HomeMy WebLinkAboutResolutions - 2008.09.18 - 9648September 18, 2008 MISCELLANEOUS RESOLUTION #08188
BY. General Government Committee, Christine Long, Chairperson
IN RE: DEPARTMENT OF HEALTH & HUMAN SERVICES/CHILDREN'S VILLAGE DIVISION — FY
2008-2009 CHILDREN'S VILLAGE SCREENING PROJECT GRANT ACCEPTANCE
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
WHEREAS in FY 2007-2008 the Michigan Department of Community Health (MDCH) awarded a
grant to the Department of Health & Human Services — Children's Village Division in the amount of
$73,000 for the purpose of screening, compiling data, and treating at-risk adolescents for sexually
transmitted -diseases (STD's); and
WHEREAS the IVIDCH is providing a ninth year of funding for the Adolescent Screening Project;
and
WHEREAS the special revenue, part-time, non-eligible General Staff Nurse position will be
continued; and
WHEREAS the MDCH has awarded a grant in the amount of $73,000 for FY 2008-2009; and
WHEREAS Children's Village and the Health Division have worked collaboratively in identifying,
screening, and treating at-risk adolescents and young adults in special settings including Children's
Village, Oakland County Jail (including Work Release Program), Frank Greenan Detention Facility,
Common Ground Sanctuary, the two Pontiac Scnool District's Teen Health Centers, Waterford Alternative
High School Teen Center; and
WHEREAS this grant is 100% federally funded with no County match; and
WHEREAS there are no additional personnel requested, and
WHEREAS acceptance of this grant award does not obligate Oakland County to future funding.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners
approves acceptance of the continuation of tnis grant award in the amount of $73,000 to the Department
of Health & Human Services — Children's Village Division.
BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute the Grant
Agreement and approve chriij did exteriiciiia not to exceed fifteen percent (15%), which is consistent
with the acceptance as originally approved.
Chairperson, on behalf of the General Government Committee, I move the adoption of the
foregoing resolution.
GENERAL GOVERNMENT COMMIT,
GENERAL GOVERNMENT COMMITTEE VOTE:
Motion carried unanimously on a roll call vote with Potter, Jacobsen and Greimel absent.
GRANT REVIEW REVIEW SIGN OFF — Children's Village
GRANT NAME: 2008/2009 Children's Village Screening Project
FUNDING AGENCY: Michigan Department of Community Health
DEPARTMENT CONTACT PERSON: Joanna Overall/ 8 -1164
STATUS: Grant Acceptance
DATE: August 25, 2008
Pursuant to Mize_ Resohnion #01320, please be advised the captioned grant materials have
completed internal grant review. Below are the returned comments.
The captioned grant materials and grant acceptance package (which should include the Board of
Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance
Committee Fiscal Note, and this Sign Off email containing grant review comments) may be
requested to be placed on the appropriate Board of Commissioners' committee(s) for grant
acceptance by Board resolution.
DEPARTMENT REVIEW
Department of Management and Budget:
Approved. — Laurie Van Pelt (8/06/2008)
Department of Human Resources:
Approved. — Cathy Shallal (8/07/2008)
Risk Management and Safety:
Approved. - Andrea Plotkowski (8/11/2008)
Corporation Counsel:
I have reviewed this grant and approve same for submission to the Board of Commissioners for
acceptance. — John Ross (08/2512008)
COMPLIANCE
The grant agreement references a number of specific federal and state regulations. Below is a
list of these speciheally cited compliance related documents for this grant.
Michigan- Payroil and payments by electronic funds transfer; implementation - The
Management and Budget Act - "P.A. 533 of 2004"
//www.leeislature.mi.2ov/(uo3 I xt3.eltmri5z55z2uiwv45)/naileg.asoxnage—vetObleet&object
Name=2003-SB-08.50
Federal Health Insurance Portability and Accountability Act of 1996 (IIIPAA, Title II)
bttp:fiwww.ems.blis,gov/HEPAAGenInfo/Dowaloads/HIPAAlawdetail.odf
Department of Health and Human Services — Children's Village Division
Children's Village Screening Project
August 2008
• MOCK through federal funds from the U.S, Centers for Disease Control (CDC), intends to
continue a grant to Children's Village or FY2008-2009. The funds are intended to facilitate
a ninth year of screening of adolescents for sexually transmitted infections. The grant total is
$73,000. There is no County match.
Salaries and Fringe f3enefits Offset• $62,064,00
Other Expenditures (includes travel, contractual. supplies, and indirect
costs) $10,936.00
• The grant objective is to continue to compile data and enhance disease detection and health
services to high-risk adolescents and young adults tag.es 13 through 24). Clinical experience
and literature review reveals that adolescents are at an increased risk for sexually transmitted
infections due to their biological vulnerability, their risk-taking behavior and their perceived
lack of consequences. Additionally. the sexually transmitted diseases are mostly
asymptomatic.
• The project presents significant opportunity for Children's Village to continue to collaborate
with other service providers dealrig with at-risk adolescents. The project sites include:
Children's Village, Oakland County Main Jail (including Work Release Program), Frank
Greenan Male Detention I•aci:ity, Common Ground Sanctuary, the two Pontiac School
District's Teen Health Centers, and the Waterford Alternative High School Teen Center,
• During the first eight years of funding over l0700 adolescents and young adults have been
screened under the auspices of the project. Positivity rates (3% lemalesil%males for
gonorrhea, 13% females\8%inales for chlamydia) arc significant with 96% of the adolescents
testing positive having been treated. All released adolescents testing positive receive
confidential communications regarding test results and the follow-up needed.
• MDCH (through federal awards) will fund 100% of the grant. Funding for the Children's
Village Screening Project will be utilized to offset personnel costs, supplies, material, travel
and other logistics. Any funding for personnel costs is strictly for the life of the grant with no
County obligation to continue once the grant period has expired. Likewise, all participating
agencies are aware that the project is funded for an additional year only.
• Positivity rates for sexually transmitted infections for chlamydia and gonorrhea will be
compiled and presented to the Oakland County Health Division and MDCH. The screening
project is part of Children's Village's effort to address the Focused Infant Mortality
Reduction Plan.
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Federal Office of Management and Budget (OMB) Circular No. A-133. This Circular sets
forth standards for obtaining consistency and uniformity among Federal agencies for the
audit of States, local governments, and non-profit organizations expending federal awards.
bao://www_whitehouse.govioatbkirculars/a133/a133.htral
Lobbying Disclosure Act of 19. 2 USC 1601
http://www.senate ntactit3.210465.pdf
Ant-Lobbying - Section 503 (Public Law 104-208)
hitqadigranan s/suideinotice-fdesinot97-032.html
Michigan Elliott-Larsen Civil Rights Act - "Act 453 of 1976"
anrilac17Act-453-of-19768zQuentid=--14718540
I 9TI 1TR 11'11 •U , '` LUP.1=17 " A Ili 4
Michigan Persons with Disabilities Civil Rights Act "Act 220 of 1976"
.2.• • • AI •; 11- II II - 11 i x7 a , etob'ect&obta
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Federal Office of Management and Budget (OMB) Guidelines to Agencies on
Governmentwide Debarment and Suspension (Nonprocurement) (2 CFR, Part 180)
pittrth`www.access.2-Do.savinarakEriwaisidx 08/2efr180 08.1tml
Federal Environmental Tobacco Smoke -Pro-Children Act of 1994"
mLgg sltr aceofrearch datalyouth/464119.htt2
Federal Hatch Act Political Activity of Certain State and Local Employees
http://ww,v.ose.govibatchaet.ht-ra
Intergoverinnental Personnel Act of 1970 (42 U.S.C. Sections 4728-4763)
btttEgfrwebkrate,ac..ceas.gpo.Rov/c2i-
e t1._0.eidite:+42USC4728
Federal Office of Management and Budget (OMB) Circular No A-102. This Circular
establishes consistency and uniformity among Federal agencies in the management of
grants and cooperative agreements with State, local, and tribal governments.
liauZuaLyzi mb/cili ruLars/a102,1a102.html
Michigan - Conflict of Interest - Contracts of Public Servants with Public Entities - "Act
317 of 1968" rhiram, 1
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Michigan - Standards of Conduct for Public Officers and Employees (Act 196 of 1973)
,t.iii:isiatutazajanctaridaaacciza2L1102.5.5ilalzwal.Wmata.asoxThaae=aetObiect&obie
etNarrte-mc1-I5-341
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Contract #:
Grant Agreement Between
Michigan Department of Community Health
hereinafter referred to as the "Department"
and
Oakland County Children's Village
1200 N. Telegraph Rd., Dept. 44. Blda 63,
Pontiac, MI 48341
Federal I.D.#: 38-6004876
hereinafter referred to as the "Contractor
for
Children's Village Screening Project
Part I
1. Period of Agreement: This agreement shall commence on October 1, 2008 and
continue through September 30, 2009. This agreement is in full force and effect for
the period specified.
2. Program Budget and Agreement Amount
A. Agreement Amount
The total amount of this agreement is $ 73.000. The Department under the
terms of this agreement will provide funding not to exceed $ 73 000. The
federal funding provided by the Department: is $ 73 000 or approximately
100%; the Catalog of Federal Domestic Assistance (CFDA) number is 93-977
and the CFDA Title is Preventive Helath Services, STD; the federal agency
name is CDC/NCHHSTP/DSTDP; the federal grant award number is
H25/CCH504341 and the award phase is, 16. The federal program title is
Comprehensive Sexually Transmitted Disease Services, (CSPS). The grant
agreement is designated as a:
subrecipient relationship; or
ri vendor relationship.
The grant agreement is designated as:
Research and development project: or
El Not a research and development project.
B. Equipment Purchases and Title
Any contractor equipment purchases supported In whole or in part through this
DCH-0665 FY2009 shoe pm Page 1 of 18
agreement must be listed in the supporting Equipment Inventory Schedule.
Equipment means tangible, non-expendable, personal property having useful
life of more than one (1) year and an acquisition cost of $5,000 or more per unit.
Title to items having a unit acquisition cost of less than $5,000 shall vest with
the Contractor upon acquisition. The Department reserves the right to retain or
transfer the title to all items of equipment having a unit acquisition cost of
$5,000 or more, to the extent that the Department's proportionate interest in
such equipment supports such retention or transfer of title.
C. Deviation Allowance
A deviation allowance modifying an established budget category by $10,000 or
15%, whichever is greater, is permissible without prior written approval of the
Department. Any modification or deviations in excess of this provision,
including any adjustment to the total amount of this agreement, must be made
in writing and executed by all parties to this agreement before the modifications
can be implemented. This deviation allowance does not authorize new
categories, subcontracts, equipment items or positions not shown in the
attached Program Budget Summary and supporting detail schedules.
3. Purpose: The focus of the program is to: Screen adolescents seen at Oakland
County Children's Village Detention site and seven additional Oakland County sites.
4. Statement of Work: The Contractor agrees to undertake, perform and complete the
services described in Attachment A, which is part of this agreement through reference.
5. Financial Requirements: The financial requirements shall be followed as described
in Part II of this agreement and Attachments B and D. which are part of this agreement
through reference.
6. Performance!Progress Report Reauiremeuta: The progress reporting methods, as
applicable, shall be followed as described in Attachment C, which is part of this
agreement through reference
7. General Provisions: The Contractor agrees to comply with the General Provisions
outlined in Part II, which is part of this agreement through reference.
8. ?Administration of the Agreement
The person acting for the Department in administering this agreement (hereinafter
referred to as the Contract Manager) is:
ease
Control, 109 Michigan Ave., 9' Floor, Lansing, Ml 48913. PH 5171241-0870,
millerm 1 CL michigan .gov
Name, Location/Building Title
9. Contractor's Financial Contact the A reemen
The person acting for the Contractor on the financial reporting for this agreement is:
Laurie Val] JPelt, Director - Oakand CountL. of Magment and Oudget _
Name
vanpeltAco.oakland.mi.us 248/858-0487
E-Mail Address Telephone No.
Telephone No Email Address
Title
DCH-0665 FY2002 5108 (V)) Page 2 of 18
Signature Date
ID. Special Conditions:
A. This agreement is valid upon approval by the State Administrative Board as
appropriate and approval and execution by the Department.
B. This agreement is conditionally approved subject to and contingent upon the
availability of funds.
The Department will not assume any responsibility or liability for costs incurred
by the Contractor prior to the signing of this agreement:
D. The Contractor is required by PA 533 of 2004 to receive payments by
electronic funds transfer,
11. Special Certification:
The individual or officer signing this agreement certifies by his or her signature that he
or she is authorized to sign this agreement on behalf of the responsible governing
board, official or Contractor.
12. Signature Section;
For the CONTRACTOR
Bill Bullard, Jr, Chairperson, Oakiand County Board of Commissioners
(Please print) Name Title
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Mary Jane Russell, Director, Bureau of Budget and Audit Date
OCH-1)665 P(20D.S /66 1W) Page 3 of 18
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 08/09 AGREEMENT ADDENDUM A
1. This addendum modifies the following sections of Part II, General Provisions:
Part II
I. Responsibilities-Contractor
J. Software Compliance. This section will be deleted in its entirety and
replaced with the following language:
The Michigan Department of Community Health and the County of Oakland will work together
to identify and overcome potential data incompatibility problems.
Assurances
A. Compliance with Applicable Law. This first sentence of this paragraph
will be stricken in its entirety and replace with the following language:
The Contractor will comply with applicable Federal and State laws, and
lawfully enacted administrative rules or regulations, in carrying out the terms
of this agreement.
Health Insurance loortal The provisions in
this section shall be deleted in their entirety and replaced with the following
language:
Contractor agrees that it will comply with the Health Insurance Portability
and Accountability Act of 1996, and the lawfully enacted and applicable
Regulations prom:gated there under.
IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the
following language:
A. Except as otherwise provided for in this Contract, all liability, loss, or
damage as a result of claims, demands, costs, or judgments arising out of
activities to be carried out pursuant to the obligations of the Contractor
under this Contract shall be the responsibility of the Contractor and not the
responsibility of the Department, if the liability, loss, or damage is caused
by, or arises out of the actions or failure to act on the part of the Contractor,
its employees, officers or agents. Nothing therein shall be construed as a
waiver of any governmental immunity for the Contractor, its agencies,
employees, or Oakland County, as provided by statute or modified by court
decisions.
2. Special Certification:
The individual or officer signing this agreement certifies by his or her signature that he or
DC11-0685 FY2009 5/08 (W) Page 4 of 18
she is authorized to sign this agreement on behalf of the responsible governing board,
official or Contractor.
3. Signature Section:
For the COUNTY OF OAKLAND
Bill Bullard, Jr„ Chairperson Oakland County Board of Commissioners
Name and Title Date
Signature Date
For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
Mary Jane RusseIJ, Director, Bureau of E3udget and Audit Date
DC11-0665 FY2009 5108 (W) Page 5 of 18
DC1-1-0665 FY2008 6/08 (W) Page 6 of 1B
Part II
General Provisions
Responsibilities - Contractor
The Contractor in accordance with the general purposes and objectives of this
agreement will:
A. Publication Rights
1. Where activities supported by this agreement produce books, films, or
other such copyrightable materials issued by the Contractor, the
Contractor may copyright such but shall acknowledge that the
Department reserves a royalty-free, non-exclusive and irrevocable
license to reproduce, publish and use such materials and to authorize
others to reproduce and use such materials. This cannot include service
recipient information or personal identification data.
2 Any copyrighted materials or modifications bearing acknowledgment of
the Department's name must be approved by the Department prior to
reproduction and use of such materials.
3. The Contractor shall give recognition to the Department in any and all
publications papers and presentations arising from the program and
service contract herein; the Department will do likewise.
B. Fees
Make reasonable efforts to collect 1 st and 3rd party fees, where applicable, and
report these as outlined by the Department's fiscal procedures. Any
underrecoveries of otherwise available fees resulting from failure to bill for
eligible services will be excluded from reimbursable expenditures.
C. Program Operation
Provide the necessary administrative, professional, and technical staff for
operation of the program.
D. Reporting
Utilize all report forms and reporting formats required by the Department at the
effective date of this agreement, and provide the Department with timely review
and commentary on any new report forms and reporting formats proposed for
issuance thereafter.
E. Record Maintenance/Retention
Maintain adequate program and fiscal records and files, including source
documentation to support program activities and all expenditures made under
the terms of this agreement, as required. Assure that all terms of the
agreement will be appropriately adhered to and that records and detailed
documentation for the project or program identified in this agreement will be
maintained for a period of not less than three (3) years from the date of
termination, the date of submission of the final expenditure report or until
litigation and audit findings have been resolved.
F. Authorized Access
Permit upon reasonable notification and at reasonable times, access by
authorized representatives of the Department, Federal Grantor Agency,
Comptroller General of the United States and State Auditor General, or any of
their duly authorized representatives, to records, files and documentation
related to this agreement, to the extent authorized by applicable state or federal
law, rule or regulation.
G. Audits
This section only applies to Contractors designated as subrecipients.
Contractors designated as vendors are exempt from the provisions of this
section.
1. Required Audit or Notification Letter
Contractors must submit to the Department either a Single Audit,
Financial Statement Audit, or Audit Status Notification Letter as
described below. If submitting a Single Audit or Financial Statement
Audit, Contractors must also submit a Corrective Action Plan for any
audit findings that impact MDCH-funded programs, and management
letter (if issued) with a response.
a. Single Audit
Contractors that expend $500,000 or more in federal awards
• during the Contractor's fiscal year must submit to the Department
a Single Audit prepared consistent with the Single Audit Act
Amendments of 1996 ! and Office of Management and Budget
(OMB) Circular A-133, "Audits of States. Local Governments, and
Non-Profit Organizations," as revised.
b. Financial Statement Audit
Contractors exempt from the Single Audit requirements that
receive $500,000 or more in total funding from the Department in
State and Federal grant funding must submit to the Department a
Financial Statement Audit prepared in accordance with generally
accepted auditing standards (GAAS). Contractors exempt from
the Single Audit requirements that receive less than $500,000 of
total Department grant funding must submit to the Department a
Financial Statement Audit prepared in accordance with GAAS if
the audit includes disclosures that may negatively impact MDCH-
funded programs including, but not limited to fraud, going concern
uncertainties, financial statement misstatements, and violations of
contract and grant provisions.
c. Audit Status Notification Letter
Contractors exempt from both the Single Audit and Financial
Statement Audit requirements (a. and b. above) must submit an
Audit Status Notification Letter that certifies these exemptions.
The template Audit Status Notification Letter and further
instructions are available at http://www.michigan.govimdch by
selecting Inside Community Health — MDCH Audit.
DC11-0565 FY2009 5/48 (M Page 7 of 1 a
Due Date and Where to Send
The required audit and any other required submissions (Le. Corrective
Action Plan and management letter with a response), or audit Status
Notification Letter must be submitted to the Department within nine
months after the end of the Contractor's fiscal year to:
Michigan Department of Community Health
Office of Audit
Quality Assurance and Review Section
P.O. Box 30479*
Lansing, Michigan 48909-7979
*For Express Delivery:
Capital Commons Center
400 S. Pine Street
Lansing, Michigan 48933
Alternatives to paper filing may be viewed at
http://www.rnichigan.qov/mdch by selecting Inside Community Health —
MDCH Audit.
3. Penalty
a. Delinquent Single Audit or Financial Statement Audit
If the Contractor does not submit the required Single Audit
reporting package, management letter (if issued) with a response,
and Corrective Action Plan: or the Financial Statement Audit and
management letter (if issued) with a response within nine months
after the end of the Contractor's fiscal year and an extension has
not been approved by the cognizant or oversight agency for audit,
the Department may withhold from the current funding an amount
equal to five percent of the audit year's grant funding (not to
exceed $200,000) until the required filing is received by the
Department. The Department may retain the amount withheld if
the Contractor is more than 120 days delinquent in meeting the
filing requirements and an extension has not been approved by
the cognizant or oversight agency for audit. The Department may
terminate the current grant if the Contractor is more than 180 days
delinquent in meeting the filing requirements and an extension
has not been approved by the cognizant or oversight agency for
audit.
b. Delinquent Audit Status Notification Letter
Failure to submit the Audit Status Notification Letter, when
required, may result in withholding from the current funding an
amount equal to one percent of the audit year's grant funding until
the Audit Status Notification Letter is received.
Page 8 of 18 DC11.0665 FY2009 5/00 WI
4. Other Audits
The Department or federal agencies may also conduct or arrange for
"agreed upon procedures .' or additional audits to meet their needs.
H. Subrecipient/Vendor Monitoring
The Contractor must ensure that each of its subrecipients comply with the
Single Audit Act requirements. The Contractor must issue management
decisions on audit findings of their subrecipients as required by OMB Circular
A-133.
The Contractor must also develop a subrecipient monitoring plan that
addresses "during the award monitoring' of subrecipients to provide
reasonable assurance that the subrecipient administers Federal awards in
compliance with laws. regulations, and the provisions of contracts, and that
performance goals are achieved. The subrecipient monitoring plan should
include a risk-based assessment to determine the level of oversight, and
Monitoring activities such as reviewing financial and performance reports,
performing site visits, and maintaining regular contact with subrecipients.
The Contractor must establish requirements to ensure compliance for for—
profit subrecipients as required by OMB Circular A-133, Section .210(e)
The Contractor must ensure that transactions with vendors comply with laws,
regulations. and provisions of contracts or grant agreements in compliance with
OMB Circular A-133, Section .210(1).
Notification of Modifications
Provide timely notification to the Department, in writing, of any action by its
governing board or any other funding source that would require or result in
significant modification :n the provision of services, funding or compliance with
operational procedures.
Software Compliance
The Contractor must ensure software compliance and compatibility with the
Department's data systems for services provided under this agreement
including, but not limited to: stored data, databases, and interfaces for the
production of work products and reports. All required data under this
agreement shall be provided in an accurate and timely manner without
interruption, failure or errors due to the inaccuracy of the Contractor's business
operations for processing date/time data.
K. Human Subjects
The Contractor agrees that prior to the initiation of the research, the Contractor
will submit institutional Review Board (IRB) application material for all research
involving human subjects, which is conducted in programs sponsored by the
Department or in programs which receive funding from or through the State of
Michigan, to the Department's IRB for review and approval, or the IRB
application and approval materials for acceptance of the review of another IRE.
All such research must be approved by a federally assured 1RB, but the
Department's IRB can only accept the review and approval of another
institution's IRB under a formally-approved interdepartmental agreement. The
DC11-0565 FY2009 5102 Page 9 of 18
manner of the review will be agreed upon between the Department's IRB
Chairperson and the Contractor's IRB Chairperson or Executive Officer(s).
II. Responsibilities - Department
The Department in accordance with the general purposes and objectives of this
agreement will:
A. Reimbursement
Provide reimbursement in accordance with the terms and conditions of this
agreement based upon appropriate reports, records, and documentation
maintained by the Contractor.
B. Report Forms
Provide any report forms and reporting formats required by the Department at
the effective date of this agreement, and provide to the Contractor any new
report forms and reporting formats proposed for issuance thereafter at least
ninety (90) days prior to their required usage in order to afford the Contractor an
opportunity to review and offer comment.
Assurances
The following assurances are hereby given to the Department
A. Compliance with Applicable Laws
The Contractor will comply with applicable federal and state laws, guidelines,
rules and regulations in carrying out the terms of this agreement. The
Contractor will also comply with all applicable general administrative
requirements such as OMB Circulars covering cost principles, grant/agreement
principles, and audits in carrying out the terms of this agreement.
B. Anti-Lobbying Act
The Contractor will comply with the Anti-Lobbying Act, 31 USC 1352 as revised
by the Lobbying Disclosure Act of 1995, 2 USC 1601 et seq, and Section 503 of
the Departments of Labor. Health and Human Services, and Education, and
Related Agencies section of the FY 1997 Omnibus Consolidated Appropriations
Act (Public Law 104-208). Further, the Contractor shall require that the
language of this assurance be included in the award documents of all
subawards at all tiers (including subcontracts, sulagrants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
C. Non-Discrimination
1. In the performance of any contract or purchase order resulting herefrom,
the Contractor agrees not to discriminate against any employee or
applicant for employment or service delivery and access, with respect to
their hire, tenure, terms, conditions or privileges of employment,
programs and services provided or any matter directly or indirectly
related to employment, because of race, color, religion, national origin,
ancestry, age, sex, height, weight, marital status, physical or mental
disability unrelated to the individual's ability to perform the duties of the
particular job or position or to receive services. The Contractor further
agrees that every subcontract entered into for the performance of any
DCH-0665 FY2009 5108 (W) Page 10 of 18
contract or purchase order resulting herefrom will contain a provision
requiring non-discrimination in employment, service delivery and access,
as herein specified binding upon each subcontractor. This covenant is
required pursuant to the Elliot-Larsen Civil Rights Act, 1976 PA 453, as
amended, MCL 37.2201 et seq., and the Persons with Disabilities Civil
Rights Act, 1976 PA 220, as amended, MCL 37.1101 et seq., and any
breach thereof may be regarded as a material breach of the contract or
purchase order,
2. Additionally, assurance is given to the Department that proactive efforts
will be made to identify and encourage the participation of minority
owned and women owned businesses, and businesses owned by
persons with disabilities in contract solicitations. The Contractor shall
incorporate language in all contracts awarded: (1) prohibiting
discrimination against minority owned and women owned businesses
and businesses owned by persons with disabilities in subcontracting; and
(2) making discrimination a material breach of contract.
D. Debarment and Suspension
Assurance is hereby given to the Department that the Contractor will comply
with Federal Regulation, 2 CFR part 180 and certifies to the best of its
knowledge and belief that it, its employees and its subcontractors:
1. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by
any federal department or contractor;
2. Have not within a three-year period preceding this agreement been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (federal, state, or local)
transaction or contract under a public transaction; violation of federal or
state antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements,
or receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a
government entity (federal, state or local) with commission of any of the
offenses enumerated in section 2, and:
4. Have not within a three-year period preceding this agreement had one or
more public transactions (federal, state or local) terminated for cause or
default.
E. Federal Requirement: Pro-Children Act
1, Assurance is hereby given to the Department that the Contractor will
comply with Public Law 103-227, also known as the Pro-Children Act of
1994, 20 USG 6081 et sed, which requires that smoking not be permitted
in any portion of any indoor facility owned or leased or contracted by and
used routinely or regularly for the provision of health, day care, early
childhood development services, education or library services to children
under the age of 18, if the services are funded by federal programs either
directly or through state or local governments, by federal grant, contract,
Page 11 of 18 DCH-0555 FY2000 5108 (W)
loan or loan guarantee. The law also applies to children's services that
are provided in indoor facilities that are constructed, operated, or
maintained with such federal funds. The law does not apply to children's
services provided in private residences; portions of facilities used for
inpatient drug or alcohol treatment; service providers whose sole source
of applicable federal funds is Medicare or Medicaid; or facilities where
Women, Infants, and Children (WIC) coupons are redeemed. Failure to
comply with the provisions of the law may result in the imposition of a
civil monetary penalty of up to $1,000 for each violation and/or the
imposition of an administrative compliance order on the responsible
entity. The Contractor also assures that this language will be included in
any subawards which contain provisions for children's services.
2. The Contractor also assures, in addition to compliance with Public Law
103-227, any service or activity funded in whole or in part through this
agreement will be delivered in a smoke-free facility or environment.
Smoking shall not be permitted anywhere in the facility, or those parts of
the facility under the control of the Contractor. If activities or services are
delivered in facilities or areas that are not under the control of the
Contractor (e.g., a mall, restaurant or private work site), the activities or
services shall be smoke-free.
F. Hatch Political Activity Act and Interoovergrnental Pprqnnnpi Arf
The Contractor will comply with the Hatch Political Activity Act, 5 USC 1501-
1508, and the Intergovernmental Personnel Act of 1970, as amended by Title VI
of the Civil Service Reform Act, Public Law 95-454, 42 USC 4728. Federal funds
cannot be used for partisan political purposes of any kind by any person or
organization involved in the administration of federally-assisted programs.
G. Subcontracts
Assure for any subcontracted service, activity or product:
1, That a written subcontract is executed by all affected parties prior to the
initiation of any new subcontract activity. Exceptions to this policy may
be granted by the Department upon written request within 30 days of
execution of the agreement.
2. That any executed subcontract to this agreement shall require the
subcontractor to comply with all applicable terms and conditions of this
agreement. In the event of a conflict between this agreement and the
provisions of the subcontract, the provisions of this agreement shall
prevail.
A conflict between this agreement and a subcontract, however, shall not
be deemed to exist where the subcontract:
a. Contains additional non-conflicting provisions not set forth in this
agreement;
b. Restates provisions of this agreement to afford the Contractor the
same or substantially the same rights and privileges as the
Department: or
OCH-0555 FY2DOD 5toa 0/1•5 Pap 12 of 18
C.
Requires the subcontractor to perform duties and/or services in
less time than that afforded the Contractor in this agreement.
3. That the subcontract does not affect the Contractor's accountability to
the Department for the subcontracted activity.
That any billing or request for reimbursement for subcontract costs is
supported by a valid subcontract and adequate source documentation on
costs and services.
That the Contractor will submit a copy of the executed subcontract if
requested by the Department
H. Procurement
Assure that all purchase transactions, whether negotiated or advertised, shall
be conducted openly and competitively in accordance with the principles and
requirements of OMB Circular A-102 as revised, implemented through
applicable portions of the associated "Common Rule" as promulgated by
responsible federal contractor(s), or 2 CFR, Part 215 (OMB Circular A-110) as
amended, as applicable, and that records sufficient to document the significant
history of all purchases are maintained for a minimum of three years after the
end of the agreement period.
Health Insurance Portability and AccountabilityAct
To the extent that this act is pertinent to the services that the Contractor
provides to the Department under this agreement, the Contractor assures that it
is in compliance with tne Health insurance Portability and Accountability Act
(HIPAA) requirements including the following:
1. The Contractor must not share any protected health data and information
provided by the Department that falls within HIPM requirements except
to a subcontractor as appropriate under this agreement.
2. The Contractor must require the subcontractor not to share any
protected health data and information from the Department that falls
under HIPAA requirements in the terms and conditions of the
subcontract.
3. The Contractor must only use the protected health data and information
for the purposes of this agreement.
4. The Contractor must have written policies and procedures addressing
the use of protected health data and information that falls under the
HIPAA requirements. The policies and procedures must meet all
applicable federal and state requirements including the HIPAA
regulations. These policies and procedures must include restricting
access to the protected health data and iaformation by the Contractor's
employees.
5. The Contractor must have a policy and procedure to report to the
Department unauthorized use or disclosure of protected health data and
information that falls under the HIPAA requirements of which the
Contractor becomes aware.
Page 13 of 13 DCH-00G5 FY2009 5/06 (W)
6. Failure to comply with any of these contractual requirements may result
in the termination of this agreement in accordance with Part II, Section V.
Agreement Termination.
7. In accordance with HIPAA requirements. the Contractor is liable for any
claim, loss or damage relating to unauthorized use or disclosure of
protected health data and information received by the Contractor from
the Department or any other source.
N. Financial Requirements
A. Operating Advance
An operating advance may be requested by the Contractor to assist with
program operations. The request should be addressed to the Contract
Manager identified in Part 1, Item 8. The operating advance will be
administered as follows:
1. The advance amount requested must be reasonable in relationship to
the program's requirements, billing cycle, etc.; and in no case may the
advance exceed the amount required for 60 days operating expense.
Operating advances will be monitored and adjusted by the Department
according to total Department agreement amount.
2. The advance must be recorded as an account payable to the
Department in the Contractor's financial records. The operating advance
payable must remain in the Contractor's financial records until fully
recovered by the Department.
3. The monthly Financial Status Report (FSR) reimbursement for actual
expenditures by the Department should be used by the Contractor to
replenish the operating advance used for program operations.
4. The advance must be returned to the Department within 30 days of the
end date of this agreement unless the Contractor has a recurring
agreement with the Department, and may not be held pending
agreement audit. Subsequent Department agreements may be withheld
pending recovery of the outstanding advance from a prior agreement. If
the Contractor has a recurring agreement with the Department, the
Department requires an annual confirmation of the outstanding operating
advance.
The Department may obtain the Michigan Department of Treasury's
assistance in collecting outstanding operating advances. The
Department will comply with the Michigan Department of Treasury's Due
Process procedures prior to forwarding claims to Treasury. Specific Due
Process procedures include the following:
a. Department offer of a hearing to dispute the debt, identifying the
time, place and date of such hearing.
b. A hearing by an impartial official.
c. An opportunity for the Contractor to examine department's
associated records.
D511-0665 FY2009 5108 1,W) Page 14 of 18
d. An opportunity for the Contractor to present evidence in person or
in writing.
e. A hearing official with full authority to correct errors and make a
decision not to forward debt to Treasury.
f. Contractor representation by an attorney and presentation of
witnesses if necessary.
5. At the end of either the agreement period or Department's fiscal year,
whichever is first, the Contractor must respond to the Department's
request for confirmation of the operating advance. Failure to respond to
the confirmation request may result in the Department recovering all or
part of an outstanding operating advance
B. Reimbursement Method
The Contractor will be reimbursed in accordance with the staffing grant
reimbursement method as follows:
Reimbursement from the Department is based on the understanding that
Department funds will be paid up to the total Department allocation as agreed to
in the approved budget. Department funds are first source after the application
of fees and earmarked sources unless a specific local match condition exists.
C. Financial Status Report Submission
Financial Status Reports (FSRs) shall be prepared and submitted to:
Michigan Department of Community Health.
Bureau of Finance
Accounting Division, Expenditure Operations Section,
P.0_ Box 30720, Lansing, Michigan 48909
FSRs must be submitted on a monthly basis, no later than thirty (30) days after
the close of each calendar month. The monthly FSRs must reflect total actual
pro a rm expenditures. of the source of funds. Attachment D
contains the FSR form. The FSR form and instructions for completing the FSR
form are available through your Contract Manager or the Department's web
site:
• http://www.michigan.govidocuments/DCH-0384-
Financial Status Report 8214 7.pdf and
• hftp://www.micnigar .govidocuments (DC H-0384-
Financial Status Report Instructions 8216 7.pdf.
Failure to meet financial reporting responsibilities as identified in this agreement
may result in withholding future payments.
Page 15 of 1B DCH-065 FYZGO9 5/08 NV)
D. Reimbursement Mechanism
All contractors must sign up through the online vendor registration process to
receive all State of Michigan payments as Electronic Funds Transfers
(EFT)/Direct Deposits, as mandated by PA 533 of 2004. Vendor registration
information is available through the Department of Management and Budget's
web site:
• http://www cpexpress.state.mi.us/
E. Final Obligations and Financial Status Report Requirements
1. Preliminary Close Out Report
A Preliminary Close Out Report, based on annual guidelines, must be
submitted by the due date using the format provided by the Department's
Accounting Division. The Contractor must provide an estimate of total
expenditures for the entire agreement period. The information on the
report will be used to record the Department's year-end accounts
payables and receivables for this agreement.
2. Final FSRs
Final FSRs are due sixty (60) days following the end of the fiscal year or
agreement period. The final FSR must be clearly marked "Final". Final
FSRs not received by the due date may result in the loss of funding
requested on the Preliminary Close Out Report and may result in the
potential reduction in the subsequent year's agreement amount.
F. Unobligated Funds
Any unobligated balance of funds held by the Contractor at the end of the
agreement period wiH be returned to the Department or treated in accordance
with instructions provided by the Department.
V. Agreement Termination
The Department may cancel this agreement without further liability or penalty to the
Department for any of the following reasons:
A. This agreement may be terminated by either party by giving thirty (30) days
written notice to the other party stating the reasons for termination and the
effective date.
B. This agreement may be terminated on thirty (30) days prior written notice upon
the failure of either party to carry out the terms and conditions of this
agreement, provided the alleged defaulting party is given notice of the alleged
breach and fails to cure the default within the thirty (30) day period.
C. This agreement may be terminated immediately if the Contractor or an official of
the Contractor or an owner is convicted of any activity referenced in Section
M.D. of this agreement during the term of this agreement or any extension
thereof.
VI. Final Reporting Upon Termination
Should this agreement be terminated by either party. within thirty (30) days after the
termination, the Contractor shall provide the Department with all financial, performance
and other reports required as a condition of this agreement. The Department will
DCH-0605 FY2009 5/06 (VVI Page 16 ot 18
make payments to the Contractor for allowable reimbursable costs not covered by
previous payments or other state or federal programs. The Contractor shall
immediately refund to the Department any funds not authorized for use and any
payments or funds advanced to the Contractor in excess of allowable reimbursable
expenditures. Any dispute arising as a result of this agreement shall be resolved in
the State of Michigan
VII. Severability
If any provision of this agreement or any provision of any document attached to or
incorporated by reference is waived or held to be invalid, such waiver or invalidity shall
not affect other provisions of this agreement.
VIII. Amendments
Any changes to this agreement will be valid only if made in writing and accepted by all
parties to this agreement. Any change proposed by the Contractor which would affect
the Department funding of any project, in whole or in part in Part I, Section 2.C. of the
agreement, must be submitted in writing to the Department for approval immediately
upon determining the need for such change.
IX. Liability
A. All liability to third parties, loss, or damage as a result of claims, demands,
costs, or judgments arising out of activities, such as direct service delivery, to
be carried out by the Contractor in the performance of this agreement shall be
the responsibility of the Contractor, and not the responsibility of the Department,
if the liability, loss, or damage is caused by, or arises out of, the actions or
failure to act on the part of the Contractor, any subcontractor, anyone directly or
indirectly employed by the Contractor, provided that nothing herein shall be
construed as a waiver of any governmental immunity that has been provided to
the Contractor or its employees by statute or court decisions.
B. All liability to third parties, loss, or damage as a result of claims, demands,
costs, or judgments arising out of activities, such as the provision of policy and
procedural direction, to be carried out by the Department in the performance of
this agreement shall be the responsibility of the Department, and not the
responsibility of the Contractor, if the liability, loss, or damage is caused by, or
arises out of, the action or failure to act on the part of any Department
employee or agent, provided that nothing herein shall be construed as a waiver
of any governmental immunity by the State, its agencies (the Department) or
employees as provided by statute or court decisions.
C. In the event that liability to third parties, loss, or damage arises as a result of
activities conducted jointly by the Contractor and the Department in fulfillment of
their responsibilities under this agreement, such liability, loss, or damage shall
be borne by the Contractor and the Department in relation to each party's
responsibilities under these joint activities, provided that nothing herein shall be
construed as a waiver of any governmental immunity by the Contractor, the
State, its agencies (the Department) or their employees, respectively, as
provided by statute or court decisions.
DCri-0605 FY2009 5roa (W) Page 17 of 1B
X. Conflict of Interest
The Contractor and the Department are subject to the provisions of 1968 PA 317, as
amended, MCL 15.321 et seq, MSA 4.1700(51) et seq, and 1973 PA 196, as
amended, MCL 15.341 et seq, MSA 4.1700 (71) et seq.
XI. State of Michigan Agreement
This is a State of Michigan Agreement and is governed by the laws of Michigan. Any
dispute arising as a result of this agreement shall be resolved in the State of Michigan.
XII. Confidentiality
Both the Department and the Contractor shall assure that medical services to and
information contained in medical records of persons served under this agreement, or
other such recorded information required to be heid confidential by federal or state
law, rule or regulation, in connection with the provision of services or other activity
under this agreement shall be privileged communication, shall be held confidential,
and shall not be divulged without The written consent of either the patient or a person
responsible for the patient, except as may be otherwise required by applicable law or
regulation, Such information may be disclosed in summary, statistical, or other form,
which does not directly or indirectly identify particular individuals.
Page 18 of 18 DCH-0665 FY2009 5108 (W)
ATTACHMENT A
Free Form
Subrecipient
E Vendor
Research and
development project
n Not a research and
development project
STATEMENT OF WORK
Project Summary: Adolescents and young adults will be screened for chlamydia and
gonorrhea at eight Oakland County sites.
1) Oakland County Children's Village Detention
2) Oakland County Children's Village Shelter Care
3) Oakland County Main Jail (including Work Release)
4) Frank Greenan Detention Facility — part of Oakland County Jail
5) Pontiac Teen Health Center - Pontiac Central High School
6) Pontiac Teen Health Center Pontiac Northern High School
7) Waterford Alternative High School — Teen Center
8) Common Ground Sanctuary — County Runaway Shelter
Adolescents and young adults will be offered testing and interviewed using a brief sexual
questionnaire. Treatment and risk reduction counseling will be provided. Screening will be
offered to 13 — 24 y.o that admit to ever having sexual contact. Data will be collected,
analyzed and reported to MDCH and Oakland County (Children's Village and Health Division)
during the project year.
Utilizing the eight identified project sites:
1) Test at least 100 adolescents! young adults each month
2) Provide counseling with a client centered risk reduction plan, promoting abstinence
3) Treat positives or contact released clients with follow-up instructions
4) Enter data from questionnaire and test results into database
5) Analyze data and send report to MDCH every three months
6) Develop data into presentation and present at various professional meetings
7) Continue to promote awareness of STD prevalence within adolescent population
Statement of Work: Contractor agrees to test and treat chlamydial and gonococcal
infections in eight Oakland County sites.
DC11-01565FY200g 5A)8 (W)
ATTACHMENT A
Fill In Form
Subrecipient n Vendor
n Research and development
project
Not a research and development
project
STATEMENT OF WORK
1 Goal: To test and treat adolescents and young adults in eight Oakland County sites for
chlamydia and gonorrhea
Methodology Activities, Responsible Individual(s), Timeline and Deliverable(s
Activity(ies) Responsible Timeline 1 Deliverable(s)
individual(s) 1
Objective Test at least 100 adolescents/ young adults each month for chlamydia and gonorrhea at 8 Oakland
County sites.
[ Project Coordinator Monthly Data updates
and Proiect
Nursing Staff
Objective Treat positives, encourage partner notification, follow-up on positive clients that were released prior
to treatment
Project Nursing Throughout Report all positives tests to OCHD
Staff project year with treatment information
1
Objective Analyze and forward data to MDCH
---r Project Coordinator Quarter)/ Quarterly data reports
Objective Present findings to various professional groups —
Project Coordinator Throughout I Written and oral presentations
project year _
1
GH-m65FY2009 5108 (W}
ATTACHMENT 8.1
- View at 100% or Larger
Use WHOLE DOLLARS Only
PROGRAM BUDGET SUMMARY
NECHIGAN DEPARTMENT OF COMMUNITY HEALTh
PROGRAM DATE PREPARED Page Of
Children's Village Screening Project 719108 1 1
CONTRACTOR NAME BUDGET PERIOD
Oakland County Children's Village From:October 1, 2008 To! September 30, 2009
MAILING ADDRESS (Number and Street) BUDGET AGREEMENT AMENDMENT #
1200 N. Telegraph Rd. Department 444 XJ ORIGINAL 0 AMENDMENT 110.
CITY I STATE -f• ZIP DDDE FEDERAL ID NUMBER
Pontiac i MI 1 38-6CQ4875 i l 48341
EXPENDITURE CATEGORY TOTAL BUDGET _
1. SALARIES & VVAGES I 56,040
1--- 2. FRINGE BENEFITS
I-----
6,024
3. TRAVEL 750
4. SUPPLIES & MATERIALS
318 J –
5. CONTRACTUAL (Subcontracts/Subrecipients) 2,000
6. EQUIPMENT i ----
--1- 7 OTHER EXPENSES
—
_
8. TOTAL DIRECT EXPENDITURES 1 SO $0 $0 $65,732
(sum of Lines 1-7)
9. INDIRECT COSTS: Rate #1 1297% $7,268
INDIRECT COSTS Rate #2 %
10. TOTAL EXPENDITURES $0 $0 $0 ii(
SOURCE OF FUNDS
11, FEES & COLLECTIONS I
12. STATE AGREEMENT
$73000 ,
13. LOCAL
14, FEDERAL
15. OTHER(S)
16. TOTAL FUNDING $O $0 1 $0 $73,000
kUTHORITY: PA 368 of 1978 The Department of Community Health is an equal
OMPLETION: Is Voluntary, but is required as a Qondition of furding opportunity employer, services arid programs provider.
101-0565FY2009 5/08 CW)
ATTACHMENT B.2
PROGRAM BUDGET COST DETAIL SCHEDULE
View at 100% or Larger MICHIGAN DEPARTMENT OF COMMUNITY HEAL r1-1
Use WHOLE DOLLARS Only _
Page 2 of 2
[PROGRAM BUDGET PERIOD DATE PREPARED
Children's Village Screening Project r From: I—To:
' October 1, 2008 ; September 30, 719/08
.1 2009
CONTRACTOR NAME i BUDGET AGREEMENT
Oakland County Cnildrerrs Village I XDORIGINAL [ JAMENDMENT AMENDMENT #
1. SALARY & WAGES POSITIONS
COrvimENTs TOTAL SALARY POSITION DESCRIPTION REQUIRED - — _
General Staff Nurse PTNE 100% Funded 1.QD $55,040
$o
Sc
$o
SO
SO
so _
1 TOTAL SALARIES & WAGES:
I.
$56,040 i
2. FRINGE BENEFITS (Specify)
X • FICA OLIFE INS, E DENTAL INS, COMPOSITE RATE
XDUNEMPLOY INS. ['VISION INS. DWORK COMP. AMOUNT 10.75%
DRETIREMENT DHEARING INS.
• HOSPITAL INS. DO THER (specity) 2. TOTAL FRINGE BENEFITS: $6.024
3. TRAVEL (Specify if category exceeds 10% of Total Expenditures)
3 TOTAL TRAvEL: I $750
4. SUPPLIES & MATERIALS (Specify if category exceeds 10 0/v of Total Expenditures)
4. TOTAL SUPPLIES & MATERIALS: $318 _
5. CONTRACTUAL (Specify Subcontracts/Subrecipients)
Name Address Amount
North Oakland Meoical Center 461 West Huron Street $200000
(Teen Hearth Centers in Pontiac. MI 48341
Pontiac Schools)
$2,000
6. EQUIPMENT (Specify items)
0. TOTAL EQUIPMENT: 0
7. OTHER EXPENSES (Specify if category exceeds 10% of Total Expenditures)
Penbase Computer Tech Support and Equipment
7. TOTAL OTHER:. $600
8. TOTAL DIRECT EXPENDITURES (Sum of Totals 1-7) 0. TOTAL DIRECT EXPENDITURES: $65,732
9. INDIRECT COST CALCULATIONS Rata 141: Base $05,732 X Rate 12.97% Total $7,268
Rate #2: Base $0 X Rate 0.0000 % Total $ 0
9. TOTAL INDIRECT EXPENDITURES: $ 0
10. TOTAL EXPENDITURES (Sum of lines 8-9) $73,000
JCI-1-0665P(2009 5/08 (W)
ilk
:I AUTHORITY! PA. 388 Of 1978 TThe Department of Community ilealtn /5 an equal opportunity emplOyer, services 1 COMPLETION: Is Voluntary, but is required as a corldition of funoino 1 and programs provide:.
DCH-03116 (E) (Rev 5-Os) (W) Previous Edition Obsolete. Use Additional Sheets as Needed
)C1-1-0665FY2009 5/08 (W)
ontractorrs Signature: Date:
ATTACHMENT B.3
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
CONTRACT MANAGEMENT SECTION
EQUIPMENT INVENTORY SCHEDULE
Please list equipment items that were purchased during the grant agreement period as specified in the grant
agreement budget's cost detail schedule - Attachment 8.2. Provide as much information about each piece as
possible, including quantity, item name, item specifications: make, model, etc. Equipment is defined to be an
article of non-expendable tangible personal property having a useful life of more than one (1) year and an
acquisition cost of $5,000 or more per unit. Please complete and forward to this form to the MDCH contract
manager with the final progress report,
Contractor Name: Oakland County Children's V Ilaoe Contract #. Date:
Quantity Item Name Item Specification Tag
Number
Purchased
Amount
$
_
$
$
_
$
$
$
$
Total
CH-0e65FY2009 5/0e (W)
ATTACHMENT C
Oakland County Children's
PERFORMANCE / PROGRESS REPORT REQUIREMENTS
A. The Contractor shall submit the following reports on the following dates:
Quarter Due
Oct. 1 - Dec. 31, 2008 Jan. 15, 2009
Jan 1 - Mar. 31, 2009 April 15, 2009
April 1 - June 30, 2009 July 15, 2009
July 1 - Sept. 30, 2009 Oct. 15, 2009
Reporting Format:
1. Agency name, address, telephone and fax number;
2. Name and title of contact person;
3. Any program level changes, including changes in staff, services, catchment
areas, etc. ;
4. Narrative description of progress toward established contract objectives.
Specifically, list each programmatic objective and a description of progress
toward that objective;
5. Narrative description of major program and service accomplishments not
directly related to the established goals and objectives:
6. Narrative discussion of any issues at the agency level that impact ability to
achieve stated goals and objectives;
7. New services added during the quarter;
8. Cost saving efforts. including areas where cost savings were achieved and
how this was accomplished:
9. Staff development and training activities related to client-level service
provision.
Any such other information as specified in the Statement of Work, Attachment A
shall be developed and submitted by the Contractor as required by the Contract
Manager,
C. Reports and information shall be submitted to the Contract Manager at:
Kristine Judd, STD Administrative Manager, Division of Health, Wellness and
Disease Control, 3056W. Grand Blvd., Ste. 3-150, Detroit, MI 48202
D. The Contract Manager shall evaluate the reports submitted as described in
Attachment C, Items A. and B. for their completeness and adequacy.
E. The Contractor shall permit the Department or its designee to visit and to make
DCH-0885FY2009 5/08 11N)
- an evaluation of the project as determined by Contract Manager.
DC11-0665FY2009 5/08 (W)
*LOUP k (IMM!INIT'Y HPA !ART k T C MFN
,
FINANCIAL STAtUS REPORT
vicHIGANC
ATTACHMENT D
Dale F r e
Contact Person Name I 'eiechone Number
Contract Number Page I Of l
. I
Local Agency Name program Code
Street Address Report Period Date Prepared
1_ Thru Final
City. State, ZIP Code Agreement Period FE ID Number
Thru
11n1_—_____,
Category Expenditures Agreement
Current Period Agreement YTD Budaet •1n1111111 -
1. Salaries & Wages . ,
2_ Fringe Benefits
-
3. Travel _
4. Supplies & Materials ,
5. Contractual (Sub-COntracts)
- • 6. Equipment _1 _
7. Other Expenses
..
. _
I I _
e TOTAL DIRECT _
9a.Indirect Costs Rate #1 2/43
9b.Indirect Costs Rate #2:21.
. _
_
10. TOTAL EXPENDITURES
SOURCE OF FUNDS:
11, State Agreement
12. Local
_ 1 13. Federal
_
14. Other
15. Fees & Collections
16. TOTAL FUNDING
k
CERTIFICATION: I certify tnat I am authorized to sign on behalf of the local agency and that tnis is an accurate statement of expenditures and ceoctions for
the report period. Appropriate documentation is aval'able and will be maintained for the required period to support costs and receipts reported
Authorized Signature
Advance '111r1.17NDEX PCA A OBJ. CODE ..... AMO N
Advance Outstanding
_
Advance Issued or Applied I
1
Balance Ii
Message
Authority: P.A. 368 of 1978
Completion: 's a Condition of Reimbursement
DCH-0384(E) (Rev. 4104) oh) Previous Edition Obso'ete
The Department ai Community Health is an equal opOrtunity.
F-rnnlnvr C.Pnhr-pc a ru,l_ rtrnnrnrric
0CH-Go65FY2009 5108 (W)
0
FISCAL NOTE (MISC. #08188) September 18, 2008
BY: FINANCE COMMITTEE, MIKE ROGERS, CHAIRPERSON
IN RE; DEPARTMENT OF HEALTH AND HUMAN SERVICES/CHILDREN'S VILLAGE DIVISION
FY 2008 -2009 CHILDREN'S VILLAGE SCREENING PROJECT GRANT-ACCEPTANCE
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen;
Pursuant to Rule XII-C of this Board, the Finance Committee has
reviewed the above-referenced resolution and finds:
1. The Michigan Department of Community Health (?CH) has awarded
funding in the amount of $73,000 to the Oakland County Children's
village for use in monitoring sexually transmitted diseases in
adolescents in special settings. This is the ninth year of
funding for the Adolescent Screening Project.
2. The special revenue part time non-eligible General Staff Nurse
(position 4t09652) will be continued.
3. The grant period runs from October 1, 2008 through September 30,
2009.
4. The County is expected to incur indirect costs of $7,568 for FY
2009, which has been budgeted in the FY 2009 Special Revenue
Budget. Indirect cost will be recorded as part of salaries and
wages on the report to the State.
5. The Fiscal Year 2009 County Executive Recommended Budget includes
costs associated with this program, therefore, no budget
amendments are recommended.
FINANCE COMMITTEE
FINANCE COMMITTEE;
Motion carried unanimously on a roll call Vote with Kowall, Middleton and
Long absent.
Resolution #08188 September 18, 2008
r=in
• .110
Moved by Rogers supported by Burns the resolutions (with fiscal notes attached) on the Consent Agenda
be adopted.
AYES: Burns, Clark, Coleman, Coulter. Crawford, Douglas, Gershenson, Gingell, Gosselin,
Gregory, Greimel, Hatchett, Jacobsen, KowaII, Long, Middleton, Nash, Potter, Potts, Rogers,
Scott, Spector, Woodward, Zack, Bullard, (25)
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 18, 2008, 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 18th day of September, 2008.
Gat
Ruth Johnson, County Clerk