HomeMy WebLinkAbout06/02/2003 Item 044
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i) INTERGOVERNMENTAL AGREEMENT
(IGA) ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 West Adams, Room 303
Contract
No. HG354356
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Project Title: Tobacco Education Prevention Program
Begin Date: July 1, 2003
Geographic Service Area: Mohave County
Termination Date: June 30, 2008
Arizona Department of Health Services has authority to contract for services specified herein in accordance with A.R.S. 99 11-951, 11-952,
36-104 and 36--132. The Contractor represents that it has authority to contract for the performance of the services provided herein pursuant
to:
~ Coo",;..,
A.R.S. ~~ 11-201, 11-951, 11-952 and 36-182.
Indian Tribes:
A.R.S. fifi 11-951, 11-952 and the rules and sovereign authority of the contracting Indian Nation.
School Districts:
A.R.S. fifi 11-951, 11-952, and 15-342.
City of Phoenix:
Chapter II, fifi 1 & 2, Charter, City of Phoenix.
City of Tempe:
Chapter 1, Article 1, fifi 1.01 & 1.03, Charter, City of Tempe.
Other:
The Contractor agrees to perform all the services set forth in the Agreement and Work Statement. Amendments signed by each of the parties
and attached hereto are hereby adopted by reference as a part of this Contract, from the effective date of the Amendment, as if fully set out
herein.
FOR CLARIFICATION, CONTACT:
Arizona Transaction (Sales) Privilege:
Name:
Federal Employer Identification No.:
Phone:
Tax License No.:
FAX No.:
Contractor Name: Mohave Countv
Health Deoartment
Address' PO Rox 7000
Kingman, AZ. 86402
City,
State Zip Code
Signature of Person Authorized to sign Date
Pursuant to A.R.S. 9 11-952, the undersigned Contractor's
This contract shall henceforth be referred to as Contract
Attorney has determined that this Intergovemmental Agreement is in
No. HG354356
The Contractor is hereby cautioned not to
proper form and is within the powers and authority granted under the
commence any billable work or provide any material, service or
laws of Arizona.
construction
under this contract until Contractor receives a fully
executed copy of the contract.
State of Arizona
Signed this day of
,2003
Procurement Officer
Attorney General Contract, No.
KR 3 - OS-~ . which RESERVED FOR USE BY THE SECRETARY OF STATE
is an Agreement between public agencies, has been reviewed
pursuant to ARS. 9 11-952 by the undersigned Assistant Attorney
General, who has determined that it is in the proper form and is within
the powers granted under the laws of the State of Arizona to those
parties to the Agreement represented by the Attorney General.
The Attorney General, BY:
Signature
Date
Print Name, Assistant Attorney General
1
Contract Number
INTERGOVERNMENTAL AGREEMENT
HG354356
SPECIAL TERMS & CONDITIONS
1.
CONTRACT TYPE:
This Intergovernmental agreement shall be a Cost Reimbursement based upon the itemized service budget.
2.
CONTRACT TERMINATION (CONTRACTOR}
a. The Contractor, in addition to other
rights set forth elsewhere in the Contract, may at any time terminate this
Contract with thirty (30) days notice
in writing specifying the termination date. Such notices shall be given by
personal delivery or by certified
mail, return receipt requested.
b. If the Contractor terminates this
Contract, any monies prepaid by the State, for which no service or benefit was
received by the State, shall be
refunded to the State within 5 days of the termination notice. In addition, the
Contractor shall indemnify the State
for any sanctions imposed by the funding source as a result of the
Contractor's failure to complete
the Contract.
3.
TITLE TO EQUIPMENT
a. The title to any and all equipment
acquired through the expenditure of funds received from the Department shall
remain in the Department. The acquisition
of any such property must be specifically authorized in advance by the
Program Manager and for property
such as a motor vehicle, which has a document evidencing title, the title shall
be acquired in the name of the Department.
Upon Contract termination the Department shall determine
disposition of all property.
b. The Contractor agrees to exercise
reasonable control over all equipment purchased with capital outlay expense
Contract funds. All equipment lost,
stolen, rendered unusable or no longer required for program operation must
be reported immediately to the Department
for disposition instructions. The Contractor shall conduct a physical
inventory of equipment, using forms
supplied by the Department, within sixty (60) days after the end of the
Contract.
10
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Contract Number INTERGOVERNMENTAL
AGREEMENT
HG354356
SCOPE OF WORK
(MOHAVE COUNTY)
I. BACKGROUND
The Arizona Department of Health Services Tobacco Education and Prevention Program (ADHS TEPP) contracts
with county health departments. community health centers, and Arizona Native American tribes to conduct
tobacco education and prevention programs to address the issue of prevention of tobacco use, cessation, and
reduction of exposure to secondhand smoke. These contracts are referred to as the "Local Projects". TEPP has
also contracted for a statewide media campaign, quit line, and training and technical assistance resources. Local
Project activities are conducted in conjunction with these other statewide activities. All services requested follow
from the goals and objectives of the statewide tobacco use prevention strategic plan.
II. OBJECTIVES
The contractor shall provide a comprehensive tobacco education and prevention program at the county level in
the following areas:
A.
Basic Service Area #1: Program Administration and Community Planning
B.
Basic Service Area #2: Prevention
C.
Basic Service Area #3: Cessation
D.
Basic Service Area #4: Tobacco-Free Environments
III. TASKS
The contractor shall:
Basic Service Area #1
Task 1: The Contractor shall develop
a comprehensive 3-year strategic plan that will provide tobacco
education, prevention, cessation
and secondhand smoke activities within its county.
Basic Service Area #2
Task 1: The Contractor shall provide
a tobacco prevention program through school-based education and
community based prevention.
Task 2: The Contractor shall provide
merchant education to its retailers in an effort to reduce youth
access to tobacco products.
Basic Service Area #3
Task 1: The Contractor shall provide
a cessation program that targets individuals that already use
tobacco.
Task 2: The Contractor shall provide
cessation service training for health care providers.
Basic Service Area #4
Task 1: The Contractor shall assist
in the creation of tobacco free environments by promoting tobacco
free homes and tobacco free workplaces.
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Contract Number INTERGOVERNMENTAL
AGREEMENT
HG354356 SCOPE OF WORK
IV. REQUIREMENTS
The contractor shall:
Basic Service Area #1
A. Mohave County Tobacco Use Prevention
Program (MCTUPP) shall develop a comprehensive 3-year
strategic plan by August 1, 2003.
B. To promote tobacco free social norms
and build capacity tailored to unique communities to sustain a
tobacco free Arizona.
C. Plan countywide strategic planning
sessions to inform key leaders and decision-makers of our program's
goals (2003). Include representation
from all areas of our recommended programs.
D. Develop goals for coalition participation
yearly and review quarterly.
E. Develop an annual action plan for
our program in the fall of 2003, identify agencies and or subcontractors
to provide tobacco education, prevention
and cessation services.
F. Maintain staffing to petiorm needed
community service.
G. Maintain countywide quarterly newsletter
and distribute to key officials.
H. All staff will participate in on
going training regarding disparity populations.
I. MCTUPP team will be diverse and
reflective of county demographics.
J. Will provide service to disparity
population by providing specific groups, using culturally sensitive
materials, and providing groups
within their community
Basic Service Area #2
A. Establish and monitor standards
for prevention services, ongoing.
B. The following youth will be exposed
to prevention pro~ramming in alignment with CDC: 4th_8th grade in
Lake Havasu City, 4th_8th grade
in Bullhead City, 4th_8 h grade in Kingman and 4th_8th grade in outlying
school districts. Youth will be
exposed to an intensive tobacco prevention education.
C. Provide a peer led tobacco prevention
education program in 3 communities, such as Kingman, Bullhead
City, Lake Havasu City, etc.
D. Provide one-time tobacco prevention
and education presentations as requested to school boards, city
councils, etc..
E. Provide after school tobacco education
to youth in Kingman.
F. Conduct prevention media campaign
with the state.
G. Develop and implement a plan to include administrators and parents in the prevention/education process.
H. Develop and implement a 3yr community
educational campaign for Mohave County on tobacco
prevention.
I. Coordinate and/or participate in
12 community-wide events yearly, such as the County Fair, Kick Ash
Bash, World No Tobacco Day, Great
American Smokeout, etc.
J. Implement Operation Storefront activities
and educate the community on the results yearly. Tobacco
merchants will be surveyed regarding
placement and promotion of tobacco products yearly.
K. 50% of those merchants in non-compliance
will be provided merchant education.
L. Educate Political Officials and
Community Leaders on youth access to tobacco issues.
M. Maintain active youth coalitions throughout Mohave County. MCTUPP staff member will attend meetings
biannually.
Basic Service Area #3
A. Provide cessation programs, 30 classes
a year throughout the county.
B. Provide clients with NRT including
patch, gum, & Zyban.
C. Continue to make referrals to the
Arizona Smokers' Help-line as needed.
D. All MCTUPP Cessation Facilitators will be trained and successfully complete the following: ACS Fresh
Start Program, Basic Cessation Skills
and Treatment Specialist. Two MCTUPP staff will be trained to be
providers of all of the cessation
certification programs.
E. Maintain relationship with WIC,
and continue to educate them on our program progress. Train any new
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Contract Number INTERGOVERNMENTAL
AGREEMENT
HG354356
SCOPE OF WORK
WIC CNW's in Basic Skills and provide refresher course as needed.
F. Provide 6 Brief interventions
training to the Health Care provider population.
G. Develop proactive referrals for
four Healthcare providers within the county.
H.
Provide cessation program to youth in County 4 times a year.
\.
A diversion program will be offered at each of the tri cities.
J.
Provide a cessation class to local college students 2 times a year.
Basic Service Area #4
A.
Update countywide businesses and categorize:
Retail/Convenience, Hotel, Restaurant & bars, 35+
employees, Government, and private to determine best way to deliver smoke-free worksite education and
information.
B.
80% of the county businesses will be surveyed regarding Tobacco Policy and Procedures, Synar, and
smoke-free rooms, cessation needs, etc.
C.
MCTUPP will work with ACS, Tobacco Free Environment Team to identify worksite willing to participate in
their Wellness Program (2003). Yearly expansion planned.
D.
Tobacco-Free worksite manuals will be given out to new businesses yearly.
E.
Utilize media advocacy opportunities to promote tobacco free businesses yearly.
F.
Smoke free dinning guides will be updated yearly and available for distribution.
G.
Information cards on effects of second hand smoke will be given out quarterly at coalition meetings and
community events.
H.
300 Healthy Home packets will be distributed yearly.
I.
Increase smoke-free work places by 15% by 2006. Develop baseline the first year; increase by 5% the
second year and additional 10% the third year.
J.
Monitor tobacco free environments at public schools and facilities.
V. DELlVERABLES
A.
3-Year Strategic Plan, Due August 1, 2003.
B. Quarterly Reports, Due 15 days
after the end of each quarter.
C. Annual Report, Due 15 days after
the end of the fiscal year. This report also replaces the 4th quarter
report.
D.
Contractors Expenditure Report, Due the 20th day of the month following the service month and/or
incurred expenditures.
VI. NOTICES
Notices, Correspondence, Billings/Contract
Expenditures and Reports from the Contractor to ADHS
shall be sent to:
Arizona Department of Health Services
Tobacco Education and Prevention
Program
1740 W Adams, Room 203-S
Phoenix, Arizona 85007
Program related Notices, Correspondences
and Reports from ADHS to the Contractor shall be sent
to:
Mohave County Department of Health
and Social Services
Tobacco Use Prevention Program
Coordinator
P.O. Box 7000
Kingman, Arizona 86402
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Contract Number INTERGOVERNMENTAL
AGREEMENT
HG354356
PRICE SHEET
Cost Reimburse'ment
Initial Period SFY04
*SFY 05 Proposed *SFY 06 Proposed
7/1/03 to 6/30{04'; ", "
7/1/04 to 6/30/05 7/1/05 to 6/30/06
1.Personnel
$170.180 *$191,025
*$199,850
2. ERE
55,365
61,293 65,871
3. Professional & Outside
215,902 282,355
288,645
4. Travel Expenses
14,760 16,184
16,184
5. Other OperatinQ
25.433 27,803
29,383
6. Capital Outlay
0
0
0
7. Other (Indirect)
0
0
0
TOTAL Not to Exceed
$481,640
*$578,660 *$S99,932
*NOTE:
The initial bUd<<:Jet period is SFY 04 Julv 1. 2003 to June 30, 2004.
Each new SFY (budget period),
is dependent upon availability of funding for that budget period.
therefore in the event the State
exercises its option to extend the contract for additional periods
(budget periods, e.g., FYOS, FY06,
etc), the Contractor is cautioned that the State of Arizona
does not automatically grant any
increase at the time of extending the (budget period), and that if
an increase is requested, documentation
of need must be provided at the time of the budget
extended period. The requested
increase shall be open to discussion and a factor in the decision
on whether to extend the budget
period.
1. ITEMIZED SERVICE BUDGET RESTRICTIONS:
A. The IS8 shown is considered to
represent the funds available. Unexpended funds do not carry
forward to subsequent fiscal years.
Professional Service Contracts which are expected to be on
going, that is, those that are
for continuing services must be funded on an annual basis and carry
the same wording regarding unexpended
funds for each year of the Contract.
B. Any changes to the ISB line items
of Personnel, ERE, or Capital Outlay Expenses shall require a
written amendment. pursuant to
the Uniform Terms and Conditions, paragraph
5.1."Amendments". Any changes
to the ISB line items of Professional and Outside Services,
Travel Expenses. Other Operating
or Other that are equal to or greater than 10% of that line item
during the term of the contract
shall also require a written amendment.
2. REPORTING REQUIREMENTS/PAYMENTS:
A. Upon receipt of the required reporting
documents, ADHS shall reimburse the Contractor in
accordance with the contract Uniform
Terms and Conditions, for actual, allowable costs incurred
in the delivery of services identified
in the Scope of Work during the term of this agreement.
B. Each month the Contractor shall
submit to the Program, an ADHS Contractors Expenditure
Form (F11 0) for reimbursement
of actual expenditures by the 20th day of the following month.
Upon receipt of the CER the report
will be reviewed and either approved for payment or advise
the Contractor of any errors or
disputes. Upon resolution of any disputes payment will proceed.
C. At the discretion of the Department of Health Services, invoices submitted for payment in excess
of 45 days after the closing of
the month being invoiced may not be paid.
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Mohave County Department of Health and Social Services
Budget Preparation Worksheet
2002.2003
Grant Year Jul - Jun
Tobacco Use Prevention 225-04-5125
05/,6/2003 '4:55
o :\healthde\aelmsh" relbu d,mt04 \ Tobacco Budoet. xis
FY03104
FY03!04 FY03lO4
Difference
Acct
Requested
Revised Change Requested
Request
Number DescriDtion
Budqet
BudQet New Contract
Vs. Base
335.70 State Grants Heaith
($600,206.00)
($600,206.00) 1481.640
118,566
390.00 MisCellaneous Revenues
0
390.50 Miscellaneous Revenues
0
399.00 Transfer from General Fund
0
Total Revenues
($600,206.00
($600,206.00 ($481,640.00
118,566
401.10 SalarieslWages
$163,571.00
$163.571.00 163.571
0
401,20 Overtime
0
401.30 Temporary Employees
0
401.40 Short Term Disability
0
401.90 Market Study Adjustment
0
401,95 Split Fur"J Salary Allocation
$312.00
5312.00 312
0
402.00 Employee Benefits
0
402.10 FICA
$12.02500 5 12,02500
12,025
0
402.20 Unemployment Compensation
0
402.30 Health Insurance
$24,044,00 $24,044.00
24,044
0
402.40 Workers Compensation
$50700
$507.00 507
0
402.60 State Retirement
$9.324.00
$9,324,00 9.324
0
402.95 Snlit Fund Benefit Allocation
($394.00)
($394.00) (394)
0
PERSONAL
$209.389.00 $209.389,00
209,389
0
411,00 Office Supplies
$2,700.00
$2,700.00 2.700
0
411.40 Copies D<,plicating Supplies
$750,00
$750.00 7,,0
0
411.50 Data Processing Supplies
0
412.30 Drugs & Chemicals
$0.00
$0.00 0
0
412.50 Cleaning Supplies
0
412.60 Fuel, Oil & Lubricants
$ 1.000.00
$1,000.00 1,000
0
412.90 Mise, Operating Supplies
$600.00
$600,00 600
0
413.90 Miscellaneous Repair Supplies
0
414.00 Small Tools
$2.00000
$2,00000 2,000
0
414.02 Equipment
0
414.04 Furniture