HomeMy WebLinkAboutAgreements/Contracts - RenewDocuSign Envelope ID: 40A5013D-E9A7-4C6B-B131-El2C59618Al7
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WHEREAS, HCA and Contractor previously entered into a Contract for CPWI Prevention Services, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 17 to add funding to expand
programs and services per the approved HCA/DBHR CPWI Action Plan and Budget;
NOW THEREFORE, the parties agree the Contract is amended as follows:
1. Business Name: The business name is hereby corrected to reflect the following:
County of Grant, doing business as Renew
2. Section 3, Term, is amended to extend the end date to September 29, 2023.
3. Section 8, Compensation and Billing, Subsection 8.1, Consideration and Source of Funds is amended
to increase Maximum Compensation by $36,000 from $220,000 to $256,000. The $36,000 must be
expended by September 29, 2022.
4. Section 8, Compensation and Billing, Subsection 8.2, Reimbursements, is replaced as follows:
HCA shall reimburse Contractor only for actual incurred and allowable costs for the services identified in
this Contract and in accordance with the Substance Use Disorder Prevention and Mental Health
Promotion Services Billing Guide.
Contractor shall not bill and HCA shall not pay for services performed under this contract, if Contractor
has charged or will charge another agency of the state of Washington or any other party for the same
services.
Reimbursement requests will not be approved for payment until Contractor is current with all reporting
requirements contained in this Contract.
HCA shall not make any payments in advance or anticipation of the delivery of services to be provided
pursuant to this Contract.
Washington State Page 1 of 3 CPWI Prevention Services
Health Care Authority HCA Contract No. K5536-1
CONTRACT
HCA Contract No.: K5536
Washington State
AMENDMENT
Amendment No.: 1
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Health Care.4,
For CPWI Prevention
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Services
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)
County of Grant
Renew
CONTRACTOR ADDRESS
CONTRACTOR CONTRACT MANAGER
840 E Plum St.
Name: Dayana Ruiz
Moses Lake, WA 98837-1874
Email: druiz(a7grantcountywa.gov
AMENDMENT START DATE
AMENDMENT END DATE
CONTRACT END DATE
July 15, 2022
September 29, 2022
June 30, 2023
Prior Maximum Contract Amount
Amount of Increase
Total Maximum Compensation
$220,000
$36,000
$256,000
WHEREAS, HCA and Contractor previously entered into a Contract for CPWI Prevention Services, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 17 to add funding to expand
programs and services per the approved HCA/DBHR CPWI Action Plan and Budget;
NOW THEREFORE, the parties agree the Contract is amended as follows:
1. Business Name: The business name is hereby corrected to reflect the following:
County of Grant, doing business as Renew
2. Section 3, Term, is amended to extend the end date to September 29, 2023.
3. Section 8, Compensation and Billing, Subsection 8.1, Consideration and Source of Funds is amended
to increase Maximum Compensation by $36,000 from $220,000 to $256,000. The $36,000 must be
expended by September 29, 2022.
4. Section 8, Compensation and Billing, Subsection 8.2, Reimbursements, is replaced as follows:
HCA shall reimburse Contractor only for actual incurred and allowable costs for the services identified in
this Contract and in accordance with the Substance Use Disorder Prevention and Mental Health
Promotion Services Billing Guide.
Contractor shall not bill and HCA shall not pay for services performed under this contract, if Contractor
has charged or will charge another agency of the state of Washington or any other party for the same
services.
Reimbursement requests will not be approved for payment until Contractor is current with all reporting
requirements contained in this Contract.
HCA shall not make any payments in advance or anticipation of the delivery of services to be provided
pursuant to this Contract.
Washington State Page 1 of 3 CPWI Prevention Services
Health Care Authority HCA Contract No. K5536-1
DocuSign Envelope ID: 40A5013D-E9A7-4C6B-B131-El2C59618Al7
All work under this Contract must end on or before the funding source end date and the final
reimbursement request must be submitted to HCA within (45) calendar days after the funding source end
date, except as otherwise authorized by either (1) written amendment of this Contract or (2) written
notification from HCA to Contractor.
Upon expiration of the Contract, any claims for payment for costs due and payable under this Contract
that are incurred prior to the expiration date must be submitted by Contractor to HCA within forty-five (45)
calendar days after the Contract expiration date or the funding source end date, whichever comes first,
except as otherwise authorized by either (1) written amendment of this Contract or (2) written notification
from HCA to Contractor.
Contractor must submit invoices for costs due and payable under this contract within forty-five (45) days
of the date services were provided, the Contract expiration date or after the funding source end date,
whichever comes first, except as otherwise authorized by either (1) written amendment of this Contract or
(2) written notification from HCA to Contractor.
HCA is under no obligation to pay any claims that are submitted forty-six (46) or more days after the
funding source end date, Contract expiration date, or date of services were provided ("Belated Claims").
HCA will pay Belated Claims at its sole discretion, and any such potential payment is contingent upon the
availability of funds.
Payment shall be considered timely if made by HCA within thirty (30) business days after receipt and
acceptance by HCA of the properly completed invoices. Payments shall be sent to the address
designated by Contractor on page one (1) of this Contract. HCA may, at its sole discretion, withhold
payment claimed by Contractor for services rendered if Contractor fails to satisfactorily comply with any
term or condition of this Contract.
5. Attachment 9, Federal Subaward Identification, is added and incorporated herein.
6. The work being described in this amendment shall start effective July 15, 2022, regardless of the date
signed by the parties, as it is the parties' intent for the work to be performed in a timely manner.
7. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Contract.
8. 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 both parties.
CONT ACTOR SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Danny E Stone, BOCC Chair
j
HCA SIGNA URE
PRINTED NAME AND TITLE
lRachelle
DATE SIGNED
DocuSignedby:
Amerine
71.1r."
9/27/2022
Contracts Administrator
Washington State Page 2 of 3 CPW I Prevention Services
Health Care Authority HCA Contract No. K5536-1
DocuSign Envelope ID: 40A5013D-EM7-4C613-13131-El 2C59618A17
Attachment 9
Federal Subaward Identification
K5536-1
1.
Federal Awarding Agency
Dept. of Health and Human Services
Substance Abuse and Mental Health Services
Administration (SAMHSA)
2.
Federal Award Identification Number (FAIN)
H79TIO83286
3.
Federal Award Date
08-27-2020
4.
Assistance Listing Number and Title
93.788 Opioid STR (Opioid Response Grants)
5.
Is the Award for Research and Development?
E]Yes ® No
6.
Contact Information for RCA's Awarding Official
Michael Langer, acting assistant director
WA State Health Care Authority
Division of Behavioral Health and Recovery
michael.tanger@hca.wa.gov
360-725-9821
7.
Subrecipient name (as it appears in SAM.gov)
County of Grant DBA Renew
8.
Subrecipient's Unique Entity Identifier (UEI)
Contractor provided proof of pending sam.gov
registration
9.
Subaward Project Description
CPWI Prevention Services
10.
Primary Place of Performance
98837-1874
11.
Subaward Period of Performance
July 1, 2021- June 30, 2023
12.
Amount of Federal Funds Obligated by this
$36,000
Action
13.
Total Amount of Federal Funds Obligated by HCA
$80,556
to the Subrecipient, including this Action
14.
Indirect Cost Rate for the Federal Award
de minimus (10%)
(including if the de minimis rate is charged)
This Contract is subject to 2 CFR Chapter 1, Part 170 Reporting Sub -Award and Executive Compensation Information. The authorized
representative for the Subrecipient identified above must answer the questions below. If you have questions or need assistance,
please contact subrecipientmonitoring,@hca.wa.gov.
1. Did the Subrecipient receive (1) 80% or more of its annual gross revenue from federal contracts, subcontracts, grants, loans,
subgrants, and/or cooperative agreements; and (2) $25,000,000 or more in annual gross revenues from federal contracts,
subcontracts, grants, loans, subgrants, and/or cooperative agreements?
❑ YES ' NO
2. Does the public have access to information about the compensation of the executives in your business or organization through
periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104
of the Internal Revenue Code of 1986?
r-] YES NNO
Washington State Page 3 of 3 CPWI Prevention Services
Health Care Authority HCA Contract No. K5536-1
Attachment 9 - Federal Subaward Identification