Week: % of Time Spent on Total Program: Salary Charged to Total Program: Position Title: Yearly Salary: $ Weeks/Year: Hours/Week: % of Time Spent on Total Program: Salary Charged to Total Program: Position 'Ette: Yearly Salary: $ - Weeks/Year: 0.0 Hours/Week: 0.0 'Yu of Time Spent on Total Program: Public Health Nurse III $: 26,032.00 22.0 40.0 100.00% 0.00% 0.00% Salary Charged to Total Program: Position Title. Yearly Salary: $ - Weeks/Year: P.O Hours/Week: 0.0 % of Time Sport on Total Program: Salary Charged to Total Pro rai Position Tile: Yearly Salary: Weeks/Year: HOLITS.IWeek: % of Time Spent on Total Program: Sal an, Charged to Total Pragram: - 0% t _ - - tit) no% 0.00% 0.00% SUBTOTAL: 26.033 CM-458-EX (Rev. 1'2-081 Previous uditicn obsole!e. MS Excel Salaries arid Wages Stee i 3 1W2V20 1G TOTAL: 75,594 59,931 I $ )5,663 CONTRACT BUDGET DETAIL LINE ITEM: FRINGE BENEFITS DEFINITION: Funds allocated to cover allowances, cost of services provided by the contractor to cr on behalf of tts employees and not included as compensation or salaries and wages. INSTRUCTIONS: List each category of fnnge benefits below and complete the requested information for each. The Required Fringe Benefits portio must be completed for all employees. Note: Unemployment base wage cannot exceed 39,000 per employee, Note: Social Security at 6.2% cannot exceed base wage of S102,200 per employee plus Medicare at 1.45% for all wages. METHOD OF ALLOCATION OF COST: The OHS percentage of the cost of each fringe benefit cannot exceed the percentage of total OH salaries to total program salaries. Fringe benefits for each individual position do not have to be itemized. Be sure base wage figures are taken inn account. Any cost item used entirely for the OHS CONTRACT PORTION, and equal to the TOTAL PROGRAM effort, equals 100%. Options Cost allocation method: b and Match _ ,---- 4. OHS 5. 1. 2. CONTRACT Match or Inkind COST ITEM TOTAL '3. DHS % (TOTAL COST) PROGRAM PORT/ON Portion _ - (Of Total Prog.) (If Applicable) REOVIRED FRINGE BENEFITS FICA Social Sego riry(%): 6.20% Times Total 1 ,r , Program Salaries and Wages $ 138.657 S 8,597 80.2% $ 6,595 S 1.702 ... FICA Ilediesre(%): 1.45%, Times Total ._ Program Salaries and Wages $ 138,657 $ 2,011 , 80.2% $ L612 $ 398 Unemployment (%): 0.20% Times Total _ Program portion of taxable salaries. Use base wage only. 5 51 ,079 5 104 80.2% 5 84 $ 21 Worker's Comp: 1 11.90 Cents per 5100 of _ - Total Program payroll: 5 138,657 $ 1,650 80.2% $ 1,323 5 327 _ OPTIONAL FRINGE BENEFIT _ Retirement: I Numbei of Ell's: 5.000 times “mtrtbutiong for cac:i per month: $ 1,641.08, times number of pro_gram months: 5 - _ _ 5 41,027 79.1% , 5 32,452 5 8,575 Health Insurance: I Number c)- FIE'l 5.000 times contributions for each per month' 1 S 77746_ Mmes number of program months: i S -- $ 19,437 79.1% 5 15,374 5 4.062 Life Ins: 1 Number of FTE'si 5.000 , times contributions for each per month: $ 15.67_ tones number of proerarn months: S $ 392 79.1% $ 310 $ 82 Long Term Disabil; [ Nu:10er oIFTEs, 5.000 _ times contributions for each per month: 18.27_ J times number of program nion:ls: 5 S 457 _ 79.1% S 361 - — Other: (lte:nize) _ Optical ict OA% of $131,578 $ 105 79.1% 5 83 $ 22 Dental "i.-p 1.38% of S131,578 S 1,816 79.1% - $ 1,436 , $ lg --` . -,.-.W-468-EX (Rev. 72....93) Q5 Ifl ON7,1ele MS Excel 04:29'2010 Pri7.ge Benefits OCeupary Ct4129!2C",0 CONTRACT BUDGET DETAIL LINE ITEM: OCCUPANCY DEFINITION: Costs arising from occupancy and use of owned or leased buildings and offices, INSTRUCTIONS: Indicate below whether facility cost was determined by rent, depreciation or use charge, the amount being charged and how the cost was determined, Itemize various utility and maintenance costs, as they apply, Note: Buildings must be depreciated over a 40 year life. METHOD OF ALLOCATION OF COSTS: Determine the DIIS percentage of the cost by using one of the following methods. Any cosi item used entirely to provide contracted services should be charged 100% to the contract Identify below the method used to determine the percentage shown in Column 3. Options include: a) Number of MS clients served, divided by Total Program clients served, X 100%; b) Direct service staff hours serving OHS clients, divided by total staffprogram hours, X 100%, e) DHS program area in square feet, divided by total program area in square feet. X 100°A,,d) Other (Identify) Cost allocation method: d in-kind match 4, DHS 5, I. 2. CONTRACT Match or Inkind TOTAL l'i'e COST ITEM (TOTAL COST) PROGRAM 3. OHS PORTION Portion I Ulf Tntal Prnrt 1 ill 4.1.-b1:,..t..1...11_, ' Rent Paid to a Third Party: Total program area in square feet: 836.0 times monthly cost per square foot: 5 0.99 Cost per Month $ 823.4 . —, times number of months: _ $ 4,117 30.5% $ 1_256 , $ 2.8.1 _ - OR - I — Depreciation: Item being depreciated: I Acquisition cost: S . Depreciated over this many years: 01 Amount depreciated per month: 5 . times this many months:, 0 CI $ .MI nM___ - 1 0.0% $ - $ - - - OR - Use Charge: Item description: - Use charge pereentaee (maximum 2.0%); 0.R limes acquisition cost: - divided by 12 months equals amount per month: S - times this many months: 0 t) $ - 0.0% $ - $ Utilities Not Included in Rent: Heat per month: 5 - limes this 4 months: 0.0 $ - 0 0% C - C 1 ' Electriciry per month: S - times this # months: 0.0, $ - 0.0% . C r Water per month: , S - times his 4 months: 0.0 $ - 0 0% & - C 1 0:her (specify): , cost per month: S - nines this bi months: 0 . II II ilv. '. TOTAL:I $ 4.117 I I C 1 75A I c .1411 CM-468-EX (Rev_ 12 1.1E1 Previous enior obsolete. MS Exzel 1.624 CONTRACT BUDGET DETAIL LINE ITEM: COMMUNICATION _._ DEFINITION: Cosi for written or verbal communication. INSTRUCTIONS: JelentitY communications cost below. Each item costing S100 or snore must he listed individually. METHOD OF ALLOCATION OF COST: Determine the DHS percentage of the cost by using one of the following methods. Any cost item used entirely tr,, provide contracted services should be charged 100% to the contract Identify below the method used to determine the percentage shown in Column 3. Options include: a) Number of DHS clients served, divided by Total Program dews served, X 100%;b) Direct service staff hours serving DHS clients, divided by total direct staff program hours, X 100%; c) Number of phone lines assigned to serve DHS clients, divided by total program phone lines. X 100%; ..I .1 $ I . a L. *ice' Other Identi Cost aVocation method: C 4. DHS 5, I. 2. CONTRACT Match or In kind COST ITEM (TOTAL COST) 3. DR ci PORTION Portion TOTAL S PROGRAM a (Of Total Prog.) . (If Applicable) Telephone: Total Agency lines: I 2 Total nhoties: Local: Number of Total Polgrain Lines: Number of Phones: Phone costhnonth: S 64.00 times /4 of months: i P 1 20 100.0% S 320 S - Lone Distance: Phone costimon -- - - - • • I 0.0% Fax Service: Fax co . . .. . . I ,.. 0.0% Postage: Item: Mail materials to clents. etc. Cost er month: S 8.33 times of mo • • 42 100.0% S 4 1 Other (Identify); Item: ) cellular phones Cost er month: S 190.03 times 4 of months: I 531 950 100.0% 5 950 Item: Printing Cost per month: % 62.50 1 times 1/ of - - • • 313 100.0% 313 CM-Cie-EX tev 2-06) r!f`,,,1:0;jti onse•ele. MS Excel TOTAL:1 5 1.624 Corrm...nications CA2S120",0 Item- Cost per month- Office Supplies $ 66 67 times # of months: I 5.G Costm month: S 25.00 Nines 4 of months I 5.0 Cost per month: 6.25 4 of montil 5_0 Cost_wr 166? limes # of months: 1 5.0 month: GAIL031 0, Item: ten': item . 0 (1% lac/ Item: TOTAL: CONTRACT BUDGET DETAIL LLNE ITEM: SUPPLIES DEFI NI TI ON: Consumable orison-consumable items with a unit cost of less than 55,000. Consumable supplies are those items that are consumed as they are used (pencils, paper, etc.). Nonconsumable supplies are those that are not consumed as they are used (file cabinets, chairs, and other durable goods). INSTRUCTIONS: Indicate below the estimated cost for general office supplies, (including duplicating supplies), and program supplies. METHOD OF ALLOCATION OF COST: Determine the DHS percentage of the cost of supplies using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% to the contract. Identify below the method used to determine the percentage shown In Column 3. Options include: a) Number of MIS clients served, divided by Total Program clients served, X 100%; b) Direct service staff hours serving DHS clients, divided by total direct staff program hours, X 100%; e) Other (Identify) Cost allocation method: 3. DHS % COST ITEM (TOTAL COST) General Consumable Supplies (Pencils, Paper. etc.): 2. TOTAL PROGRAM 4. MIS CONTRACT PORTION Tntal Prna 5. Match or inkind Portion etc 333 100.0% I S 333 Item Educational Supplies 125 100_0% I $ 125 ;tem Ilvfetlical Supplies 31 100.0% 1 S 31 Duplicating Supplies: Item: Convenience Copier 83 100.0% $ 83 Non-Consumable Supplies: (Itemize) Item Item: CM-Oa-EX (Rev 12-ca: Previous edilw cbsclele MS ESCO SUMOS CONTRACT BUDGET DETAIL LINE ITEM: TRANSPORTATION DEFINITION: Transportation costs include the costs of staff travel, lodging, meals and incidental expenses incurred by personnel in a trove; status while on official business. Travel rates established by the State of Michigan wit: be used as a guideline in determining reasonableness of rates. INSTRUCTIONS: Indicate beloi.v thc estimated staff mileage cost and the per mile charge. Also, indicate any addition transportation-related costs, such as meals. lodging, etc. METHOD OF ALLOCATION OF COST: Determine the DS percentage of the cost using one of the following methods. Any Cost item used entirely to provide contracted services should be charged 100% to the contractidentify below the method used to determine the percentage shown in Coloinn 3, Options include: a) Number of DHS clients served. Divided by Total Program clients served. X 100%: b) Direct service staff hours serving DI-IS clients, divided by total direct staff program hours. X 100%:e) Miles Program miles traveled, X I 01.1%)1) Other fftle. Cost allocation method: c and d (matchl - ,- 4. DNS S. 2. 1. PROGRAM , TOTAL 3 DHS CONTRACT Match or Inkind 'A COST ITEM (TOTAL COST) PORTION Portion _ (01-Total Prog.) (If Applicable) - _J Program Mileage: _ Number of miles expected to be driven. 4928.0 times costBr mile: $ 0.5110 _ _ $ 2.464 100.0% $ 2.464 $ -- Meals (Itemize Costs); Per Diem for Denver CO 561 per day $ 488 0.0% $ - $ 488 - _ S - 0.0% , $ -_ $ - _ - • , S - 0.0% $ - .. $ _ Lodging (Itemize Costs): _ Training in Denvea CO hotel S100 per night ,...$ 1 000 0,0% $ . - . 5 1.000 _ _. _ _ 0.0% - _ $ - $ -- Training Mileage: 7 Number of rm let, expected to be driven: 0(1 _ times cost per mik: $ - $ - 0.0% $ - $ - - - 0.0% $ - $ - I:Other (Identify and Itemize costs): _ - Airfare to National NEP office ie. Denver CO $ 800 0.0% 5 - 5 800 - Supervisor mileage for inonth:y meetings r. $ 125 0.0% $ - 5 125 $ - 0.0% $ - .. $ - _ $ • 0.0% $ - .. S - TOTAL: $ 4.877 , $ 2,464 , $ 2,413 - `,7•M-465-LX {Rev.. 12-08 F7ei(e.4s aOrtc IOt MS:Exce TrnrsNiEstion C429"20.7C SUBTOTAL: 1,470 I $ 1,470 1,470 CONTRACTED SERVICES TOTAL: 1,470 J $ CONTRACT BUDGET DETAIL LINE ITEM: CONTRACTED SERVICES DEFINITION: Compensation paid by the Contractor to a third party under a subsontract for performance of any activities designated in the contract as a service to be delivered to OHS. Other services, such as CPA services, should be identified in the Miscellaneous line item. INSTRUCTIONS: indicate below each subcontractor by name with a brief explanation of services to he provided. Show bow cost was determined. For amounts over 52300, attach a separate buget for the subcontractor. METHOD OF ALLOCATION OF COST: Determine the DHS' percentage of the cost using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% to the contract. Identify below the method used to determine the percentage shown in Column 3. Options include; a) Number of DHS served divided by Total Pmgram clients served X 100%: h) Direct service staff hours serving pHs clients divided by total direct staffprograin hours X 100%; e) Other (Identify). Cost allocation method: 1 , 4. DHS 5. I. 2. • CONTRACT Match or Inkind TOTAL 3. DHS COST ITEM (TOTAL COST) PORTION Portion PROGRAM 101 Total Prop) (If Applicable) Subcontractors: Name of Agency or Individual: Telelanruaric Brief description of service provided: Translation & Interpmmtion Client enabling services Cost breakdown of service provided: Per unit cost: 1 $ 0.99 I times 4 dunks: I 1485.G $ 1,470 100.0% $ 1,470 $ - - ----, Name of Agency or Individual: Brief description of service provided: Cost breakdown of service provided: Per unit cost: I 1 times 4 of units: I $ - 0.0% $- $ - .. Name of Agency or Individual: 13rieldeseription of service provided Cost breakdown of service provided: Per unit cost: I I times 4 of units: I 1$ - 0.0% $ - $ - • CM-458-EX Ray. 12-0B) PTvious edaior see. MS Exce Contractc- Senricus 041292Q10 CONTRACT BUDGET DETAIL LUST ITEM: SPECIFIC ASSISTANCE DEFINITION: The dollar amount cf money or other items of value purchased for a specific client and given to that client as part of service delivery. INSTRUCTIONS: List each type of cos'. item including a brief explanation. unit cost and quantity. METHOD OF ALLOCATION OF COST: Determine the DTIS percentage of the cost using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% to the contract. Identify below the method used to doermine the percentage shown in Column 3. Options include: a) Number of OHS clients served divided by Total Program clients served X 100%: WI Other ildentiM. Cost allocation method: a 2. 4. DHS I 5. I.CONTRACT Match or InkInd TOTAL 3, OHS % COST ITEM (TOTAL COST) PORTION Portion PROGRAM (Of Total Frog.) (If Applicable) Specific Assistance Given Clients: Type of item given:Ileachingichild safety EA planation of Assistance: iBooks safety gates plug covers nuartitv to each client- 1 2.0 'nines cost ner unit: 5 20 59 Imes number of clients to whom item(i) given: a.4 $ 1,400 100.0% 5 1.400 5 - 1 Type of item given: 1 B us Fare Explanation of Assistance: I fast resort transportation ,for clients (doctor amts. etc) (-)11111inv to each orient. 1 4 0 I times cost per unit S 200 t:mes number of clients to w ont item(s) given: 12 $ 96 100.0% S 96 $ - I Thew of Item piven: Explanation of ASSISSanee: flusintirv tic r.nrii client I 0 Ol tales cost De: unit: S - times number ofpents to whom noMs) given: 0 $ - 0.0% $ - $ - I type of item giver.: Explanation of Assistance: (ltra may to each ['front I 0 0 I ttmeg COQ nor unit S - iimes number of clients to whom itern(si given: 0 S - 0.0% 5 - S - Type of nem given: Explanation of Assistance: rn each olipni• i 0 0 ltimeg Cost 11/Cr unit. i - . •irnel roimher nf clients. in whom items) given: 0 5 - , 0.0% $ - $ - TOTAL:,1 5 1.496 1 $ 1.496 $ - -EX .:ReV. P-ev ous Excel speelcAs sce cc lildly!uals 7:4!29127.!0 CONTRACT BUDGET DETAIL LINE ITEM: MISCELLANEOUS DEFINITION: Expenses related to the contract which are not chargeable to other line items. INSTRUCTIONS: List and briefly explain each miscellaneous cost item below.Cost Items that are designated "other ur "miscellaneous" are unacceptable. METHOD OF ALLOCATION OF COST: Determine the OHS percentage of the cost using one of the tbllowing methods. Any cost item used entirely to provide contracted services should be charged 100% to the contractidentify below the method used to determine the percentage shoAn in Column 3. Options include: a) Number of DEIS clients served, divided by Total Program clients served. X 130%: b) Direct service staff hours serving OHS clients. divided by total direct staff program hours, X 100%; rt nthrr fliienrifv1 Cost allocation method: b and c (in-kind match) 1 4. DHS 1 I. CONTRACT TOTAL 3. DHS % COST ITEM (TOTAL COST) PORTION PROGRAM (Of Total Prog.) .— Miscellaneous: Item: 2 desktop computers ... Ex/Inflation: Quarterly rental charge S576 ea. , Cm:Intim- I ^ 0 I times cost ua unit : I $ 1 152.00 S 2,304 0.0% 5 - Item: 'Liability Insurance Explanation: tltinntrw I 1 01 times cost net unit . I S 630.00 5 630 100.0% $ 630 Item: I Indirect costs Explanation: Per established rate 14_14% of- salaries flonntirv. 1 118 657 ()I times cost net LID& I 14.14% 19.606 100.0% 5 19,606 . Item: NIT National Ofrice ExDiannt;on: Licensing. technical support Oakland County has paid fees of $8,559 for FY2010 nisaniilb" I n times cost oer unit: I - 0.0% Item: Explanaton: 1 nuantiiv• I I ti Infls c us t mn- un it: i S - $ - 0.0% $ _ SUBTOTAL: I $ 22,540 I I S 20.236 MISCELLANEOUS TOTAL:I $ 31,184 S 20,236 CM-458-EX (Rev. 12-08) Previous &don ObSOM. EXCel u1sceI arcods 04/29/2010 2,304 5. klatch or Inkind Portion (If Applicable) 2,304 10,948 CM-468-EX 2-DB) Prevbus eabon obsu.ete_ MS Exce! Misce4aneuus 0412940"C CONTRACT BUDGET DETAIL LINE ITEM: MISCELLANEOUS (Continued) 4.1:11-15 2. 1, CONTRACT TOTAL 3. DHS 94 COST ITEM (TOTAL COST) PORTION PROGRAM (Of Total Nog.) Miscellaneous: Item: 'National Nni Offi:e Exrilanation: Ongo:ng mime education Oakland County has paid fees of$1,482 for FY2010 , Ouantiq:: 1 1 Mmes cost per unit: 1 $ - 0.0% $ - Item: National "FP Office Explanation; Initial training For 2 new nurses Training $3.835 ca.. manuals $487 ea. Quantity: 1 2.01 times cost per unit: 1 $ 4,322.00 $ 8,644 0.0% S ltern: Explanation: i.-- 9uantity: ] 1 times cost per ungt; 1 0.0% $ - Item: -- - . Exp.anation: ,...._ Quantity: 1 0.01 times cost per unit: 1 5 - $ - 0.0% $ . Item: Explanation: Quantity: 1 0.01 times cost per unit: 1 $ - $ - 0.0% $ - Item: Explanation: • _QJanitty: 1 0.01 times cost per :mit: i $ - $ - 0.0% $ _ Item: Explanation; Quantirv. 1 0.01 times cost per unit: 1 $ - $ - 0.0% $ - SUBTOTAL: 5 8.644 I $ - 2:M-468-EX (Rev. "2-C6) Drevtous edition °Beim MS Exael hel•sceliarecus Sheet 2 04.29/2G'D 5. Match or inkitni Portion (If Applicable) 8.6,44 8.644 cM-468-EX (Rev 12-09) n"revio-uethtr cosonele. MS EK.Del M!sce ,areoos Sheet 2 04/29.201a Michigan Department of Human Services Division of Contracts and Rate Setting Contract Budget Preparation Program The objective of this program is to facilitate the completion of DHS Form CM-468 for submission to the Division of Contracts and Rate Setting as part of the contract application process. The Michigan Department of Human Services delivers social services to qualified state residents through the efforts of agency personnel and non-agency personnel. Non-agency personnel deliver services pursuant to contract terms mutually agreed to by the agency and the contractor. Some applications must be accompanied by a budget. Please utilize this program to prepare the budget form. Users load in this workbook as a workina coov of a template should save the file under a different name. Click on File from the menu above: then choose Save 6s Several changes have been made to this version of the CM-468EX. Please click the link below to view those changes. All other versions will be obsolete as of April 1, 2009. Revision Changes CM-468-EX (Rev. 4.09) Previous eettion obso ete. MS Excel Introdunt;tion CM 468-EX Changes on April 2009 update 1. Salaries and Wages % of Time Spent on Total program decimal points changed to 2. Workman's Compensation calculation corrected. CM-MB-EX (Rev 4-09) Previo.is editIon ().,soiete. MS Excel Changes Michigan OHS - DCRS - Contract Budget Preparation Program Main Menu Complete all budget sections which apply to your contract or bid proposal (Salary, Fringe Benefits, etc When you have completed and saved all pertinent sections * For bid response, print completed form and follow instructions in Request For Quote (RFC * For awarded contract budgets, submit completed forms with contract to DHS Contract Administrato electronically. The command buttons on this shet are available to assist in navigating through the font The sheet tabs below can also be used I Salaries and Wages I cietfing Started ' Equipment „ Fringe Benefits . I Transportation Budget Summary Sheet Occupancy , I Contracted Services Communication Save File I Specific Assistai-ce Supplies Print Options Miscellaneous Purpose j Guidelines Instructions Comments CM-468-EX (Rev. 12-08) Pre0ous e Lc1.-.L.s.1)1ele_ MS Ex:-.1 Ma;n Menu I. CONTRACT BUDGET PURPOSE A potential contractor may be asked to prepare a budget as part of a bid response The budget is used for two different purposes 1. BASIS FOR REIMBURSEMENT: Actual Cost Reimbursement Methoc. The approved projected budget is part of the contract anc serves as the basis for payment. Total expenditures are limited to the total budget amount. The contractor is paid actual expenditures made in accordance with the budget. Expenditures cannc exceed 5% or $1,500, whichever is greater, of any line item without a line transfer from underspe line items in the same budget approved in advance by the Division of Contracts and Rate Settinc, (DCRS). The required form, Line Item Transfer Request (CM-4070EX) can be found on the DH website. 2. DOCUMENTATION TO SUPPORT REASONABLENESS OF PRICE Unit Rate Reimbursement Method. The approved projected budget is used to justify the uni price. The budget is used as basis for negotiation, or to analyze (together with the narrative proposal) the resources to be used in providing service. The budget does not control expenditun or serve as the basis for payment because the contractor is paid a set price for each un of service provided. The unit rate cannot be changed during the term of the contract, unless th contract specifically provides for a rate change. CM-468-EX (Rev. -2-38) Previous eClion obsolete WS Ex::,e1 PUrpOSie GM•468-EX (Rev. 72-'3E) Prev.obs bso e•,e MS Enel P!..1DCSe II. Getting Started Summary Sheets If multiple service types are to be delivered under the contract, spread the various expenditures between the service categories after you have completed the individual spreadsheets detailing expected spending (Salaries, Fringe Benefits, Occupancy, etc.). Use the second Budget Summary sheet i there are additional services. The Total Program Cost" column and the "DI-IS Contract Portion" column will VII in automatically based on the dollar amounts you enter on each detail page. Match or In-Kind portion of the program fields must be completed manually on each detail page. The totals will transfer automatically to the Total Program Budget Summary. Spreadsheets The individual detail pages permit the entry of data only in the appropriate cells (shaded light yellow in color). If the instructions at the top of each sheet are inadequate, there is a "Help" button in the upper riget hand corner which will display additional elorreation when clicked. If you are new to the bucget preparation process, it :s suggested that you read the Purpose', "Guidelines" and "Instructions" pages of the program fpr useful background information. If you still have questions, Gall the avision of Contracts and Rate Setting in Lansing at (517) 373-3724. Navigating A data input range is avai!abe for each detail page. When the range is selected you can press the tab key or the enter key to move between data input cells. Enable the range by selecting the appropriate range name from the range rame list box. The name of the spreadsheet you are on corresponds to the name of the range for that spreadsheet. (For irstance, "range_Salary" is tee cake input range used on the Salary sheet.) To disp ay the range rame list box, click on the downward pointing arrow on the left side of the format bar immediately above the spreadsheet. You can also move to different pages within the workbook Dy using the labeled tabs at the bottom of the page. Comments Page A comments page is included on tOis form for your use If you need to supplement your proposed budget with additional information. Click on tee Comments button to access that page. Printing Print the sheets which you need using the printing features of MS-Excel, or click on the Print Options button at the Main Menu and make your selections from there. Screen images If the text image on your screen becomes distorted, that does not necessarily mean the your data has been corrupted. Save your work and exit the program. When you re-enter the program the problem should be gone. Printing is not normally affected. Not Enough Pages Open a second, separate, copy of Ole CM-455ex workbook and enter the remaining unrecorded cost items on the appropriate spreadsheet(s) provided in that new workbook, It is important to remember that the total cf costs recorded on a supplemental page(s) must be included in the body of the main workbook for those costs to be picked up and added to the total flgures on the Summary page of tee spreadsheet provided for that category of cost. In the item description space there should then be a reference to the suople.mental page, For example . 'Total (item type) from Supplemental page, A printed copy of a supplemental page should also be very oleany ma:ked as being a supplemental page. CM-468-ax lRev. 12-U8) prevlous etiltior obsolete. MS Exzel Gettiog Started III. CONTRACT BUDGET GUIDELINES The potential contractor should review the entire budget package before completing the Budget Statement and Budget Statement Detail forms to become familiar with aliowable and unallowable cost. * Budget development shall be based on sound cost accounting principles. * Budgets submitted by non-profit organizations for contracts involving federal funding, in whole or in part, shall be in compliance with OMB Circular A-122. * Budget figures shall be the projected amount of actual allowable expenditures. * Only those costs that support program activity shall be included in the budget. * Costs not specifically identified as "Allowable and Unallowable Costs" may be included if reasonable and necessary. These costs should be discussed with DHS staff. * Unallowable costs as described in these materials shall not appear in the budget for DNS' portion of the contract. * Some cost items allowed by other funding sources may not be allowable in DE-1S' portion of the budget. These cost items should be included in the "Total Program" column, but not charged to DRS. A brief narrative describing these cost items should be provided on the Budget Statement Detail or the Comment page. * Copies of appropriate budget and contract/grant award letters for services funded by other sources should be submitted to DHS along with this budget, * For Public Agencies, as part of the budget review process, the relationship of proposed program costs with those of existing programs will be determined, Duplicate costs are not allowed. * Budgets for subcontractor's receiving over $2,500 must be included with contractor's budget. CM-468-EX (Rev. 12-08) Prev.:3Js e1 otIso ete. MS Ene: GuiCe'ireu V. CONTRACT BUDGET INSTRUCTION! (DETAIL FORMS) 1, DEFINITION: Self-explanatory 2. INSTRUCTIONS: Self-explanatory 3. METHOD OF ALLOCATION: For each line item, insert in the space provided above the column headings, the letter that corresponds to the method of allocation used to determine the percentage figure for column 3 on the form. The method of allocation refers to how the potential contractor determined the amount of a cost that could be attributed to the DHS portion of the service(s)/program. An acceptable cost allocation method is one that equitably assigns program expenditures according to service delivery and shall be documented in the contractor's bookkeeping records. 4. COLUMN 1. - COST ITEM (TOTAL COST); Each cost item must be separately identified and detailed. Show method of computation. No items may be combined as one cost unless their combined cost is less than $100, 5. COLUMN 2. - TOTAL PROGRAM: Column 2 should include the total cost to the potential contractor to provide the type of program or service for which a budget is being submitted, and includes the cost of the services to be purchased by DHS plus the costs of providing similar services to non-DHS clients paid from other funding sources. 6. COLUMN 3. • %DHS: Determine the portion of the cost item that can be allocated to OHS (see item 3 above). Enter the percentage allocated to DHS in column 3. This percentage should be consistent among all line items unless another method of allocation is more appropriate for an individual tine item. 7. COLUMN 4. - DHS CONTRACT PORTION: This program will multiply each cost in column 2 by the percentage figure in column 3 and enter the resulting figure in Column 4. This is DI-IS' portion of the cost item. Each figure in column 4 must be equal to or less than the corresponding figure in column 2. 8. COLUMN 5. - MATCH OR IN KIND PORTION (If applicable) Must be filled in manually. 9. TOTAL: The workbook will total columns 2 and 4 and 5 if applicable based on the dollar amounts entered, 10, COMMENTS: Enter any additional information or explanation necessary for any of the line items use Comments page if not enough room on detail page. CM-468-EX (Rev. 12-08) Previous edition obsmte. MS Excel Instructions You may enter additional comments on this sheet or attach supplemental materials to your CM-468. Out of State Travel - A requirement of agencies adopting the Nurse-Family Partnership model is for direct service workers (Nurse Home Visitors) and supervisors to attend a 4 day training in Denver CO (on rare occasions these classes may be held in another location). Our supervisor and two nurses for this project have already been training and do not need to travel. However, to have a full team (4 nurses), two additional nurses will need to be hired for this project and must attend NFP required training. THESE CHARGES NOW SHOW AS MATCH DOLLARS. Indirect Costs - Oakland County has an established indirect cost rate. Our federal cognizent agency does not issue indirect cost rate agreements to local/county governments because it is not required. We would be happy to provide a copy of our cost allocation plan that is prepared by Maximus. It is 333 pages and too large to include in this application. Attached is a copy of our Certification by the Responsible County Official. DETAILED INFORMATION WAS E-MAILED FOR REVIEW AND SUBMITTED BY SHARENE JOHNSON TO FISCAL FOR APPROVAL. Required Fringe Benefits - Workers Comp - The County calculates the average rate for this benefit at 1.19%. Because this cell on the worksheet calculates at "Cents per $104 of", the rate is shown as 11.9 in order to get it to calcuate correctly. Specific Assistance - Teaching/Child Safety - This fine item has been pro-rated to show the total $10,000 allocated over the 2 1/2 years of the grant ($1,600 yr 1, $4,204 yr 2, $4,200 yr 3) Bus Fare - Based on past experience, we do not anticipate that all 100 clients will need assistance with transportation expenses. Therefore. this line does not reflect a proration for all 100. Contracted Services - Translation & Interpretation - this is calculated at .99 per minute of usage. CM-468-EX (Rev. 12-08) Rrevicus cdtior. ipsolete. MS Exce Comments Contract Number: Contract Amount: Budget Period: 7TT-10-6300 I $472,997 12 Morrill NUMBER OF UNITS TO BE PROVIDED: RATE PER UNIT OF SERVICE; Service Category (A)• Service Category (B). Service Category (C): Authority: P.A. 280 of 193! Completion: Mandator), Penalty Contract Invalit (A) SERVICE CATEGORY (B) SE:RV1(7E I (C) SERVICE CATEGORY i CATEGORY MI SERVICE CATEGORY 330,13t 180,981 9,8821 1 $ 1$ S 3,8981 1,375 $ 0.0 S S -IN 8,43b1 3,500 4,29( 71,474 613.986 100.0 6,139.8 0.0 #D1WO Is $ 0.0 TO FAL PROGRAM BUDGET IMS CONTRACT :BUDGET PrIATCII or 1_NKIND AMOU (If Applicable) 1,3751 $ 1,375 8,4381 S 5,85Q 71,4741 $ 45,81 1 S 25,651 613,980 472,9971 $ 140,981) 2,58 65,358 37,504, 9,881 264,7181 143,481 3,8981 330,13t 180,9V 9,8821 2,89)1 $ 3,500 4,290 3,500 4,290 TOTALS: Contractor's Legal Name: Mailing Address: LINE:ITEM SALARIES FRINGE BENEFITS OCCUPANCY COMMUNICATION SUPPLIES EQ1PMENT 1PANSPORl'ATION CONTRACTED SF.14 'VICES SPECIFIC ASSISTANCE TO INDIVIDUALS MISCELLANEOUS Cow ay of Oaklaud II I 200 N "[ eleguaFliDcrl 34E Pcmtrac MI 48341 Service Category (D): Department of Human Services (DI-IS) will not discriminate against any individual or group because of race, religion. age. national origin. color. height weight, inernal status, sex, se*tial orientation. gender identity or expression, political helmets or disability. 0 you need help with reading, writing, hearing. etc., under Pia Americans with Disabilities Act, you are invited to !make your needs known to a OHS office In your area TOTAL PROGRAM BUDGET SUMMARY CM-468-Fl( (Rev. 12.08) Plavioliseeition obsolete.. MS Excel Budget Summary 5/2-1i2010 Contractor's Legal Name: Mailing Address: County of Oakland MI 1200 N. Telegraph Dept 34E Pontiac MI 48341 Contract Number: Contract Amount: Budget Period: ZTT-10-63001 472,997 12 Month TOTAL PROGRAM BUDGET SUMMARY (Continued) (E) W) (G) (H) 1.1) 01 SERVICE LINE IFEN1 SERVICE SERVICE SERVICE SERVICE SERVICE SERVICE TOTAL CATEGORY CATEGORY' CATEGORY CATEGORY' CATEGORY CATEGORY SALARIES , - 5 - - S - S 330,130 FRINGE BENEFITS S S - -S - -. $ I 80,987 OCCUPANCY' - S - $ ,S - $ 9,882 COMMUNICATION $ - S - $ S - $ 3,898 SUPPLIES S -S - 5 - S - 5 1,375 EQUIPMENT S - - 2 S - 5 - - -,-- TRA NS POR 1 AT ION - $ $ $ 8,438 CONTRACTED SERVICES S S - - S - S - $ SPECI IP IC ASSISTANCE - - $ - 5 4,296 TO INDIA/URALS MISCELLANEOUS S - - $ - - 5 71,474 TOTALS: _ _ 5 613,98t UNITS PROYI1)EU7; RATE PER UNIT: #D111/0! #DIV/W #D1WO! 4DEV/0! #DIV/01 #1)1W01 Service Category (E): Service Category (H): Service Category (F)- Service Category (1): Service Category (G)7 Service Category (J): , CM-468-LX IRev. 12O) Previous edition obsolete.. MS Excel Burk* Summary Shiest 2 5/2112010 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES DEFINITION: Gross compensation paid to employees in the form of cash, products, or services including vacations, holidays, sick leave and leaves of absence. Paid absences must be reimbursed uniformly for both employees paid under this contract as well as employees not paid under this contract but performing similar work. INSTRUCTIONS: List each position below including total yearly salary or wages, how many weeks employed yearly, how many hours worked per week, percent of time spent on Total Program, percent of salary/wages charged to DHS Contract Program. Provide additional detail budget sheets as needed. Example on Help_Salaries. METHOD OF ALLOCATION OF COST:Determine the DHS percentage of the cost of each salary position using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% of the cantracklentify below the method used to determine the percentage shown in Column 3Options include: a) Number of DI-IS clients served divided by Total Program clients served X 00%.b) Direct service staff hours serving DHS clients divided by total direct staff program hr. ei Other (identify) Cost allocation method: b and match (Use Comment page if not one of the above methods) 1 2. 4. DHS 5. . CONTRACT Match or Inkind COST ITEM TOTAL 3. DHS % (TOTAL COST) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) PROGRAM POSIT1ONS-ADMINISTRATIVE Position Title: Yearly Salary: Weeks/Year: 0.0 Hours/Week: , 0.0 % of Time Spent on Total Program: 0.00% Salary Charged to Total Program: $ - 0.0% $ - $ - Position Title: Yearly Salary: i Weeks/Year: _ 0.0 Hours/Week: 0.0 {.14) of Time Spent on Total Program: 0.00% , Salary Charged to Total Program: $ - 0.0% $ - $ - Position Title: Yearly Salary: $ - Weeks/Year: 0.0 Hours/Week: 3.0 % of Tine Spent on Total Program: 0.00% Salary Charged to Total Program: i 1 - 0-0% , $ - $ - SUBTOTAL: S - $ - I $ SALARY TOTAL: $ 330.136 $ 264,778 $ 65,358 CM-468-EX 07ev. previous editon obsolete. MS Excel Saaries and Wages 5/2V2C-.0 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) cost allocation method: b and Match 4. DHS S. 2. 1. TOTAL 3 DHS % CONTRACT Match or Inland . COST ITEM (TOTAL COST) PORTION Portion PROGRAM (Of Total Prug,) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE Position Tide: Health Program Coordinator Yearly Salary' $ 65,358 00 Weeks/Year: 52.0 Hours/Week: 40.0 e-,n Tnt a I Prno-Arr - 1 00.0r _ ; cnlpirv (Thawed to Total ProPram: $65 358 0.0% 65,358 'nn, Position Title: Office Assistant 11 Yearly Salary: $ 16,854.00 Weeks/Year: 52.0 Hours/Week: 19.2 % • T,.,.. e_n.r. ro i Prwrtv— 4......... AMMI00.191M0% — __..alarv ChArl..1, trdaial Protram: 16,84 100.0% 16,854 5-, ...., Position Tide; Public Health Nurse III Yearly Salary: S 61,981.00 Weeks/Year: 52.0 Hours/Week: 40.0 aL ,-,4- -r-;,-.-- Q"...,,t ,n TANI Prno ram. / 100,00°4, c4:11n a • . = 1 • T ) al Profiram: 61,981 100.0% 5 61,981 -, Position Title: Public Health Nurse 111 Yearly Salary: $ 61,981.00 Weeks/Year; 52.0 Hours/Week: 40.0 % of Time .5;.sent on TotL-alag Salary Clawed Total Promm: S 61 ,981 100,0% 61,981 - Postion Title: P -Jblic health Nurse Ill Yearly Salary: $ 61,9S1.00 Weeks/Year: 52,0 Hours/We:k: 40.0 % of Time Sent on Total piiiini. 100 ono Salary rharoed_to Tp4a1ProaTarn: $ 61; 981 100.0% 61,981 -I SUBTOTAL: $ 268,155 S 202,797 65,358 CM-468-EX (Rey. 12-05) P7evious ed.ticr. obso.ete. MS Excel 5f 2 1,'201 0 Salaries and Wages Sheet 2 61,981 I SUBTOTAL: 61,981 I S CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: b , 4. DHS 5. 2, I. CONTRACT Match or Inkind TOTAL 3. DHS % COST ITEM (TOTAL cosi-) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE Position Title: Public Health Nurse ITT Yearly Salary: $ 61,981,00 Weeks/''ear: 52.0 Hours/Week: 40,0 % of Time Spent on Total Program: 100.00% Salary Charged to Total Program: $ 61,981 100.0% $ 61,981 $ - Position Title: Yearly Salary: S , - , Weeks/Year: 0.0 Hours/Week: 0.0 % of Time Spent on Total Program: 0.00%, Salary Charged to Total Program: $ - 0.0% Position 'Fite: Yearly Salary: $ - Weeks/Year: 0.0 ,Hours/Week: 0.0 % of Time Spent on Total Program: 0.00% 1 Salary Charged to Total Program: $ - 0.0% $ - S - Position 'Title: Yearly Salary: $ - Weeks/Year: 0.0 Hours/Week: 0.0 % of Time Spent on Total Program: 0.00% Salary Charged to Total Program: $ - 0.0% $ - $ - , Position Title: Yearly Salary: $ - WeekslY ear: 0.0 Hours/week: 0.0 °,4) of Time Spent on Thtai Program: 0.00% ' Salary Charged to Total Program: $ - ' 100,0% $ - S - CM-468-EX (Rev. P.-evioLs edifier' obsc.-efe. MS Excei 5;21/2010 Sala rigs and Wages Sheet 3 Salary Charged to Total Program: -I 0.0% 1 $ CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: 4. DHS 5. 2, 1. OTAL 3 DHS CONTRACT Match or Inkind T. % COST ITEM (TOTAL COST) PORTION Portion PROGRAM (Of Total Frog.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND ' DIRECT SERVICE - -. Position Title: _Yearly Salary: $ - _Weeks/Year: 0.0 ,Hours/Week: 0.0 , % of Time S•ent on Total Program! 0.00% Salary Charged to Total Program! $ - 0.0% $ - S - Position Title: 1 Yearly Salary: Weeks/Year: 0.01 Hours/Week: , 0,01 % of Time Spent on Total Prograin: I 0.00% —__ Salary Charged to Total Program: S - 0,0% $ - $ - Position Title: Yearly Salary: $ - Weeks/Year: 0.0 Hours/Week: 0.0 % of Lime Spent on Total Program: 0.00% _.... Salary Charged to Total Program: $ - 0.0% - $ Position Title: Yearly Salary: $ - Weeks/Year: 0.0 ._._. . Hours/Week: 0.0 % of Time Spent on Tctal Program: , 0.00% Salary Charged to Total Program: $ - 0.0% $ $ - Position Title; - •• • Yearly Salary: $ - Weeks/Year: Hours/Week: 0.0 % of Time Spent on Total Program! 0,C0%, — SUBTOTAL: CM-458-EX (Rev. 12-95) Drevious edition ozsolete. MS Excel Salaries and Wages Sneet 4 5,21/2010 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) • Cost allocation method: 4. DHS 5. 2. 1.% CONTRACT Match or Inkind TOTAL PROGRAM 3. DEIS COST ITEM (TOTAL COST) PORTION Portion (Of Total Prog.) (If Applirable) . PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE Position Title: Yearly Salary: S - Weeks/Year: 0,0 i Hours/Week: 0.0 % of Time Spent on Total Program; 0.00% Salary Charged to Total Program: $ - 0,0% - $ - Position Title: 1 Yearly Salary: I Weeks/Year: 0.0 Hours/Week: I 0.0 % 0 r Time Spent on Total Program: 0.00% Salary Charged to Total Program: $ - 0.0% $ - S - Position Title: ' Yearly Salary: S - Weeks,'Year: 0.0 Flours/Week: 0.0 % of Time Spent on Total Program: , 0.00% Salary Charged to Total Program: S - 0.0% $ - S - Position Title; Yearly Salary: S - Weeks/Year: 0.0 Hours/Week: 0.0 % of Time Spot: on Total Program: 0.00% Salary Charged to Total Program: $ - 0.0% S - S - POsttion Title: Yearly Salary: - Weeks/Year: 0.0 Hours/Week: 0.0 % of Time Spent on Total Program: 0.00% Salary Char2a1 to Total Program: I $ - 0.0% $ _ $ - SUBTOTAL: cm-c65-EY, ;Rev 17-091 c'revtous cvicr cPosclete, MS E:xce! .5,'2112070 SaarieG arii Wages S'ieet 5 OPTIONAL FRINGE BENEFITS Cost allocation method: 1. COST ITEM (TOTAL COST) Program portion of taxable salaries. Use base wage only. b and Match 2. 'TOTAL PROGRAM 20,468 4,787 108 3,929 REOU1RED FRINGE BENEFITS FICA Social Seen rity(%): Program Salaries and Wages Fl CA Medicare(/o): Program Salaries and Wages 6.20%! Times Total 330,136 Times Total 330,136 1.45% 54.000 0.20% 11.99 Unemployment (va): Times Total Cents per $100 of Worker's Comp: Total Program payroll: 330,136 16 416 3 X39 87 3 151 80.2% 80.2% 80.2% 80.2% 79 1% 77 RR& 79.1% 79.1% 79.1% 7_44 867 1 c)C) times contributions for each per month: times number of program months: Health Insurance: Nutnbcr f FL E's Retirement: Number of FT L's times contributions for each per month: limes number of program months: Life Ins: I Number of Fr d times contributions for each per month; times number of arogram months: I. Long Term Disabil: Number of Hr.:, times contributions for each aer month: times number of program months: Other: (Iterni7e) Optical :a 0.08% of $313,282 Finge Berets il-sev. Prev,ous edition cosolete. WS Exc:e: 512 CONTRACT BUDGET DETAIL LINE ITEM: FRINGE BENEFITS DEFINITION: Funds allocated to cover allowances, cost of services provided by the contractor to or or behalf of its employees and not inc:uded as compensation or salaries and wages. INSTRUCTIONS: List each category of fringe benefits below and complete the requested information for each. The Required Fringe Benefits porno] must be completed for all employees. Note: Unemployment base wage cannot exceed $9,000 per employee. Note: Social Security at 6.2% cannot exceed base wage of $102,200 per employee plus Medicare at 1,45% for all wages. METHOD OF ALLOCATION OF COST: The DITS' percentage of the cost of each fringe benefit cannot exceed the percentage of total DHS salarie to total program salaries. Fringe benefits for each individual position do not have to be itemized. Be sure base wage figures are taken into account. Any cost item used entirely for the DHS CONTRACT PORTION, and equal to the TOTAL PROGRAM effort, equals 100%. Options include: a) number of clients served b) direct staff hours DHS 5.000 1,64108 12 98.465 5.000 777.00 1 1 5 4642 5.000 1 18. .67 12 $ 94 5.000 27 12 1,096 251 5. Match or InkInd Portion (If nintid...t,t,..% (lc, 21 78 20,579 9,744 L.LLI 4. DHS CON-TRACT PORTION (Of Toni! Prnol :44hfl c(1,1 CONTRACT BUDGET DETAIL LINE ITEM: OCCUPANCY DEFINITION: Costs arising from occupancy and use of owned or leased buildings and offices, INSTRUCTIONS: Indicate below whether facit0 cost was determined by rent, depreciation or use charge, the amount being charged and how & cost was determined. Itemize various utility and maintenance costs, as they apply. Note: Buildings must be depreciated over a 40 year life. METHOD OF ALLOCATION OF COSTS :Determine the DHS percentage of the cost by using one of the following methods. Any cost it= ased entirt to provide contracted services should be charged 100% to the contract. Identify below the method used to determine the percentage shown is Column). Options include. a) Number of DLIS clients served, divided by Total Program clients served, X 100%, b) Direct service staff hours serving MIS clients, divided by total staff program Lours, X 100%x) DIAS program area in square feet, divided by total program area in square feet, X I 004d) Other(klciitify) Cost allocation method: _ d in-kind match , 4. DHS 5. 2. I. : CONTRACT Match or Inkind TOTAL 3. . °/ COST ITEM (TOTAL COST) DM PORTION Pottion PROGRAM (Of Total Prog,) _ (If Appicable) Rent Paid to a Third Party: Total program area in square feet: 836.0 times monthly cost per square font: 5 0.q9 Cost per Month $ 82146 :Lines number of months: 12.0 $ 9,882 0.0% S - $ 9,882 . - OR - Depreciation: Item being depreciaied: [ , Acquisition cost: $ - ._ Depreciated over this many years: 0.0 Amount depreciated per month: _ S . . . times this many months: 0.0 _ S 0.0% S - $ .. - OR - Use Charge: Item description: _ I Use charge percentage (maximum 2.0%): 0.0 times acquisition cost: 5 - divided by 12 months equals amount per month: $ _ times this many months:_ 0.0 0.0% - Utilities Not Included in Rent: Heat per month: .... 5 - times this # months:, .0 S - 0.0% $ S - Electricity per month: $ - times this # months: 0.0 $ - 0.0% $ - - _ - _ _ i Water per month: S - times this 4 months: 0.0 $ - 0.0% , $ - Other (specify): cost per month: S - times this # months: {i S 0.0% 011/ TOTAL: $ 9,882 9,882 CM-468-LX (Rev 12-08) P -evious d ioi cb3tAte. MS ERcel OncLpancy $ 3,898 TOTAL: 3.898 CONTRACT BUDGET DETAIL UNE ITEM: COMMUNICATION DEFINITION: Cost for written or verbal communication. INSTRUCTIONS: Identify comniunications cost below. Each item casting $100 or more must be listed individually. METHOD OF ALLOCATION OF COST:Determine the DHS percentage cf the cost by using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% to the contract Identify below the method used to determine the percentage shown in Column 3Dptions include: a) Number of DHS dents served, divided by Total Program clients served. X i00%p) Direct service staff hcurs serving DI-IS clients, divided by total direct staff program hours, X 100%;c) Number of phone lines assigned to serve DHS clients, divided by total program phone lines, X 100%; d) Number of phones assigned to serve DHS clients, divided by total prog:-atn phones, X 100574 Other (Identify) Cost allocation method: 4. DHS 5, 2. 1. CONTRACT Match or Inkind TOTAL 3. DHS % COST ITEM (TOTAL COST) PORTION Portion PROGRAM (Of Total Prot) (If Atlicablel , Telephone; 1 Total Agency lines: I 2ITotil phones: I 2 Local: Number of Total Program Lines: 2 Number of Phones: 2 Phone costimonth: ) S 64.00 nm es 4 of months: 12.0 768 100.0% $ 768 $ _ Long Distance: Phone cost/month: I $ times 4 or months: I 0.01 $ - 0.0% - $ - Fax Service: Fax cost/month: $ - I times 4 of months 71 0.0 $ - 0.0% $ - $ - Postage: Item: IMail materials to cl:ents, etc. Cost per month: I $ 8.33 times # of months: 12.0 $ 100 100.0% 5 100 $ - Other (Identify): _ Item: 5 ccilu:ar phones Cost per momh: 5 190.00 times 4 of months: i 12.0 $ 2,280 100.0% $ 2,280 5 - hem: P:intirg Cost per month: $ 62.50 I dines ti of months:! 12.0 , $ 750 100.0% S 750 ,S CM-466-LX tev. 12-06) P-evioa edition obsolete. MS Excel Communicatiors 512112010 -375 1 TO FAL: 1,375 CONTRACT BUDGET DETAIL LINE ITEM: SUPPLIES DEFINITION: Consumable or non-consumable items with a unit cost of less than $5,000. Consumable supplies are those items tha arc consumed as they are used (pencils. paper, etc.). Non-consarnable supplies are those that are not consumed as they are use, (file cab;nets. chairs. and other durable goods) INSTRUCTIONS: Indicate below the estimated cost for general office supplies. (including duplicating supplies). and program supplies. METHOD OF ALLOCATION OF COST: Determine the DI-1S percentage of the cost of supplies using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% to the contractidentify below the method used to determine the percentage shown in Column 3. Options include: a) Number of OHS clients served, divided by Total Program clients served. X 1.30%; b) Direct service staff ?tows serving DI1S clients, divided by total direct staff program hours, X 100%; c) Other (Identify) _ Cost allocation method: a 1 4, DHS 5. 1. 2, CONTRACT Match or Inkind , COST ITEM (TOTAL COST) TOTAL 3. DHS %PORTION Portion , PROGRAM _l (Of Total Frog.) (If Applicable) Geeeral Consumable Supplies (Pencils, Paper. etc.): Item: Office Supplies Cost per month: $ 66.67 times id of months] 12.0 $ 800 100.0% $ 800 S , • Item:, Udocational Supplies Cost per month: $ 2S00 times ii of manths] 12_0 $ 300 100.0% $ 300 $ .. Item- Medical Supplies Cost per month: $ 625 !times 4 of months: 12.0 $ 75 100.0%, $ 75 $ . Duplicating Supplies: Hein: !Convenience Copier Cost per month: $ 16.67 times 4 of mend's] 120 $ 200 ' 100_0% $ 200 _ $ - ,Non-Consumable Supplies; (itemize) . item: 0.0% $ .. Item: , $ - 0.0% $ - 1 S , Item: S -. 0.0% $ - $ --. Item: $ - 0.0% $ - , $ ._.. him: $ - 0.0% $ - $ - _ Item. $ - 0.0% - $ i CM-465 EX (Rev.:12,m PrevieJs enalcia. M& Enc.! 521!7:-.:11 St.uples CONTRACT BUDGET DETAIL LINE ITEM: EQUIPMENT DEFINITION: Any non-consumable item costing more than 55,000 that is not attached to or included as part of the cost of a facility. INSTRUCTIONS: Indicate below the method of charge (rent, depreciatian or use charge) for all indicated equipment costs, including cost per month for rental, or purchase cost of each depreciated items or those to which a use charge is applied. METHOD OF ALLOCATION OF COSTS; Determine the DHS percentage of the costs of equipment using on of the following methods. Any cost item used entirely to provide contracted services shou;c1 be charged 100% to the contrintlicate below the method used to determine the percentage shown in Column 3Options include:a) Number of DHS clients served divided by Total Program clients served X I Cli)%b) Direct service staff hours serving 1)1-IS clients divided by total direct staff program hours X I 00%, e) Other (Identify), Cost allocation method: C - no equipment costs 4. DHS 5. 2. 1. TOT M CONTRACT Match or Inland AL 3. S % COST ITEM (TOTAL COST) PRO AM PORTION Portion GR (Of Total Prog.) (If Applicable) Rent Paid to a Third Party Item: Cost per month: $ - times # of months: I 0.0 $ - 0.0% $ - $ Item: Cost per month: S - times # of months: 0.0 S - 0.0% $ - $ Depreciation: _ Item being depreciatd Acquisition cost less salvage value: $ - Depreciated over this many years: 0.0 Amount depreciated per month: $ times this many mouths; 0.0 $ - 0.0% $ - $ - Use Charge Item: Aqui si tionCost; $ - Cost per month: S - times # of months: 0.0 $ - 0.0% 5 - $ - Other: RCM: Cost per month; S - I(jrneS # of months: I 0.0 , $ 0.0% $ - $ - Itzm: Cost per month: S - times of months: . 0.0 — _ $ — -- 0.0% $ - $ - TOTAL: I $ C..10-46.8-EX (Rev. Previous edition obsolete. MS Excel Equipment Y2V2D1D CONTRACT BUDGET DETAIL LINE ITEM: TRANSPORTATION DEFINITION: Transportation costs include the costs of staff travel, lodging, meals and incidental expenses incurred by personne; in a travel status while on official business. Travel rates established by the State of Michigan wi:1 be used as a guideline in determining reasonableness of rates. INSTRUCTIONS: Indicate below the estimated staff mileage cost and the per mile charge. Also, indicate any addition transportation-re1ated costs, such as meals, lodging, etc. METHOD OF ALLOCATION OF COST: Determine the DHS percentage of the cost using one of the following methods. Any cost itern used entirely to provide contracted services should be charged 100% to the contrixlentify below the method used tt determine the percentage shown in Column 3 Options include:) Number of DI -IS clients served. Divided by Total Program clients served, X 100%; b) Direct service staff hours serving DHS clients, divided by total direct staff program hours, X 100WMilcs traveled serving DHS clients. divided by total program miles traveled. X 1001/) Other (Identify). Cost allocation method: C and d (match) , 2 4. DHS S. . 1.CONTRACT Match or Inkind TOTAL S PROGRAM 3. DH % COST ITEM (TOTAL COST) PORTION Portion (Of Total Prog.) (If Applicable) Program Mileage: Number of miles expected to be driven; 11700.0 times cost per mile: 0.500 $ 5,850 100.0% $ 5,850 $ - Meals (Itemize Costs): Per Diem for Denver CO S6 I per day $ 488 0.0% $ - $ 488 $ - 0.0% $ - S - $ - 0.0% $ - $ - Lodging (Itemize Costs): Training in Denver CO hotel $100 per night S 1,000 0.0% $ - $ 1,000 $ - 0.0% $ $ _ Training Mileage: Number of miles expected to be driven: 0.0 times cost per mile: $ - — $ - 0.0% $ - $ , $ - 0.0% $ - $ Other (Identify and Itemize costs): Airfare to National NI7 office in Denver CO S 800 0,0% 5 - $ 800 Supervisor mileage for monthly meetings S 300 0,0% $ - , $ 300 S - 0.0% $ - 2 5 - n S - 0.0% $ - ( $ - - $ 2,588 TOTAL: $ 8,438 $ I CM-488-EX (Rev. ".2-05) 9:cvou5 ecrton abso.ele. MS Exce! 7r.arspor.al:Q7 E224J2C1C 1 3.500 3.500 3.500 CONTRACT BUDGET DETAIL LINE ITEM: CONTRACTED SERVICES DEFINITION: Compensation paid by the Contractor to a third party under a .subsontract for performance of any activities designated in the contract as a service to be delivered to OHS. Other services. such as CPA services, should be identified in the Miscellaneous line item. INSTRUCTIONS: Indicate below each subcontractor by name with a brief explanation of services to he provided Show how cost was determined. For amounts over 32,500, attach a separate huge% for the subcontractor, METHOD OF ALLOCATION OF COST: Determine the DHS percentage of the cost using one of the following methods. Any cost item used entirety to provide contracted services should be charged 100% to the .contractidentify below the method used to determine the percentage shown in Column 3. Options include: a) Number of DNS served divided by Total Program clients served X 130°/..: b Direct service staff hours serving OHS clients divided by total direct staff program hours X 100%:c) Other (Identify). Cost aliocation method: -7 4. DHS 5. 1. 2. CONTRACT Match or Inkftid COST ITEM (TOTAL COST) TOTAL 3. OHS %PORTION Portion PROGRAM (Of Total Prog.) (If Applicable) Subcontractors: Name of Agency or Individual: Telelanguage . - Brief description of service provided . !Translation & Interpretation Client enabling services Cost breakdown of service provided Per unit CM $ 0.99 times A' of units: 3535.0 3,500 100-0% 5 3,500 - Name of Agency or Individual: Brief description of service provided Cost breakdown of service provided Per unit cost. [limes li of units: - 0.0% S ., Name of Agency or Individual: Brief description of service pros [deli! Cost bteakdown of service providvl Per unit cost 1 times ofunits; 0.0% , SUBTOTAL: $ 3,500 CONTRACTED SERVICES TOTAL: cm-468 EX (Rcv 12-08) Previous edlion olosoleto MS Excel Contractor services 5i21:2c CONTRACT BUDGET DETAIL LINE ITEM: CONTRACTED SERVICES (Continued) 4. DIIS 5, Z. 1, CONTRACT /- TOTAL Match or Inkind 3. DI-IS 1%. COST ITEM (TOTAL COST) PORTION Portion PROGRAM (Of Total Prog.) (If Applicable) - - Subcontractors: Name of Agency or Individual: Brief description of service provide( . , Cost breakdown of service provide( Per unit cost i $ - ) times # of units I 0.6 S - 0.0% Is - $ -. Name of Agency or Individual: Brief de.scripdon of service provide( Cost breakdown of service provide( l Per unit cost i $ - i times rt of units I 0.0 - S - 0.0% $ - $ - - Name of Agency or Individual: Brief description of service provide( -1 Cost breakdown of service provide( Per unit cost I S - [times # of units I 0.0 . _ . $ - ' 0.0% $ - $ - .'Name of Agency or Individual: _ Brief desenption of service provides Cost b:.eakdown of service provide( Per Jrut cost 1 S - 1 times # of Jnits I 0:0' - 0.0% $ - $ - "lame of Agency or Individual: _ Brief desripr or: of servic: provides Cost breakdown of service pros :de( Per unit cost I $ - I iirr.eS 5 of units I 0.3 $ - 0.0% $ - $ -I SUBTOTAL: $ - i 1 S - $ _ CV-408-E) (Rev: '.2-C8) Previo:..s 55.iC oDSC.ete. MS Fy.ce! Contracwe Services Se,V, 2 73 4.296 CONTRACT BUDGET DETAIL LINE ITEM: SPECIFIC ASSISTANCE DEFINITION: The dollar arnounl of money or other items of value purchased for a specific client and given to that client as part of , service delivery. INSTRUCTIONS: List each type of cost item including a brief explanation, unit cost and quantity. METHOD OF ALLOCATION Of COST: Determine the D1-1S percentage of the cost using one of the following methods_ Air cost item used entirely to provide contracted services should be charged 100% to the contractidentify below the method used to determine the percentage shown in Column 3. Options include: a) Number of DHS clients served divided by Total Program clients served X 100%; h) Other (Identify). Cost allocation method: 4. DRS S. I. 1 .2. . CONTRACT Match or Inkind TOTAL 1 3, DRS % COST ITEM (TOTAL COST) PORTION Portion PROGRAM - _ (Of Total Frog.) (If Applicable) Specific Assistance Given Clients: Type of item givem-Teachingichild gaiety Explanation of Assistance-. Books safety gates plug covers _! .__ Quantity to each client: 1 2.0 times cost per unit: S 21.00 _ times number of clients to whom item(s) given: 100: $ 4,200 100,0% , S 4,200 $ _ _ I I Type of item given: Bus Fare Explanation of Assistance: 1Lasi resor, transportation for clients c-iolaor appes, cu.) Quantity to each client: 1 4.01times cost per unit. S 2.00 limes number of clients lowborn item(s) given: 12 $ 96 100.0% 96 I I Type of item given: - 1 Explanation of Assistance; , Quantity to each client: 1 0.0Itimes cost per Knit: S - - times number of clients to whom item(s) given: 0 $ - 0.0% $ - $ - Type of item given: . Explanation of Assistance: Quantity to each client: I 0.01 times col per unit: $ - ., _ times number of clients to whom items) given; 0 $ - 0.0% S - i Type of item giverd Explanation of MsiFlance: . , Quantity to each c'ienv I 0.01th:1es cost per unit: 1 S _ times number of c bents to whom item(s) given, 0 $ - 0.0% S - , $ - TOTAL:I S 4,296 I Cm-488.-EX (Rev ",2.(38) PreViouS edit.cr obsolete MS Excel Specific Assistance to inovivals 5/2:fIcio CONTRACT BUDGET DETAIL LINE ITEM: MISCELLANEOUS DEFINITION: Expenses related to the contract which are not chargeable to other line items. INSTR UCTiONS: List and briefly explain each miscellaneous cost item beloyCost Items that are designated "other" or "miscellaneous" are unacceptable, METHOD OF ALLOCATION OE COST: Determine the DHS percentage of the cost using one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% ta the contrablentify below the method used to determine the percentage shown in Column 3Dptions includeia) Number of DHS clients served, divided by Total Program clients served, X I OD%; b) Direct service staff hours serving DHS clients, divided by total direct staff program hours, X 100%; c) Other (Identify). Cost allocation method: ib and c (in-kind match) I 2, 4. DIIS 5, 1, TOTAL 3 DHS CONTRACT Match or Inkind . % COST) PORTION Portion COST ITEM (TOTAL PROGRAM _ (Of Total Prog.) (If Applicable) Miscellaneous: . , Item: 2 desktop computers _, Explanation - Quarterly rental charge 5576 ea. . _ Quantity. 1 2.0! times cost per unit 1 $ 2,304.00 , __ - - _ $ 4,608 0.0% $ - $ 4,608 , Item: Liability. insurance Explanation 1— _ Quantity: L 1.0 times cost per Lint S 1,500.00 $ 1.500 100.0% $ 1,500 $ - - I ten_Indirect costs Explanation Per established rate 14.14% of salaries Ch.:aunty 1 330136.CI times cost per unit 14.14% 46.681 76.6% 5 35,758 $ 10.913 Item: . NH' National Office Explanation_ Licensing. technical support - r Quantity: J I .fli tmitS cost per unit 1 $ 8,559: de _ 5 8.559 100.0% $ 8,559 5 _ :iem:-1 _ Explanation Quantity: J ) times cost per unit 1 . $ 0.0% $ - SUBTOTAL:) $ 61.348 1 1 S .75:81771 $ 15,531 71,474 MISCELLANEOUS TOTAL: $ 45.81 1 15 25.657 M-46C-EX !Rev. previoo ea!lity) orrsaele, MS ,ine. 5..21/2010 Migce.ianeou LINE ITEM: MISCELLANEOUS (Continue, 1, COST ITEM (TOTAL COST) 2. TOTAL PROGRAM 3. DIIS % Explanation lOngoing nurse education Item; 'National NFP Office Item; INational NFP Office Explanation Initial training for 2 new nurses hunt Nationa: NFP Office hunt INationa: NFP Office 0.0% 0.0% Explanation I lterr,1 herr,: 0.0% Laal 0.0% 0.0% Item: Explanation Quantity Item: Explanation Quantity. 0.01 times cost per unit I 0.01 times cost per unit I 0.0% 0.0% III 1 16 CONTRACT BUDGET DETAIL Miscellaneous: 4. DHS CONTRACT PORTION (Of Total Prof.) 5. Match or Inkind Portion (If Annlirohlel Quantity:1 M i times cost per unit I 5 1,482.00 1,482 1,4821 Training $3,835 ca., manuals 5487 ea. uantitv: Explanation 2.01 nes cost per unit I $ 4,322.00 8,644 'tenni Item 8,644 Quantity: I I times cost per unit 1 Quantity: I 0.01 times cost per unit I $ Explanation Quantity: I 0.01 times cost per unit -F.5 Item: Item: SUBTOTAL:1 10,126 CM-468-EX (Rev. 12-013) Previws edlon obsolete. MS Excel Misce0atieciu5 Seel 2 5.'21,2010 V. CONTRACT BUDGET SUMMARY INSTRUCTIONS 1. Enter the complete potential contractor name, address, contract or bid number and budget period. The contract number can be obtained by DHS, 2. For a single service contract, the Total Program Budget and VHS Contract Budget columns for each line item will transfer automatically from the "Total" figures (columns 2 and 4 respectively) from the appropriate Budget Statement Detail sheets. Each column will total automatically. 3. For a multiple service contract, COLUMNS A-J (Service Categories): Write in each service title for which costs are being entered. The dollar figures in each budget distribution column (A-.1) will reflect the projected dollars needed to provide clients with the number of service units identified in each service category. Complete the respective service categories for each line item by transferring the "Total" figures (column 4) from the appropriate budget statement detail sheet for each service. Each line item of the total program budget is the total of column 2 of each budget detail sheet. The same applies for the second budget summary sheet. 3. NUMBER OF UNITS OF SERVICE TO BE PROVIDED: Indicate the proposed number of units of service being offered under each service category total. The same applies for the second budget summary sheet. 4. RATE PER UNIT OF SERVICE: Will automatically compute when number of units of service is entered CM-468-EX (Rev. 12-48) Previous ;or. obsolete. MS Excel Help - EllJdget Summary IV. ALLOWABLE AND UNALLOWABLE COSTS A. SALARIES AND WAGES DEFINITION: Gross compensation paid to employees in the form of cash, products, or services including vacations, holidays, sick leave and leaves of absence. Paid absences must be reimburse( uniformly for both employees paid under this contract as well as employees not paid under this contrac but performing similar work. ALLOWABLE COSTS: 1. Only costs that support the goals and activities of the total program 2. Rates reasonable and consistent with those paid for similar activities by the contractor 3. Rates competitive with those paid for similar services provided by other agencies for doinl similar work. 4. Incentive compensation for efficient performance may be paid if it is a part of a standard agreemer between the employer and employee 5. Overtime and multi-shift premiums: a) When management of the contractor authorizes such costs as part of their established policies and in accordance with sound business practices b) For emergencies or performance of tasks which cannot reasonably be interruptec 6. EXAMPLE DI-IS CONT Position Title Family Mentor Total Program DHS% PORTEON Yearly Salary: 20,800 Weeks/Year: 52 Hours/Week: 40 % of time spent on Total Program 100 20.800 50% 10,400 UNALLOWABLE COSTS: I. Any payment over and above regular salaries and wages for the purpose of inducing employees tc undertake or continue work at locations which may be isolated or in an unfavorable environment 2. The value of donated volunteer time in providing services 3. Bonuses, non-accrued lump-sum severance payments, annuities or other deferred compensatiot unavailable to all employees in the organization 4. Costs already funded through a separate contract and/or another funding source Example: Frog. MGR. :s currently charged to Contract A © 60% of salary/fringes and to Contract B 30% of salary/fringes. In the Budget for new Contract C, the same Frog. MGR, cannot be charged 0 more than 10% of the serre salary/fringe compensation package that was used for Contracts A & B, CM-468-EX 17ev. 12-06) Previous edition obsolete. 1VS Ex.;ei He - Salaries ALLOWABLE AND UNALLOWABLE COSTS B. FRINGE BENEFITS DEFINITION: Funds allocated to cover allowances, costs and services provided by the contractor to or on behalf of its employees and not included as compensation or salaries and wages ALLOWABLE COSTS: I. Typical fringes include: a) Social Security (Maximum 6.29%) b) Medicare (Maximum 1.45%) c) Unemployment (* see below) d) Worker's Compensation e) Retirement 2. All fringes required by taw are mandatory. Those not required by law, such as health insurance. retirement and disability, must meet the following criteria to be allowable: a) Fringe benefits must be established in policy, labor agreements, etc. prior to the time the contract is awarded. b) Fringe benefits charged to the contract must be calculated in the same manner as fringes not charged to the contract for employees in similar classifications. * The Social Security base wage is $102,000 per employee or the entire wage if under $102,000. * The employment base wage is 59,000 per employee or the entire wage if under $9,( Do not charge any unemployment for the employee if this is a shared position and the $9,000 base wage limit included in another Cost Reimbursement Agreement or payment rate. UNALLOWABLE COSTS: 1. Any costs associated with an employee's personal expenditures during the course on normal employment; such as parking, clothing, meals. 2. Costs or allowance paid by the contractor but not required by law, agreement, or established policy 3. Severance Pay. 4. Costs in excess of the prorated portion attributable to partial (less than fulltime) FTE's. 5. Self insured worker's compensation and unemployment compensation costs are not allowable if costs exceed rates and premiums that would have been allowed if insurance premiums or taxes would have been paid. 6. Costs already funded through a separate contract and/or another funding source. f) Health Insurance g) Life Insurance h) Disability Insurance i) Any other services costs or allowances paid by the employer as required by law, agreement or established policy CM-2168-EX (Rev. 12-) Previous ecition oLsolate. MS Excel Heir) - Rine Benefits CM•468-EX (Rev. 12-O8) Prevbus edition obsolete. MS Excel He!p - Frbge Benefits ALLOWABLE AND UNALLOWABLE COSTS C. OCCUPANCY DEFINITION: Costs arising from occupancy and use of owned or leased buildings and offices. ALLOWABLE COSTS; 1. Depreciation of that portion of the organization's building and improvements used for the program as figured on a straight line basis on contractor facilities, based on computation of valuation of property as filed with the IRS, by a generally accepted accounting procedure, with adequate property records. Depreciation or use charge on assets donated by third parties is allowable. The value of the donated asset used to calculate these charges shall be the market value at the time of the donation. 2. Use allowances are a means of allowing compensation when depreciation or other equivalent costs are not considered. The use allowance for facilities and their improvements can be calculated at an annual rate of up to 2% of acquisition costs, 3. The actual payment of rental costs to a third party for use of the facility and property. Rates must be reasonable in light of such factors as rental costs of comparable facilities and personal property market conditions in the area, the type, life expectancy, condition and value or the facilities leased, options available, and other provisions of the rental agreement, 4. Insurance to cover loss of assets. 5. Normal maintenance and repair costs. 6. Costs incurred for rearrangement and alteration of facilities required specifically to meet conditions of the contract that do not increase the value of the property. 7. Alterations that increase the value of the facility, that add to the useful life, that are required by DHS to meet local, city or State code requirements must become part of the overall facility cost and must be charged in the same method as the facility costs, 8. Operation costs, such as cost of utilities, security, janitorial service, elevator service to the extent they are not otherwise included in rental or other charges for space. 9. Costs necessary to comply with security requirements, including wages and equipment of personnel engaged in plant protection. 10. Depreciation on plant protection capital assets, such as security systems, shall be included with the building as stated above. UNALLOWABLE COSTS: 1. Cost of rent or lease of items between plants, divisions, or organizations under common control ownership, or any less than arms-length transaction cannot exceed allowable cost the 2,ame asset(s). 2. Special assessments on land that represent capital improvement, such as sewer and sidewalk assessments. 3. Depreciation or use charges for assets fully depreciated by the contractor. 4. Building depreciation expense grrater than the amount calculated using straight-line method and a 40 year useful life. 5. Costs related to idle facilities, CM-468-EX Rev 12-08) Previo65 eclun obso e:e MS Excel Heil) - Occunancy ALLOWABLE AND UNALLOWABLE COSTS D. COMMUNICATION DEFINITION: Costs for written or verbal communication ALLOWABLE COSTS: I. Costs incurred for telephone calls or service, pagers, fax service, cellular phone service, wide telephone services (WATS), centrex, postage, messenger service and similar expenses related contract services. Telephones, pagers and other communication devices should be charged to this item. 2. Printing, reproduction and publication costs required by the contract. 3. Costs of informing or instructing groups, individuals, or the general public about services provided, as required by the contract. 4. Costs of gaining the interest of groups or individuals to participate in a service program, including recruitment of volunteers. 5. State and Federal excise taxes. UNALLOWABLE COSTS: Fundraising activities. CM-468-EX (Rev. 12-a) Previous edition obsolete. MS Excel Help - Communication CM468-EX (Rev. 12-08) Previousedi1n obsolete. M8 Excel -leLp - Cur mun:cation ALLOWABLE AND UNALLOWABLE COSTS E. SUPPLIES DEFINITION: Consumable or non-consumable items with a unit cost of less than $5,000. Consum supplies are those that are consumed as they are used (pencils, paper, etc.). Non-consumable supplies are those that are not consumed as they are used (file cabinets, chairs, and other durable goo ALLOWABLE COSTS: 1. Costs associated with delivery of supplies. 2. Materials from the contracting agency's stock inventory using purchase price as the cost. 3. State sales taxes. UNALLOWABLE COSTS: Consumable supplies that will not be consumed during this contract budget period. CM-468-EX (Rev. 12-08) Previous edttion obsolete. MS Excel Help - Supplies able ds). CM-468-EX P7.evous ec.;:tion obsolete. MS Excel Help - Supples ALLOWABLE AND UNALLOWABLE COSTS F. EQUIPMENT DEFINITION: Any non-consumable item costing more than $5,000 that is not attached to or included as part of the cost of a facility. ALLOWABLE COSTS: 1. Depreciation costs due to the normal depreciation as figured on straight line basis on of valuation of property as filed with the IRS, by a generally accepted accounting procedure, with adequate property records and depreciation schedules. 2. Use allowance for equipment calculated at an annual rate of 6 213% of the acquisition cost. 3. Rental costs for equipment paid to a third party in an arms length transaction must be reasonable, using factors such as rental costs for comparable equipment and personal property, market conditions in the area, the type, life expectancy, condition and value of the equipment leased, options available and other provisions of the rental agreement. Include such items as computers, phone systems, copiers and office furniture if the unit cost equals or exceeds $5,000. 4. Insurance to cover loss of equipment. 5. Normal equipment maintenance and repair costs. 6. Cost of transportation or freight in delivering equipment to providers. UNALLOWABLE COSTS: I. Rental of equipment between plants, divisions or organizations under common control or ownership. 2. The amount that rental costs under any type of "option to buy" arrangement exceed rental costs without an "option to buy''. 3. The total purchase price of equipment over $5,000. See "allowable costs" for proper method of charging equipment. CM-468-EX {Rev 12-08) Previous edition obsolete. MS Excel Help - Equipment ALLOWABLE AND UNALLOWABLE COSTS G. TRANSPORTATION DEFINITION: Transportation costs include the costs of travel, lodging, meals and incidental expenses incurred by personnel in a travel status while on official business. Travel rates establisl by the State of Michigan will be used as a guideline in determining reasonableness of rates. ALLOWABLE COSTS: 1. Actual expenses controlled by maximum reimbursement rate for meals and lodging. 2. Per diem or mileage in lieu of actual costs if a standard reimbursement schedule exists for all employees. 3. Actual cost of a contractor owned or leased vehicle, including insurance, gasoline, oil, depreciation and all normal maintenance when use of the vehicle is required to accomplish the contracted service(s). Depreciation for vehicles must be based on acquisition cost less salvage value of vehicle to be replaced. Use straight-line and 5 year useful life. 4. Leased or rental vehicles at a mileage or fixed rate that includes vehicle maintenance, inspection and repair services. 5. Air travel less than first class when required in providing the service(s). 6. Transportation of clients when this cost is required by the contract. UNALLOWABLE COSTS: 1. Air travel outside the state unless prior written authorization from OHS is received. 2. Mileage reimbursement when contractor vehicle is used. 1 Mileage costs in excess of prevailing Contractor rate or State of Michigan rate, whichever is less. 4. Costs related to conferences/meetings that are not identified in the contract as activities to be included, CM-468-EX (Rev, 12-08) Previous edIon obsolete. MS Ex sel Help -Transportation hed CM-465-EX (Rev 12-08) Previous edition obsolete. MS Excel Help - Transportation ALLOWABLE AND UNALLOWABLE COSTS IL CONTRACTED SERVICES DEFINITION: Compensation paid by the Contractor to a third party under a subcontract for performance of any activities designated in the contract as a service to be delivered to DHS. When sub-contractor expenditures exceed £2,500.00 a budget is required to be submitted with th Contractor's bidder's budget. Other services, such as CPA services, should be identified in the Miscellaneous line item. ALLOWABLE COSTS: 1. Professional services costs rendered by members of a particular profession who are not employees of the Contractor and who provide services designated in the contract as services t , be delivered to DHS. Subcontracts are subject to review based on their necessity as they relat contract requirements. The following criteria are considered: a) The costs arc reasonable in relation to the service rendered. If reasonableness is questioned, the Contractor must document how the price or cost was determined. b) The nature and scope of the subcontractor services are in support of the program services. e) The service can be performed more economically by subcontracting. d) The subcontractor's fees are consistent and competitive with other providers. e) The subcontraetual agreement for the service to be provided is adequate in description of the service, estimate of time required, rate of compensation and termination provisions. 0 The subcontract is awarded through a competitive process if, in the opinion of DHS, the dc value and other factors would require bidding to assure reasonable cost and quality of serv g) The subcontract agreement adequately conforms to the Agreement between the Contractor and DHS. 2. Management studies to improve the effectiveness and efficiency of the agency by persons not employees of the agency and when required by the contract. UNALLOWABLE COSTS: I. Retainer fees, 2. Subcontracts with persons who meet the legal definition of an employee for the purpose of avoiding mandatory fringe benefits. 3. Subcontracts with agencies or individuals that have common ownership or contracts with the Contractor. CM-468-EX (Rev, 12-08) Frev,ous edori Dbsolete. MS Excel Help - Cont'euted Services :e to )113T ice. CM-466-EX (Rev. 12-0E) Previous edition obsolete. MS Excel Help - Contracted Services ALLOWABLE AND UNALLOWABLE COSTS L SPECIFIC ASSISTANCE TO INDIVIDUALS DEFINITION: The dollar amount of money or other items of value purchased for a specific cli and given to that client as part of service delivery. ALLOWABLE COSTS: Items purchased for a specific client and given to that client as required by the contract. UNALLOWABLE COSTS: Items not identified or included in the contract. 4. CM-468-EX (Rev. ',2-00) Prev:o..is etition u'osciete. MS Excel Help - Specific Ass:stance ent CM-46B-EX (Rev. 2-08) Previous edition obso;ete. MS El He p - Specific Assstence ALLOWABLE AND UNALLOWABLE COSTS J. MISCELLANEOUS DEFINITION: Expenses related to the contract which are not chargeable to other line items. ALLOWABLE COSTS: 1. The cost of establishing and maintaining all accounting and other information systems required for management of the contract, not included in other line items. This includes costs incurred a central administration for those purposes. 2. Advertising specifically for: 1) recruitment of personnel required for the contract, 2) solicitatic of bids for the procurement of goods and services required, and 3) other purposes specifically provided for in the contract. 3. Audit services for the administration and management of functions related to services provided under the contract. 4. Professional liability insurance. 5. Premiums on bonds covering employees who handle contract funds. 6. Costs of maintaining and operating a central store for supplies, equipment and materials used directly or indirectly for provision of services under the contract. 7. Data processing specifically required in the contract or where required for management, such a payrolls, personnel records, 8. Services to cover processing of checks or warrants from preparation to redemption, including t1 necessary records of accountability and reconciliation of such records with related cash accoun 9. Employee counseling services, as generally covered by health insurance providers, including outpatient mental health services, family and marriage counseling and substance abuse counseling. 10. Meetings and conferences required in the contract. *11. Professional memberships for agencies that do not have an indirect cost rate and for memberships which have a direct relationship to the specific goals and objectives of DIIS for the services purchased. May include costs of memberships in trade, business, technical and professional organizations, as required for affiliation with the parent body. 12. Preparing contract payTolls and maintaining necessary related wage records. 13. Recruitment, examination, certification, classification, training, establishment of pay standard: and related activities for provision of services under the contract. *14. Subscriptions, if the agency does not have an indirect cost rate and the subscriptions; 1) are considered necessary to the administration of the program, 2) provide a training component that increases the knowledge and skill of the agency staff, 3) have a direct relationship to the program's specific objectives, 4) are specifically job and staff performance related, andlor 5) are not readily available in a library. CM-168-EX (Rev. 2-08) Rrevtous edition obsolete. MS Excel HeIp - Misceeneous IS. Contractors may charge the cost of training conferences and employee training if it 1) is specifically identified training for the service purchased in the contract, 2) is not applicable to other services provided by the agency, and 3) would not normally be considered a part of general professional development. Examples of acceptable training costs include wraparound and Families First. Eligible on-the-job training and part-time education, includes training materials, textbooks, fees charged by the educational institution, tuition and compensation paid to employees while attending classes, if these costs are paid for employees in similar classifications who are not covered by the contract. 16. Indirect costs are those: 1) incurred for a common or joint purpose benefiting more than one c objective, and 2) not readily assignable to the cost benefited, without effort disproportionate tc the results achieved. Any request for indirect costs will require prior written approval. To request approval, a complete explanation of the percentage, including all mathematical calculations and supportin, documentation, must be submitted along with the budget. A current federally approved indire , rate is acceptable documentation. A decision to approve or deny the request will be rendered DI-IS. and written notification will be provided. If the request is denied, DHS may reject the indirect cost or approve a lesser indirect cost rate. * Executive Orders effective 2007 disallow memberships and subscriptions without prior approva . UNALLOWABLE COSTS: 1. Interest on borrowed capital or temporary use of endowment funds. 2. Organized fundraising, including financial campaigns, endowment drives, solicitation of gifts and bequests and similar expenses incurred solely to raise capital or obtain contributions. 3. Investment and related expenses incurred solely to enhance income from investments. 4. Staff training not required in the contract. Charges to DHS for employee training are not allowable if the training is basic training that will teach the employees the basic skills required to perform the service being purchased. DHS will not assume the cost of giving contractor employees the skills necessary to perform the duties of the contract. It is expected that contracts will be executed only with agencies that already have properly trained employees. There may be exceptions to this policy in cases where a service is performed within a copyrighted model where it is not reasonable to expect any contractor to have the basic skills required for the service (such as multi-systemic therapy). These exceptions will require approval of the appropriate administration director. 5. Costs of preparing contracts or bid proposals. 6. Individual staff memberships in trade, business, technical and professional organizations. 7. Food and food preparation for employees. R. Salaries and other expenses of local government bodies such as county supervisors, city counei school boards, etc.. whether incurred for purposes of legislation or executive direction, 9. Prosecution of claims against the State. 10. Costs related to discharging general responsibilities as legal officer. CM-46-8-EX (Rev. 12-68) Previceus edition obso)ete. MS Excel help - Miscellaneous 11. The costs of amusement, diversion, social activities, ceremonials and incidental costs relating thereto, such as meals, lodging, rentals, transportation and gratuities, unless required by the contract. 12. Costs resulting from violations of or failure to comply with Federal/ State/local laws and regulations. 13. Contributions and donation costs for free-will offerings to individuals and agencies. 14. Contingency costs related to possible future events or conditions rising from presently known unknown causes, the outcome of which is indeterminable at the present time, e.g. pending litigation and other general business risks, 15. Bad debt losses (whether actual or estimated) arising from uncollectible customer's accounts a other claims, related costs and related legal costs. 16. The cost of maintaining central accounting records required for overall local government purposes, such as appropriation and fund accounts by treasurer, comptroller, or similar official 17, Accreditation fees. 18. Costs of employee recognition awards. \1-46-EX (Rev. 128) PrevtL:.s eton obzPete, MS Exccl Hep- Uscollarteot.s Contractual Services Miscellaneous tos tractions: [ Contractual Services (2) Specific Assistance - — . Miscellaneous (2) Comments Print Options Click on the name of the page you want printed. Worksheets: Entire Workbook I All Sheets Claiming Costs Budget Summary , Budget Summary (2) ' Salary Salary (2) I Salary (3) Salary (4) Salary (5) . . . _ _ 1 Fringe Benefits Occupancy i l Communication _ . , Supplies I 1 Equipment Transportation L , _ [ Purpose ' Guidelines j _ Instructions Revision Changes Budget Summary I (Getting Started, _ Allowable and Unallowable Costs: Salary I Fringe Benefits _ _ Occupancy Communication _ Supplies i Equipment Transportation I Contracted Services Specific Assistance Miscellaneous CM-408-EX (Rev, 124.ht” Previous edition cbv3lete. MS Excel Print Options FISCAL NOTE (MISC. #10137) June 9, 2010 BY: FINANCE COMMITTEE, TOM MIDDLETON, CHAIRPERSON IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2010 MICHIGAN DEPARTMENT OF HUMAN SERVICES ZERO TO THREE SECONDARY PREVENTION GRANT AGREEMENT ACCEPTANCE TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS Chairperson, Ladies and Gentlemen: Pursuant to Rule XI:-C of this Board, the Finance Committee has reviewed the above-referenced resolution and finds: 1. The Health Division has been awarded $1,146,251 of grantor funds by the Michigan Department of Human Services for the Zero to Three Secondary Prevention Program. 2. The program is designed to prevent child abuse and neglect of Pontiac children ages birth to three years of age. 3. This is the first year of this grant. 4. Funding period is May 1, 2G10 thru September 30, 2012. 5. The grant requires a grant match of $341,313, for a total program of $1,487,564. 6. The grant match will come from Health Fund (#20221) for local match of $34,145, and Title V MCH Block funds of $307,168, for a total match of $341,313. 7. Totai Program Budget for FY2010 amounts to $259,592, FY2011 equates to $613,986, and FY2012 equals $613,986, totaling $1,407,564. 8 The budget will be amended for the grantor funds (Reimbursement Revenue in the Health Fund) for FY2010 $200,257, FY2011 $472,997, and FY2012 $472,997, for a total of $1,146,251. 9. The Health Division will charge four (4) GFGB Public Health Nurse III positions (position #0765, #2008, #2727 and #3103) to the Zero to Three Secondary Prevention Program. These positions are, and will remain, GF/GP positions. 10. No additional position5 are required and the Michigan Department of Human Services has agreed that charging the (4) Public Health Nurse III positions will not be viewed as supplanting. 11. Since current positions are being used, additional funds can be used to correct timing issues from termination of the Nurse Family Partnership Program. 12. The FY 2010, FY2011, and FY2012 Budget will be amended as follows: FY2010 FY2011 FY2012 Services to Children 0-3 Project #100000001385 Health Fund 20221 Revenue 1060236-133355-515571 State Operating $ 200,257 $ 472,997 p 472,997 Expense 1060236-133355-702010 Salaries 111,207 264,77B 264,770 1060236-133355-7 22740 Fringe Benefits 59,931 143,483 143,483 1060236-133355-770631 Bldg. Space 1,256 1060236-133355-770675 Telephone Comm. 1,270 3,040 3,048 1060236-133355-750399 Office Supplies 333 800 800 1060236-133355-77066 7 Convenience Copier 83 200 200 1060236-133355-750567 Training & Ed. Supp. 1,525 4,500 4,500 1060236-133355-750301 Medical Supplies 31 75 75 1060236-133355-731346 Personal Mileage 2,464 5,850 5,850 1060236-133355-730982 Interpreter Fees 1,470 3,500 3,500 1060226-123355-731397 Transportaton of Clients 96 96 96 1060236-133355-774667 Insurance Fund 630 1,500 1,500 1060236-133355-730926 :ndirect Cost 19,606 35,758 35,758 1060226-133355-731941 Contracted Svs, 8,559 8,559 1060236-133355-750448 Postage 42 100 100 1060236-133355-731383 Printing 313 750 750 Sub-Total Services tO Children 0-3 Project Expense $ 200,257 $ 472,997 $ 472,997 Health Fund 20221 Other Revenue: 20221-9090101-134860-695500 -10100 Transfer from General Fund 20221-1060231-133215-615571 State Operating Grants $ (211,657) $ (448,780).$ (448,780) 40,519 40,519 40,519 Sub-Total Health Revenue $ (171,138) $ (408,261)$ (408,261) Other Expense 1060236-133390-702010 Salaries 1060236-132390-722740 Fringe Benefits $ (111,207) $(264,7781 $ (264,778) (59,931) (143,483) (143,483) Sub-Total Health Expense $ (171,138) $(408,261) $ (408,261) General Fund 410100 9090101-134860-788001-20221 Transfer Out to Health Fund 9090101-196030-730800 Non-Deptl. Grant Match Total General Fund Expense $ (211,657) $(448,780) $ (448,780 211,657 448,780 448,780 -0 - $ -0 - $ -0 - FINANCE COMMITTEE T 6 Resolution #10137 June 9, 2010 Moved by Long supported by Potter the resolution (with fiscal note attached) be adopted. Discussion followed. George Miller, Director of Health and Human Services, addressed the Board and answered questions. Vote on resolution: AYES: Gingell, Gossefin, Greimel, Hatchet Jackson, Jacobsen, Long, McGiilivray, Middleton, Nash. Potter, Potts, Runestad, Schwartz. Scott, Taub, Woodward, Zack, Bullard, Burns, Capello, Coleman, Coulter, Douglas, Gershenson. (25) NAYS: None. (0) A sufficient majority having voted in favor, the resolution (with fiscal note attached) was adopted. I HEREBY APPROVE THE FOREGOING RESOLUTION ACTING PURSUANT TO 1973 PA 139 STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Ruth Johnson, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on June 9, 2010. with the original record thereof now remaining in my office. In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 9th day of June, 2010_ Gat Ruth Johnson, County Clerk