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K20-018 :bl- 1�) WHEREAS, HCA and Contractor previously entered into a Contract for obtaining Community Prevention and Wellness Initiative (CPWI) Prevention Services in order to increase capacity to implement direct and environmental substance use prevention services in high need communities qualified to immediately implement identified evidence -based practices and programs to prevent and reduce the misuse and abuse of alcohol, tobacco, marijuana, opioids, and other drugs and; WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3 to award funding to increase capacity for coalitions to implement prevention programming in their community as outlined in the coalition's strategic/action plan; NOW THEREFORE, the parties agree the Contact is amended as follows: 1. The Contractor shall implement all programs as approved by HCA/DBHR in the proposed action plan. 2. Total consideration payable to the Contractor for this Amendment for timely and satisfactory performance of the work is based on the following: A. The source of the funds are: 1) Partnerships for Success 2018 (PFS 2018) CFDA#93.243 a. Period of Performance is July 1, 2019 through September 29, 2019 b. Quincy: $1,956.00 2) State Opioid Response (SOR) CFDA#93.288 a. Period of Performance is July 1, 2019 through September 29, 2019 b. Quincy: $7,103.00 HCA Contract No. K3919-01 Pagel of 3 HCA Contract No.: K3919 Washington State `°' ~' CONTRACT Amendment No.: 01 Health Care U hority AMENDMENT THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority and the party whose name appears below, and is effective as of the date set forth below. CONTRACTOR NAME CONTRACTOR doing business as (DBA) Grant County CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS IDENTIFIER 840 E Plum St (UBI) Moses Lake, WA 98837 WHEREAS, HCA and Contractor previously entered into a Contract for obtaining Community Prevention and Wellness Initiative (CPWI) Prevention Services in order to increase capacity to implement direct and environmental substance use prevention services in high need communities qualified to immediately implement identified evidence -based practices and programs to prevent and reduce the misuse and abuse of alcohol, tobacco, marijuana, opioids, and other drugs and; WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3 to award funding to increase capacity for coalitions to implement prevention programming in their community as outlined in the coalition's strategic/action plan; NOW THEREFORE, the parties agree the Contact is amended as follows: 1. The Contractor shall implement all programs as approved by HCA/DBHR in the proposed action plan. 2. Total consideration payable to the Contractor for this Amendment for timely and satisfactory performance of the work is based on the following: A. The source of the funds are: 1) Partnerships for Success 2018 (PFS 2018) CFDA#93.243 a. Period of Performance is July 1, 2019 through September 29, 2019 b. Quincy: $1,956.00 2) State Opioid Response (SOR) CFDA#93.288 a. Period of Performance is July 1, 2019 through September 29, 2019 b. Quincy: $7,103.00 HCA Contract No. K3919-01 Pagel of 3 B. Funds shall be utilized according to the requirements and guidelines established for funding source. C. Funds must be fully obligated and all costs incurred by September 29, 2019. D. Final billing for work under this exhibit shall be submitted no later than December 12, 2019. 3. This Amendment will be effective July 1, 2019 ("Effective Date"). 4. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Contract. 5. All other terms and conditions of the Contract remain unchanged and in full force and effect. The parties signing below warrant that they have read and understand this Amendment and have authority to execute the Amendment. This Amendment will be binding on HCA only upon signature by HCA. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Tom Taylor, Vice Chair Richard StevANens, Member yy l/�� 'm HCA SIGN RE PRINTED NAME D TITLE DATE SIGNED Rachelle Amerine, Contracts Administrator Division of Legal Services HCA Contract No. K3919-01 Page 2 of 3 AWARD AND REVENUES 2019-2021 Biennium CONTRACTOR NAME: Grant County CONTRACT NUMBER: K3919-01 COUNTY: Grant COMMUNITY/COALITION: Quincy rho nhrnro nnmari r'nntrnr-tnr is herehv nwnrded the followina amounts for the ouraoses listed REVENUE SOURCE CODE: TYPE OF SERVICE AWARD AMOUNTS SFY20 SFY21 Total 19-21 Biennium 333.99.59 SABG Prevention (7.1.19-6.30.21) $ $ $ 334.04.6X GF -State- Admin (for SABG Prevention) $ $ $ 334.04.6X Dedicated Marijuana Account -Fund 315 -State $ $ $ 333.92.43 2018 PFS -Total $42,633 $10,500 $53,133 Year 1 FFY19 (7.1.19-9.29.19) $11,283 Year 2 FFY20 (9.30.19-9.29.20) $31,350 $10,500 333.92.43 2013 PFS No Cost Extension (7.1.19-9.29.19) $ $ $ 333.37.88 SOR-Total $73,471 $17,050 $90,521 Year 1 FFY19 (7.1.19-9.29.19) $22,321 Year 2 FFY20 (9.30.19-9.29.20) $51,150 $17,050 333.37.88 SOR Supplemental -Total $ $ $ Year 1 FFY19 (7.1.19-9.29.19) $ Year 2 FFY20 (9.30.19-9.29.20) $ $ 333.37.88 STR No Cost Extension -Total (8.15.19-4.30.20) $ $ $ Total Federal Funds $116,104 $27,550 $143,654 Total State Funds $0 $0 $0 TOTAL ALL AWARDS $116,104 $27,550 $143,654 Federal CFDA: Substance Abuse Block Grant (SABG), CFDA 93.959, Substance Abuse and Mental Health Services Administration (SAMHSA) Funding period(s): 7.1.19-6.30.21; Funds may be used in SFY 20 or 21 up to the total biennium award as indicated above. General Fund State (GF -S), Admin (for SABG Prevention) Funding period(s): 7.1.19-6.30.20 (SFY 20) and 7.1.20-6.30.21 (SFY 21); Funds must be used only in the SFY in which they are awarded as indicated above. Dedicated Marijuana Account (DMA) Fund 315 State. Funding period(s): 7.1.19-6.30.20 (SFY20) and 7.1.20-6.30.21 (SFY 21); Funds must be used only in the SFY in which they are awarded as indicated above. 2018 Partnerships for Success (PFS), CFDA 93.243, Substance Abuse and Mental Health Services Administration (SAMHSA) Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used only in the FFY in which they are awarded as indicated above. Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20. 2013 PFS, Partnerships for Success (PFS) No Cost Extension Funding period 7.1.19-9.29.19; Funds must be used in this time period State Opioid Response (SOR), CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA) Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used in the FFY in which they are awarded, as indicated above. Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20. State Opioid Response (SCR) Supplemental, CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA) Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used in the FFY in which they are awarded, as indicated above. Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20. State Targeted Response (STR) to the Opioid Crisis No Cost Extension, CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA) Funding period 8.15.19-4.30.20; Funds must be used in this time period. HCA Contract No. K3919-01 Page 3 of 3 Contractor Intake Form 1— Identifvina Information A) Contractor Legal Name: B) DBA or Facility Name: Grant County Grant Integrated Services C) WA Uniform Business Identifier (UBI) Number: D) Taxpayer Identification Number (TIN): 132001884 91-6001319 E) State Wide Vendor Number (SWV#): SWV00002426-11 2 — Contractor Address A) Number, Street, Apartment/Suite: PO Box 37 B) City, State, Zip Code: Ephrata, WA 98823 C) Email Address: D) Phone Number: thtaylor@grantcountywa.gov (509) 754-2011 x 2928 3 — Contractor/Vendor Primary Contact A) Full Name: Dell Anderson B) Job Title: Executive Director C) Email Address: D) Phone Number: daanderson@Prantcounty)A . (509) 765-9239 Authorized to Sign Contracts? ❑ Yes © No if 'no' selected — Section Four (4) is REQUIRED A — Cnntractnr/Vendor Primary Sienatory A) Full Name: B) Job Title: Cindy Carter Chair, Grant County Board of County Commissioners C) Email Address: D) Phone Number: ccarter@grantcountywa.gov (509) 754-2011 x 2928 S — Arirlitinnni Cnntractnr/Vendor Staff to be Notified A) Full Name: B) Email Address: Tom Taylor thtaylor@grantcountywa.gov C) Full Name: D) Email Address: Richard Stevens rstevens@grantcountywa.gov 6 — Contract Information A) Contract Number: B) Exact Start Date: C) Exact End Date (this contract/work order/amendment ONLY): K3919 7/1/2019 6/30/2021 D) Funding Amount (this contract/work order/amendment E) Funding Amount (ALL amendments included): ONLY):$9,059 $371,354 F) Additional Instructions: Completed By: Linze Greenwalt Date: 1/9/2020