HomeMy WebLinkAboutDoc 621 - Amend IGA - Youth Suicide PreventionDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 -Fax (541) 385-3202 -www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of October 12, 2011
Please see directions for completing this document on the next page.
DATE: October 3,2011
FROM: Debi Harr CCF (541) 330-4692
TITLE OF AGENDA ITEM:
Consideration of Board Signature on Document # 2011-621, Amendment #2 to Intergovernmental
Agreement # 131278.
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
This amendment adds the third year of funding for the Youth Suicide Prevention grant that was first
received in 2009. The grant provides funding for training and delivery of comprehensive school-based
youth suicide prevention programs, and the implementation of public awareness programs.
FISCAL IMPLICATIONS:
The intergovernmental agreement provides for $14,500 for each year of the grant. Amendment #2
awards the third year of funding, for a total amount of$43,500. This amount was included in the
201112012 budget.
RECOMMENDATION & ACTION REQUESTED:
Approval and signature on document # 2011-621, Amendment #2 to Intergovernmental Agreement
#131278
ATTENDANCE: Jessica Kelly or Debi Harr
DISTRIBUTION OF DOCUMENTS:
Return all originals to Debi Harr at CFC 1130 NW Harriman, Ste A, Bend OR 97701.
DESCHUTES COUNTY DOCUMENT SUMMARY
uired to be submitted with ALL contracts and other agreements. regardless of whether the document is to be
can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda. the Ag Request Form is also required. If this form is not included with the document. the document will be retumed to
the Department. Please submit documents to the Board Secretary for tracking purposes. and not directly to Legal Counsel. the
County Administrator or the Commissioners. In addition to submitting this form with your documents. please submit this form
electronically to the Board Secretary.)
Please complete all sections above the Official Review line.
Date: (October 3, 20111 Department: ICFCj
Contractor/Supplier/Consultant Name: IState of Oregon Department of Humanl
IServiceij
Contractor Contact: !Michael Hew@ Contractor Phone #: k503) 945j
1581~
Type of Document: Intergovernmental agreement 131278 -amendment #2
Goods and/or Services: This agreement describes the services CFC will provide in
collaboration with the Public Health Division to reduce suicide and suicide attempts
among youth ages 15-24. The services are:
1. training and delivery of comprehensive, school-based youth suicide prevention
programs
2. training and delivery of suicide intervention skills to the public
3. implementation of "public awareness campaigns"
4. evaluation of the effectiveness of program components
5. comply with evaluation requirements
CFC will work with community partners to convene a local coalition to implement the
grant objectives.
Background &History: Because of the relatively high prevalence of youth suicide
attempts in Oregon, youth suicide was identified as a priority during recent
comprehensive community planning efforts. CFC worked closely with community
partners to apply and plan for this grant. In particular, the Health Services, has served
to establish and lead an ad hoc Youth Suicide Prevention Coalition to identify and
address needs in the community. CFC and the Health Services will lead this community
wide initiative to address identified gaps and improve the communities response to
suicide ideation. This amendment adds the third year of funding for the Garrett Lee
Smith grant.
Agreement Starting Date: ISeptember 30, 20111 Ending Date:
(September 29, 201~
Annual Value or Total Payment: @43,50~
o Insurance Certificate Recei,ed (CleCk box)
Insurance Expiration Date:
Check all that apply: o RFP, Solicitation or Bid Process
1015/20 II
~alth
-----Authority
Agreement Number 131278
Amendment to
State of Oregon
Grant Agreement
In compliance with the Americans with Disabilities Act, this document is available in
alternate formats such as Braille, large print, audio recordings, Web-based
communications and other electronic formats. To request an alternate format, please send
an e-mail to dhsalt@state.or.us or call 503-378-3486 (voice) or 503-378-3523 (TTY) to
arrange for the alternative format.
This is amendment number 02 to Agreement Number 131278 between the State of Oregon, acting by and
through the Oregon Health Authority, hereinafter referred to as "aHA" and
Deschutes County Commission on Children and Families
Attention: Hillary Saraceno
1130 NW Harriman, Suite A
Bend, OR 97701
Phone number: (541) 317-3178
Email address: hils@deschutes.org
hereinafter referred to as "County".
1. This amendment shall become effective September 30, 2011 when this amendment has been fully
executed by every party and, when required, approved by Department of Justice.
2. The Agreement is hereby amended as follows:
a. The Agreement face page is amended to add a new paragraph after identification of the parties
to the Agreement as follows:
The parties acknowledge and agree that, effective July 1, 2011, all references
herein to DHS shall mean Oregon Health Authority (aHA) and any right or
obligation of DHS under this Agreement shall be a right or obligation of aHA.
b. Section 1, Effective Date and Duration, the termination date is hereby changed from
September 29, 2011 to September 29,2012.
c. Section 3, Consideration, paragraph a is hereby superseded and replaced with the following,
new paragraph a.:
"a. The maximum not-to-exceed amount payable to County under this Agreement, which
includes any allowable expenses, is $14,500 for the period October 1,2009 through
September 29,2010 and a separate sum of$14,500 for the period September 30,2010
through September 29, 2011. and a separate sum of$14,500 for the period September
30,2011 through September 29,2012. Funds authorized but not expended during the
period of October 1,2009 through September 29,2011 may not be added to or
expended during any subsequent authorization period."
d. Exhibit A, Part 3, Payment and Financial Reporting, the paragraph that begins "Payment for
all work performed" ... is hereby superseded and replaced with the following:
"Payment for all work performed under this agreement shall be subject to the provisions of
Section 3. Consideration and shall not exceed the total maximum not to exceed of $14,500 for
the period October 1, 2009 through September 29, 2010 and a separate sum of $14,500 for the
period September 30, 2010 through September 29, 2011 and a separate sum of $14,500 for the
period September 30,2011 through September 29,2012 including any travel and other
expenses when noted below."
e. Exhibit B, Section 25, Notice, the Office of Contracts and Procurement address is hereby
changed to the following::
Office of Contracts & Procurement
250 Winter Street NE, 3rd Floor
Salem, OR 97301
Telephone Number: (503) 945-5818
Fax Number: (503) 378-4324
3. In accordance with the State Controller's Oregon Accounting Manual, policy 30.40.00.102, OHA's
determination is that:
I:8J County is a sub-recipient; OR 0 County is a vendor.
Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this
Contract: [93-243]
4. Certification
a. By signature on this Agreement, the undersigned hereby certifies under penalty ofpeIjury
that:
(1) The undersigned is authorized to act on behalf of County and that County is, to the
best of the undersigned's knowledge, not in violation of any Oregon Tax Laws. For
purposes of this certification, "Oregon Tax Laws" means a state tax imposed by ORS
320.005 to 320.150 and 403.200 to 403.250 and ORS chapters 118,314,316,317,
318, 321 and 323 and the elderly rental assistance program under ORS 310.630 to
310.706 and local taxes administered by the Department of Revenue under ORS
305.620;
13 I 278/mah Page 2 of 5
(2) The information shown in County Data and Certification, of original Agreement or as
amended is County's true, accurate and correct information;
(3) To the best of the undersigned's knowledge, County has not discriminated against and
will not discriminate against minority, women or emerging small business enterprises
certified under ORS 200.055 in obtaining any required subcontracts.
(4) County and County's employees and agents are not included on the list titled
"Specially Designated Nationals and Blocked Persons" maintained by the Office of
Foreign Assets Control of the United States Department of the Treasury and currently
found at: http://www.treas.gov/offices/enforcement/ofac/sdnJtllsdn.pdf;
(5) County is not listed on the non-procurement portion of the General Service
Administration's "List of Parties Excluded from Federal procurement or
Nonprocurement Programs" found at: http://www.epls.gov/;
(6) County is not subject to backup withholding because:
(a) County is exempt from backup withholding;
(b) County has not been notified by the IRS that County is subject to backup
withholding as a result of a failure to report all interest or dividends; or
(c) The IRS has notified County that County is no longer subject to backup
withholding.
b. County is required to provide its Federal Employer Identification Number (FEIN). By
County's signature on this Agreement, County hereby certifies that the FEIN provided to
OHA is true and accurate. Ifthis information changes, County is also required to provide
OHA with the new FEIN within 10 days.
c. Except as expressly amended above, all other terms and conditions of the original Agreement
and any previous amendments are still in full force and effect. County certifies that the
representations, warranties and certifications contained in the original Agreement are true and
correct as of the effective date of this amendment and with the same effect as though made at
the time of this amendment.
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4. SIGNATURES
COUJlty:
Authorized Signature Title Date
OHA:
Authorized Signature Title Date
Approved for Legal Sufficiency:
N/A < $150,000
Assistant Attorney General Date
OHA Business Support Manager:
Authorized Signature Title Date
Office of Contracts and Procurement:
Contract Specialist Date
131278/mah Page 4 of5
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COUNTY DATA AND CERTIFICATION
County shall provide County's infonnation set forth below.
Please print or type the following information
If County is self-insured for any of the Insurance Requirements specified in Exhibit C of this Agreement,
County may so indicate by writing "Self-Insured" on the appropriate line(s).
Name (exactly as filed with the IRS): ___________________
Address:
E-mail address:
Telephone: ( Facsimile: (
)-------)-------
Proof of Insurance:
Workers Compensation -Insurance Company: ______________________
Policy #________________ Expiration Date: __________
Auto Liability Insurance Company: _______________________________
Policy #________________ Expiration Date: __________
The above infonnation must be provided prior to Agreement approval. County shall provide proof of
Insurance upon request by OHA.
131278/mah Page 5 of5