HomeMy WebLinkAboutDWS-Workforce Dev 10/06-9/07
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] State Copy
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DWS AGREEMENT
by and between
The Department of Workforce Development (DWD)
and
City of Oshkosh Health Department
This Agreement, which includes Appendix A and Exhibit 1, is entered into by and between the
Division of Workforce Solutions (DWS) on behalf of the Department of Workforce Development
(DWD), whose principal address is 201 East Washington Avenue, P.O. Box 7972, Madison,
Wisconsin 53707-7972, hereinafter referred to as the Purchaser (sometimes referred to as the
Grantor), and City of Oshkosh Health Department, whose principal address is 215 Church
Avenue, P.O. Box 1130, Oshkosh, Wisconsin 54903, hereinafter referred to as the Provider
(sometimes referred to as the Grantee). This Agreement covers the period of October 1,2006
through September 30,2007, except as provided in the attachment (s).
WHEREAS, the Purchaser wishes to grant funds to the Provider as it is authorized to do so by
Wisconsin law; and,
WHEREAS, the Provider is engaged in administering the desired services; and,
NOW, THEREFORE, in consideration of the mutual undertaking and agreements hereinafter
set forth, the Purchaser and the Provider agree as follows:
Definitions:
1. "Agreement Appendix" means an addition to the main body of the agreement,
which is attached prior to the parties signing the agreement. An appendix does
not require signatures of either party.
2. "Agreement Modification" means an addition to the main agreement, which is
attached after both parties have signed the agreement. A modification requires
the signature of both parties or their designees.
3. "Agreement Supplement" means a signed unilateral letter from the Purchaser
which notifies the Provider that funds will be added to or will be decreased from
the agreement but does not require signature of the Provider.
I. Services to be Provided
A. Service Description
A detailed description of the services to be provided and the Provider's means of
delivering them shall be contained in the attached appendix(ces).
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B. Adherence to State and Federal Rules and Regulations
The Provider shall administer the programs as specified in the attached
appendix(ces) according to the directives of the Purchaser including those
contained in or amended during the period of the agreement. Specific
references are included in the attached appendix(ces).
II. Funding of Services
A. Payment for services is provided in accordance with the terms and conditions of
this agreement. This amount is contingent upon receipt of funds by the
Department. Specific funding amounts are enumerated in the attached
appendix(ces).
B. De-obligation of Funds
1. Mid-Period: The Purchaser may de-obligate unexpended funds via an
agreement supplement when the agreement is under spent by 20 percent
or more on a year-to-date basis. The funds allocated in future
agreements may be reduced accordingly.
2. End of Agreement Period: the Purchaser shall consider unused funds as
de-obligated funds at the end of the period, unless carry-over authority is
granted in writing by the Purchaser.
C. Cost Allocation Plan and Overhead Rate
The overhead rate shall be in accordance with a cost allocation plan prepared by
the Provider. This plan must be available for review as of the date a claim is
made and must conform to federal and state requirements. The Provider's
auditor must include procedures in the annual audit to evaluate compliance with
applicable federal and state requirements.
III. Payment for Services
A. Payment Process
The Purchaser shall make payments to the Provider based upon the following
provisions:
1 . Payment to the Provider shall be initiated upon receipt by the Purchaser
of a monthly expenditure report (invoice), itemizing total Provider
expenditures related to those services provided under Section II of the
applicable appendix (ces).
2. The Purchaser will not make advance payments.
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3. The Purchaser shall reimburse the Provider for all such allowable
expenditures that are reported, up to the funding level specified in this
Agreement. Payments shall be used for only current agreement period
expenses, as defined by the attachment(s).
4. Payments may be reduced or recovered by the Purchaser anytime during
the agreement period if the Purchaser determines that payments have
been in excess of reported allowable costs or if payments outstanding are
not supported by average monthly reported expenditures.
B. Expenditure Reports
Claims for reimbursement must be submitted electronically to
dwdgrants@dwd.state.wLus. The Expenditure Report form is available at
http://dwd.wisconsin.qov/core/forms. htm
1. The Expenditure Report must be submitted to the Purchaser by close of
business (4:30 pm CT) on or before the 20th day of the month following
the month for which reimbursement is being claimed. The Department
will issue the reimbursement using direct deposit on the last day of the
same month, subject to reduction, recovery and reimbursement as
provided in this Agreement. Late reports will be processed in the next
month's payment cycle.
If the 20th day of the month and/or the last day of the month fall on a non-
business day (per the State of Wisconsin calendar), the Expenditure
Report due date and/or reimbursement date become the next business
day. For example, the Expenditure Report for April, 2006 expenditures
that is due in May is due no later than 4:30 pm CT on May 22nd and the
reimbursement date will be the last day in May. The reimbursement for
March expenditures due to DWD on April 20th will be deposited to agency
accounts on May 1 st.
2. DWD requires all grants to be paid through an Automatic Clearing House
payment (direct deposit). ACH payments will be deposited into your
agency's account according to your agency's contract terms. To begin
receiving ACH payment, complete the ACH Set-Up form available at
http://dwd.wisconsin.Qov/core/forms.htm sign and submit to the address
on the form.
3. The Department can not pay Expenditure Reports that are incomplete.
Expenditure Reports that do not contain all required information will be
returned to the agency to be completed and resubmitted. Resubmitted
claims will be paid with the next regular payment cycle. It is important to
fill in all fields, with the CORe Agency Number and the Reporting Period:
both month and year, being the most critical. See form details for
appropriate file naming conventions.
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Program expenditures and descriptions of allowable costs are further described
in the Office of Management and Budget (OMB) Circulars OMB A-87, A-122 and
A-21 or the program policy manual. http://www.whitehouse.gov/omb/circulars/
If your agency is not able to submit the form electronically, contact Sue Losen of
DWD Finance at (608) 266-7915 for instructions. A copy of the report must also
be forwarded to the Division of Workforce Solutions Contract Manager
(Purchaser's employee responsible for day-to-day administration of the
Agreement).
C. Final Expenditure Report
The Provider shall submit all claims for reimbursement under this agreement to
the Purchaser within 90 days of the end of the period as specified in each .
attachment. Expenses incurred within the agreement period and reported later
than 90 days will not be recognized, allowed or reimbursed under the terms of
this agreement.
D. Return of the Excess Payments
The Provider shall return to the Purchaser any funds paid to the Provider in
excess of the allowable costs of services provided under this agreement within
30 days of notification by the Purchaser (Allowable costs are defined by OMB
Circulars A-87, A-122 and A-21, the attachment(s) to this agreement, and/or the
program policy manual). If the Provider fails to return funds paid by the
Purchaser in excess of the allowable costs of the services provided, the
Purchaser may recover from the Provider any funds paid in excess of the
conditions of this agreement from subsequent payments made by the Purchaser
to the Provider or may recover such funds by any legal means.
IV. Reporting and Monitoring
A. General Requirements
The Provider shall comply with the reporting and auditing requirements of the
Purchaser. Any required reports shall be forwarded as directed by the
Purchaser. The Provider shall report all costs, as requested by the Purchaser,
for federal reporting purposes.
B. Noncompliance
The Provider shall provide written notice to the Purchaser of all instances of
noncompliance with the terms of this agreement, including noncompliance with
any written assurance provided by the Provider to the Purchaser. Notice shall be
given as soon as practical, but in no case later than 30 days after the Provider
knows, or should have known, about the noncompliance. The written notice
shall include information on reason(s) for and effect(s) of the noncompliance. If
the Purchaser becomes aware of noncompliance with this agreement, either
through notice from the Provider or through other means, appropriate
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procedures shall be instituted to protect the interest of the Purchaser. If audits
or other required information are not submitted timely, sanctions may be applied.
C. Participant Reporting
The Provider shall submit data necessary to comply with federal and state
requirements. The Purchaser agrees to minimize the Provider's effort
associated with this reporting.
D. Consequence of Failure to Submit Reports
Failure to report expenditures and the clients served as specified above shall
result in the loss of these funds by the Provider and the repayment by the
Provider to the Purchaser.
E. Monitoring
The Purchaser's review and monitoring of the Provider's programs covered
under this agreement may occur anytime during the year. The purpose of the
monitoring visits will be to determine the extent of compliance with this
agreement and applicable federal laws and regulations, state statutes and
administrative rules, or Department policy. Monitoring reviews may also include
performance assessments based on the Provider's state approved proposal for
the period of this agreement.
V. State and Federal Rules and Regulations
A. General Requirements
The Provider agrees to meet state and federal service standards as expressed
by state and federal laws or rules and regulations applicable to the services
covered by this agreement.
B. Civil Rights Compliance Plan
The Provider shall submit its Civil Rights Compliance Plan within 30 calendar
days of the Provider signing this agreement. If a similar Civil Rights Compliance
Plan has been submitted by the Provider and is approved or is pending approval,
or if a similar plan was approved by another State agency within the previous two
years, a copy of the Civil Rights Compliance Plan submitted or approved or
evidence of other agency approval will fulfill this requirement, if submitted to the
Division of Workforce Solutions Civil Rights Compliance Officer, P.O. Box 7972,
Madison, Wisconsin 53707-7972.
C. Non-Discrimination Policy
In connection with the performance of work under this agreement, the Provider
agrees not to discriminate against any employee or applicant for employment
because of national origin, age, race, religion, color, disability or association witt'1
a person with a disability, sex, arrest or conviction record, sexual orientation,
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marital status, political affiliation 1, military participation or use or non-use of
lawful products off the employer's premises during non-work hours. This
provision shall include, but not be limited to, the following: employment,
upgrading, demotion or transfer, recruitment or recruitment advertising; lay-off or
termination; rates of payor other forms of compensation; and selection for
training, including apprenticeship. The Provider agrees to post in conspicuous
places, available for employees and applicants for employment, notices to be
provided by the Division of Workforce Solutions Civil Rights Compliance Officer
setting forth the provisions of this non-discrimination policy.
1. The Provider agrees that the agency and their subcontractors will comply
with guidelines in the Civil Rights Compliance Standards and Resource
Manual for the Department of Workforce Development, its Service
Providers and their Subcontractors for Equal Opportunity in Service
Delivery and Employment (April 1999 Edition or its replacement).
2. Requirements herein stated apply to any subcontracts or grants. The
Provider has primary responsibility to take constructive steps, as per the
CRC Standards and Resource Manual, to ensure the compliance of its
subcontractors. However, where the Provider has a direct contract with
another service provider, the agency need not obtain a subcontract or
sub-grantee Civil Rights Compliance Action Plan or monitor that service
provider.
3. The Purchaser will monitor the Civil Rights Compliance of the Provider.
The Purchaser will conduct reviews to ensure that the agency is ensuring
compliance by its subcontractors or grantees according to guidelines in
the CRC Standards and Resource Manual. The Provider agrees to
comply with Civil Rights monitoring reviews, including the examination of
records and relevant files maintained by the agency, as well as interviews
with staff, clients, applicants for services, subcontractors and referral
agencies. The reviews will be conducted according to Department
procedures. The Purchaser will also conduct reviews to address
immediate concerns of complainants.
4. The Provider agrees to cooperate with the Purchaser in developing,
implementing and monitoring corrective action plans that result from
complaint investigations and other monitoring efforts.
D. Accounting and Management Information Systems
1. For agreements of $25,000 or more, the Provider shall maintain a
uniform double entry, full accrual accounting system and a financial
management information system in accordance with Generally Accepted
Accounting Principles. (See OMB Circulars A-87, A122 and A-21,
available upon request to Grant Administrator.)
1 Providers who receive funding from The United States Department of Agriculture, whether directly from
DWD or through one of its contractors or grantees, will also not discriminate against otherwise qualified
persons based on political affiliation.
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2. For agreements of less than $25,000, the Provider is encouraged to
maintain a uniform accounting entry, full accrual accounting system and a
financial management system in accordance with Generally Accepted
Accounting Principles, but shall at least maintain a simplified double entry
bookkeeping system as defined in the OMB Circulars A-110 and A122.
3. The Provider's chart of accounts and accounting system shall permit
timely preparation of expenditure reports required by the Purchaser as
defined in Sections III and IV.
4. The Provider shall reconcile costs reported to the Purchaser for
reimbursement or as match to expenses recorded in the Provider's
accounting bookkeeping system, as determined under Section V (D), on
an ongoing and periodic basis. The Provider agrees that reconciliation
shall be completed at least quarterly and will be documented. The
Provider shall retain the reconciliation documentation in accordance with
the records retention requirements specified in Section VI.
5. The Provider may only change its accounting period with prior written
approval from the Purchaser. The Purchaser may approve a change in
accounting period only if the Provider has a substantial verifiable
business reason for changing the accounting period and agrees to submit
a close-out audit, as defined in Section V (K)(6), within 90 days after the
first day of the new accounting period. Proof of Internal Revenue Service
approval shall be considered verification that the Provider has a
substantial business reason for changing their accounting period.
6. A change in accounting period shall not relieve the Provider of reporting
or audit requirements under this agreement. An audit meeting the
requirements of this contract shall be submitted within 90 days after the
first day of the start of the new accounting period for the short accounting
period and within 180 days of the close of the new accounting period for
the new period. For purposes of determining audit requirements,
expenses and revenues incurred during the short accounting period shall
be annualized.
E. Subcontracting
1. All subcontracts awarded by the Provider must be consistent with the
Provider's obligations under this agreement including, but not limited to,
the following:
a. be embodied in a written agreement signed by the Provider and
subcontractor;
b. include a requirement that subcontractors comply with the
requirements and provisions of this agreement;
c. specify the services to be provided and the costs of those
services; and,
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d. include provisions for modifying or terminating the subcontract.
2. The Provider shall establish appropriate instruction and monitoring
procedures for ensuring each subcontractor's compliance with the
provisions of this agreement and applicable state and federal regulations.
The Provider remains responsible for the performance of any part of this
agreement that is subcontracted.
These procedures shall include, but not be limited to, distribution of policy
documents.
3. Upon execution of all subcontracts, the Provider must submit a copy of
each subcontract to the Purchaser.
F. Treatment of Items Produced Under this Agreement
All data, documentation or innovation developed as a result of these contractual
services cannot be copyrighted without authorization from the Purchaser. All
data, documentation or innovation becomes the property of the Purchaser to
reproduce, publish or otherwise use, including authorization of use by others.
The Purchaser shall have all ownership rights in any software or modifications
thereof, and associated documentation designed, developed or installed as a
result of this agreement.
The Provider and the Purchaser shall work together to ensure the efficient and
effective operation of automated systems in support of the programs covered by
this agreement.
1. The Provider shall keep all data processing equipment purchased under
this agreement in a secure place and compensate the Purchaser for any
theft, damage or other loss of the equipment if the Purchaser's
prescribed security precautions have not been met.
2. The Provider shall designate one or more employees to function as its
Functional Agency Security Liaison to be responsible for ensuring
compliance with security precautions for equipment, data confidentiality
and user access.
3. The Purchaser shall retain ownership of all data processing equipment
purchased under this agreement. The Purchaser shall be responsible for
maintenance and installation costs as specified by the Purchaser.
G. Protection of Funds
Any funds advanced to the Provider by the Purchaser for services provided
under this agreement shall be deposited in a financial institution with Federal
Deposit Insurance Corporation (hereinafter FDIC) insurance coverage. Any
balance exceeding FDIC coverage must be collaterally secured.
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H. Competitive Procurement
The Provider shall conduct all procurement transactions, regardless of whether
by sealed bids or by negotiation and without regard to dollar value of the
transactions, in a manner that provides maximum open and free competition.
I. Use of State Employees
The Provider will not engage the services of any person or persons concurrently
employed by the State of Wisconsin, including any department, commission or
board thereof, to provide service relating to this agreement without the written
consent of the employer of such person or persons and of the Purchaser.
J. Conflict of Interest
If a state public official (s.19.42, Wis. Stats.), a member of a state public official's
immediate family or any organization in which a state public official or a member
of the official's immediate family owns or controls a 10 percent interest is a party
to this agreement; and, if this agreement involves payment of more than $3,000
within a 12-month period, this agreement is void by the state unless appropriate
disclosure is made according to s.19.45(6), Wis. Stats., before signing the
agreement. Disclosure must be made to the State of Wisconsin Ethics Board,
44 East Mifflin Street, Madison, Wisconsin 53703 (telephone 608/266-8123).
K. Provider Audit Requirement
1. General Requirements
a. Governmental Entities: governmental entities shall comply with
the Single Audit Act of 1984, Office of Management and Budget
(OMB) Circular A-133 (Revised 6/24/97) and the State Single
Audit Guidelines issued by the Department of Administration.
b. Nonprofit Agencies: nonprofit agencies that have been certified
under USC 501 (c)(3) shall comply with OMB Circular A-133 and
the Department's Provider Agency Audit Guide.
c. The Provider shall submit at least one copy of a certified annual
audit report to the Audit Coordinator, Department of Workforce
Development, 201 East Washington Avenue, P.O. Box 7972,
Madison, Wisconsin 53707-7972, within 30 days from the
issuance of the report, but no later than six months after the end
of the Provider's fiscal period. The audit shall be conducted and
reports submitted in accordance with applicable state and federal
regulations and guidelines and professional standards, including,
but not limited to: OMB Circular A-133 as applicable; the State
Single Audit Guidelines or the Department's Provider Agency
Audit Guide as applicable; the Department's Allowable Cost Policy
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Manual; Section 46.036 of the Wisconsin Statutes and General
Accepted Auditing Standards.
d. When the Provider's fiscal year is not the same as the agreement
period, a bridging schedule shall be prepared and included in the
certified annual report. The bridging schedule shall identify costs
to the agreement period. The bridging schedule may be part of
the Schedule of Federal and State Financial Assistance.
e. The Provider shall submit with the certified annual audit report a
copy of the Management Letter received from the auditor. If the
auditor does not issue a Management Letter, the Provider shall
submit a written assurance to the Purchaser that a Management
Letter was not submitted because the audit firm did not issue one.
Documents issued by the auditor, which contain information
comparable to that, which would be issued in a Management
Letter, under another title, shall be considered Management
Letters for purposes of this agreement.
f. When contracting with an outside auditor, the Provider shall
authorize the auditor to provide access to work papers, reports,
and other materials generated during the audit to the appropriate
representatives of the Purchaser.
2. DWD Response to Audit Report
The Purchaser shall notify the Provider within 90 days of receipt of the
audit completed by the independent certified auditor, whether or not the
audit meets the requirements of the Purchaser's audit guidelines. The
Purchaser shall initiate resolution of audit findings with the Provider within
180 days following notification of the audit's acceptance. If the audit is
not complete or is acceptable only in part, the Purchaser shall rely upon
the acceptable portion of the audit and any additional audit work shall
build upon the work already done.
3. Provider Failure to Meet General Requirements
The Purchaser reserves the right to conduct an independent audit of the
Provider if the Provider fails to secure an audit covering all funds or a
follow-up review of selected areas is determined to be necessary. In the
event that the Provider fails to secure an audit, the Purchaser's costs for
completing an audit will be charged back to the Provider.
4. Requirement of Subcontractors
The Provider agrees that it is responsible for assuring that all purchase of
service contracts of $25,000 or more meet the requirements of the OMS
Circular A-133 that pertain to subrecipient audits.
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5. Resolution of Findings
The Purchaser shall initiate resolution of audit findings with the Provider
pursuant to Audit Resolution Policies developed by the Purchaser.
6. Close-Out Audits
a. An agreement specific audit of an accounting period of less than
12 months is required when an agreement is terminated for
cause, when the Provider ceases operations or when the Provider
changes its accounting period (fiscal year). The purpose of the
audit is to close out the short accounting period. The required
close-out agreement specific audit may be waived by the
Purchaser upon written request from the Provider for grants,
except when the agreement is terminated for cause. The required
close-out audit may not be waived when an agreement is
terminated for cause.
b. The Provider shall ensure that its auditor contacts the Purchaser
prior to beginning the audit. The Purchaser or its representatives
shall have the opportunity to review the planned audit program,
request additional compliance or internal control testing and
attend any conference between the auditor and the Provider.
Payment of increased audit costs as a result of the additional
testing requested by the Purchaser is the responsibility of the
Provider.
c. The Purchaser may require a close-out audit with all audit
requirements specified in Section V(K)(6). In addition, the
Purchaser may require that the auditor annualize revenues and
expenditures for purposes of applying OMB Circular A-133 and
determining major federal financial assistance programs. This
information shall be disclosed in a note to the schedule of federal
awards.
L. Liabilities
1. The Provider shall notify the Purchaser in writing within 30 days of the
date payment was due of any past due liabilities to the federal
government, state government or their agents for income tax withholding,
FICA, worker's compensation, unemployment compensation,
garnishments or other employee related liabilities, sales tax, income tax
of the Provider, or other funds owed. The written notice shall include the
amount(s) owed, the reason the funds are owed, the due date, the
amount of any penalties or interest, known or estimated, the unit of
government to which the funds are owed, the expected payment date and
other related information.
2. The Provider shall notify the Purchaser in writing within 30 days of the
date payment was due of any past due liabilities in excess of $500, or
when total past due liabilities exceed $1,000, related to the operation of
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this agreement for which the Purchaser has or will reimburse the
Provider. The written notice shall include the amount(s) owed, the
reason the funds are owed, the due date, the amount of any penalties or
interest, known or estimated, the vendor to which the funds are owed, the
expected payment date and other related information. If the liabilities are
in dispute, the written notice shall contain a discussion of facts related to
the dispute and information on steps being taken by the Provider to
resolve the dispute.
3. The Purchaser may require written assurance, quarterly, that the Provider
has reconciled costs, receipts and refunds reported to the Purchaser for
reimbursement or as match to the expenses and revenues recorded in
the Provider's accounting records and that all necessary adjustments
have been reported to the Purchaser or recorded in the accounting
records, as appropriate. Upon request from the Purchaser, written
documentation of reconciliation may be required.
4. The Purchaser may require written assurance at the time of entering into
this agreement that the Provider has in force, and will maintain for the
course of the agreement, employee dishonesty bonding sufficient to hold
the Purchaser harmless in the event of an employee fraud or defalcation.
5. The Purchaser and Provider each agree that they shall be responsible for
any losses or expenses (including costs and attorney fees) attributable to
the acts or omissions of their officers, employees or agents.
VI. Records
A. General Requirements
The Provider shall maintain such records as required by state and federal laws.
The Provider shall maintain records in a manner that will restrict disclosure of
confidential information unless required or permitted by state or federal law or
court order.
B. Inspection of Records
The Purchaser reserves the right to inspect records and programs, insofar as is
permitted by state and federal laws, by representatives of the Purchaser and its
authorized agents and federal agencies in order to confirm the Provider's
compliance with the specifications of this agreement.
C. Retention of Records
The Provider agrees to retain and make available to the Purchaser all program
and fiscal records in accordance with applicable federal regulations (OMB
Circulars A-102 and A-110) or until the audit and subsequent audit resolution
processes have been completed, whichever is later.
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The Purchaser or its agents shall have access to all existing agreement related
records, regardless of record retention requirements.
D. Confidentiality of Participant Information
The use or disclosure by any party of any information concerning eligible
individuals who receive services from the Provider for any purpose not
connected with the administration of the Provider's or the Purchaser's
responsibilities under this agreement is prohibited except with the informed
written consent of the eligible individual or the individual's legal guardian.
VII. Access to Provider
The Provider agrees to hire staff with special translation or sign language skills and/or
they will provide staff with special translation or sign language skills training or find
persons who are available within a reasonable time and who can communicate with
non-English speaking or hearing impaired clients; train staff in human relations
techniques, sensitivity to persons with disabilities and sensitivity to cultural
characteristics; and make programs and facilities accessible, as appropriate, through
outstation~, authorized representatives, adjusted work hours, ramps, doorways,
elevators or ground floor rooms, and Braille, large print or taped information for the
visually impaired. Informational materials will be posted and/or available in languages
and formats appropriate to the needs of the client population.
VIII. Agreement Revisions and/or Termination
A. Remedy for Failure to Comply
Failure to comply with any part of this agreement may be considered cause for
termination of this agreement.
B. Allowable Conditions for Renegotiation
This agreement or any part thereof may be renegotiated in such circumstances
as: (1) increased or decreased volume of services; (2) changes required by
state or federal laws or regulations or court action; or, (3) funds available
affecting the substance of this agreement.
C. Requirement of Written Amendments
Revision of this agreement is not effective until agreed to by the Purchaser and
the Provider by a modification or requiring the signature of both parties, or
supplement requiring the signature of the Department.
D. Right to Terminate/Suspend Agreement
Upon 60 days written notice, either party has the right to terminate this
agreement. The Purchaser reserves the right to immediately terminate the
agreement upon notice via certified mail to the Provider if the Purchaser believes
there is a substantial noncompliance with program and financial requirements.
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The Purchaser will not pay any costs incurred after the termination date. Failure
to comply with any part of this agreement may be considered cause for revision
or suspension of this agreement.
E. Inability to Provide Services
The Provider shall notify the Purchaser whenever it is unable to provide the
required quality or quantity of services specified. Upon such notification, the
Purchaser shall determine whether such inability will require revision or
cancellation of this agreement.
F. Remedy for Early Termination
If the Purchaser finds it necessary to terminate this agreement prior to the stated
expiration date for a reason other than nonperformance by the Provider, actual
costs incurred by the Provider may be reimbursed for an amount determined by
mutual agreement of both parties.
IX. Sanctions
The Provider shall comply with all requirements under this agreement. Instances of
noncompliance shall be corrected promptly and reported timely by the Provider to the
Purchaser. If the Purchaser becomes aware of noncompliance with this agreement,
either through notice from the Provider or through other means, appropriate procedures
shall be instituted to protect the interests of the Purchaser. If audits or other required
information are not submitted timely, sanctions may be applied.
X. Conditions of the Parties Obligations
A. Requirement of State and Federal Authorization
This agreement is contingent upon authorization of Wisconsin and United States
laws, and any material amendment or repeal of the same affecting relevant
funding or authority of the Purchaser shall serve to revise or terminate this
agreement, except as further agreed to by the parties hereto.
B. Legal Powers and Duties
The Purchaser and the Provider understand and agree that no clause, term or
condition of this agreement shall be construed to supersede the lawful powers or
duties of either party.
C. Debarment or Suspension
The Provider certifies that neither the Provider organization nor any of its
principals are debarred, suspended, or proposed for debarment for federal
financial assistance (e.g., General Services Administration's List of Parties
Excluded from Federal Procurement and Non-Procurement Programs). The
Provider further certifies that potential sub-recipients, contractors, or any of their
principals are not debarred, suspended or proposed for debarment.
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D. Related Party Transactions
If the Provider plans to use a related party (see OMB Circular A-133 for a
definition of related party and allowable costs associated with related parties) in
the provision of services under this agreement, the Provider agrees to the
following:
1. Prior to the execution of this agreement, the Provider shall obtain from
the Purchaser, approval of a written detailed description of the business
to be transacted with the related party, the terms of reimbursement or
transactions between the parties, and an estimate of the volume of
business with the related party. The approved description shall be
incorporated into this agreement by reference.
2. Provide to the Purchaser such information as may be requested to
enable it to approve the written agreement referred to in Section V(D)(1)
above.
3. Notify the Purchaser if the actual amount and/or type of business
conducted with the related party during the contract period differs
significantly from the approved written description.
4. Require that the related party follows all federal, state, and grants and
financial management rules as they apply to related parties.
5. Require an audit of the related party (regardless of the type of
organization of the related party). The audit may be either consolidated
with the Provider's audit or be a separate audit in accordance with
requirements established by the Department in conformance with OMB
Circular A-133, if applicable; and the Provider Agency Audit Guide. The
audit shall identify related party transactions including a schedule
showing actual allowable costs incurred in providing goods or services by
the related party. The Provider agrees to provide the Purchaser with a
copy of the related party's audit upon request.
E. Pro-Children Act of 1994
Since a portion of the funds under this agreement includes federal funds, the
Provider agrees to comply with Public Law 103-227, also known as the
Pro-Children Act of 1994. The law requires that smoking not be permitted in any
portion of any indoor facility owned or leased or contracted for by an entity 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. The law does not apply to children's services provided in private residences;
portions of facilities used for iflpatient drug or alcohol treatment; service
providers whose sole source of applicable federal funds is Medicare or Medicaid;
or facilities where WIC coupons are redeemed.
, :\11I
16
F. Completeness of Agreement
It is understood and agreed that the entire agreement between the parties is
contained herein and includes the attached appendix(ces), except for those
matters incorporated herein by reference, and that this agreement supersedes
all oral agreements and negotiations between the parties relating to the subject
matter thereof.
XI. Certification Regarding Lobbying
In conformance with federal law, the authorized Provider representative must review,
sign and return with this agreement either the Certification Regarding Lobbying form
(Attachment A) or the Disclosure of Lobbying Activities (Attachment B).
XII. Certification Regarding Debarment and Suspension
In conformance with federal law, the authorized Provider representative must review,
sign and return the Certification Regarding Debarment and Suspension form
(Attachment C).
XIII. Validity of this Agreement
This agreement becomes null and void if the time between the earlier dated signature
and the later dated signature exceeds 60 days, unless waived by the Purchaser. Please
sign both originals and return one original (State) to the Agreement Administrator.
. 'H// ~
rerovider's Authorizeq Rep~~sen~?tive r-.
\K-1:cX\o.rA A. ~()o ~ ~"'j ~ \ C \ 'l ~ '{Jv>^A:jC~r
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Bill Clingan, Division Administrator
Division of Workforce Solutions
(",--eepa ment of W orkfo(Ge-Devel
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Log #2956
,'"
ATTACHMENT A
CERTIFICATION REGARDING LOBBYING
Certification for Contracts. Grants. Loans. and Cooperative Aareements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any Federal contract, grant, loan, 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 agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants,
loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by Section 1352, title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.
~~
(p!gnatu. re of Official AutDorized C9 Sign Application)
~~rc\ A. \A::b l VJ;J t---...
For: c:-\~ o-\:- OcS\\k:o.s.h.
Name j)f Provider
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I,
By
Date: ~----$ -2 e;o~
Date:
L(y3D-~
DISCLOSURE OF LOBBYING ACTIVITIES
ATTACHMENT B
Approved by OMB
0:348-0046
(Reproduced by DWDIDWS/BDS)
,-f.
,.-
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
1.
Type of Federal Action:
a. contract
b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
2.
Status of Federal Action:
3.
Report Type:
o
o a. bid/offer/application
b. initial award
c. post award
o a. initial filing
b. material change
For Material Change Only:
year _quarter __
date of last report__
4.
Name and Address of Reporting Entity:
5.
If Reporting Entity in No.4 is Subawardee, Enter Name
and Address of Prime:
o Prime
o Subawardee
Tier _, if known:
Congressional District, if known:
Congressional District, if known:
6.
Federal Department/Agency:
7.
Federal Program NamelDescription:
CFDA Number, if applicable:
8.
Federal Action Number, if known:
9.
Award Amount, if known:
$
10. a. Name and Address of Lobbying Entity
(if individual, last name, first name, MI):
10. b. Individuals Performing Services (including address if
different from No. 10a) (last name, first name, MI):
11. Amount of Payment (check all that apply):
13. Type of Payment (check all that apply):
$
o actual
o planned
o a. retainer
o b. one-time fee
o c. commission
o d. contingent fee
o e. deferred
o f. other; speCify:
12. Form of Payment (check all that apply):
o a. cash
o b. in-kind; specify:
nature
value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s)
contacted, for Payment indicated in Item 11:
15. Continuation Sheet(s) SF-LLL-A attached:
DYes
ONo
Signature:
Print Name:
A. WoI~+-
16. Information requested through this form is authorized by title 31 U,S.C. section 1352. This
disclosure of lobbying activities is a material representation of fact upon which reliance was
placed by the tier above when this transaction was made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress
semi..annually and will be available for public inspection. Any person who falls to file the
required disclosure shall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
LL
-rr--
,f" .'l"'"
DISCLOSURE OF LOBBYING ACTIVITIES
CONTINUATION SHEET
m148-0046
(cont. )
Reporting Entity:
Page
of
," ,-
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered
Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or
agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use the
SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing
and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information,
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal
action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previous'ly
reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity
for this covered Federal action,
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate
classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,
e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limit to subcontracts, subgrants ad contract awards under
grants.
5. If the organization filing the report in item 4 checks "Subawardee", then enter the full name, address, city, state and zip code of the prime
Federal recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if
known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic
Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP)
number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal
control number assigned by the Federal agency). Include prefixes, e.g., "RFP-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the
award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence
the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name,
and Middle Initial (MI).
11. Enter the amount of compensation paid or reasonable expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10).
Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report,
enter the cumulative amount of payment made or planned to be made.
12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of
the in-kind payment.
13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.
14. Provide a speCific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any
services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal
official(s) or employee(s) contacted or the officer(s). employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the
Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503.
,e_ r
ATTACHMENT C
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
The undersigned (authorized official signing for the applicant organization) certifies to the best of his or her
knowledge and belief that the applicant defined as the primary participant in accordance with 45 CFR
Part 76, and its principles:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from covered transactions by any Federal department or agency.
(b) have not within a 3-year period preceding this proposal 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; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statement, or receiving stolen property;
(c) are not presently indicated or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (b) of
this certification; and
(d) have not within a 3-year period preceding this application/proposal had one or more public
transactions (Federal, State, or local) terminated for cause or default.
Should the applicant not be able to provide this certification, an explanation as to why should be placed
after the assurances page.
The applicant agrees that it will include, without modification, the clause titled "Certification Regarding
Debarment, Suspension, In-eligibility, and Voluntary Exclusion-Lower Tier Covered Transaction".
Appendix B to 45 CFR Part 76 in all lower tier covered transactions (i.e., transactions with subgrantees
and/or contractors) and in all solicitations for lower tier covered transactions.
BY (S~~toSign)
_._S~::~clXA-_r& f\. l ~<..
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Date
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Exhibit 1
City of Oskosh Health Division
The agency will seek to have each patient complete a release of information form in accordance
with HIPAA regulations, in order to facilitate coordination of health education and care with the
voluntary resettlement agency. Whenever authorized by the patient the Health Screening
Service provider will inform the agency of resettlement about the health condition of each
individual screened for follow-up care. The screening agency will also coordinate health
education activities with the local voluntary agency.
Local public health agencies will be eligible for reimbursement for the following public health
services when provided to eligible refugees, entrants or asylees:
Outreach and health education
To assure that refugees obtain initial health assessments and health education services
by a public or private provider is reimbursable when the agency verifies that the refugee
has received an assessment and health education services within 90 days of arrival in
the United States. The agency will contact at least 70% of new arrivals within 90 days of
arrival.
Outreach health education services include individual consultations on:
. assess patient's understanding and awareness of basic health and hygiene in
America;
. basic information on health screening and immunization;
. identifying a clinic for patient's ongoing health care
Screening and Follow-up
Screening and follow-up includes all tests, exams and immunizations and follow-up
recommended in the protocol approved by the Office of Refugee Resettlement when
performed within 90 days of arrival in the United States. Health education services
include individual consultations on:
. results of health screening and other ongoing health issues such as the
importance of follow-up appointments.
. prescription medications and over the counter medications appropriate for his/her
needs.
Other Public Health Services
Other public health services normally available to indigent state residents at public
expense by a public agency include:
. follow-up care and testing for conditions identified in an initial assessment for such
communicable diseases as tuberculosis (TB), hepatitis and parasites;
. TB prophylaxis;
. immunizations;
. health education to acquaint refugees with the health care delivery system and
risk reduction techniques; and
~ u _e
. reproductive health, such as family planning; hepatitis B identification, education
and inoculation; prenatal care education; nutrition education and other healthy
birth initiatives designed to increase birth weights and assure healthy deliveries
among at-risk groups;
These services are only available for refugees and asylees eligible for Refugee Medical
Assistance and only within the eligibility period allowed for Refugee Medical Assistance.
A copy of the MA identification card or number and the U.S. Department of Homeland
Security record documenting refugee eligibility must be retained in the case file.
Interpretation Services
Interpretation services to be provided to non-English speaking and limited English
proficient clients during their screenings, follow-up, and health education.
Expected Number to be Served:
Estimated Estimated
Number Amount
of per Estimated
Clients Client Total
Outreach 5 $50 per client $250
Screeninq and Follow-Up N/A $200 per client N/A
Partial Screeninq 5 $100 per client $500
Other Public Health Services 50 hr $60 per hour $3,000
Interpretation Services 50 hr $60 per hour $3,000
Estimated Proqram total cost $6,750
2
Log #2956
~ l1.. ~
..~
APPENDIX A
to the
Agreement between
DWD/DWs
and
City of Oskosh Health Division
for the
REFUGEE HEALTH SCREENING AND EDUCATION PROGRAM
The Provider's employee responsible for day-to-day administration of this agreement will be
Paul Speigel. In the event that the administrator is unable to administer this agreement, the
Provider will contact the Purchaser and designate a new administrator.
The Purchaser's employee responsible for day-to-day administration of the agreement will be
Arthur Upham, whose business address is 201 East Washington Avenue, P.O. Box 7972,
Madison, Wisconsin 53707-7972. In the event that the administrator is unable to administer this
agreement, the Purchaser will contact the Provider and designate a new administrator.
It is further understood and agreed by both parties through this attachment to the DWS-
DWD/City of Oskosh Health Division agreement that:
I. Funds Provided/Period Covered
This agreement provides funds for the period beginning October 1, 2006 through
September 30, 2007. Payment for services is provided in accordance with the terms
and conditions of the original agreement and this Appendix. The amount is contingent
upon receipt of funds by the Department. Specific funding amounts and the period
covered are enumerated at the end of this Appendix.
II. Purpose and Services to be Provided
The purpose of this agreement is to purchase from the Provider health screening and
public health services authorized under Chapter 2 of Title IV of the Immigration and
Nationality Act as amended by PL 97-363 and PL 99-605. A detailed description of the
services to be provided and the Provider's means of delivering them are included in
Exhibit 1, which will be incorporated into this agreement by reference.
Program Assurances:
A. The Provider will verify and document that all clients served under this
agreement are refugees or asylees as defined in the Immigration and Nationality
Act.
B. The Provider is eligible for reimbursement for outreach, health screening, and
related health education services only if the refugee has been in the country for
90 days or less on the date of service, or the asylee was granted asylum no more
than 90 days prior to the date of service.
C. The Provider is eligible for reimbursement for other public health services only if
the refugee is eligible for Refugee Medical Assistance on the date of service.
.,.
:- ll.. ~
~
Provider Requirements: the Provider shall administer the health screening program
according to the directives of the Purchaser including those contained in or amended
during the period of the agreement.
A. All applicable state and federal laws, rules and regulations.
B. The State Refugee Services Plan and Screening Protocol as approved by the
Administration for Children and Families of the U.S. Department of Health and
Human Services.
C. Applicable Department Administrative Rules.
D. Requirements found in the Department's Allowable Cost Policy Manual.
III. Reporting and Monitoring
The Provider shall submit a quarterly report of the number served in each of the
following service categories:
A. Outreach
B. Screening and assessment
C. Clients with Class A or Class B medical conditions provided follow-up and
treatment
D. Other public health services provided to Refugee Medical Assistance clients and
E. Interpretation services during health screenings and follow-up.
This report will be submitted to the Purchaser's agreement administrator within 30 days
of the close of each quarter.
The Provider shall submit a report of the screening results to the Bureau of
Communicable Diseases of the Wisconsin Division of Public Health within thirty (30)
days following the completion of each screening.
The Provider will also submit to the Purchaser a report evaluating its Refugee Health
Program within 90 days of the end of this agreement.
Agency: City of Oskosh Health Division CORe Code #: RQ
FEIN #: 39-6005563 Contract Period: 10101/06-09/30/07
Line Previous Contract New
Code Contract Change Contract
Program Name Number Level Amount Level
Refugee Health Screen & Ed 7309 $6,750
2
Log #295Ei