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HomeMy WebLinkAboutAgreements/Contracts - Juvenilet,J A -1-k— — un DocuSign Envelope ID: FFC5A2DE-C803-4529-849A-DCD21ABFA283 A ew I A ......... .. ....... CONTRACT AMENDMENT . . .... Consolidated Contract ON*) h?. This Contract Amendment is between the State of Washington Department of Children, Youth& Families (DCYF) and the Contractor identified below. DCYF CONTRACT NUMBER: 2163-22119 Amendment No. 01 Program Contract Number Click Contractor Contract Number CONTRACTOR NAME CONTRACTORdoing businessas(DBA) Grant County CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DCYF INDEX NUMBER IDENTIFIER (UBI) POB 818 1221 Ephrata, WA 98837- 132-001-884 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Suhail Palacios 509) 7545690 (509) 754-5797 s pal ac ibs.@grahtc,o(i n.tyWa'. ., gov, DCYF ADMINISTRATION DCYF DIVISION DCYF CONTRACT CODE Department of Children, Youth, and Families Children, Youth and Families 2072CS--63 DCYF CONTACT NAME AND TITLE DCYF CONTACT ADDRESS Karena McGovern 1115 Washington St SE Contract Specialist I Olympia, WA 98504' a=_ DCYF CONTACT TELEPHONE DCYF CONTACT FAX DCYF CONTACT E—MAIL ADDRESS (360) 70-5727 :1 Click here -to ei,,-\,�,ter' -text. karena. mcgovei-n@dcyf.wa.gov IS THE CONTRACTORA SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? I CFDA NUMBERS —I No DCYF SIGNATURE Department of Children, Youth & Families 2024PF Contract Amendment (8-1-2019) suhail Palacios juvenile court Administrator PRINTED NAME AND TITLE DATE SIGNED MAY 31 2022 5/61 C2 on e4 Paae 1 V n, DocuSign Envelope ID: FFC5A2DE-C803-4529-849A-DCD21ABFA283 This Contract between the State of Washington Department of Children, Youth & Families (DCYF) and the Contractor is hereby amended as follows: 1. Purpose. The purpose of this amendment is to increase Contract Consideration by $1,085 to a llowfor Concrete Goods purchases as instructed on Exhibit D and attach Exhibit E. Concrete Goods Guidance -Exhibit D is included as follows: 2. Exhibit D CONCRETE GOODS GUIDANCE Grant County 1. Based on the allowable spending of state contracts, these funds for concrete goods must"be spent by June 30, 2022. Concrete goods purchased by June 30, 2022 should be distributed no later than September 30, 2022. 2. Contractor will purchase and provide concrete goods to families for the purposes of supppr ' t ' i -n g:l ow-, income families. Goods maybe provided directly to families through non -profit partner organizations. a. Funds allocated in this Contract maybe used for short-term supports, such as: diapers, car seats, cleaning supplies, hygiene supplies, school supplies, transportation costs (e.g.. b,us:.pasS), short-term housing assistance, and grocery gift cards. L In distributing gift cards, Contractor must make reasonable efforts to assure gift cards are not used for the purchase of items that are prohibited from being purchased. 1. If available, Contractor will use gift cards that prohibit the purchase of alcohol, tobacco and firearms. ii. Contractor must track each gift card individually, including: retailer, amount, identification number or other unique identification, and client signature or electronic verification of receipt. iii. There is no max amount per family/youth. There is a maxof $200 value per item. Provider can seek approval item of greatervalue than $200 — e.g. gas and grocery cards. iv. Appliances are not considered a concrete good. b. Funds allocated in this Contract may not be used to pay for alcohol, marijuana, tobacco, vaping supplies, firearms, or other weapons in anyway. They also may not be used for utilities, extended housing, medical care, medical supplies, or other long-term supports. 3. The Contractor will maintain documentation for these concrete goods purchased by this funding source, including: how needs were identified for specific supplies, what specific supplies were purchased, and how many unduplicated families received these supplies. 4. Financial Reporting and Documentation a. Compensation is based on reimbursement for actual expenses incurred and approval of all invoices by DCYF. Contractor must attach back-up documentation to the billing that demonstrates the actual expenses incurred. b. Contractor will submit a properly completed A-19 Voucher, accompanied by the following documentation of the actual expenses incurred, as described below: i. Invoice documentation supporting payment for concrete goods, including quantity and cost of each type of good purchased. ii. If Contractor provides gift cards for concrete goods, a copy of the records Department of Children, Youth & Families Page 2 2024PF Contract Amendment (8-1-2019) DocuSign Envelope ID: FFC5A2DE-C803-4529-849A-DCD21ABFA283 demonstrating both the purchase and distribution of gift cards have occurred in accordance with requirements in 2.a. (1). 5. 10% admin fee is authorized for concrete goods. 6. All concrete goods provided by this contract must be purchased by June 30, 2022. Any services after June 30, 2022 are not billable underthe terms of this Contract. Exhibit E is due by October 31, 2022 in order to capture all the data for the completed program. Concrete Goods Reporting Template -Exhibit E is included as follows: 3. Exhibit E Wll be provided electronically by the DCYF Program Administrator. All other terms and conditions of this Contract remain in full force and effect. Department of Children, Youth & Families Page 3 2024PF Contract Amendment (8-1-2019) ATTEST: Barbara J. Vasquez Clerk of the Board Approved as to form: Rebekah KaylorAVS'BA #53257 Civil Deputy Prosecuting Attorney Date: BOARD OF COUNTY COMMISSIONERS GRANT COUNTY, WASHINGTOK Danny E. Stone, Chair Rob Jones, Vice -Chair Cindy Carter, Member W95 FORM STATE OF WASHINGTON A19 -1A INVOICE VOUCHERLjFI.isl:: (REV 5/91) 'FCG III{``t L'1S �3NtT:' :x1GI�jC:NG :'QR: 3070 1 2163-22119 INSTRUCTIONS TO VENDOR OR CLAIMANT: Submit claim payment for materials, merchandise or services. Show complete detail for each item. Vendor's Certificate. I hereby certify trader penalty of perjury that the items and totals listed herein are proper charges for materials merchandise or services furnished to the State of Washington, and that all goods Rirnished and/or services rendered have been provided without discrimination because of age, sex, material stahts, race, creed, color, national origin, handicap, religion, or Vietnam era or disabled veterans status. (SIGN IN INK) (TITLE) DATE ...................... ............. :A.G:ENCY• 3v?ihEE:............. DEPARTMENT OF CHILDREN, YOUTH, AND FAMILY SERVICES 6830 N. Nevada SPOKANE, WA 99208 :v; 0R:0 ci;A;i iAr47' ::.::: = :::: = ::: err v U]' A � ::::: tVl is t><i bc: ' av tf �) �T GRANT COUNTY JUVENILE COURT c/o Grant County Treasurer PO Box 37 Ephrata, WA 98823-0037 FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For Reporting Personal Services Contract Payments to I.R.S.) RCEIVED BY DATE RECEIVED �. . FI :;: t 5C Ql'J: DL ` I Ie'I'I' `I'T1t: :Q U tI :�TJ iV)tT : : :ftN I`C ; �;' E: >� : tiNi' .� O> JIY �:H` •IAS NL' ;. S Concrete Goods _ Total $ - PREPARED BY Pepper L. Teterud TELEPHONE NUMBER (509) 754-5690 x4432 DATE 05/26/22 AGENCY APPROVAL DATE DOC. DATE PMT DUE DATE CURRENTDOC.NO. REF. DOC NO VQ 2163-22119 utu VENDOR NUMBER VENDORMESSAGE USE TAX NUMBE SWV0002426-08 JR Recr.1 Concrete Goods - Grant Co. REF M MASTER INDEX SUB WORK CLASS CITY/TOWN DOC SUF TRANS CODE O APPN PROGRAM SUB SUB ORG D FUND INDEX INDEX OBJ OBJ INDEX ALLOC BUDGET SUB PROJ UNIT MOS PROJECT PROJ PHAS AMOUNT INVOICENUMBER 210 001 DC1 A1918 NB 6252 5700 0010 2509 $ - ACCOUNTING APPROVAL FOR PAYMENT DATE WQARANT TOTAL WARRANT NUMBER Exhibit E Total Budget ...... ......-.....Tot-al-Budget Remaining rant Juvenile $19685 $1,685 - ---------------------- �o - - - ------------ ------------------- Total 0 $0 Juvenile Court Concrete Goods and Services Reporting Instructions As stated in your contract amendment, Exhibit E will need to be provided no later than October 31, 2022. Thorough completion of Exhibit E (both tabs) will fulfill the reporting documentation in your contract amendment — 4.b.i. & ii. Below are systematic instructions on how to fill out Exhibit E. If additional questions still exist, please contract Cory Redman, JR Program Administrator — cory. redman2dcyf. wa. gov. Exhibit E Orientation The Exhibit E you receive will be juvenile court specific. This will include the juvenile court name and the concrete goods total budget. Juvenile Court Jar$8500 Please note there are two tabs at the bottom and each will need to be completed and returned by October 31, 2022. Gift �retp Goods Gift Cards L.a�di�tix,.eL'uv�.s�na�SX�L:�ed,e�fiw�Y ,Yf:�Rx !�cwkf ';�Xw'� �;G i�.J�:sS�a.�o"�Mc`4✓� 3 Please note that to the right of the Total Budget there is Total Budget Remaining. This total (red font) will automatically decrease as more concrete goods are provided to families and documented. Budget'Total Total Budget Rema'ining When additional rows in Concrete Goods Reporting need to be entered, go to the far right of the last total row, click and hold on the bottom right corner and pull down for the desired number of rows. $400 Concrete Goods Reporting The Concrete Goods Reporting tab will need to be completed electronically. All concrete goods — gift cards, household supplies, transportation costs, etc., will need to be entered in this report. In addition to the concrete goods, you will have a series of other items to report on: • How Needs Were Identified — Please enter where the youth came to you from • Cost Per Item — Please enter the cost per concrete good • Quantity — Please enter the number of concrete goods being distributed • Families Served — Please enter the number of youth/families receiving these concrete goods • Total Charges — THIS WILL AUTO -CALCULATE Juvenile Coin Jefferson $7,150. Walmar. Gift Cavi Depen den $200 2 2 $400 Safeway GaS VOUGher ARY 100 1 1 $100 The total number of families served, and the total charges will be auto -calculated and will not need to be entered manually. Safeway Gift Gard Truancy $200 2 2 $400 Total<7 $x.;350 0, 77 Gift Card Reporting The Gift Card Reporting tab should be printed off and completed manually. All gift cards will need to be logged here (in additional to being entered on the Concrete Goods report). You will need to report on the following for each gift: • Retailer —Enter the retailer that the gift card was purchased for • Card Number —Each gift card has a unique card number on the back, list it here • Amount —Enter the amount of each gift card — no card can exceed $200 • Client Signature —Upon receipt of the gift card, a family member must sign that they have received it Exhibit E (Concrete Goods and Gift Card Reports) must be returned electronically to Cory Redman — corv.redmanAdc, .wa.gov, by no later than October 31, 2022.