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Resolutions - 2010.09.01 - 10320
MISCELLANEOUS RESOLUTION #10213 September 1, 2010 BY: General Government Committee. Christine Long, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2010 MICHIGAN DEPARTMENT OF HUMAN SERVICES CHILD ABUSE AND NEGLECT 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 $292,401 for the Child Abuse and Neglect Prevention Program for the period of August 1, 2010 through September 30, 2011; 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 eighteen years of age utilizing the evidence- based Nurturing Skills for Families home visitation model: and WHEREAS it is estimated that 90 families ir the City of Pontiac will be assisted by this program; and WHEREAS no new positions will be utilized for this initiative; and WHEREAS a grant match of $71,912 will be utilized from MCH 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 Child Abuse and Neglect 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 GENERAL GOVERNMENT COMMITTEE VOTE: Motion carried unanimously on a roll call vote Page 1 01'2 Worthington, Pamela From: Piir, Gala [piirg@oakgov.com ] Sent: Tuesday, August 17. 2010 10:46 AM To: 'Fockler, Torn '; 'Forzley (Mgr.), Kathy'; 'Plsacreta ; Antonio' Subject: Grant Review Sign Off: Health Division - 2010 Child Abuse and Neglect Prevention - Grant Acceptance GRANT REVIEW SIGN OFF — Health and Human Services / Health Division GRANT NAME: 2010 Child Abuse and Neglect Prevention FUNDING AGENCY: Michigan Department of Human Services DEPARTMENT CONTACT PERSON: Tom Fockler 2-2 151 STATUS: Grant Acceptance DATE: August 17.2010 Pursuant to Misc. Resolution 401320, 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 Comm ittee Fiscal Note, and this Sign Off email containing grant review comments) may be requested to be place 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 (8.11/2010) Department of Human Resources: Approved. — Cathy Shallal (8/12/2010) Risk Management and Safety: Approved by Risk Management. - Andrea Plotkowski (8/12/2010) Corporation Counsel: I have reviewed the above referenced grant acceptance and I approve. — Bradley G. Benn (8/13/2010) COMPLIANCE The grant agreement references a number of specific federal and state regulations. Below is a list of the specifically cited compliance related documents for this grant. Federal Office of Management and Budget (OMB) Circular No. A-87, A-102, and A-133 littp://www,whitehouse.goviornbicirculars/index.litnil Michigan Civil Service Rules and Regulations (Article XI, Section 5, Michigan Constitution) littp://www.inichigait .goviose.'0,1607,7 -143--16377--,00.11tm I Michigan Elliott-Larsen Civil Rights Act — "Act 453 of 1976" http //vvbw 1egislatui mi go I tiq 1 geltnii j5z55/2 w v=45 )/rn ileg.aspx?pagegetobjeet&objectriame=mol-Act-453-of- 19708queryid=14718540 Michigan Persons with Disabilities Civil Rights Act — "Act 220 of 1976" http://www.legislaturc.ini ,e,ov/t uq3Ixtt,eltm rj z55z2ti iv..-vz15)/in i leg.aspx?page=getobjeet&objectname=mel-Act-220-of- 1970&queryid-14718589 8723/2010 Page 2 of 2 The Rehabilitation Act of 1973, Section 504 (29 U.S.C. Section 794) littp://www.dol,gov/oasam/repistatutesis:x504.11: in The Americans with Disabilities Act of 1990 (42 U.S.C., Sec 12101) littp://www.ada.govipubsiada.him Michigan — Freedom of Information Act 442 of 1976 (MCL 15.231) http://www.legislature ,mi,govAS(iii x b rn fitly b5 p3 Wm i le 2.,4isp.0 page=ge1Object&objcetName --9-n Services provided by charitable, religious, or private organizations (42 USC 604a) bilpf/ftwebgate5,aecess,gpo.gov/cgi-biniwakt4a1c.cgi?W A ISdoef D-=.993865208201±0-0+084W Al Saction=retrieve Michigan Public Act 93 of 2002 State of 3.1ichigan early retirement program littp://www.IegiIatui e. m .go S(111112514 51,i5 pycq fh2)- pykr15)) flile...aspx?page=getObject&objectNarne=-2002-H Federal Anti-Lobbying Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions (31 USC 1352) littp://useode.hoose.gov/uscode-cgillsiweb.e\egodoc 'rsev iew-Ft2M32 8I 8-,-0-----G/028 A nti_Lobby Restrictions on Lobbying (28 (FR part 69) hit p /AMIN . access. gpo.go :Haratc fr!‘x isid _04 '28c11 -69...p<1. htin 1 Government-Wide Debarment and Suspension (28 ('FR, Part 67) fittpliwww. access. gpo.gov/nil raief6ya isidx ._04;286-67 ._04,1itm Gala V. Piir Grants Camploance and Prd9rams Coordinator Oakland County Fiscal Services Division Phone (248) 858-1037 Fax (248) 858-9724 ptirgeoakgov cam 8/23/2010 Contract No: Total Contract Amount: 1 51 Year Amount: 2nd Year Amount: County: Method of Payment: PVPR-10-63001 $292,401.00 $ 41,756.00 $250,645.00 Oakland Actual Cost AGREEMENT between Michigan Department of Human Services & Oakland County Health Division (hereinafter referred to as "OHS") (hereinafter referred to as "Contractor") 235 South Grand Avenue 1200 N. Telegraph Road P.O. Box 30037 Pontiac, MI 48341 Lansing, Michigan 48909 This Agreement is effective from August 1, 2010, through September 30, 2011. I. CONTRACTOR RESPONSIBILITIES A. Email Address The Contractor authorizes DI-IS to use the contact information below to send Agreement related notifications/information. The Contractor shall provide OHS with updated contact information if it changes. Contact email address: forzleyk©oakgov.com B. Geographic Area The Contractor shall provide services described herein in the following geo- graphic area: Pontiac, Oakland County including zip codes 48340. 48341, 48342, 48343. C. Location of Facilities The Contractor shall provide services described herein at the following location(s): In clients homes. D. Client Elidibility Criteria Families within the identified geographic area with one or more children aged birth through 18 who: -1- GiV-!-102 (Rev. 6-10) Previous e!tion obsolete. MS Word Contractor's Legal Name: Mailing Address: County of Oakland MI 1200 N. Telegraph Dept. :34R Pontiac MI 48341 Contract Number: Contract Amount: Budget Period: PVPR 10-61001 5250,645 12 Month Budget TOTAL PROGRAM BUDGET SUMMARY — _ TOTAL DRS 1 MAT CU or LEINE ITEM PROGRAM CONTRACT [MOND AMOUNT (A) SERVIC.E (B) SERVICE (C) SERVICE (D) SERVICE BUDGET BUDGET • (If Applicable) CATEGORY CATEGORY CATEGORY CATEGORY _ — S.kt,ARI.F.S $ .149,637 5 128,595 $ 21,042 $ 128,595 5 - $ - $ - - FRINGE BENEFITS $ 86,378 $ 70,944 5 15,433 5 70,945 $ - $ -... S - ocCurANCY 3 21,412 S - $ 25,412 $ - S $ - 5 - COmmuNLICATION 5 3,384 $ 3,384 $ - $ 3,384 $ - 5 - $ - SUPPLIES $ 7,517 S 7,577 $ - S 7577 $ - $ - $ - . — EQUIPMENT $ - $ - S - $ - $ - $ - $ - 1 'TRANSPORTATION $ 7,200 $ 7,200 $ - S 7,200 5 - $ - $ .. r 1 CONTRACT.ED SERVICES $ 15,040 $ 15,040 $ - $ 15,040 $ - $ - $ - SPECIFIC ASSISTANCE $- $ - $ - $ - $ - $ TO INDIVIDUALS , MISCELLANEOUS $ 17,905 $ 17,905 5 - 5 17,905 5 •- 5 - S - TOTALS: S 312,533 $ 250,645 S 61,337 S 250,646 5 - 5 - $ - , NUMBER OF UNITS TO BE PROVIDED: 020 0.0 0.0 RATE P.ER USTI' OF SERVICE #D : IV/0 / #DIV/01 /3.1NWO! eDiVo"U! Service Category (A1: Service Category (D): Service Category (13): Service Calegory CC): Department of Human Services (OHS) will riot discriminate against any Individual or group because of race, religion, age, 'Authority: PA. 280 of 1939 nallionie origin, color, height. weight, marital status, sex. sexual orientation, gender identity or expression, political beliefs or Completion: Mandatory disability. if jeou need help with reading. writing, hearing, etc.., under the Americana with Disabilities Act, you are invited to make Penalty: Contract Invalid your needs known to a OHS office In your area. C (Rev. 12-08) Previous edition obsolete, MS Excel Budget Summary 07/20,200 Contractors Legal Name: Mailing Address: County of Oakland MI 1200 N. Telegraph Dept. 34L Pontiac MI 48341 Contract Number: Contract Amount: Budget Period: PVPR 10-63001 250,645 12 Month Budget Service Category CE) Sen.6ce Category (F): Service Category (H): Service Category (I): Service Category (G): Service Category (J): 07129)2010 CM-468-EX (Rev. 12-08) Previous edition obsolete. MS Fxcel Budget Summary Sheet 2 TOTAL PROGRAM BUDGET SUMMARY (Continued) (E) (F) (G) (11) (I) (j) SERVICE LIN E ITEM SERVICE SERVICE SERVICE SERVICE SERVICE SERVICE TO FAL CATEGORY CATEGORY CATEGORY CATEGORY CATEGORY CATEGORY SALARIES $ - $ - $ - $ - $ - $ - $ 123,595 FRINGE BENEFITS $ - $ - $ - $ - $ - $ 5 70,945 OCCUPANCY S - $ - $ . - $ - $ - 5 $ - COMMUNICATION $ - $ - $ $ - $ - $ 5 3,384 SUPPLIES 5 - S - $ - $ - $ - $ - $ 7,577 EQu wytENT $ - 3 - $ - $ -, $ - $ - $ i TRANSPORTATION $ -3 - 5 - 5 - $ - 5 - 5 7,200 CONTRACTED SERVICES $ $ - $ $ - 3 - 5 - S 15,04c SPECIFIC ASSISTANCE n - -1 $ - $ - $ - $ $ - S $ TO INDIVIDUALS — MISCELLANEOUS $ - $ - $ $ - $ $ - $ 17,94 _ TOTALS: $ - $ - $ - $ $ $ 250,64 ____ ....____ UNITS PROVMED: RATE PER UNIT: EFOLVICI! gpl[V/0! gnIV101 liEDIV/0! #INVIOI 4DIVI0! 1. Have a Category ill or IV case disposition and have been referred by a DHS Children's Protective Services (CPS) Worker, or 2. Have been determined by the Contractor to have three (3) or more of the following risk factors: • Famiiy history of child abuse and/or neglect. • Family who is homeless. • Pa,ent with negative or ambivalent attitude regarding pregnancy or parenting. • Parent with a destructive temperament who has unrealistic expectations of the child. • Parent who 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-term or chronic illness, • Child with diagnosed handicapped condition. • Child with a diagnosed mental health condition or documented behavioral issue. Families identified as Category ill or IV shall be given priority and will be immediately be eligible for services. Families with an open DHS-CPS Category I or II case, an open Foster Care (FC) case or Juvenile Justice (A) case are not eligible for services under this Agreement. 3, Determination of Eligibility DHS shall determine eligibility for Category III and IV cases. The Contractor shall determine client eligibility for self referrals and community referrals based on the following process: Risk shall be assessed by the contractor, following an intake referral, using the OHS Chid Abuse and Neglect Risk Factor Checklist. E. Credentials -2- CM-Fl 02 (Rev, 6-10) Previous edition obsoiete. MS Word The Contractor shall assure that appropriately credentialed or trained staff shall perform functions under this Agreement. • The Public Health Nurse UI shall have a minimum of 3 years of full time increasingly responsible public health nursing experience under professional nursing supervision. Shall be licensed by the Michigan Board of Nursing to practice as a registered professional nurse in the State of Michigan. Shall possess a Bachelor's Degree in Nursing from an accredited college or university. • The Public Health Nursing Supervisor shall have a minimum of 3years of full time public health nursing experience, at least one year of which involved program evaluation or functional supervision of an educational or preventative health program. Shall be licensed by the Michigan Board of Nursing to proactive as a registered professional nurse in the State of Michigan. Shall possess a Master's Degree in nursing or another comparable field from an F. Services to be Delivered Service # I of I: Intensive Home Visitation Services I. Activities the Contractor shall perform: The Contractor shall: a. Provide 2 full time registered public health nurses (RN) to perform direct services dedicated to CPS referred families. b. Provide I public health nursing supervisor to provide direct oversight of the public health nurses dedicated to this Agreement. c. Ensure fidelity to the Nurturing Skills for Families (www.nurturing parenting.com ) model of service. d. initiate contact with the referred client within one (1) business day of receiving a written referral to: 1.) Verify program eligibility, 2.) Determine willingness to voluntarily participate with services. 3.) Schedule a date for initial home visit. e. Attempt a face-to-face visit with the referred family within three (3) business days of the initial referral. If the attempt is unsuccessful adhere to the Contractor's Persona/ and Prevention Health Services procedure which addresses the process for locating clients that are not home for services. Including interventions such as contacting the -3- CM-F102 Rev,6-10) Fre,Aty,:s enitan posutiete.,. MS VIDEd j. referring agency to coffin client's address and telephone number, drop by visits, follow-up letters, getting assistance from DHS etc, f. Develop a written family service plan through collaborative goal setting between the family and the public health nurse by the second visit. Development of the service plan wili include a solution focused family case conference that may include persons chosen by the family. The service plan shall include at a minimum: 1.) A minimum of 3 reasonable and attainable goals. ) Family strengths and needs which will include linkage to other community supports (e.g., substance abuse treatment, domestic violence counseling, legal aid assistance, food assistance, mental health counseling, etc.) 3.) A safety plan based on the family's assessment using, at a minimum, the Protective Factors Survey (PFS), the Parenting Stress Index (PSI), and the Adult-Adolescent Parenting Inventory (AAR-2). The service plan shall be documented in the client file and, if indicated on the referral form, submit a copy to the referring DNS worker. g. Provide weekly home visits lasting from 60 to 90 minutes for a minimum of 16 weeks, h. Follow up each missed appointment with the client by a phone call, reminder card or personal visit. i. Assist the 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. Provide health education targeted at nutrition, parenting skills, smoking cessation, alcohol and drug abuse avoidance, accident prevention, healthcare, problem solving and accessing basic needs, k. Provide life skills guidance for domain areas of Education, Employment, Housing, regular medical care. I. Teach/model to families coping skills, problem resolution, stress reduction techniques, appropriate discipline and growth and realistic developmental expectations of their children. -4- CM- F102 ,,7ev.5 10) preMous aditior MS Word m. Conduct routine, and as needed, periodic risk assessment for depression, domestic violence, nutrition, substance abuse, safe housing, safe neighborhood, alcohol abuse, smoking, healthcare and parenting skills. n. Provide specific assistance of S100 total per family based on the needs of the families and agreed upon by the nurse and client. Each client's record shall include a form on which learning and support items shall be listed by type, date given and cost. Items provided may incrude the following: • Educational books • Safety products such as cribs or pack n' plays, safety gates, plug covers, corner and doorknob covers etc. • Educational toys • Books for the children • Emergency formula or diapers • Necessary clothing • Language specific materials for non-English speaking clients • Educational CD's or DVD's o. Provide referral and follow-up to mental health services for positive screening of depression and/or domestic violence. p. Maintain close and consistent contact with DHS Child Protective Services (CPS) workers and work in conjunction with CPS on the plan of intervention/recommendations for any Category III or IV families. Encourage clients that are not initially successful in achieving their goals +.1p reflect on and help identify barriers to goal achievement and jointly review the family service plan to determine whether revisions are necessary. The Contractor shall use Motivational Interviewing techniques to help those families identify barriers to tneir success. The Contractor shall revise service plans to meet family needs and ensure improvements are made. r. Conduct all required assessments and a satisfaction survey with each family when service provision ends. s. Close cases within 14 days of reaching the family's goals or when the family agrees that services are no longer needed. The Contractor shall provide the with information about accessing community support. t. Ensure those families in need of additional support services at case closure are referred to the appropriate community partner ageny(ies). -5- q. CM-F IC2 (Rev. 0) Previou8 editon obsolete. MS Word 2. Volume of Service a. Clients - The estimated number of unduplicated eligible clients to be served during the period of this Agreement shall be: 90 August 1, 2010 through September 33, 2010 5 October 1, 2010 through September 30, 2011 90 b. Unit Definition(s): Length of Service: One unit equals one (1) family completing at least 50% of the prescribed period for the proposed model. Outcome Achievement: One unit equals one (1) family completing at least 80% of the service outcomes outlined in their service plan. G. Number of Units; The estimated number of units of service to be provided during the following period is: Length of Service Fiscal Year Estimated Number of Units August 1,2010 through September 30, 2010 3 October 1, 2010 through September 30, 2011 76 Outcome Achievement Fiscal Year Estimated Number of Units October 1, 2010 through September 30, 2011 68 G. Evaluation Reporting Requirements The Contractor shall submit to DI -IS monthly reports that indicate the status and effectiveness of activities performed under this Agreement as indicated: DHS will evaluate grantee performance through written bimonthly reports submitted to the DHS. Contractors are required to submit reports on forms provided by OHS. -6- CM-F1C2 (Rev. P.revious edition obsolete. MS Word CFDA # Federal Program Title FFP% Title IV B-2 93.5561 100% The Contractor shall submit repoit v11 furr7rb provided by DHS as follows: • A Data Collection form. The Data Collection Form collects data on families such as the types of services provided, ages of enrolled children, household income, service outcomes, etc. The Contractor shall submit this form to DHS monthly with the 'Statement of Expenditures' (OHS 3469) form. • The 3-1 b form. This form is used to collect the names of all of the chi!dren served by the grants during the fiscal year and shall be submitted to DHS annually. H. Audit Requirements Subrecioient Relationship This Agreement constitutes a subrecipient relationship with DHS. The Contractor is required to comply with all federal regulations related to the accounting and auditing of the federal award used to fund this Agreement. This includes, but is not limited to, compliance with ONIB 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 financial participation (FFP) rate DHS will use for this Agreement are: However, DHS 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 DHS website. The Contractor is required to check the website to obtain up to date information regarding the CFDA numbers. The Contractor shall consult the following website to obtain CFDA numbers, payments, program updates, and ether audit information: http://www.miehigan.govidhs/0,1607,7-124-5455_7199_8380--,00.html DHS agrees to participate in audit cost related to the audit as described in other sections of this Agreement. Reportind Requirements -7- CM-1C2 (Rev. 6-10) Previous ediboi obtaete. MS Word The Contractor must immediately report to the OHS Office of Monitoring and Internal Control accounting irregularities including noncompliance with provisions of this Agreement. If the Contractor is required per OMB Circular A-133 to have a single audit performed, the Contractor 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. The 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 Contractor is responsible to identify in the audit transmittal letter ail organizations it operates that administer OHS subrecipient programs and the different names the Contractor may use to contract with DHS. The Contractor 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. Contractor's name as reported in the DI-ES contract(s) 2. Contractor's Federal Identification number(s) as reported in the OHS contract(s) 3. Contractor's fiscal year end 4. Other name(s) and other Federal Identification number(s) used by the Contractor If a single audit is not required per OMB Circular A-133, the Contractor must still submit an audit transmittal letter stating why a single audit was not required and the Contractor's fiscal year to which the letter pertains. The audit transmittal letter should include The four items 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 -8- CM-Fl 02 (Rev. 6-10) Previous cation obsolete. MS Word Office of Monitoring and Internal Control Grand Tower Suite 1112 P. 0. Box 30037 Lansing, MI 48909 If the Contractor is a subrecipient of DHS, but asserts it is not required to have a single audit performed, the Contractor shall submit an audit transmittal letter to the DHS Office of Monitoring and internal Control stating the reason the single audit is not required. Failure by the Contractor to submit the audit transmittal letter shah result in invoking the same sanctions on the Contractor 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 to this Agreement if the Contractor is not required by federal requirements to have a single audit. No audit costs may be charged to DHS 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 Contractor 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 Contractor to comply with audit requirements, OHS may impose sanctions such as: 1. Withholding a percentage of the federal award until the audit is completed satisfactorily. 2. VVithhoding or disallowing overhead costs. 3. Suspending federal awards until the audit is conducted. 4. Terminating the federal award. 5. Recouping the federal payments made to the Contractor under this or any other agreements between DHS and the Contractor. I. Client Records -9- CM-F1Ct2 (Rev, 6-1(") PrevIcus edtion obsoiete. MS Word For each eligible client served under this Agreement, the Contractor shall maintain client case records consisting of: - Eligibility certification documents. - Date of contact with client. - Problem identification - Methods of service delivery. - Significant contacts with client and significant events. - Other material as may be specified by DHS. J. Service Documentation The Contractor agrees to maintain program records required by DHS, program statistical records required by OHS, and to produce program narrative and statistical data at times prescribed by, and on forms furnished by, DNS. K. Fiscal Requirements The Contractor 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 Contractor'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 Contractor 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 Contractor shall establish and maintain payroll records for all employees. The Contractor shall maintain payroll records to support amounts billed to DNS 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. L. Billinq Method 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 Contractor certifies that this budget has been prepared in accordance with the Budget Completion instructions provided by OHS. This document details the amount and object of expenditures for which the Contractor shall use funds paid under this Agreement. The Contractor is authorized to expend funds only for those resources indicated in the budget that -10- CM-F102 tRe\,. 0) Previou5 edtor obsolete, MS Word are allowable, properly allocated and reasonable as defined in the Budget Completion instructions. The Contractor shall follow and adhere to the budget. However, expenditures up to a 5% increase or S1,500, 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 Contractor shall not be reimbursed for any expenditures incurred in budget line items that do not include do!lar amounts. The Contractor must obtain prior written approval from DHS to increase any line item by more than 5% or $1,500, whichever is greater. The DNS representative authorized to approve budget revisions is the Director, Division of Contracts and Rate Setting. The Contractor's request for DNS 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 Contractor may bill DNS the premium state rate, or Contractor's usual reimbursement rate for employees, whichever is less. State of Michigan travel rates may be found at the following website: httb:Pwww.michiga n.gov/dmb/0,1607,7-150-9141_13132 —,00.html The Contractor cannot charge OHS more for a provision of service than is charged to other entities for whom the Contractor provides services. M. Billing Procedure The Contractor shall submit a monthly "Statement of Expenditures" (DNS-3409) to OHS. 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 30 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 deadline& In no event shall DNS make a payment to the Contractor 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 form the Contractor's monthly invoices N. Criminal Background Check -11- CM-1O2 (Rev. 6-10) Prev'ous edn. ob5Qlete. MS Wad As a condition of this Agreement, the Contractor certifies that the Contractor shall, prier 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://apps.michigan.goviichat . The Michigan Public Sex Offender Registry website address is httpllwww.mipsonstate.mi us. The National Sex Offender Public Web site address is hftp://www.nsopw.gov . 2. children under this Agreement, a Central Registry (CR) cheek. Information about CR can be found at http://wvvw.mi.gov/dhs/0,1607,7-124- 5452_7119_48330-180331—,00.html. The Contractor shall require each new employee, 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 velunteer 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 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 new employee, 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 witten policy describing the criteria on which its determinations shall be made and must document the basis for each -12- CM-F.102 (Rev. E-1:1;, Previous ciiton obOete. MS Ward determination. The Contractor may consider the recency and type of crime when making a determination. Failure to comply with this provision may he 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 trust also assure that any subcontractors have both of these written policies. ft DHS determines that an individual provided services under this Agreement for any period prior to completion of the required checks as 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, O. Support of Wages Charged on the Statement of Expenditures Upon request of DHS, the Contractor shall submit employee activity sheets to support the amount of wages charged on the Statement of Expenditures. DHS will identify a specific Statement of Expenditures and request the Contractor to submit all employee activity sheets for employees who were charged in whole or in part to OHS, along with any other schedules or workpapers necessary to support the amount of wages charged. The Contractor shall provide the requested information no later than 10 days after the request. If, after review of the information, OHS determines that the Contractor is in substantial compliance with documentation requirements related to compensation, DHS will communicate with the Contractor that no further action is necessary. In the event the Contractor cannot support the amount of wages charged on the Statement of Expenditures, DHS may, at its discretion, request recoupment for the difference between the amount charged and the amount that can be supported by the activity sheets. II. OHS RESPONSIBILITIES A. Payment OHS shall make payments to the Contractor within 45 days after receipt by DHS of the Contractors "Statement of Expenditures" detailing budgeted program expenditures as set forth in the Cost Documentation attached to this Agreement. B. Maximum Amount of Agreement OHS hereby agrees to pay the Contractor an amount not to exceed Two Hundred Ninety Two Thousand Four Hundred One dollars and 00/100 ($292,401.00) for -13- CM-F.132 (Rev 6-10) Previous edition xsolete. MS Ward services performed in accordance with the terms of this Agreement exclusively during the period August 1,2010 to September 30, 2011. From the total amount, the maximum amount that may be expended during the following periods is: Fiscal Year Amount August 1, 2010 through September 30, 2010 $ 41,756.00 October 1, 2010 through September 30, 2011 $ 250,645.00 C. Initial Payment DHS shall make an initial payment (IP) in the amount of Twenty Thousand Eight Hundred Eighty Seven dollars and 00(100 (S20,887.00 ) to the Contractor no later than October 31, 2010. Recovery of the IP shall be made through deductions from each payment to the Contractor during the fiscal year in which the IP is made, to prevent total payments from exceeding total expenditures and not to exceed the Agreement amount for that fiscal period. The formula for the deduction shall be: (current bill amount/total first fiscal year amount) multiplied by the IP. OHS reserves the right to accelerate the rate of recovery when, in the sole opinion of OHS, the amount of previous. ancllor future billings is anticipated to be less than that needed to assure full recovery of the IP from the current year's award. In such a case, payments may be adjusted to recover up to 100% of the outstanding IP from a single billing. Where the P. or any portion of the IP, remains uncovered at the end of the fiscal year, it becomes an obligation of the Contractor to OHS and must be remitted to DHS within 30 days of the end of the fiscal year. Any portion of an IP remaining owed to OHS beyond the close of a fiscal year could make the Contractor ineligible for an IP in succeeding fiscal years. D. Evaluation Criteria The services provided by the Contractor under this Agreement shall be evaluateo by DHS on the basis of the following criteria: 1. 85% of families participating in this program will not have a substantiated child abuse or neglect Category I or II case during or within a six (6) month period of completing services. -14- CM-F1C,2 fRev 0) P7evious editior, obsfte. MS Word 2. 80% of families participating in the program will demonstrate improved family functioning after three months in the program and/or at program discharge as measured by the parameters in the PFS, PSI, etc. 3. 90% of the families who participated in prevention activities indicate that they were satisfied with services as assessed by the DHS Parent Satisfaction Survey. 4. 90% of families who have participated in prevention activities will indicate that their parenting skills improved as a result of services as assessed by the DNS Parenting Skills Survey. GENERAL PROVISIONS — PUBLIC A. Conciusion, Termination, and Cancellation Terms 1. OHS Source of Funds-Termination DRS' 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 OHS 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. Di-IS may temiinate 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 OHS may cancel this Agreement upon thirty days written notice if OHS 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 OHS or its employees by giving the Contractor written notice of such cancellation thirty days prior to the date of cancellation. The Contractor -15- CM-F102. (Rev. 613; Pecevoas editor) obso!ete. M Woid may terminate this Agreement upon thirty days written notice to DHS at any time prior to the completion of the Agreement period. ln case of default by the Contractor, DHS may immediately cancel this Agreement without further liability to DHS or its employees, and procure the services from other sources. In addition, DHS may immediately cancel this Agreement without further liability to DHS or its employees if the Contractor, an officer of the Ccntractor, 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: embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property, attempting to influence a public empioyee 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 she immediately comply with it 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 actbn, OHS may receive and act upon a Contractor billing submitted at any time before final payment under the Agreement. -16- CM-1C2 F. v. 6-1U) PT;y13U5 dton obsol-?..te. MS Word 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. 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 OHS 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 OHS. At least sixty (60) 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 OHS funds and not fuily 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 OHS. No disposal, sale or transfer of fixed assets obtained under this Agreement in whole or part, may occur without the express written consent of OHS. 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 OHS contained in Section UI , "Examination and Maintenance of Records" and Section 111, 'Closeout" of this Agreement. C. Compliance with Rules and Regulations -17- CM-F102 (Rev. 6-10) Previous editor cssoiete. MS Word 1. Compliance with Federal and State Requirements The Contractor shall comply with all Federal, State and local statutes, regulations and administrative rules. and any amendments thereto, as they may apply to the performance of this Agreement. This shall include, but shall not be limited to, those laws and reguiations 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. 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 focal 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 tne conduct of the work done under this Agreement. 2. Civi Service Rules and Regulations 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 X1, Section 5 of the Michigan Constitution or applicable civil service rules and regulations. Porn_pliance 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 -18- CM-1)2 ':ev. 6•'O) Dosolete. MS Ward 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 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 against Using Funds to Support Religious Activities The Contractor shah 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 DHS under this Agreement shall not be financed by any source other than OHS under the terms of this Agreement. If funding is received through any other source, the Contractor agrees to deduct from the amouet bilied to DHS the greater of either the fee amounts, or tne 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 fee scale and criteria for charging -19- CM-F1D2 ;71ev. 6-10) Previcus fAibor. cosoete. M5 Wurd 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 OHS may be billed for the amount of the co-pay. No supplemental billing is allowed. E. Confidentiality 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 intonation 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 tne 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 Subcontractor's scope of responsibility, and (C) the Contractor obligates the Subcontractor in a -20- CM-F102 (Rev. 6-10) Previous edition obsole.:e. MS Word 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 tnis 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. F. ExaminatIon and Maintenance of Records The Contractor shall permit OHS 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 OHS 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. OHS 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 DHS. 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 business operations cease, the Contractor shall maintain records as OHS may direct. The Contractor shall notify OFIS when and if the Contractor operations cease during the sk-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 OHS may make reasonable inquiries of the auditor relating to audit workpapers and, furthermore, that OHS may review the auditor's workpapers in support of the audit. G. Repotne and Monitoring -21- CM-F132 (ev. 5-10) Previous editon obsdete. MS Word 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 reportirg procedures established by DHS in completion of Progress reports at time intervals, on forms, in formats, and by means specified by DHS. 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 DHS shall be made and submitted by the Contractor upon request. 2. Monitoring Requirements OHS 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. DNS 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 DHS 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 DI-IS' 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, DHS 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. Audit Reports that Contain a Going Concern Statement -22- CM-:.:102 (Rev, 6-10) n'evious otwlete. MS Wsrd 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 DHS Office of Monitoring and Internal Control within 10 days from the date of the audit report. The submission of this audit report to OHS 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 OHS 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 OHS. Failure of the Contractor to either timely submit the audit report with the Going Concern, or timely submit a financial plan, or DHS' rejection of the Contractor's 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 H. Recouoment of Funding and Repayment of Debts. 1. Recouoment 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, OHS may, at its discretion, recoup or require the Contractor to reimburse payments made under this Agreement which DHS has determined that the Contractor has been overpaid. The Contractor is liable for any cost incurred by OHS in the recoupment of any fundThg. Upon notification by DHS that repayment is required, the Contractor shall make payment directly to DHS within 30 days or OHS 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 OHS, (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, -23- CM-1i2 tRev. 6-1D) Prevbus ,adton osolete. MS Word such faiiure shall constitute grounds to terminate immediately any or all of DHS' agreements with the Contractor. DHS 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 VHS with the Contractor or Contractor's predecessors. If the Contractor has an outstanding debt due to DHS but does not have a repay agreement, the Contractor agrees to make 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 DI-IS approval, and then only in accordance with the explicit written instructions from DRS. No results of the activities associated with the Agreement are to be -24- CM-F 102 (Rev. 6-10) Previoaz edtor ocsoiete. Wcrd- released without prior written approval of DHS and then only to persons designated. J. Subcontracts The Contractor shall not assign this Agreement or subcontract tnis Agreement to other parties without obtaining prior written approval of the VHS 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. If subcontracting, the Contractor must obligate the subcontractors to maintain the confidentiality of OHS' client information in conformance with State and Federal requirements. At OHS' request, any employee of the Contractor and of any subcontractor having access or continued access to OHS' confidential information may be required to execute an acknowledgment 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 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 DHS, 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, regardirg the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. M. Reporting of Retiree Employment Ali other provisions of this Agreement notwithstanding, the Contractor shall provide written notification within fifteen (15) days of hiring to DHS Office of Human Resources (HR) the name, social security number, and work site of any employee who retired from the State of Michigan. Failure to notify HR within the -25- CM-Fl 32 (Rev. 6-10) Prevlous eaThon obsolete. MS Word 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 HR. 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, or is a State of Michigan retiree currently receiving retirement benefits from the State of Michigan. N. Certifications Regarding Lobbyiag 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, 0. Certification Regarding Debarment, Suspension, and Other Responsibilitv 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 -26- GM-F 02 (Rev. 6 ,1'3) Prev.:ous eddor ct,sdete. MS Ward court, or voluntarily excluded from covered ti drisdcliurib 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 or fraud or a criminai offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under 3 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. 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 writing 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 settioments, 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 Conti actoi LIIIii 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. -27- CM-F102 (Rev. 5- 0) Previozs edtion crbso.ete. MS Word 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. 4. Failed to perform a state contract or subcontract in a manner consistent with any applicable state or federal law, rule, regulation, order, or decree. The Contractor shall include Section 0. (Certification Regarding Debarment, Suspension. and Other Responsibility Matters) language as written above in ail 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 principais, is or is not debarred, suspended, or proposed for debarment by the State of Michigan. The Contractor shall then inform DHS of the subcontractors 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 ail other provisions of this Agreement and, if one or more of the provisions of this -28- CM-F102 (.ov. 6-10) r'y icript:solete_ MS Word 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 DHS and receipt of a proposed amendment, amend this Agreement, if and when required in the opinion of DHS, due to the revision of Federal or State laws or regulations. lf the 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 Contractor. 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 OHS, -29- CM-F 102 (Rev. 5-10) Pcevtouz, ecittiorl ok -sscstete. MS Wcsd c. If the State requests or directs the Contractor to perform any activites 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, 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. T. Notice and Right to Cure it the Contractor breaches this Agreement, and OHS, in its sole discretion, determines that the breach is curable, then OHS must provide the Contractor with written notice of the breach and a time period (not less than 30 days) to cure the breach. The notice of breach and opportunity to cure is inapplicable for successive or repeated breaches or if OHS determines, in its sole discretion, that the breach poses a serious and imminent threat to the health and safety of any person or the imminent loss, damage, or destruction of any real or tangible personal property. -30- CM-1 02 (Rev. 15i-10) PteviQus erjJon ot)5,..-Aote. MS Word IN WITNESS WHEREOF, the DHS and the Contractor 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 Contractor to the terms set forth in this Agreement. Dated at Michigan Oakland County Health Division (Contractor) this day of (Signature) Witness: (Print Name) Dated at i Michigan DEPARTMENT OF HUMAN SERVICES this_ day of By: , Director Witness: Contract ft: PVP R-10-630G1 By: CM-F 102 (Rev. 6-10) PresAcus edibon cbsolete. MS Word 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 efferrts -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 loadina this workbook as a workina COIN of a template should save the file under a different name. Click on File from the menu above; then choose Save As. 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-465-EX (Rev. 4-09) Previous edition obsolete- MS Excel Introduction Contractors Legal Name: County of Oakland Mt Mailing Address: 1200 N. I ele a 1L Dept. 34E Pootin MI 48341 Contract Number: Contract Amount: Budget Period: PV,PR 10 63001 $41,756 2 Month Budget TOTAL PROGRAM BUDGET SUMMARY I IOTAL MIS VIATCH or (A) SERVICE (B) SERVICE (C) SERVICE (I)) SERVICE LINE ITEM r PROGRAM CO NTHA1121 IN KIN D AMOUNT CATEGORY CATEGORY CATEGORY CATEGORY BuncE BUDOET (If Alargicablie/ SALARIES $ 26, I 1'7 5 22,420 $ 3,69F 5 22,420 $ - - S - 1--- FRINGE BENEFITS $ 13,140 $ 11,300 $ 1,840 S 11,300 $ - $ - $ - OCCUPANCY $ •4,4M $ - $ 4,486 $ - 5 - 5 - $ COMMUNICATION S 690 $ 690 S $ 690 $ - $ -S - SUPPLIES $ 1,345 $ 1,345 $ - $ 1,345 $ $ - $ EQE T Pm ENT $ - S - $ - $ - $ - S - $ - TRANSPORTATION. 5 1,500 S 1,500 $ - $ 1,500 $ - S - - CONTRACTED SERVICES 5 1,405 $ 1,405 $ - 5 1,405 $ - 5 - S - SPECIFIC ASSISTANCE $- $ - $ $ - $ $ TO INDIVIDUALS NuscELLANFOUS $ 3,096 $ 3,096 $ -5 3,096 $ - $ - $ - TOTALS: 5 51,7E0 $ 41,756 $ 10,024 $ 41,756 $ - S - $ - NUNWER OF UNITS TO BE PROVIDED: I 110 0.0 0.0 RATE PER UNIT OF SERVICE: iiDIVICI K./IWO! #1)1V70: #DIVAI! Service Category (A): Service Category BD): Service Category (B): Service Category (C): ineeertnent of Human Services (DNS; Mil not discriminate against any lnciMclual or group because Of race, religion. age, Authority: PA. 2 BD of 1939 national origin, color, height weight, marital status. sex, sexual orientation, gander identity or expression, political beliefs or Completion: Mandatory disability. if you need help wilh reading, writing, hearing, eta, under the Americana with Uitabilmes Act, you are invited to make Penalty: Contract Invalid Your needs known to a DHS orCe In your area. CM458.E.X (Rev 12 08) Previous edition obsolete MS Lxcet Budget Summery 07229;7010 Contractor's Legal Name: Mailing Address: County of Oakland MI 1200 N. Telegraph Dept. 34E Pontiac MI 48341 Contract Number: Contract Amount: Budget Period: PVPR 10-63001 41,756 2 Month Budget Service Category (G): Service Category (P): Service Category tF): Service Category (1-1): Service Category (I): Service Category (J): 0712912010 CM-4S8-EX (Rev. 12-0e) Previous ediliQn ohtufete. MS Excel Budget Summery Sheet 2 TOTAL PROGRAM BUDGET SUMMARY (Continued) (E) (F...) (G) au (1) (s) SERVECE LINE /TEM SERVICE SERVICE SER'VICE SERVICE SERVICE SERViCE TOTAL CATRGORy CATEGORY CATEGORY CATEGORY CATEGORY CATEGORY SALARIES 3 - $ - $ - $ - $ 3 $ 22,420 FRINGE BENEFITS $ - $ - 3 - $ - $ - 3 3 11,300 OCCUPANCY $ - $ - $ - $ - $ - cOmmLN i C AT to N $ - $ $ - $ - $ - $ $ 690 SUPPLIES $ - $ - $ - 3 - $ - $ $ 1,345 EQUIPMENT $ - 3 - 3 - $ - $ - $ $ - TRANSPORTATION $ $ - $ - $ - $ 5 $ 1,500 _ CONTRACTED SERVICES 3 - 3 - $ $ - $ - $ $ 1,405 SPECIFIC Ass1ST ANCV, $ - $ - $- $ - $ - $ $ TO INDIVIDUALS _ MISCELLANEOUS $ - $ - $ - $ - $ - $ S 1,09( TOTALS: $ - $ $ - $ $ - $ $ 41,756 , UNITS PROVIDED: RATE PER UNIT: rfOl.VA.1! O13IV701 DIV/0! #DIV/0 1 ODIN/1011 itDI Vi0 1 n 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 Di-IS' 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 contructidengfy below the method used to determine the percentage shown in Column 3. Options include: a) NumberofDHS clients served divided by 'Total Program clients served X 100%. b) Direct service. staff hours serving D1-IS clients divided by total direct staffprograin hrs. nrhsr I irlentl fv1 Cost allocation _method: (Use Comment page if not one of the above methods) 1 4. DHS 5 . 2. C COST ITEM TOTAL 3. MIS % ONTRACT Match or Inkind (TOTAL COST) PROGRAM PORTION Par lion (Of Total Frog.) If Applicable) r PROGRAM POSITIONS-ADMINISTRATIVE Position Title: Public Health Nursing Supervisor Yearly Salary: $ 1 1 ,123.72 Weeks/Year: 9.0 'pours/Week: 8.0 % ofTiroe Spent on Total Program: 20.00% ,- Salary Charged to Total Program: 2.425 0.0% - 2,425 Position Title: Office Assistant II Yearly Salary: 6,363.36 Weeks/Year: 9.0 I-lours/Week: 80 % of Time Spent on 'Total Program: 20.00% Salary Charged to Total Program: 1,273 0.0% - S 1.2731 Posizion Title: Yearly Salary: _ Weeks/Year; 0.0 HoursTWeek: 0.0 % of Time Spent on Total Program: i 0.00% ir Salary Charged to Total Program: __—$ 0.0% - -, L SLIBTOTA.L :1 $ 3.697 r $ _,$ 3,698 SALARY TOTAL- :1 $ 26,117 f 5 22,420 $ 3,698 , CM-468-EX (Rey 11..08; r'revious editiwl obsoiete MS Excel Salaries and Wages 07:29/2010 SUBTOTAL: 22,420 22,420 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: b 4. DHS 5. 2. I. TO'rAL 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: Public Health Nurse III Yearly Salary: $ 10,728.00 Weeks/Year: 9.0 How's/Week: 40,0 % of Time Spent on Total Program: 100.00% Salary Charged to Total Program: 5 10,728 100.0% $ 10,728 Position Title: Pubic Health Nurse III OT Yearly Salary: $ 482.00 Weeks/Year: Hours:Week: % of Time Spent on Total Program: 100.00% Salary Charged to Total Program; 5 482 100.0% $ 482 Position Title: Public Heath Nurse III Yearly Salary: $ 10.728.00 Weeks/Year. 0 0 Hours/Week; 1 40.0 ..,i, of Time Spent on Total Program: 100.00% Salary Charged to Total Program: $ 10,728 100.0% $ 10,728 '-- - Position Title: !Public Health Nurse III UT Yearly Salary: $ 482.00 Weeks/Year: Hours/Week; .,%, of Time Spent on Total Program: 100.00% Salary Charged to Total Program: $ 482 100.0% $ 482 , Pasition Title: Yearly Salary: Weeks/Year: ‘ Hours/Week: % of Time Spent on Total Program: &Ilan' Charged to Total Progratn: S - 0,0% $ - S • CM-468-EX (Fiev. 12-08). Previous edition obsolete. MS Excel Salaries and Wages Sheet 2 07/29/2010 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: 4. DHS 5. CONTRACT Match or lnkind 1, 2. ± ) TOTAL 3. PROGRAM DHS */ COST ITEM (TOTAL COST) PORTION Portion (Of Total Prog.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE I Position Title: -- Yearly Salary: Weeks/Year: , 0.0 Hours/Week: _ % efTime 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 Sperit on Total Program: 0.0004 _ - $ - Salary Charged to Total Program: $ - 0.0% PosiWn Title: , Yearly Salary: $ - . Weeks/Year: 0.0 Hours/Week: 0.0 % of Time Spent on Total Program: 0,00% Salary Charged to Total Proyram: $ - 0.0% $ Position Title: Yearly Salary: S - Week.st'Year: , 0.0 Hours/Week: 0.0 _ I% of Time Spent cm Total Program:. Salary Charged to Total Program: $-- - 0.0% S - S . Position Tite: Yearly Salary: $ - Week/Year: 0.0 Hours/Week: 0.0 % of Time Spent on Total Program: 0.00% Salary Charged to Total Program: $ 100.0% $ - SUBTOTAL: S 1 $ - 5 - CM-468-EX ;.Rev. 12-08) Previous ei:Mion obsolete. MS Excei &stories ei-rd Wares S1reei 3 37f2W2010 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: 4. DHS 5. Z. I. TOTAL 3 DHS CONTRACT Match or Inland . % COST ITEM (TOTAL COST) PORTION Portion PROGRAM (Of Total Prog.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE 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 Title: _ - Yearly Salary: - _ WeelcslYear: 0.0 _ hours/Week: 0.0 % of Time Spent on Total Program; .• 0,00% Salary Charged to Total Program: S - 0.0% $ _ $ .. I '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% S - S Position Title: — Yearly Salary: - WeeksiYear: 0.0 Hours/Week: 0.0 % of Time Spent on Total Program: 0.00% Salary' Charged to Total Program: $ - 0.0% S - - Position Title: _ Yearly Salary: S - Weeks/Year: 0.0 :-- --- - - Hours/Week: 0.0 % of Time Spent on Total Program: i 0.00% Salary Charged to Total Program: - 0.0% $ S - SUBTOTAL: $ - $ - $ - CM-488-EX (Rev. 12-08) Previous edition onso;ete. MS Lxuel Salaries and Wages Sheet 4 07122/2010 CONTRACT BUDGET DETAIL LINE ITEM: FRINGE BENEFITS DEFINITION: Funds allocated to cover allowances, cost of services provided by the contractor to or on behalf of its employees and not included asj compensation or salaries and wages. INSTRUCTIONS: List each category of fringe benefits below and complete the requested information for each. The Required Fringe Benefits portion 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 phis Medictu -c at L45% for all wages. METHOD OF ALLOCATION OF COST: The OHS' percentage of the cost of each fringe benefit cannot exceed the percentage of ;mai 1714S salaries 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 fee the OHS CONTRACT PORTION, and equal to the TOTAL PROGRAM effort, equals 100% Options Cost allocation method: 4. DHS S. 1. 2. CONTRACT Match or Inkind COST ITEM TOTAL 3. DHS % (TOTAL COST) PROGRAM , PORTION Portion (Of Total Prog.) (If Applicable) R.E0I2 RED FRINGE BENEFITS FICA Social Security(%); 6,20% Times Total , Program Salancs and Wages $ 26,117 S 1,619 86.0% 1,393 S 226 FICA Medicare(%): L45% Times Total Program Salaries and Wages $ 26,117 S 86.0% . 326 $ 53 Unertiplovmera (%): [ 0,20% Times Total Program portion of taxable salaries. Use base wage only. $ 21,697 43 86.0% 37 1 .. Worker's Comp: 11.19 Cents per 5100 of Iota! Program payroll: 5 26.117 $ 292 86.0% S 251 . 41 OPT1ONA.L FRINGE BENEFITS Retirement: J Number of FTE's; 2.000 times contributions for each per month: S 1.149.48 times number of program months: 2 6,998 86.0% 5 6,018 S 980 Hcalth Insurance: Number of FTEs 2.000 times contributions for each per month: $ 828.70 times number of program months: 2 $ 3315 86.0% 1851 5 464 Life Ins: NUM beT of FTE::: 2.000 times contributions for each per month: S 16.69 times number cf program months; 1 67 86.0% 5 57 S id Long Term Diutbil; I Number ot FTE's. 2.000 times contributions for each per month' S 1948. times number of_prograrn months: 2 8 86.0°./ 5 67 S i I Other: (Itemize) , - aPucal (Fr 0.08% otS23.880 J 9 86.0% $ 16 $ 3 Lirditi l 880 5 330 86,0% 5 284 S 46 TOTAL: 5 13,1401 1 L300 71711 CM-4-EX (Rev. 12-08; Previou.5 eciltiart obsolete. MS Exce! 07;2914n10 Fringe Boiefrts CONTRACT BUDGET DETAIL LINE ITEM: OCCUPANCY DEFINITION: Costs arising Porn 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 DHS' percentage of 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 3. Options include: a) Number of DIIS clients served, divided by Total Program clients served, X 100%; b) Direct service staff hours serving DHS clients, divided by total staff program hours, X 100%; c) DH S program area in square feet, divided by total program area in square feet, X 100%;d) Other (Identify) Cost allocation method; d - No occupancy costs 4. DRS 5. 1. TOTAL 3 DHS CONTRACT Match or Inkind ' . !!/: COST ITEM (TOTAL COST) PROGRAM PORTION Portion (Of Total Frog.) (If Applicable) Rent Paid to a Third Party: Total program area in sqaare feet: 200.0 dines monthly cost per square foot: $ 1:.22 Cost per Month $ 2,243.21 , Ones number of months: 2.0 , $ 4,486 0,0% 5 - $ 4486 - OR - Depreciation: Item being depreciated: 1 Acquisi:dcin cost: $ - — Depreciated over this many years: 0.0 Amount depreciated per =nth: $ - times this many months: 0.0 - 0.0% 5 - - - OR - Use Charge: Item description: L:se charge percentage (maximum 2.0%): 0.0 times acquisition cost: $ divided by 12 months equals amount per month: $ — times this many months: 0.0 $ - 0.0% $ - S - Utilities Not Included in Rent: Heat per month: $ - times this # months: 0.0 $ - 0.0% $ - $ - Electricity per month: $ - times this d months: 0.0 $ - 0.0% $ - $ - Water per month: $ - times this # months: 0.0 $ - 0.0% $ - I $ - Other (specify): i cost per month: S - times this tt months: 1 0 $ - 0.0% S - 1 $ - — TOTAL: 1 $ 4,486 I I $ -1 8 4,486 CM-406-EX (Rev_ '2-C6) Previous ealVon obso}ele. MS Excel 'J7'29/2010 Occupancy 690 690 TOTAL; CONTRACT BUDGET DETAIL LINE ITEM: COMMUNICATION DEFINITION: Cost for written or verbal communication. INSTRUCTIONS: Identify f)orntamicatio»5 cost beiow. Each item costing $100 or more must be listed individually. METHOD OF ALLOCATION OF COST: Determine the DHS percentage of the cost by using one of the fcliowing methods. Any cost item used entirely to provlde soutracted services should be charged 100% to the contract Identify below the method used to determine the percentage shown In Column.). Options include; a) Number of DHS clients served, divided by Total Program clients served. X 100%;b) Direct service staff hours serving OHS clients, divided by total direct staff program hours, X 100%; e) Number of phone lines assigned to serve OHS clients, divided by total program phone lines, X 100%; d) Number of phones assigned to serve DHS clients, divided by total program phones. X 100%4 Other (identify) . Cost allocation method: le 4. DHS S. 1 1, TOTAL 3 DHS % CONTRACT Motel) or Inkind . COST ITEM (TOTAL COST) PROGRAM PORTION Portion _ (Of Total Frog.) , (If Applicable) . , Telephone: Total Agency lines; I .Total phones: I g Local: Number of 1 otal Program Lines: 2 Number of Phones: 2 Phone costimonth: I S 120.00 times # of months; 2.0 — -, $ 240 100.0% , $ 240 S - Long Distance: Phone coWeitorh: S - flimes ft of months: 1 0.0 — $ - 0.0% 5 - S .. ' Fax Service: . Fax cost/m(111th: 1 .S. - 1 times ft of months; 1 0,0 _ $ - 0.0% S -S .., _ Postage: — Item: Mail materials to zlicrits, etc. — Cost per month: . S 25.00 I times 4 of months: I 2.0 _ $ 50 100.0% $ 50 5 - _ Other (Identif),): Item: [Wireless Service . Cost per month: I $ 25.00 ft of months: I 2.0 . . $ 250 100.0% S 250 $ - Item: Printing . Cost per month: $ 75.00 . trines 4 climatal's: I 2.0_ $ 150 100.0% $ 150 CM-468-EX Tev. 1Z-Q4 PreViCIU e0i1ir obsolete. 1\0.. Excel Ccrnmunications. 07:291201C CONTRACT BUDGET DETAIL LINE ITEM: SUPPLIES DEFINITI 01N: Consumable or non-consumable items with a unit cos: of less than $5,000. Consumable supplies are those items 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 goods). INSTRUCTIONS: Indicate bciow the estimated cost for general office. supplies, (including duplicating supplies), and program supplies. METHOD OF ALLOCATION OF COST; 'Determine the OHS 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 OHS clients served, divided by Total Program clients served, X 100%; h) Direct service staff hours sewing DHS clients, divided by total direct staff program hours, X 100%; c) Other (Identify) Cost allocation method: la 4. DM' 5. 2. 1• TOTAL 3 DI'S% CONTRACT Match or InIdnd . COST ITEM croTAL, COST) PROGRAM PORTION Portion , (Of Total Pmg.) . (If Applicable) General Consumable Supplies (Pencils, Paper, etc.): Item :Office Supplies for staff 6, Cosi per month: 1 58.00 times ft of-months: 2.0 $ 116 100.0% 5 116 $ - Item: Education & Assessment Supplies/clients Cost per month: 1 $ 583.33 times /4 of months. 2.0 $ 1,167 100.0% $ 1,167 s _ Item: Medical Supplies Cost per month: S 6.25 'times 11 of months I 2.0 S 13 100.0% $ 13 - 13 Duplicating Su plies: Item: Convenience Cts,pier COS:per month: 5 25.00 Itimes # of months: I 2.0 S 50 100.0% $ 50 - Non-Consumable Supplies: (Itemize) Item: 0.0% $ - $ - Item: $ - 0.0% g-.: $ _ Item: $ - 0.0% $ - $ - 1..em: $ - 0.0% 5 - $ - Item: $ - 0.0% 5 - $ - Item $ 0.0% $ $ - , TOTAL:1 $ 1,345 i 5 1,345 1 $ - CPI-48-EX (Rev_ 12-051 Previous eriit+s,- Wsolele_ MS Suppi.es 0729,'.2010 CONTRACT BUDGET DETAIL LINE ITEM: EQUIPMENT DEFINITION: Any non-consumable item costing more than S5,000 that is not attached to or included as part of the cost of a facility. INSTRUCTIONS: lridicatc below the method of chargc (rent, depreciatsup to use charge) for all indicated equipment costs, including cost per morth for rental, or purchase cost of each depreciated items or those to which a use charge is applied. METHOD OF ALLOCATION OF COSTS: De:ermine the DFIS percentage of the costs of equipment using on of the following methods, Any ensl item used emirely to provide contracted services should he charged 100% to the contractIndicide below the method used to determine the percentage shown in Column 1 Options include: a) Number of DHS clients served divided by Total Program clients saved X 100%. b) Direct service staff hours serving DHS clients divided by total direct staff program hours X 100%; c) Other (Identifs„,). Cost allocation method: C - no equjpment costs 4. DHS 5. 2. CONTRACT Mitch or Inland L TOTAL 3 NIS/ . 6 . COST ITEM (TOTAL COST) PROGRAM PORTION Portion (Of Total Prug.) Of Applicable) Rent Paid to a Third Party Item: 1 Cost per month: S - limes I/ of months: 0.0 0.0% - - Item Cost per month: - times ft of months: 0.0 0.0% - .. Depreciation: item being depreciate Acquisition cost less salvage value: Depreciated over this many years: 0.0 Amount depTeciateti per month r S - times this many months: 0.0 0.0% - - Use Charge Item: AcuinsiiionCest: S _ Cost per month: - times # of months: I 0.0 0.0% - - Other Item: Cost per month. j S - !imes # of months: 0.0 0.0% 5 - . - Item: Ccst per month: - times of months: I 0.0 .. 0.0% S - TOTAL:I $ CM-468-EX ?Rev. 17-M Prev1ou6 ktdition OD5Olete. MS Lxctl ECuipMent 07129?7010 CONTRACT BUDGET DETAIL LINE ITEM: TRANSPORTATION DEFINITION: Transponstion costs include the costs of staff travel, lodging, meals and incidental expenses incurred by personnel in a travel status v.ttie on official business. Travel rates established by the State of Michigan will 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-related costs. such as meals, 1Wgirig. etc. METHOD OF ALLOCATION OF COST: Determine the DI-IS' percentage of the cost using one of the following methods. Any cost item used entirely to provide uonnoted services should be charged 100% to the contractIderitify 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 100%; b) Direct service staff hours serving DEIS clients, divided by total direct staff program hours, X I 00%:e) Miles trave!ed serving DHS clients. divided by total program miles traveled. X l00%4) Other (Identify?. Cost allocation method: c and d 4. MIS S. 2. 1. CONTRACT Match or Inkind TOTAL 3. MIS % COST ITEM (TOTAL COSI) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) Program Mileage: Number of miles expected to be driven: 3000.0 times cost per mile: 5 0.500 1,500 100.0% $ 1,500 S - Meals (Itemize Costs): 0.0% $ - S - 5 - 0.0% $ - $ - - $ 0.0% $ - $ _ Lodging (Itemize Costs); 0.0% 5 - $ - ' 1 - 0.0% . 5 $ - Training Mileage: . . , Number of miles expected to be driver.: 0.1) times cost per mile: S . S - 0.0% 5 - 5. - 0.0% 5 S - Other (Identify and Itemize costs): 0,0% $ _ 0.0% $ . $ - 0.0% $ --- _ $ - 0.0% $ - $ TOTAL: 5 1.500 $ 1,500 CM-4E4 EX (Rev. 12-0S) PreVIOLI5 edition ot*oete. M3 EAtiEll Tran5portatiOn M729.7010 CONTRACTED SERVICES TOTAL: Is 1,405 1 $ CONTRACT BUDGET DETAIL LINE ITEM CONTRACTED SERVICES DEFINITION: Coinnensation 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 explaaation of services to be vroviricii. Show how cost was determined. For amounts over $2,5410, attach a separate buget for the subcontractor. METHOD OF ALLOCATION OF COST; Determine the OHS percentage of the MCI usiug one of the following methods. Any cost item used entirely to provide contracted services should be charged 100% to the contrast. Identify below the method used to determine the percentage shown in COIU MR 3. Options include: a) Number of DIIS served divided by Total Program clients served amitimiftwes --i..— mic ,i;,..h., rii.L.im ht. ?Mot tietPrl staff n-npramX 'd 00%; e) Other !Identify). lir Cost allocation method: ie - No contracted services 4. DFIS 5. 1. 2. %. CONTRACT Match or Inkind TOTAL 3. DIIS COST ITEM (TOTAL COST) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) Subcontractors: Name of Age ay or Individual: farief description of service provided: 'Teachirif Safety 13ooks, Safety Gates, Plug Covers Cost breakdown of service provided: Per unit cost S 25.00 times # of units: 20.0 - 500 100.0% 500 Name of Agency or Individual: Brief description of service provided: Bus Fare/Taxi Last Resort Transportation Cost breakdown of service provided: Per unitcostI 3.50 I ttmcs # of uMts: I 80.0 280 100.0% 280 00 Name of Agency or Individual: Brief desertption of service provided: Translation Services Provide interim cuttion Cost breakdown of semcc provided: Per unit coo IS 125.00 I times 2 of units: ...0 625 100.0% 5 625 SUBTOTAL: $ 1.405 L 5 1,405 $ - CM-468-EX (Fiet,_12-08;' P7eVi.0.45 eelvai oosuele MS Duei Contraclo- Services 3719/2010 CONTRACT BUDGET DETAIL LINE ITEM: SPECIFIC ASSISTANCE DEFINITION; The dollar amount o f money or other items of value purchased for a specific client and giveu 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 DI-IS percentage of the cost using one of the following methods. Any cost item used entirely to provide contracted services should be charged I 00% 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 clients served X 100%; b) Other (Identify). Cost allocation method: 4. DHS 5, 2. 1. TOTAL 3 D115 % CONTRACT I Match or InIcind . COST ITEM (TOTAL COST) PROGRAM PORTION Portion (Of Total Prou.) (If Annli Ahlel Specific Assistance Given Clients: Type of kern given: Explanation of Assistance: ., Quantity to each diem: I limes cost per unit: times number of clients to whom item(s) given: 5 S - 0.0% - S - I Type of item given], Fxpianation of Assistance. Quantity to each client: I itimes cost per unit: times number of clients to whom item(s) given: 5 $ - 0.0% $ - S - I Type of :tern given: ,E.xplanation of Assistance; Quantity to each client: I 'times cost per unit: tur,es number of clients to whom item(s) given: $ 0.0% i - Type of item given:i I Explanation of Assistance: I Quantity to each client: I 0.0 [Lines cost per unit: - I times number of clients to whom item(s) given: - 0.0% - $ - 4 'Eve of item given: Explanation of Assimance: Quantity to eacli client I 0.0Itimeg cos: ye: unit: 1 - 4 times number of clients to whom item(s) given: 0 $ - 0.0% $ - $ i TOTAL: $ - r I s _ 1 , _ CM-I68-EX (Rev 12-3,31 Previods edit ubme*.e. MS EYce: SpecifiuArzistanc;e to Indivivals 3.096 3,096 CONTRACT BUDGET DETAIL LINE ITEM: MISCELLANEOUS DEFINITION: Expensa related to the contract which are not chargoble to other line items, INSTRUCTIONS: List and briefly explain each tniseellanwus cost item liclow.Cost items that are designated "other" or "miscellaneous' are unacceptable. METHOD OF ALLOCATION OF COST: Determine the OHS percentage of the cost using one of the followirg methods_ Any cost item used entirey to provide contracted services should be charged I 00% to the contractIcientify below the Fri ethod ttsed to determine the percentage shown in Column 3. Options include: a) Number of OHS clients served, divided by Total Program clients served, X 100%; b) Direct service staff hours serving OHS clients, divided by total direct staff program hours, X 100%; ,e) Other (Ident Cost allocation method: b and c 4. DI-IS 2. 1. CONTRACT TOTAL 3. DRS % COST ITEM (TOTAL COST) PORTION PROGRAM .. (Of Total Prise.) ' Misuaaueous: _ Ex piatiation!_ . Quantity: I 1 times cost per tat& —1 $ , - 0.0% $ - , Item: ILiahility Insurance Exlanation: Quaati:-yr. i 1.0] times cost pa unit: 1 $ 6200, _ $ 62 )00.0% $ 62 _ Item: Indirect eosts Explanatiort Pet evatthshod rate 14.14% • of salaries Quantity: I 21456.61 times cost per unit: 1 14.14%_ _ $ 3,034 100.0% $ 3,034 ' . Item: Explanation7 ------77--)LianthY:ilt-T------F----1--)es COSI per 1.1111t. _._ . -- $ - 0.0% $ Item: ' - Explanatiom , Quantity: r I limes cost OLT 'Jolt: 1 , J $ -, 0.0% $ _ SUBTOTAL: S V% 1 Ts 3,096 MISCELLANEOUS TOTAL: CM456-EX (Rev, 12-08) PR.,vious editor' obsolete MS Ee1 Mtuei(anecut; 3712912010 5. Match or Inkind Portion Of Applicable) CM-468-EX (Rev, 12-08) Provinus edition obsoiete. MS Excel Miticeilaneous D7,29;2010 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. kem Inariinn this wnrkhnok as a workirig COD/ of a template should save the file inripr a nifferent name Clink on File from the menu above: then choose Save As 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 I CM-468-EX (Rev. 4-09) PrevioJs editor obsolete, MS Exce Introduction You may enter additional comments on this sheet or attach supplemental materials to your CM-468, Salaries & Fringe Benefits: Oakland County Health Division has an existing FTE Public Health Nursing Supervisor paid from County dollars that will supervise the staff working in this program. This Supervisor was trained and certified in 11/1999 in the Nurturing Parenting Program. Clerical support (Office Assistant II) will also be provided by County funded staff. Indirect Costs - Oakland County has an established indirect cost rate currently with OHS (Zero to Three Secondary Prevention contract), Our federal cognizent agency does not issue indirect cost rate agreements to local/county governments because it is not required. The County calculates the average rate for Worker's Compensation 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 a correct calculation. Overtime expenses include salary at 1.5 times the normal rate and fringe benefits calculated at .391 of salary for FICA and retirement, Occupancy: The staff will be housed in existing Oakland County Health Division office space which will be provided by Oakland County. Educational & Assessment Supplies for clients consisting of: • Parent Stress Index booklets and hand-scorable sheets for 90 families (Intro. Kit 2 @ $182 ea., 3 packets of scorable sheets @ $60 ea. $568.00 • Two (2) Nurturing Skills for Families program kits and additional lesson material for 90 families (some culturally appropriate) $6,000 • AAPI-2 test administrations for 90 families and Iwo handbooks = $265.00 • Misc. charges (shipping, handling, spoiled material) = $157.00 CM-468-EX (Rev. 12-08) Previous edition obsolete, MS Excel Comments CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES TDEEINITION: 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 unifomtly for both employees paid under this contract as well as employees not paid under this contract but performing srnilar 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 Belp_Salaries. METHOD OF ALLOCATION or COST: Determine the OHS' percentage of the cost of each salary position using one of the following methods. Any cos: item used entirely to provide contracted services should be charged 100% of the contracticientify below the method used to determine the percentage sholin in Column 3. Options include: a) Number of DHS 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. Cost allocation method: (Use Comment page if rot one of the above methods) 4. DEIS 5. 1. 2. COST 11 EM TOTAL 3. DH CONTRACT Match or Inkind S % (TOTAL COST) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) PROGRAM POSITIONS-ADMINISTRATIVE Position Title: Public Health Nursing Supervisor Yearly Salary: S 68,997.00 Weeks/Year: 52.0 HoursrWeek: 8.0 a c Mlle% Ci-,..ni nn T-,ral Prrmnirri• 20.00% C.ninry rh.laropd tn Tntal Prooram: 13 799 0,0% 13,799 Position Title: Office Assistant 1.1 Yearly Salary: $ 36,215,00 WeeksfYear: 5211 Hours/Week; 8.0 '' .. •• . • .. , . i I 0 'I c a 1:1 ri• ("KR ruell yi Tru al PrCilifain: 7,243 0.0% - 7.243 —1 Position Title: Yearly Salary: . Weeksricar: 0.0 Hours/Week: 0.0 o ' - .. • -@ .--@ -'--• -IL- • II . Cn1•41-1; (l-ijjj tri Mtn] PrfIVTATTi• 0.0% - I SUBTOTAL: $ 21.042 $ $ 21.042 SALARY TOTAL:I $ 149,637 S 128.595 I S 21,042 CM-458-EX (Rev 12-08) Previous edition obsolete. MS Excel Salaries and Wanes Cl7i2T2010 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: _ [-b. I 4. DHS _ g. 2. 1. TOTAL 3 DRS % CONTRACT Match or 1nkind . COST ITEM (TOTAL COST) PROGRAM PORTION Portion ' _ (Of Total Prin.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND '- - DIRECT SERVICE .?osition Title: Public Health Nurse In Yzarly Salary- 61,983.00 Weeks/Year: _ 52.6- •Hours/Week: 40.0 ,fliti ,11i Spent on Total Program: , 100.00% _ Salary Charged to Total Program: 61.983 100.0% $ 61,983 _ PosMon Tide: Pohlic Health Nurse III OT Yearly Salary: S 2,314.50 - Weeks/Year: - ,1-lours/Week: _ % of Time Spent on Total Program: 100.00% _ Salary Charged to Total Program: ._$ 2,315 , 100.0% _ $ 2 315 $ , _ r _ Position Title: Public health 'Norse 1:I Yearly Salary! _$ 61,98300 Weeks/Yea: _ 51 .0 Hours/Week., 40.0 J % of Time Spent on Total Program: 100.00% _ Salary Charged to Total Program: $ 61,983 100,0% , S 61,983 $ _ — _ Pos non Title: Public Health Nurse 111 OT Yearly Salary: $ 2,314.50 'Weeks/Year: Hours/Week: _ % of Tim: Spent on Total Prognim: 100.00%, Salary Charged to Total Program: _ $ 2,315 , 100,0% $ 2,315 - Position Title: Yearly Salai-y: Weeks/Year: Hours/Week: % of Time Spent on Total Program! _ Salary Charged to Total Program: $ 0,0% $ - . SUBTOTAL: $ 128,595 128,595 CM-466-EX (Rev. 12-013) Pfevlous edition olo5Qlete. MS' Excel Salaries and Wages Sheet 2 07/201201C CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AND WAGES (Continued) Cost allocation method: 2. if. DHS I 5. I.4,'. CONTRACT ; Match or Inkincl TOTAL PROGRAM 3. DHS COST ITEM (TOTAL COST) PORTION Portion (Of Total Prog.) or Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE Position Iltle: Yearly Salary: Weeks/Year: 0.0 Hours/Week: oh: af TIrnew crpnr nn 'rival Priwrarrr 0.00V, Salary Charged to Total Program: - 0.0% S - :Position Title: Yearly Salary: - Weeks/Year: 0.0 Hours/Week: 0.0 g' r Tirnt. qr,ent Iln Total Palomar . 0.00V _ Salani Clammed to Total Program: S 0.0% Position Title: Yearly Salary: S - Weeks/Year: 0.0 Hour /Week: 0.0 ,% of VrIlf, capnt an Tatal Pu rsrn I 0,00% 12ro Charopri to Total Program: S - 0.0% S _ Position Title: Yearly Salary: - Weeks/Year: 0.0 Hours/Week: 0.0 Tire, cirto_iiinn MYR} Praimirry 0,00% . . & i , - a 0.0% - Position Title: Yearly Salary: S - Weeks/Year: 0.0 Hours/Week: 0.0 0.,...-,FTImr crwn nn Tntlil Pranrany 0.00% _ Saiand Charoed to Total Program: S - 100.0% SL'13TOTAL:1 S CM-468-EX (Rev. 12-o8s Previnia; edition cosoieie. MS Excel Salaries and Wages Sheet 3 n7/29/2010 CONTRACT BUDGET DETAIL LINE ITEM: SALARIES AN]) WAGES (Continued) Cost allocation method: 1. 4. MIS 5. 2. 1. (T TOTAL 3 DRS CONTRACT Match or Inkind . COST ITEM (TOTAL COST) PROGRAM % PORTION Portion (Of Total Prog.) (If Applicable) PROGRAM POSITIONS - SUPERVISORY AND DIRECT SERVICE 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: Weeks/Year: 0.0 Hours/Week: 00 % of Time Spent on Total Program: 0.00% Salary Charged 0 Total Program: 0.0% Position Title: Yearly Salary: ¶ _ Weeks/Year: 0,0 Hours/Week: 0.0 % of Time Spent on Total Program: L 0.00% Salary Charged to Total Program: 0.0% Position Title: Yearly Salary: 1 - Weeks/Year: 0() Hours/Week: j 0.0 % of Time Spent on Total Program: 0.00% Salary Charged to Total Program: 0.0% Position Title: Ycarl!, Salary: - - Weeks/Year: 0_0 Hours/Week: 0.0 % of Time Spent on Total Program: 0.00% Salary Charged to Total Program: 0.0% _ T L SUBTOTAL:1 $ $ - $ - 0M-488-EX IRev. 12-08) Previous edition obsolete MS Excel Sale lies arid Wages sreat 4 07/2S/201C TOTAL:I $ 86,378 70.9414 I $ 15,433 CONTRACT BUDGET DETAIL LINE ITEM: FRINGE BENEFITS DEFINITION: Funds allocated to cover allowances, cost of services provided by the contractor to or on behalf of its employees and not inciuded 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 pont° must he completed for all employees_ Note; Unemployment base wage cannot exceed $9,000 per employee.. Note: Social Seeurity at 6_2% cannot exceed base wage of $102,200 per employee plus Medicare at 1.45% for all wages. rovnioD OF ALLOCATION OF COST: The DHS percentage of the cost of each Fringe benefit cannot exceed the percentage of total OH' salaries to total program salaries. fringe benefits kr each individual position do no have to be itemi -zed. Be sure base wage figures are taken int+ account. Any cost item used entirely for the OHS CONTRACT PORTION, and equal to the TO IAL PROGRAM effort, equals 100%. Option ' Cost allocation method: 4. OHS 5. 1. 2. CONTRACT Match or Inkind COST ITEM TOTAL 3. DHS % (TOTAL COST) PROGRAM PORTION Portion (Of Total Prog.) (If Applicable) REQUIRED FRINGE BENEFITS FICA Social Security(/o): 6.20% Times To-211 _.1 .4.1it`O TaM Sulanes and Wages $ 149,637 9,278 82,1% ' 7,617 1,661 FICA Ili edicare(%): L45% Times Total Program Salaries and Wages $ 149,637 S 2,170 82.2% 1,784 386 -Un2.ifill/WIng-t-L-I—L-.1 % :11114 0.20% Times Total $ 34,243 68 82.2% ' 56 12 Wm- i n I 11.19 Centa• Total Fro.rdin ia Toll: 149,637 5 1,674 82.1% 5 1,375 5 299 OYTIONA,L FRINGE BENEFITS Retirement: t'',miber f11'E's: 2.000 :imes coniiibutions for each per month: $ 1.98446 — $ 47627 82.1% ,, 39,102 $ 8,525 Ikalth Insurance: Number of ITE's: IMO t;mes contributions for each Der month: 5 940.13 1--- t',.•,,- n• her If nirrio'ram trinithS' 12 1 $ 22,563 561 82.2% 18,547 4,016 mmemmr- .....1 IJfr , Number of FTE's: 2.000 times contributions for each :ler month: S 19.00 rirue,.-mmther peruvram months- 12 456 82.2% 5 375 81 Long Term Disithil: Number of FTE's: 2.000 times coniributions for each per month: $ 22.11 iimes number or Ivo • ra • 12 531 822% S 436 5 95 OthiXralgialZej nraeral ifj) f") ()X% of S,117.7V 110 82.2% 5 90 20 Pntal iiii i ltl'14, r,,f 117.76i 1,901 82.2% 1.563 5 3381 1113 CM-468-EX (Roy. 12-08) Previous edition ono eta. MS Excei 07129/2010 Frinige Berserls CONTRACT BUDGET DETAIL LINE ITEM: OCCUPANCY DEFINITION: Costs arising from occupancy and use of owned or leased buildings and offices. INSTRUCTIONS: InJicate below whether facility cost was determined by rent, depreciation or use charge, the amount being charged and how the cost was determined, Itemize various utibty and maintenance costs, as they apply, Note: Buildings must be depreciated over a 40 year life. METHOD OF ALLOCATION OF COSTS: Determine the DEIS percentage of the cost by using one atilt following methods. Any cost i tem used entirely to provide contracted services should be charged 1(10% to the contract. Identify below the method wed to determine the percentage shown in Column 3. Options include: a) Number of DRS clients served, divided by Total Program clients served.)( 100%; b) Direct service staff hours serving DHS cheats, divided by total staff program hours, X 100%: c) 1)115 program area in square feet., divided by total program area in square feet. X 1(10%:d) Other (Identify) Cost allocation method: Id - No occupancy costs 1 4. DI-IS 5. 2. 1, CONTRACT Match or Inland T OTAL 3. DRS % COST ITEM (TOTAL COST) PORTION Portion PROGRAM — _ (Or Total Frog.) (If Applicable) Rent Paid tu a Third Party: , Total prosram area n square feet: 200.0 tunes monthly cost per square foot: S 10.59 _ Cost per Month $ 2,117.63 times number of months: , 12.0 _ $ 25,412 _ 0.0% $ - $ ,.._ 25,412 - OR - Depreciation: Rem being depreciated: I Acquisition cost: $ - Depreciated over this many years: 0.0 Amount depreciated per month: times this many months: 10 , r--- _ - 0.0% 5 - $ - _ - OR - Use Charge; Item description: Use charge percentage (maximum 2,0%n 0.3 - times acquisition cost: $ divided by. 12 months equals amount per mouth: , S _ times this roan - months: 0.0 1 - _ 0.0% S - $ _ _ r Utilities Not Included in Rent: _ Heat per,month: _ S - !limos this # months: 0,0 - 0.0% 5 - $ - -, _ Electricity per month: S - times this 4 months: _ 0_(1 - 0.0% 5 - 5 _ - Water per month; , $ - times this # months: 0.1) $ _ ' 0.0% $ - i $ - Other (specify): .._. cost per month: $ - times this # months: 1 $ - i 0.0% 5 - I_ $ - TOTAL: 25,412 . S 25,412 CM-46&-ZX (Rev 12-08) Previous ocittion obsolete MS E gee! C7Y2W2C1D Occupancy TOTAL:1 $ 3.384 3.384 $ CONTRACT BUDGET DETAIL II _ DEFINITION: Cost for written or verbal communication. INSTRUCTIONS: Identify communications cost below. Each item costing S100 or more most be listed individually. METHOD OF ALLOCATION OF COST: Determine the DI-1S percentage attic 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 3. Options include: a) Number cf DM clients served, dwided by Total Program clients served, X 11)0%;b) Direct service staff hours serving DI-IS clients, divided by total dirixtt staff program hours, X 100%; c) Number of phone lines assigned to serve DHS clients, divided by total program phone lines, X 100%; - — - - - • • - - - - • - ' '• • • . : 111.41 4141 . i 0 .... Other Identifyi Cost allocation method: lc ------ 2. 1, AL 1 DHS % COST ITEM 4-TOTAL COST) TOT PORTiON Portion PROGRAM (Of Total Prog.) (If Applicable) Telephone; Total Agency lines: I 0 Total phones: I 0 Local: Number of Total Proorain Lines: 2 I. NI n • net; 2 Phone cost/month: S 1 20.00 times # of months: 12.0 1,44 100.0% 1.440 Lon , Distance: _ . _ . ... 1_ $ - Fax Service: Posta_e: Item: Mail materials to clients. etc. --- co . .. • . . • - t '.• , • it' 1 - 12.0 60•100.0% 60 , - Other (Identify : - . Wireless Service •00.0% 1.500 $ - 5 384 e : Pnntin 100.0iMi $ 384 $ - CM-488-EX (Rev 12-08) Previous eclItion obsoiete. MS Excel Communications 0112512010 CONTRACT BUDGET DETAIL LINE ITEM: SUPPLIES DEFINITION: CONsumable or no items with a unit cost of leis than S'5,000. Consumable supplies are those items that are comomed as they are used (pencils. paper, etc.). Noo-consurnable supplies are those that are not consumed as they are used (fi:e cabinets, chairg, 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 DRS' percentage of the CORI of supplies using one of the following methods. Any cost item used entirely to movide contracted services should be charged IOC% to the contract. Identify 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 100%; b) Direct service surf hours serving OHS clients, divided by total direct staff program hours, X 100%; c) Other (Itienti*) Cost allocation method: la _ _ 4. PBS 5. 2. I, CONTRACT Match or Inkind TOTAL 3. MIS °A COST ITEM (TOTAL COST) PORTION Pardon PROGRAM _ j (Øf] Prog.) 1,11 Applicable) General Consumable Supplies (Pencils, Paper, etc„): Item; Office Supplies for staff Cost per month: i $ 33.34 Itimes itt of months: I '12,0 - 1 $ 400 100_0% $ 400 _ — — Item: Education 8.,. Assessment Supplimiclients Cost per month7 , 5 583.331times le or months , 12.0_ i 7,000— 100.0% _ $ 7,000 S F 1 --. Itm: FMedic.a I Supplies _ _ _ Cost per month: $ 6.25 Ituries of months: 12.0_ - $ 75 "100.0% S 75 5 - Duplicating Su plies: I- Item Convenience (pier — Cost per month: $ 8.50 itirries '4 of months. 12.0 A $ 102 100.0% $ 102 $ .. Nun-Consumable Supplies: (Itemize) Item: 0,0% - Item: $ - 0.0% $ Item: $ - _ 0.0% $ - $ _ _ Item: .- 0.0% $ . - Item: 1 s - _ 0.0% . $ - $ - .. _ item: $ - - i... TOTALI $ 7,577 I_ 7,5 77 I $ — CM-4O8,-EX .'nev 12-08; previous edibcn nbscoele MS Excel SLoches 07!29,1c, l0 CONTRACT BUDGET DETAIL LINE ITEM; EQUIPMENT DEFINITION: Any non-con.sainable item ccsting more than $5,000 that is not anacheli to or included as part of the cost of a facility. INSTRUCTIONS: Indicate below the method of charge (rent, depreciation 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 DRS' peruentage of the costs of equipment using on of the following methods. Any cost item used entirel!, to provide contracted services should be charged 100% to the contractIndicate below the method used to determine the percentage shown in Column 3. Options include: a) Number of DI-IS clients served divided by Total Program clients swied X 100%: b) Direct service staff hours serving 1)1-IS clients divided by total direct staff program hours X 100%; c) Other (Identify). • • . • O SI - II • • i g - ment costs 2 4. DHS 5. 1. TOTAL 3 . D ITS % CONTRACT Match or Inkind PORTION Portion COST ITEM (I'OTAL COST) PROGRAM Of Total Pro _.) (If Applicable) Rent Paid to a Third Party . . .. , . . . , . ,... . o 1 $ - 0,0% _ Item: • .• I I I.M. 0.0% - lareciation; It:.-in batty depreciate Ac tiiition cost less salva • e value: De• eciated over this many Years 0.0 Anima depreciated per month: $ - I.. o/ .1kil 0.0 $ - 0.0970 - - .,1;se Char,g Item: Act ion ost: - 11111 . 00 __ $ - 0.0% - Other: Item II 0,0% - - I . I I 0.0% $ - S _ TOTAL:1 S - Cm-ano.F.x (Rev 12-08) Previous edition oeeolete. MS ESN! quiproent 07.'29/2010 CONTRACT BUDGET DETAIL LINE ITEM: TRANSPORTATION DEFI(rTION: Transportation costs include the costs of staff navel, lodging, meals and incidental expenses incurred by personnel in a travel status while on official business_ Travel rates established by the State of Michigan will 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-reiated costs, such as meals, lodging. etc. METHOD OF ALLOCATION OF COST; Determine the DT'S' percentage of the cost using one of the following methods. Any cost item used entirely to provide crinaaeted 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%; ft) Direct service staff hours serving DHS clients, divided hy total direct staff program hours, X 100%;c) Miles traveled serving DHS clients, divided by totalyroirarn miles traveled, X 100%4)0th a (111Critify). Cost allocation method: C and d - _ _ . 2. 4. DRS I S. 1.TOTAL DRS PROGRAM CONTRACT Match or Inkind 3, 6/0 COST rrEm (TOTAL COST) PORTION Portion - (Of Total :Frog.) (If Applicable) Program Milea4,3e: Number of miles cxoteted to be driven: 14400.0 times cost per mile: S 0.500 - .., _ 5 7,200 100,0% $ 7,200 $ -. Meals (Itemize Costs): t _ — 0.0% $ - $ - _ $ - 0.0% $ - $ - _ -$ - 0.0% - $ - . -r Lodging (Itemize Costs): _ - L _ . 0.0% S -$ - 0_0% $ - $ .- I -,.----- •,. Training Mileage: Number of miles expected to be driven: 0.0 times cos'. per mile: $ - , _ S 0.0% 5 ,. • . _ ". --- - 0.0% $ - $ - - — —1 Other (Identify and Itemize costs): r _ 0.0% $ - $ _ _% _ . 0,0 $ $ - 0,0% S - . 5 7. - 0.0% $ _ ,, . - . _ TOTAL:_ $ 7,200 - $ 7200. S -- CM-46.5-EX (Rey. 12-03; PrevIcAn eilltoct ciOsolet. VS Excel TrartsvDtbition 01/29/a010 CONTRACTED SERVICES TOTAL: I S 15,040 I 15,040 I $ CONTRACT BUDGET DETAIL LINE ITEM: CONTRACTED SERVICES DEFINITION: Compensation paid by the Contractor to a third party under a subsontract for perfctrmance of any activities designated in the contract as a service to be delivered to DI-IS. 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 be provided. Show how cost was determined. For amounts over $2,500, attach a separate huget for Use tub contractor. METHOD OF ALLOCATION OF COST: Determine the DEIS 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 Program cheats served X 100%; 1:1) Direct service staff hours servin a OHS clients divided by total direct staff proRrarn hours X 100%; t) Other Gdentifyl. Cost allocation method: IC - No contracted services 4.1)115 5. 2. I. CONTRACT Match or Inkind TOTAL % COST ITEM (T PROGRAM 3. DHS (TOTAL COST) PORTION Portion (Of 'Total Frog.) (If Applicable) Subcontractors: Name of Agency or individual: Brief description of service provided: - Teaching/Child Safety Books, safety gates, Mug covers Cost breakdown of service provided: S Per unit cost; 1 s 25.00 I times 4 of units: I 360 0 , $ 9,000 100.0% S 9,000 $ - Name of or Individual: Brief description of service provided; Bus Fare/Taxi Last Resort Transportation Cost breakdown of service provided: Per unit cost: ] S 3.50 1 times # of units: I 1440.0 $ 5,040 100.0% S 5,040.00 $ _ Name of Agency or Individual: Brief description of service provided: _ Translation Services Provide interpretation Cost breakdown of service provided: Per unit cost: I S 125 00 I times 4 of units: I 8.0 $ 1,000 , 100.0% $ 1,000 $ - SUBTOTAL:1 S 15,040 15,040 I $ CM-468-EX ;Rey '2-08:, ore,cout, edition a:Mete MS Excel 27;29,2C10 Consrac:cr Senrices CONTRACT BUDGET DETAIL LINE ITEM: SPECIFIC ASSISTANCE ,DEFJNITION: The dollar amount of money or other items of value purchased for a specific client and given to that client as part of service delively. ENSTRUCTIONS: List each type of cost item including a bilef explanation, unit cost and quantity. MEl'HOD OF ALLOCATION OF COST: Determine the DIIS' percentage of the cast using one of the fo/lowing 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 showm in Column 3. Options include: a) Numbez of DI-IS clients served cl:vided by Total Program clients served X 1000/0; b) Other (Wend fy). [ Cost allocation method: Ja 4. DI1S S. 2. 1. TOTAL 3 DI1S CONTRACT Match or Inkind . % COST ITEM (TOTAL COST) PORTIOIV Portion PROGRA.M (Of Iota/ Prog) (If Applicable) Specific Assistance Given Clients: • 1 vie of item given: Explanation of Assistance: Quantitv to each client: L 'times cost per unit: times number of clients to whom items ; given: 0.0% Type of 11enl,g1VC1 . Explanation of Assistance: Quantity to each client- Jiuenes cost pes- unit: tmes niimber of clients to whom item(s) giVaf: 0.0% • Type of item given: Explanation of Assistance: Quarany to each client j (times cost per unit' times number of clients to whom antra) given - 0.0% , Type of item given. Explanation of ASSlistance: Quantity to each client. 00 F.irres cost per unit: S - times number o. clients to whom item's) given: 0.0% . . Tyne a Item given: Explanation cf Assistance: Quantity to each client: I 0 0 [times cost per unit: S - tittles number of clients to whom ileit(s) yen. 9 S 0.0% . TOTALIS [5 cm468-Ex fnev •12.oel P70.10L5 etitior. Deso.ete. lvIS Excel sKarc Assivarcv IQ od:vluais D7129:2010 MISCELLANEOUS TOTAL: 17,905 17,905 CONTRACT BUDGET DETAIL LINE ITEM; MISCELLANEOUS DEFINITION: Expenses related to the contract winch are not chargeable to other line items. INSTRUCTIONS; List and briefly explain each miscellaneous cost item below.Cost items that are designated "other" or 'miscellaneous" are itnacceptable. 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 contractidentify helot 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 30%; b) Direct service staff hours serving DHS clients. divided by total direct staff program hours. X 100%; c) Other (Identify), Cost allocation method: b and c 1 4. DHS 2. 1. PROGRAM CONTRACT TOTAL 3. 1)118 % COST ITEM (TOTAL COST) PORTION (Of Total Prog.) Miscellaneous: Item: Explanation: _ — Quantity: I I times cost per unit: I S - 0.0% _. Item: Liability Insurance Explanation: Quantity: I 1.01 times cost per unit: I $ 376.00 376 100.0% S 376 Item: 'Indirect costs Explanation: Per established rate. 14.14% of salaries Quantity: 1 123966.01 times cost per unit: 1 14.14% $ 17,529 100.0% $ 17,529 Item: Explanation: • Quanttry. I I times cost per unit; 1 - 0.0% $ - Item: Explanation: Quantity: I 1 times cost per unit: 1 0.0% $ 1 SUBTOTAL: 1 5 17,905 1 S 17,905 1 CM-468•EX (Rev -:2-08) Previous edition oestnete. m5 Exce. MISCeltanecus C7.'25.2010 5. Match or Ink hid Portion (If Appiicabk) CM-4138-EX (Rev. 12-Os) Previous edition obsolete MS Excel Miscellaneous 07:29/2010 Fund 20221 Budget Reference 2010/ 100000001406 Revenue: 1060236-133375-610313 FY 2010 $41,756 Federal Operating Grants $22420 11,300 490 50 150 116 1.167 13 50 1.500 500 280 625 61 3 034 S 41,756 Expenditures: 1060236-133375-702010 1060236-133375-722740 1060236-133375-730324 060236-133375-750448 1.060236-133375-731388 1060236-133375-750399 1060236-133375-750567 1060236-133375-750301 1060236-133375-770667 1060236-133375-731346 1060236-133375-750245 1060236-133375-731997 1060236-133375-730982 1060235-133375-774677 1060236-133375-730926 Salaries Regular Fringe Benefits Communications Postage-Standard Mailing Printing Office Supplies Training-Educational Supplies Medical Supplies Convenience Copier Personal Mileage Incentives Transportation of Client Interpreter Fees Insurance Fund Indirect Costs Total Expenditures FINANCE COpATTEE ,--/ September 1 2010 FISCAL NOTE (MISC. #10213) BY: FINANCE COMMITTEE. TOM MIDDLETON. CHAIRPERSON IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — 2010/2011 CHILD ABUSE AND NEGLECT PREVENTION PILOT PROJECT ACCEPTANCE TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS Chairperson, Ladies and Gentlemen: Pursuant to Rule Xll-C of this Board, the Finance Committee has reviewed the above-referenced resolution and finds. 1. The Michigan Department of Human Services (MDHS) has awarded the Oakland County Health Division funding in the amount of $292,401 with a grant match and source from Title V MCH Block Grant in the amount of $71,912 for a total of $364.313 in funding for this program. 2. The $71,912 grant match from Title V IVICH Block Grant is comprised of salaries and fringes ($42,013) and in-kind service of building space ($29.899). 3 The portion of funding from (MDHS) allocated for FY2010 (August 1. 2010 to September 30, 2010) amounts to $41.756 while the remaining 'portion of funding is allocated for FY 2011 (October 1. 2010 to September 30. 2011) amounting to $250,645. 4. Home visitation services wiil be provided to families referrea from the Department of Human Services or meeting risk criteria as established by the Department of Human Services, The project encourages home visitation services cesigned to prevent child abuse and neglect of Pontiac Children ages birth to eighteen, to strengthen their families and prevent them from entering the protective child welfare system 5. Funding period is August 1.2010 through September 30. 2011 6. There is no county match or additional positions required. Fiscal Year 2011 will be amended with the budget process and included in the Finance Committee Recommended Budget. The Fiscai Year 2010 budget is amended as specified below: Finance Committee Vote Motion carried unanimously on a roll call vote IPI ifEL„: /el FOREGOING RESOLUTION I HEREBY A Resolution #10213 September 1,2010 Moved by Nash su pported by Gosselin the resolutions (with fiscal notes attached) on the Consent Agenda be adopted. AYES: Burns, Coulter, Douglas, Gershenson, Gingell, Gosselin, Greimel, Hatchett, Jackson, Jacobsen, Long. McGillivray, Middleton, Nash, Potts, Runestad, Schwartz, Scott, Taub, Woodward, Zack, Bullard. (22) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent Agenda were adopted. 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 September 1 , 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 1st day of September, 2010. Ruth Johnson. County Clerk