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HomeMy WebLinkAboutRefugee Health Screening 10/8/2010 [ ] State Copy [ j Agency Copy GRANT AGREEMENT J by and between The Department of Children and Families (DCF) Division of Family and Economic Security (DFES) and Oshkosh, Health Services Division, City of Oshkosh for REFUGEE HEALTH SCREENING This Agreement, which includes Appendix A and Exhibit 1, is entered into by and between the Division of Family and Economic Security (DFES) on behalf of the Department of Children and Families(DCF), whose principal address is 201 East Washington Avenue, P.O. Box 8916, Madison, Wisconsin 53708 -8916, hereinafter referred to as the Purchaser (sometimes referred to as the Grantor), and Oshkosh, Health Services Division, City of Oshkosh, whose principal address is , Oshkosh, WI 54901, hereinafter referred to as the Provider (sometimes referred to as the Grantee). This Agreement covers the period of October 1, 2010 through September 30, 2011, 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. 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). 2 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 1I of the applicable appendix (ces). 2. The Purchaser will not make advance payments. 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 3 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 FinGrantsdwd.wisconsin.gov. The Expenditure Report form is available at http://dwd.wisconsin.gov/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 20 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 20 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. The payment schedule is available on the CORe website: http: / /dwd.wisconsin.gov /CORe /resources /Payment Schedule.htm 2. DCF 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.gov /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. 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/ 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 4 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 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 5 The Grantee 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 (CRC) Requirements The Agency agrees to meet state and federal Civil Rights Compliance (CRC) laws, requirements, rules and regulations, as they pertain to the services covered by this agreement. The website with Instructions and Templates necessary to complete both your CRC Letter of Assurance (LOA) and CRC Plan to meet civil rights compliance requirements is located at: http: / /dhs.wisconsin.gov /civilrights /CRC /requirements.htm The process by which the Agency will ensure compliance with the CRC Requirements has changed from previous years. Additional resources and training information is available at: http:l /dcf.wisconsin.gov /civil rights /default.htm Below is a brief summary of the requirements. 1. Civil Rights Compliance Plan A Civil Rights Compliance (CRC) Plan is required to be completed by any Agency that has twenty -five (25) or more employees and receives a total of $25,000 or more in total government funding from Department of Children and Families (DCF), the Department of Health Services (DHS) and /or the Department of Workforce Development (DWD). The CRC Plan must be developed and completed in accordance with the instructions provided in the CRC Requirements document at the Zink above. The CRC Plan is to be completed and must be kept on file at the Agency. It is not to be submitted to the Department of Children and Families. This is a change from previous CRC Plan requirements. All CRC Requirements must be met, including the training of all agency staff and the posting of all required notices, prior to the submittal of the Letter of Assurance (LOA) required below in Section 2. 2. Letter of Assurance (LOA) The Agency is required to submit a Letter of Assurance (LOA) to ensure that the agency has implemented state and federal Civil Rights Compliance (CRC) laws, requirements, rules and regulations, as they pertain to the services covered by this agreement, and as a condition for receiving federal and /or state financial assistance from DCF. The Agency, regardless of size, must complete and submit a Civil Rights Compliance LOA to the Department's Civil Rights Compliance Unit. The LOA must be completed and submitted to the Department by 105 day from the start date of this Agreement. Send the completed LOA to: 6 Equal Opportunity Officer Civil Rights Compliance Unit Department of Children and Families 201 E. Washington Avenue, Room G200 PO Box 8916 Madison, WI 53708 -8916 C. Non - Discrimination /Affirmative Action Requirements In connection with the performance of work under this contract, the Provider agrees not to discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical condition, developmental disability as defined in s. 51.01 (5), sexual orientation or national origin. This provision shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. Except with respect to sexual orientation, the contractor further agrees to take affirmative action to ensure equal employment opportunities. 1. Written Plan Contracts that are twenty -five thousand dollars ($25,000) or more require the submission of a written Affirmative Action (AA) Plan by the Provider. An exemption from this requirement occurs if the Provider has a workforce of less than twenty -five (25) employees. Within fifteen (15) calendar days of signing this Contract, the Provider must submit the Plan to the Department for approval. Instructions for preparing the Affirmative Action Plan are available on the WI Department of Administration website at: http://vendornet.state.wi.us/vendornet/contract/contcom.asp Send the completed written Affirmative Action Plan and any questions to: Department of Children and Families Bureau of Finance — Procurement Officer 201 E. Washington Avenue, Room A200 PO Box 8916 Madison, WI 53708 -8916 2. Posting of Notice The Agency agrees to post in conspicuous places, available for employees and applicants for employment, a notice to be provided by the Department that sets forth the provisions of the State of Wisconsin's non - discrimination law. 3. Failure to Comply Failure to comply with the conditions of this Non - Discrimination /Affirmative Action section may result in the Agency becoming declared "ineligible ", termination of the Contract or withholding of payment. 7 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, Al22 and A -21, available upon request to Grant Administrator.) 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 Al22. 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 111 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; 8 c. specify the services to be provided and the costs of those services; and, 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. H. Competitive Procurement 9 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. 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 Government Accountability Board, 212 East Washington Ave. 3rd Floor, Madison, Wisconsin 53703 (telephone 608/266- 8005). 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 6/27/03) 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 Children and Families, 201 East Washington Avenue, P.O. Box 8916, Madison, Wisconsin 53708 -8916, 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; Section 49.34 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. 10 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. DCF 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 OMB Circular A -133 that pertain to subrecipient audits. 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 Tess 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 11 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 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. 12 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. 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 outstations, authorized representatives, adjusted work hours, ramps, doorways, elevators or ground floor rooms, and Braille, large print or taped information for the 13 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. 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 14 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. 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 15 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 inpatient drug or alcohol treatment; service providers whose sole source of applicable federal funds is Medicare or Medicaid; or facilities where WIC coupons are redeemed. 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. Provider's A thorized Representative Date /0/5 Julie Ke k�, Division Administrator D to Division of Family and Economic Security Department of Children and Families Log #170 Exhibit 1 Oshkosh, Health Services Division, City of Oshkosh 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. Services are reimbursable once 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: • Assessment of 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, 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 • 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 30 $ 50 per client $1,500.00 Screening and Follow -Up NA $ 400 per client $0.00 Partial Screening and Follow -Up 30 $ 200 per client $6,000.00 Other Public Health Services 30 hrs $ 60 per hour $1,800.00 Interpretation Services 150 hrs $ 60 per hour $9,000.00 Estimated Program Total Cost $18,300.00 Log #170 APPENDIX A to the Agreement between DCF /DFES and Oshkosh, Health Services Division, City of Oshkosh for the REFUGEE HEALTH SCREENING AND EDUCATION PROGRAM The Provider's employee responsible for day -to -day administration of this agreement will be Jayne Tebron. 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 8916, Madison, Wisconsin 53708 -8916. 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 DFES- DCF /Oshkosh, Health Services Division, City of Oshkosh agreement that: I. Funds Provided /Period Covered This agreement provides funds for the period beginning October 1, 2010 through September 30, 2011. 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. 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. III. Reporting and Monitoring The Provider shall submit a trimester report of the number served in each of the following service categories on the form provided: 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 15 days of the close of each trimester. Reports are due February 15, 2011, June 15, 2011 and October 15, 2011. 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: Oshkosh, Health Services Division, CORe Code #: RQ City of Oshkosh CFDA #: 93.566 Contract Period: 10/01/10 - 09/30/11 Line Previous Contract New Code Contract Change Contract Program Name Number Level Amount Level Refugee Health Screen & Ed 7309 $18,300.00 Log #170 ATTACHMENT A CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements 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. By a� _.� Date: //00 Si natlrre of Official Authorized to Sign Application) ( g 9 PP ) For: C_.4 p i t,OSi `—h /4/ i se.rfi',,ceS Nam of Provider —� f n � fee : A./.4 Title of grogram • Attachment B OMB DISCLOSURE OF LOBBYING ACTIVITIES Approved 0348 -0046 (Reproduced by DCF) DCF -F -138 (N. 06/2009) 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: 2. Status of Federal Action: 3. Report Type: ❑ a. contract ❑ a. bid /offer /application ❑ a. initial filing S b. grant ❑ b. initial award ❑ b. material change c. cooperative agreement ❑ c. post award ❑ d. loan For Material Change Only: ❑ e. loan guarantee ❑ f. loan insurance 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: ❑ Prime ❑ Subawardee Tier , if known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name /Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying Entity 10. b. Individuals Performing Services (including address if (if individual, last name, first name, MI): 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): $ ❑ actual ❑planned ❑ a. retainer ❑ b. one -time fee ❑ c. commission ❑ d. contingent fee ❑ e. deferred ❑ f. other; specify: 12. Form of Payment (check all that apply): ❑ a. cash ❑ 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) attached: ❑ Yes 0No 16. Information fbthrougethisformirarized at ef U.S.C. onr35a. This Signature: disclosure e'���/G� disclosure ure lo of lobbying bying activities is a material l representation of f which fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is �/ sequired yant to 31 U.S.C. 1352. This . Any person who reported the Congress O �� b semi—annually and will be available for public llc inspection. n. Any person who fall tfile falls to file the J ( y required disclosure shall be subject to a civil penalty of not Tess than $10,000 and not more Print Name: /I/ark than $100,000 for each such failure. Title: Ci c/ C2 r1 EE,q t°•� Tele. No.: 2 .::•?3‘ - 5 .- c 00 Date: /O /g /o DISCLOSURE OF LOBBYING ACTIVITIES 0348 -0046 CONTINUATION SHEET (cont.) Reporting Entity: Page of INSTRUCTIONS FOR COMPLETION OF DISCLOSURE OF LOBBYING ACTIVITIES FORM 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 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 previously 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 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. 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 �rj Date 4/0, (Sign ture of official authorized to sign)