HomeMy WebLinkAbout2019 COOPERATIVE AGREEMENT BETWEEN AUGUSTA, GEORGIA AND CSRA REGIONAL COMMISSION FOR SENIOR NUTRITION SECTION I
CSRA REGIONAL COMMISSION-AREA AGENCY ON AGING COOPERATIVE SUB-GRANT AGREEMENT
TITLE III AND NSI NUTRITION MEALS
Fiscal Year 2019
Contract#19-0089
RC AAA Qualified Nutrition Program Food Vendor:COMPASS GROUP USA,INC.,by and through its BATEMAN division
Fiscal Year 2019 Unit Cost for All Congregate Meal: $ 4.45 ($4.08 from C-1,$0.37 from NSI fund sources)
Fiscal Year 2019 Unit Cost for All Home Delivered Meal: $ 5.75 ($4.67 from C-2,NSI State,or NSI SSBG,$1.08 from NSI Fed Fund Sources)
The following table outlines the meals that have been approved
for your jurisdiction for the FY 2019.
Meal Types:
Title III C-i Congregate Meals(requires a 10 percent match)
Title III C-2 Home-Delivered Meals(requires a 10 percent match)
NSI-Cong Congregate Meals(no match required)-used in conjunction with C-i to pay for raw food costs
NSI-HD Home-Delivered Meals(no match required)-used in conjuction with other HDM funds to pay for raw food costs
NSI-State-Cong Congregate Meals(no match required)
NSI-State-MOW Home-Delivered Meals(no match required)
NSI-SSBG-MOW Home-Delivered Meals(no match required)
Annual Number of Meals Alloted By Category
Jurisdiction Title III Cl Title III C2 NSI-Cong NSI-HD NSI-SSBG-MOW NSI-State-MOW Total
Richmond 60,199 16,627 - - 8,919 36,212 121,957
Dollar Value of Meals By Category
Funding Title III C1 Title III C2 NSI-Cong NSI-HD NSI-SSBG-MOW NSI-State-MOW Total
RC Funds: $ 222,779 $ 71,212 $ 20,347 $ 65,017 $ 41,693 $ 169,274 $ 590,324
Local Match: $ 24,753 $ 7,912 $ - $ $ - $ - $ 32,666
Total Cost: $ 247,532 $ 79,125 $ 20,347 $ 65,017 $ 41,693 $ 169,274 $ 622,989
Note that this agreement includes the final allocation for meals from the CSRA RC. All Site meals are purchased
voluntarily by the local jurisdiction. Paragraph 1 of the attached Cooperative Agreement duly notes the right to
alter final numbers based on funding availability.
*Note: Meals are funded by two fund sources-NSI Fed funds are strictly used to pay for raw food costs while the remaining fund
sources are available for all costs of the meal,including production and delivery. The portion of the meal paid for by Title III Cl
will be reimbursed by the RC at ninety(90)percent of their value(i.e.$4.08 x 0.9 equals$3.672). The portion of the meal paid
for by Title III C2 will be reimbursed by the RC at ninety(90)percent of their value(i.e.$4.67 x 0.9 equals$4.203).
Site Cl and Site C2 locally funded meals are voluntarily provided by the community and are not reimbursed by the RC
and therefore not shown in this agreement.
Periodic adjustments may be made during the course of the year to allocate unused meals in the region
to other areas of need or based on reductions in federal/state funds.
Cooperative Agreement
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SECTION TWO
AREA AGENCY ON AGING
COOPERATIVE SUBGRANT AGREEMENT FOR SERVICES
THIS COOPERATIVE SUBGRANT AGREEMENT, entered into as of the 30th day of June 2018, by
and between Augusta, Georgia, a political sub-division of the State of Georgia (hereinafter referred
to as "Subgrantee") and the CENTRAL SAVANNAH RIVER AREA REGIONAL COMMISSION,
(hereinafter referred to as "CSRA RC").
WITNESSETH THAT:
WHEREAS, CSRA RC, under the Older Americans Act, has funding for the provision of Title III,
SSBG and NSI meals for the elderly and desires to allocate those funds to the RC's member
jurisdictions for the public purpose identified below; and
WHEREAS, the CSRA RC, as the state-designated Area Agency on Aging (AAA), has the
responsibility under the Older Americans Act (§306(a)(1)), and under the Georgia Department of
Human Services (DHS) Regulations §304.6 to provide in its area plan a comprehensive and coordinated
system for supportive services, and nutrition services; and
WHEREAS, the provisions of the OAA, as well as the DH Regulations, clearly contemplate the
development by the RC as the AAA of cooperative arrangements with both government and non-profit
organizations to provide those services described in §301 of the Older Americans Act; and
WHEREAS, the Federal Office of Management and Budget (OMB) Circular A-102 is the federal
guideline governing the RCs handling of federal grant funds, and also governing cooperative
agreements; and
WHEREA OMB Circular A-102, derived from 31 USC §6301-08 notes that "a grant or cooperative
agreement shall be used only when the principal purpose of a transaction is to accomplish a public
purpose..."; and
WHEREAS, the CSRA RC wishes to achieve a public purpose, specifically, the provision of nutritious
meals to older citizens by passing through sub-grant funds for the nutrition services program to its
member jurisdictions and to jurisdictions authorized under DHS's contract for FY 2019; and
WHEREAS, the Official Code of Georgia Annotated (OCGA) 50-8-32 "created and established as
public agencies and instrumentalities of their members ..."; and
WHEREAS, OCGA 50-8-33 requires each municipality and county within the region to be a member of
the RC; and
WHEREAS, the RC, has the authority to enter into sub-grant agreements and cooperative agreements
with its member jurisdictions, and with jurisdictions authorized under DHS's FY 2019 contract; and
WHEREAS, the allocation of the nutrition service program funds (Title III, SSBG and NSI) will be done
on a formula basis related to the State of Georgia's interstate funding formula(1FF); and
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WHEREAS, the CSRA RC has developed an allocation plan for FY 2019 nutrition funds for the region;
and
WHEREAS, each local jurisdiction operates a multi-purpose senior center, which has been designated a
focal point by the AAA and, as defined by the Division of Aging Services' Taxonomy of Services as
being "a community facility for the organization and provision of a broad range of services, on a daily
basis, to include health services (including mental health), social, nutritional, and educational services
and the provision of recreational activities for older persons"; and
WHEREAS, as the designated focal point in each county, the senior centers in the counties is
specifically eligible to serve as a congregate nutrition site; and
WHEREAS, Senior Centers are eligible to provide certain services hereinafter described in connection
with an undertaking or program (hereinafter referred to as the "Program") which is to be wholly or
partially financed by a grant from the U.S. Government through the Georgia Department of Human
Resources (hereinafter, along with the appropriate auditing agency of the entities making such a grant,
referred to as "the funding agencies"), and
WHEREAS, the CSRA RC has qualified a food vendor through an open and competitive bid process on
behalf of the region as a whole; and
WHEREAS, the Subgrantee desires to accept the funds outlined in this cooperative agreement for the
purchase of meals under the Title III, SSBG and NSI programs connection with the program;
NOW THEREFORE, in consideration of the premises and the mutual covenants and agreements
hereinafter contained, the parties hereto agree as follows:
SECTION THREE
GENERAL PROVISIONS AND FINANCIAL AND PROGRAMMATIC INFORMATION
1. Engagement of the Subgrantee: CSRA RC hereby agrees to allocate the funds outlined in
Section One (based on availability from the State) for the purchase of meals in the Title III,
SSBG and NSI meal programs in accordance with the terms and conditions herein.
2. Scope. The Subgrantee shall be authorized to purchase nutrition meals funded by Title III Cl,
Title III C2, NSI Cl and NSI C2, and/or SSBG C-2 for the senior population in accordance with
state and federal guidelines and to be served in the county's senior center(s) under this
agreement. To be eligible for reimbursement as noted in Section One of this agreement, the
Subgrantee must purchase its meals from the RC's qualified nutrition program food vendor.
3. Qualified Nutrition Program Food Vendor. The qualified nutrition program food vendor for
FY2019 is Bateman Community Living. This vendor was selected under an open and
competitive bid placed by the RC on behalf of its member jurisdictions. Bateman Community
Living has been competitively selected to provide congregate meals for $4.45 and home-
delivered meals for $5.75 per meal. Attachment "A" outlines the performance measures and
work scope that must be adhered to when receiving state/federal funds for this program. The
competitive invitation to bid specifically noted that the qualified food vendor would contract
directly with the local jurisdictions.
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4. Term and Time of Performance. This term of this agreement runs from July 1, 2018 through
June 30, 2019. The effective date of this agreement is July 1st, 2018. All meals outlined in
Section One shall be purchased and consumed on or before June 30th, 2019.
5. Method of Payment. The amount of this agreement is included in Section One of this
agreement (page 1). Total payments from the CSRA RC to the Subgrantee shall not exceed the
maximum payments noted in Section One unless otherwise approved in writing as an official
amendment to this agreement. Such amendments shall become addendums to this agreement.
Unless otherwise specified in Attachments, which are attached hereto and made a part hereof, the
following method of payment shall be used:
(a) Progress Payments. Unless otherwise approved by CSRA RC and the funding agencies,
the Subgrantee shall be entitled to receive progress payments on the following basis:
(1) a) Cost Reimbursement Agreement - On or before the fifth day of the month
following the month for which payment is requested, the Subgrantee shall submit to
CSRA RC, in a form acceptable to CSRA RC as specified in Attachment "B", a
request documenting actual costs incurred during that month for each cost center as
specified in Attachment"A".
b) Performance Based Fixed Rate Agreement - On or before the fifth day of the
month following the month for which payment is requested, the Subgrantee shall
submit to CSRA RC, in a form acceptable to CSRA RC as specified in Attachment
"B", a request documenting the actual number of service units provided during that
month for each cost center as specified in Attachment "A".
(2) Upon the basis of CSRA RC's determination to its satisfaction that the Subgrantee is
in compliance with the terms of this agreement, including but not limited to the
Paragraph titled Subcontracts below, and its audit and review and approval of (1)
the monthly program performance report for the relevant month, and (2) the payment
request by cost center, for the relevant month as specified hereinabove, CSRA RC
will make payment to the Subgrantee not more than once per month.
(3) CSRA RC may, at its discretion, disallow or delay payment of all or part of a request
if CSRA RC determines that the Subgrantee is not in compliance to CSRA RC's
satisfaction with any of the terms of this agreement. Unless the monthly program
performance report and the reimbursement request are received by CSRA RC
on or before the fifth day of the month reimbursement may be withheld until
the following payment cycle.
(b) Final Payment.
(1) The Subgrantee's payment request for the last month of the agreement term must be
received by CSRA RC no later than five days after the termination date of this
agreement. Proposed adjustments subsequent to this date are to be requested within
ten days of agreement termination. CSRA RC may, at its discretion, disallow
payment of all or part of a final request received after this deadline.
(2) The final request will be the request submitted on or before the fifth day following
the termination date. Adjusted reports received by CSRA RC on or before the tenth
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day after the agreement termination will become the final request.
(3) Upon receipt by CSRA RC of the Subgrantee's final payment request and all other
required documentation, CSRA RC will review such documents and make
comparisons among the costs authorized in Attachment "A" for each cost center and
the cumulative value of all payments for each cost center. Based on such
comparisons and upon its determination that all other requirements hereunder have
been completed, CSRA RC will make either a final payment to the Subgrantee for
any allowable expenditures in excess of prior payments for each cost center or
request from the Subgrantee reimbursement of any overpayment. The Subgrantee
shall refund to CSRA RC any such overpayment within thirty calendar days of
notification by CSRA RC.
(c) Advance Payments. This agreement is a reimbursable agreement. No advance payments
will be made.
6. Communications. All formal communication regarding this agreement shall be in writing
between the person executing this agreement on behalf of the Subgrantee (executor) and CSRA
RC's Executive Director. Formal communications regarding this agreement shall include, but
not necessarily be limited to amendments, correspondence, progress reports and fiscal reports.
The Subgrantee shall bear the cost and other liability risks of making any changes covered by
this agreement in advance of receiving a formal agreement change order from the CSRA RC
Executive Director. The Subgrantee executor and CSRA RC's Executive Director shall each
have the right to designate in writing to the other an agent to act in his or her behalf regarding
this agreement. Any restrictions to such designation shall be clearly defined in the written
designation.
7. CSRA RC's Designated Agent. According to the paragraph titled "Communications" above,
CSRA RC's Executive Director hereby designates JEANETTE CUMMINGS, CSRA RC'S
AREA AGENCY ON AGING DIRECTOR, as his agent for purposes of this agreement only,
except for executing amendments (see paragraph titled "Amendments" below) or terminations
(see paragraph titled "Terminations" below) or for interpretation of the requirements of this
agreement. In addition, all formal communications regarding this agreement to include
correspondence, reports, and requests for payments shall be submitted directly to the CSRA
RC's AAA CONTRACT MANAGER, JACKIE HARRIS and copied to the CSRA RC's
Executive Director. Such appointments herein may be changed only by the CSRA RC via a
written addendum to this agreement.
8. Review and Coordination. To ensure adequate assessment of the Subgrantee's program and
proper coordination among interested parties, CSRA RC shall be kept fully informed concerning
the progress of the work and services to be performed hereunder. The Subgrantee may be
required to meet with designated representatives of CSRA RC and the funding agencies from
time to time to review the work and services performed. Reasonable written notice of such
review meetings shall be given to the Subgrantee. The execution of a Health Insurance
Portability and Accountability Act (HIPAA) Business Associate agreement shall occur prior to
execution of this agreement and the HIPAA Business Associate agreement shall outline access
granted to records under HIPAA regulations.
9. Access to Records and Inspections. The state and federal government and the CSRA RC (a
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staff member and/or an outside party hired to review certain records, documents and/or
procedures) shall have full and complete access to all consumer/customer/client records,
administrative records, financial records, pertinent books, documents, papers, correspondence,
including e-mails, management reports, memoranda, and any other records of the Subgrantee and
fourth party Subgrantees(s). Upon request of such records, the Subgrantee shall immediately
provide the records requested. Failure to provide such records may result in termination of the
agreement and withholding of any remaining payments due until such time the Subgrantee
furnishes the records requested.
The Subgrantee has executed a Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement with the CSRA RC. Through the Business Associate Agreement,
the Subgrantee acknowledges and agrees that the Georgia Department of Human Resources
Division of Aging Services, including the Long-Term Care Ombudsman, and the CSRA RC
Area Agency on Aging provide functions that are considered health oversight agencies in their
funding, quality improvement and regulatory functions. As health oversight agencies, protected
health information must be shared with them and authorization is not required, according to
HIPAA. The Subgrantee is responsible for ensuring that a HIPAA Business Associate
Agreement is executed by any fourth party Subgrantees authorizing the same level of access to
the entities noted above.
The Subgrantee and fourth party Subgrantees (subcontractors) record retention requirements are
six (6) years from submission of final expenditure reports. If any litigation, claim, or audit is
started before the expiration of the six-year period, the records shall be retained until all
litigations, claims, or audit findings involving the records have been resolved.
The Subgrantee agrees that the DHS Office of Investigative Services, upon the request of the
Commissioner or his designee, has full authority to investigate any allegation of misconduct in
performance of duties arising from this agreement made against an employee of the Subgrantee.
The Subgrantee agrees to cooperate fully in such investigations by providing the Office of
Investigative Services full access to its records and by allowing its employees to be interviewed
during such investigations.
The CSRA RC and the State Department of Human Resources shall have the right to monitor
and inspect the operations of the Subgrantee and any fourth party Subgrantees (subcontractors)
for compliance with the provisions of this agreement and all applicable federal and state laws
and regulations, with or without notice, at any time during the term of this agreement. The
Subgrantee agrees to cooperate fully with these monitoring and inspection activities. Such
monitoring and inspection activities may include, without limitation, on-site health and safety
inspections, financial and behavioral health/clinical audits, review of any records developed
directly or indirectly as a result of this agreement, review of management systems, policies and
procedures, review of service authorization and utilization activities, and review of any other
areas, activities or materials relevant to or pertaining to this agreement. The Department and/or
CSRA RC will provide the Subgrantee with a report of any findings and recommendations and
may require the Subgrantee to develop corrective action plans as appropriate. Such corrective
action plans may include requiring the Subgrantee to make changes in service authorization,
utilization practices, and/or any activity deemed necessary by the Department and/or CSRA RC.
The Central Savannah River Area Regional Commission's Board of Directors has established the
following sanctions for any violations of this section of the agreement:" If at any time an official
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„.;.,.,. representative of the CSRA RC (a staff member and/or an outside party hired to review certain
records, documents, and/or procedures) is denied access to the information requested, or if the
Contractor does not provide such information as requested, the CSRA RC will withhold any
pending and/or future payments for services rendered until such time that the information is
presented."
10. General.
(a) The Subgrantee agrees to carry out the program in accordance with all terms, provisions
and conditions of the applicable guidelines and regulations issued by the funding
agencies (e.g., the Older Americans Act of 1965, as amended, 45 CFR 74, 45 CFR 92,
and 45 CFR 202). CSRA RC shall determine the appropriateness and application of such
terms,provisions, and conditions. The Subgrantee also agrees to carry out the program in
compliance with requirements relating to the application, acceptance and use of Federal
funds for this program, including, but not limited to, Executive Order 12372 and 41 CFR
29-70 or 45 CFR 74 or 45 CFR 92, as appropriate. The Subgrantee assures and certifies
that it shall comply with all requirements imposed by CSRA RC or the funding agencies
concerning special requirements of law or program requirements including, but not
limited to,45 CFR 1321, or 45 CFR 202, as appropriate.
(b) The Subgrantee agrees that the purpose of this program is to develop greater service
capacity and to foster the development of comprehensive and coordinated service
delivery systems to serve older persons and others deemed in need. To accomplish this
purpose, the Subgrantee agrees to execute a program which will:
(1) secure and maintain maximum independence and dignity in a home environment
for older persons and other eligible individuals capable of self-care with
appropriate supportive services;
(2) remove individual and social barriers to economic and personal independence;
and
(3) provide specified services to eligible individuals who reside within the planning
area, with greatest social need being determined by advanced age (75 years or
more);
(4) transport those deemed in need to scheduled sites.
11. Subgrantee's Personnel. The Subgrantee represents that it has, or will secure at its own
expense, all personnel required to perform the services under this agreement. Such personnel
shall not be employees of CSRA RC
12. Standards for Service Performance.
(a) The Subgrantee shall perform all services in accordance with the definitions cited in
Attachment "A" and as further defined in relevant notices issued by CSRA RC, or
through CSRA RC from the Georgia Department of Human Resources or the
Administration on Aging,U.S. Department of Health and Human Services.
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(b) The Subgrantee agrees that no changes resulting in a decrease in the scope of services,
units of service to be provided, or numbers of persons to be served will be
made without prior written approval of CSRA RC as provided in the Paragraph titled
Amendments, herein below.
(c) The Subgrantee acknowledges that CSRA RC has developed a multi-year Area Plan on
Aging which is updated annually (hereinafter referred to as the "Area Plan") for a
comprehensive and coordinated system for the delivery of supportive services and
nutrition services to the elderly within the planning area pursuant to the Older Americans
Act of 1965 and the Community Care Act of 1985, as amended. Subgrantee further
acknowledges that the services provided herein may be included in the Area Plan and that
the Area Plan may, from time-to-time, be amended to reflect changes in services, service
delivery methods, vendors, subgrantees, and/or subcontractors. Subgrantee
acknowledges that inclusion in the Area Plan does not constitute a contract or agreement
for the delivery of services within the period of time covered by the Area Plan. Copies of
the plan are maintained on file at the CSRA RC.
(d) The Subgrantee further acknowledges that said Area Plan defines the specific services to
be provided to eligible persons residing within the planning area and that those services
provided under this agreement are a part of said Area Plan.
(e) The Subgrantee acknowledges that the CSRA RC Area Plan delineates a range of
available services for the elderly and, therefore, the Subgrantee agrees to coordinate and
cooperate with other CSRA RC contracted service providers or subgrantees to the fullest
extent possible and in a manner satisfactory to CSRA RC.
(f) Supportive services and nutrition services, if any, included in this agreement, are
aggregated into defined sub-elements. Descriptions of these sub-elements are on file at
CSRA RC and are incorporated herein by reference. The service standards listed in
Attachment A wherefore shall be the basis for determining the Subgrantee's performance
of supportive services and nutrition services.
13. Termination of Services to Clients. The Subgrantee agrees, with respect to any individual who
is a potential program participant or a potentially aggrieved program participant, to provide such
individual with meaningful opportunity to be heard concerning his or her eligibility or continuing
eligibility at a hearing. The Subgrantee shall have procedural requirements which, at a
minimum, include all of the safeguards and elements of the model Client Grievance/Complaint
Procedure on file at CSRA RC and available from CSRA RC upon written request.
14. Reports. The Subgrantee shall furnish CSRA RC with monthly program performance reports, in
such form as may be specified by CSRA RC, describing the work accomplished by the
Subgrantee. Such report(s) shall be furnished to CSRA RC within five days after the end of the
period reported. All due dates in this agreement shall be based on calendar days. If any such
due date should occur on Saturday, Sunday or CSRA RC holiday, the next CSRA RC workday
shall be considered the due date.
15. Rights in Documents, Materials and Data Produced. The Subgrantee agrees that all reports,
studies, records, and other data prepared by or for it under the terms of this agreement shall be
the property of CSRA RC upon termination or completion of the work. CSRA RC shall have the
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right to use the same without restriction or limitation and without compensation to the
Subgrantee other than that provided for in this agreement. For the purposes of this contact,
"data" includes writings, sound recordings, photographs, films, videotapes or other graphic
representations and works of a similar nature. No documents, material or data produced in
whole or in part under this agreement shall be the subject of an application for copyright by or on
behalf of the Subgrantee or its fourth party Subgrantees. The Subgrantee acknowledges that
matters regarding the rights to inventions and materials generated by or arising out of this
agreement may be subject to certain regulations issued by the funding agencies. Information
regarding the applicability of such regulations to a specific situation may be obtained by written
request to CSRA RC.
16. CSRA RC'S Right to Suspend Agreement. The CSRA RC reserves the right to suspend the
agreement/subgrant in whole or in part under this agreement provision if it appears to the CSRA
RC that the Subgrantee is failing to substantially comply with the quality of service or the
specified completion schedule of its duties required under this agreement, and/or to require
further proof of reimbursable expenses prior to payment thereof, and/or to require improvement,
at the discretion of the CSRA RC, in the programmatic performance or service delivery and/or to
comply with any order or directive of a state or federal agency or court or arbitrator(s) with
jurisdiction,by law or by consent, over the CSRA RC.
17. Cooperation in Transition of Services. The Subgrantee agrees upon termination of this
agreement, in whole or in part, for any reason that the Subgrantee will cooperate as requested by
the CSRA RC to effectuate the smooth and reasonable transition of the care and services for
consumers/customers/clients as directed by the CSRA RC. This will include but not be limited
to the transfer of the consumer/customer/client records, personal belongings, and funds of all
consumers/customers/clients as directed by the CSRA RC. Subgrantee further agrees that should
it go out of business and/or cease to operate, all original records of consumers/customers/clients
served pursuant to this agreement shall be transferred by the Subgrantee to the CSRA RC
immediately and shall become the property of the CSRA RC in addition to any other remedy
afforded the CSRA RC hereunder or by law. Failure to cooperate in the transition of services
will result in the Subgrantee becoming an ineligible contractor/Subgrantee for a period of three
(3) years from the end of this agreement period.
18. Force Majeure. Each party will be excused from performance under this agreement to the
extent that it is prevented from performing, in whole or in substantial part, due to delays caused
by an act of God, civil or military authority, war, court order, acts of public enemy, and such
nonperformance will not be default under this agreement nor a basis for termination for cause.
Nothing in this paragraph shall be deemed to relieve the Subgrantee from its liability for work
performed by any fourth party Subgrantees. If the services to be provided to the CSRA RC are
interrupted by a force majeure event, the CSRA RC will be entitled to an equitable adjustment to
the fees and other payments due under this agreement.
19. Publicity.
A. Subgrantees must ensure that any publicity given to the program or services provided herein
identify the CSRA RC and the State Department of Human Resources as sponsoring
agencies. Publicity materials include, but are not limited to, signs, notices, information
pamphlets, press releases, brochures, radio or television announcements, or similar
information prepared by or for the Subgrantee. Prior approval for the materials must be
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received from the CSRA RC and DHS's managing programmatic division/office. All media
and public information materials must also be approved by the State of Georgia's
Commissioner's Office of Policy and Government Services, Office of Communications. In
addition, the Subgrantee shall not display the CSRA RC or DHS's name or logo in any
manner, including, but not limited to, display on Subgrantee's letterhead or physical plant,
without the prior written authorization of the Executive Director of the CSRA RC and/or the
Commissioner of DHS.
B. Notwithstanding subparagraph A above, if the Subgrantee is a county board of health, the
Commissioner's Office of Policy and Government Services must be notified prior to major
publicity and/or media campaigns developed by or for the board-operated programs which
identify the Department as a sponsoring agency. In addition, the Subgrantee shall not display
the Department's name or logo in any manner, including, but not limited to, display on
Subgrantee's letterhead or physical plant, without the prior written authorization of the
Commissioner of the Department.
20. Inventions, Patents, Copyrights, Intangible Property and Publications. The Subgrantee
agrees if patentable items, patent rights, processes, or inventions are produced in the course of
work supported and funded by this agreement, to report such facts in writing promptly and fully
to the CSRA RC. The CSRA RC, the federal agency, and DHS shall determine whether
protection of the invention or discovery shall be sought. The CSRA RC, the federal agency and
DHS will also determine how the rights to the invention or discovery, including rights under any
patent issued thereon, shall be allocated and administered in order to protect the public interest
consistent with Government Patent Policy.
Copyrights. Except as otherwise provided in the terms and conditions of this agreement, the
author or the CSRA RC or DHS is free to copyright any books, publications, or other
copyrightable materials developed in the course of, or under this agreement. Should any
copyright materials be produced as a result of this agreement, the CSRA RC, the federal agency
and DHS shall reserve a royalty-free nonexclusive and irrevocable right to reproduce, modify,
publish, or otherwise use and to authorize others to use the work for government, CSRA RC,
and/or departmental purposes.
Publications: All publications, including pamphlets, art work, and reports shall be submitted to
the CSRA RC on disk or electronically.
21. Financial Management System. Subgrantee certifies that its financial management system
currently complies and will continue to comply with all of the standards for financial
management systems specified in 45 CFR 74, or 45 CFR 92, or 41 CFR 29-70 as appropriate. In
addition, the Subgrantee agrees to accurately maintain its financial records for each cost center as
specified in Attachment C in such form and utilizing such procedures as CSRA RC or the
funding agencies may require. This includes, but it not limited to, the requirement that
Subgrantee financial records shall provide for (1) accurate, current, and complete disclosure of
the financial results of each cost center; (2) records that identify adequately the source and
application of funds by cost center for activities supported under this agreement; and (3) time,
attendance, and payroll distribution records to support salaries and wages paid to employees of
the Subgrantee.
22. Employee's Rate of Compensation. The rate of compensation for work performed under this
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program by a staff member or employee of the Subgrantee shall not exceed the compensation of
such person that is applicable to his or her other work activities for the Subgrantee. Time and
attendance and payroll distribution records shall support charges for salaries and wages of
individual employees.
23. Financial Reports. In addition to other records required by this agreement, the Subgrantee
agrees to provide to CSRA RC such additional financial reports in such form and frequency as
CSRA RC may require in order to meet the CSRA RC's requirements for reporting to funding
agencies.
24. Audits. Subgrantees that expend $750,000 or more in Federal funds during their fiscal year
agree to have a single entity-wide audit conducted for that year in accordance with the
provisions of the Single Audit Act Amendments of 1996 (Public Law 104-156) and their
im'lementing regulation, OMB Circular A-133 entitled, "Audits of States, Local Governments,
and Nonprofit Organizations." The audit reporting package shall include the documents listed in
Policy 1244 of the DHS Directives Information System.
Subgrantees expending $100,000 or more in State funds during their fiscal year agree to have an
entity-wide audit conducted for that year in accordance with Generally Accepted Auditing
Standards issued by the American Institute of Certified Public Accountants. The audit reporting
package shall include the documents listed in Policy 1244 of the DHS Directives Information
System.
Subgrantees expending at least $25,000 but less than $100,000 in State funds during their fiscal
year agree to prepare unaudited entity-wide financial statements for that year. Assertions
concerning the basis of financial statement preparation must be made by the president or other
corporate official as described in Policy 1244 of the DHS Directives Information System.
The Subgrantee further agrees to submit the required audit or financial statement, within 180
days after the close of the Subgrantee's fiscal year to:
L. Mack Shealy, CPA, CGFM
Director of Finance and Administration
3626 Walton Way Ext, Suite 300
Augusta, GA 30909-2016
The Central Savannah River Area Regional Commission's Board of Directors has established the
following sanction for any violation of this requirement:
If a Contractor fails to provide a final audit statement as required under the
contract's terms, the CSRA RC will withhold any pending and/or future payments
for services rendered until such time that the final audit is submitted and verified.
If a pattern of such failures materializes, the Contractor will become ineligible to
receive CSRA RC contracts for a period of 12 months. Recognizing that some
situations might arise that are above and beyond the Contractor's control, the
CSRA RC may extend the date of receipt of the final audit for a thirty (30) day
period upon request and verifiable documentation related to the reason for the
extension. Extensions past the thirty (30) day period may be requested, but any
such request must be presented in person before the CSRA RC's Board of
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Directors with the Contractor's auditor present.
25. Interest of Subgrantee. The Subgrantee covenants that neither the Subgrantee, nor anyone
controlled by the Subgrantee, controlling the Subgrantee, or under common control with the
Subgrantee, nor its agents, employees or fourth party Subgrantees, presently has an interest, nor
shall acquire an interest, direct or indirect, which would conflict in any manner or degree with
the performance of its service hereunder, or which would prevent, or tend to prevent, the
satisfactory performance of the Subgrantee's service hereunder in an impartial and unbiased
manner. The Subgrantee further covenants that in the performance of this agreement no person
having any such interest shall be employed by the Subgrantee as an agent, fourth party
Subgrantees or otherwise. If the Subgrantee contemplates taking some action which may
constitute a violation of this paragraph, and Subgrantee shall request in writing the advice of
CSRA RC, and if CSRA RC notifies the Subgrantee in writing that the Subgrantee's
contemplated action will not constitute a violation hereof, then the Subgrantee shall be
authorized to take such action without being in violation of this paragraph.
26. Interest of Members of CSRA RC and Others. No officer, member or employee of CSRA
RC, and no public official of any local government which is affected in any way by the program,
who exercises any function or responsibilities in the review or approval of the program or any
component part thereof, shall participate in any decision relating to this agreement which affects
his or her personal interests or the interest of any corporation, partnership or association in which
he or she is directly, or indirectly, interested; nor shall any such officer, member or employee of
CSRA RC, or public official of any local government affected by the program, have an interest,
direct, in this agreement or the proceeds arising therefrom.
27. Officials Not to Benefit. No member or delegate to the (1) Legislature of the State of Georgia,
elected or appointed State of Georgia official, or employee of the State of Georgia Department of
Human Services (and Division of Aging Service) and (2) Congress of the United States of
America, resident commissioner or employee of the United States Government, shall participate
or influence any decision relating to the award or administration of this agreement which affects
his or her personal interests or the interests of any corporation, partnership or association in
which he or she is directly, or indirectly,has any involvement.
28. Restrictions on Hiring of CSRA RC Employees. The Subgrantee and any associated fourth
party Subgrantees shall not hire, retain, or engage in any paid or unpaid capacity (employee,
consultant, or advisor) an employee (full-time, part-time, or consultant) of the CSRA RC within
a twelve (12) month period after the termination date of this agreement without the express
written consent of the CSRA RC's Executive Director. Further, any former CSRA RC employee
who is hired, retained, or engaged having met the above 12 month restriction may not be directly
involved with the management and performance of this agreement without the express written
approval of the CSRA RC Executive Director. Subgrantee violation of this restriction shall be
grounds for agreement termination at the CSRA RC's discretion.
29. Project Administration.
(a) The Subgrantee agrees that the Subgrantee executor is responsible for ensuring that all
terms and conditions of the agreement are fully met to CSRA RC's satisfaction.
(b) The Subgrantee agrees that all persons who administer the funds associated with this
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agreement on behalf of the Subgrantee will be responsible to the Subgrantee executor.
(c) The Subgrantee agrees that the Subgrantee executor and all persons who administer the
funds associated with this agreement on behalf of the Subgrantee will be bonded in an
amount equal to at least ten percent of the total amount specified in Attachment "A" of
the agreement or $25,000, whichever is less, if receiving an advance of funds. The
Subgrantee shall transmit written documentation of such bonding to CSRA RC, in form
satisfactory to CSRA RC, prior to receipt of any funds from CSRA RC. For bonds that
expire before the completion date of this agreement, proof of renewal of such bond shall
be provided to CSRA RC, within 20 days after renewal.
(d) The Subgrantee agrees to administer the program in a manner satisfactory to CSRA RC
and in accordance with relevant procedures, as determined by CSRA RC and the funding
agencies (e.g., 29 CFR 1321 or 45 CFR 202 as appropriate).
(e) The Subgrantee shall at all times maintain during the term of this agreement policies of
insurance (including, where applicable, Worker's Compensation coverage) covering any
property acquired with funds made available by this agreement, as well as public liability
insurance with generally recognized, responsible insurance companies authorized to do
business in the state of Georgia, each of which are also qualified and authorized to
assume the risks undertaken. Such insurance shall be in such amounts as a responsible
and prudent company or organization would require under similar circumstances. Such
insurance shall cover the Subgrantee and its above, described property, as well as its
employees, agents and volunteers.
30. Subcontracts. Work or services to be performed under this (third party) agreement by the
Subgrantee may be subcontracted(fourth party) under the following conditions:
(a) The Subgrantee agrees that the selection of fourth party Subgrantees requires competition
between potential fourth party Subgrantees pursuant to 45 CFR 74 or adequate
justification for sole source selection.
(b) All such subcontracts shall bind the fourth party Subgrantee to applicable terms and
conditions of this (third party) agreement between CSRA RC and the Subgrantee.
(c) Any fourth party agreement in excess of$10,000 total value shall have written CSRA RC
approval prior to execution. CSRA RC approval shall not be unreasonably withheld.
(d) A copy of all fourth party agreements shall be on file at the Subgrantee's office and
available for review by CSRA RC monitors upon request.
(e) The Subgrantee will be responsible for the performance of any fourth party Subgrantees
to whom any duties are delegated under any provision of this agreement.
(f) The Subgrantee agrees to reimburse the CSRA RC for any federal or state audit
disallowances arising from a fourth party Subgrantees's performance or non-performance
of duties under this agreement which are delegated to the fourth party Subgrantees.
(g) If the Subgrantee subcontracts for the provision of any deliverables pursuant to this
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agreement, the Subgrantee agrees to include the following in each subcontract:
1. Stipulations that the fourth party Subgrantees is required to adhere to each provision
of this agreement related to the quality and quantity of deliverables, compliance with
state and federal laws and regulations, confidentiality, auditing, access to records and
agreement administration.
2. A clear statement of the service or product being acquired through said subcontract
with detailed description of cost including properly completed Division of Aging
Services Unit Cost Methodology documentation, as appropriate.
(h) The Subgrantee shall promptly pursue, at its own expense, appropriate legal and equitable
remedies against any fourth party Subgrantees who fails to adhere to the agreement
requirements. The Subgrantee's failure to proceed against a fourth party Subgrantees will
constitute a separate breach by the Subgrantee in which case the CSRA RC may pursue
appropriate remedies as a result of such breach.
Failure by the Subgrantee to comply with the provisions of this paragraph in a timely manner as
determined by CSRA RC, may at CSRA RC's discretion result in disallowance or delay in
payment under the Paragraph titled Method of Payment or in termination pursuant to the
Paragraph titled Termination.
31. Assignability. The Subgrantee shall only assign, sublet or transfer all or any portion of its
interest in this agreement with the prior written approval of CSRA RC.
32. Amendments. The CSRA RC may require changes in this agreement from time-to-time. Such
changes, including any increase or decrease in the amount of the Subgrantee's compensation
shall be incorporated in written amendments to this agreement. Only the CSRA RC's Executive
Director may execute amendments to this agreement on behalf of the CSRA RC.
33. Disputes and Appeals. The CSRA RC Executive Director shall decide any questions arising
under this agreement. Such questions must be submitted to the CSRA RC's Executive Director
in writing via certified mail, return-receipt requested. The CSRA RC's Executive Director shall
reduce such decision concerning the question to writing and mail or otherwise furnish a copy
thereof to the Subgrantee within ten (10) business days after receipt of the question. The
Subgrantee agrees that the decision of CSRA RC's Executive Director shall be final and
conclusive unless, within ten (10) days of receipt of such copy, the Subgrantee mails or
otherwise furnishes a written request for appeal concerning the question of fact to CSRA RC's
Commission of Directors, who shall arrange a formal hearing within thirty (30) business days
after receipt of the appeal request. All such requests must be mailed via certified mail, return-
receipt requested to the attention of the CSRA RC's Board of Directors at 3626 Walton Way Ext,
Suite 300, Augusta, GA 30909. Both the Subgrantee and CSRA RC's Executive Director shall
have the right to present witnesses and give evidence concerning the question of fact at such
time. Within thirty-two (32) days after the hearing, the CSRA RC's Commission of Directors
shall render its decision concerning the question of fact in writing to the Subgrantee and to
CSRA RC's Executive Director.
Pending final decision of an appeal to the CSRA RC's Board of Directors, the Subgrantee shall
proceed diligently with the performance of the agreement and in accordance with CSRA's Board
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of Director's decision.
The Subgrantee agrees that the decision of the CSRA RC's Commission of Directors concerning
the question shall be final and conclusive unless determined otherwise by the funding agencies,
or the Comptroller of the United States. In the event the funding agencies provide input, the
CSRA RC's Commission of Directors will reconsider its decision at the next regularly scheduled
meeting of the CSRA RC Commission. Any decision made based on the information provided
from the funding agencies (the reconsideration action) shall be final and conclusive.
34. Assurances. The Subgrantee hereby assures and certifies that it will comply with the
regulations, policies, guidelines and requirements, including the Executive Order 12372, 45 CFR
74, 45 CFR 92, and U.S. Office of Management and Budget Circular (as currently amended)
Nos. A-87, A-102, A-110, A-122, and A-133 (including compliance supplement), as appropriate,
as they relate to the application, acceptance, use and audit of Feder 11 funds for this federally
assisted program. Also, the Subgrantee gives assurance and certifies with respect to this
purchase of service agreement that:
(a) For all purchase of service agreements:
(1) It possesses legal authority to apply for this purchase of service agreement, and, if
appropriate, to finance and construct any proposed facilities; and, a resolution,
motion or similar action has been duly adopted or passed as an official act of the
Subgrantee's governing body, authorizing the filing of the application, including
all understandings and assurances contained therein, and directing and authorizing
the person identified as the official representative of the Subgrantee to act in
connection with the application and to provide such additional information as may
be required, and, upon CSRA RC's approval of its application, that the person
identified as the official representative of the Subgrantee is authorized to execute
a purchase of service agreement incorporating the terms of its application.
(2) It will comply with Title VI of the Civil Rights Act of 1964 (P.L. 88-352 and
42USC 2000d) and in accordance with Title VI of that Act, no person in the
United States shall, on the ground of age, disability, religion, creed or belief,
political affiliation, sex, race, color, or national origin, be executed from
participation in, be denied the benefits of, or be otherwise subjected to
discrimination under any program or activity for which the applicant received
Federal financial assistance and will immediately take any measures necessary to
effectuate this assurance. It will further comply with Title VI provisions
prohibiting employment discrimination where the primary purpose of a grant is to
provide employment. It will not discriminate against any qualified employee,
applicant for employment or service fourth party Subgrantees, or client because of
age, disability, religion, creed or belief, political affiliation, race, color, sex or
national origin. The Subgrantee shall take affirmative action to ensure that
qualified applicants are employed and qualified fourth party Subgrantees are
selected, and that qualified employees are treated during employment, without
regard to their age, disability, religion, creed or belief, political affiliation, race,
color, sex or national origin. Such action shall include but not be limited to the
following: employment, upgrading, demotions, or transfers; recruitment or
recruitment advertising; layoffs or terminations; rates of pay or other forms of
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compensation; selection for training including apprenticeship, and participation in
recreational and educational activities. If the Subgrantee has fifty or more
employees (regardless of the funding sources) and if the total compensation and
reimbursement to be paid to the Subgrantee as specified in Attachment "A" of the
agreement is fifty thousand dollars ($50,000) or more, the Subgrantee certifies
that: (A) It has developed a written Affirmative Action Program (AAP) which
includes: an analysis of the Subgrantee's work forces showing by job category
the extent to which minorities and females are being underutilized, and where
minorities and females are being underutilized, realistic goals and timetables in
each job category for correcting the underutilization; and (b) it presently has such
a plan in effect and such plan will remain in effect at least until the program
completion date of this agreement. The Subgrantee agrees to post in a
conspicuous place available to employees and applicants for employment, notices
to be provided setting forth the provisions of this non-discrimination clause.
The Subgrantee shall in all solicitations or advertisements for fourth party
Subgrantees or employees placed by or on behalf of the Subgrantee, state that all
qualified applicants will receive consideration for employment without regard to
age, disability, religion, creed or belief, political affiliation, race, color, sex or
national origin. The Subgrantee shall not discriminate against any qualified client
or recipient of services provided through this agreement on the basis of age,
disability, religion, creed or belief, political affiliation, race, color, sex or national
origin. The Subgrantee shall cause the foregoing provisions to be included in all
subcontracts for any work covered by this agreement so that such provisions will
be binding upon each fourth party Subgrantees, provided that the foregoing
provisions shall not apply to subcontracts for less than ten thousand dollars
($10,000).
The Subgrantee shall keep such records and submit such reports concerning the
racial and ethnic origin of applicants for employment and employees as CSRA
RC or the funding agencies may require.
The Subgrantee agrees to comply with such rules, regulations or guidelines as
CSRA RC or the funding agencies may issue to implement the requirements of
this paragraph.
(3) It will comply with requirements of the provisions of the Uniform Relocation
Assistance and Real Property Acquisitions Act of 1970 (P.L. 91-646) which
provides for fair and equitable treatment of persons displaced as a result of
Federal and federally assisted programs.
(4) It will comply with the applicable provisions of the Hatch Act, which limits the
political activity of employees.
(5) It will establish safeguards to prohibit employees from using their positions for a
purpose that is or gives the appearance of being motivated by a desire for private
gain for themselves or others, particularly those with whom they have family,
business, or other ties.
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(6) It will cooperate with CSRA RC in assisting the funding agencies in compliance
with Section 106 of the National Historic Preservation Act of 1966, as amended
(16 U.S.C. 470), Executive Order 11593, and the Archeological and Historic
Preservation Act of 1966 (16 U.S.C. 469a-1 et seq.) by (a) consulting, through
CSRA RC, with the State Historic Preservation Officer on the conduct of
investigations, as necessary, to identify properties listed in or eligible for
inclusion in the National Register of Historic Places that are subject to adverse
effects (see 3 CFR Part 800.8) by the activity, and subject to adverse effects (see
36 CFR Part 800.8)by the activity, and notifying, through CSRA RC, the funding
agencies of the existence of any such properties, and by (b) complying with all
requirements established by CSRA RC or the funding agencies to avoid or
mitigate adverse effects upon such properties.
(7) It understands that the phrase "Federal financial assistance" is included any form
of loan, grant, guaranty, insurance payment, rebate, subsidy, disaster
assistance loan or grant, or any other form of direct or indirect Federal
assistance.
(8) For purchase of service agreements involving Federal financial assistance for
construction, it will make certain that the facilities under its ownership, lease or
supervision which shall be utilized in the accomplishment of the Project are not
listed on the Environmental Protection Agency's (EPA) list of Violating Facilities
and that it will notify the fund agencies, through CSRA RC, of the receipt of any
communication from the Director of the EPA office of Federal Activities
indicating that a facility to be used in the program is under consideration for
listing by EPA.
(9) It will comply with the flood insurance purchase requirements of Section 102(a)
of the Flood Disaster Protection Act of 1973, Public Law 93-234, 87 Stat. 975,
approved December 31, 1976. Section 102(a) requires, on and after March 2,
1975, the purchase of flood insurance in communities when such insurance is
available as a condition for the receipt of any Federal financial assistance for
construction or acquisition purposes for use in any area that has been identified by
the Secretary of the Department of Housing and Urban Development as an area
having special flood hazards.
(10) The Subgrantee agrees to abide by all State and Federal laws, rules and
regulations and DHS and Division of Aging Services policy or procedure on
respecting confidentiality of an individual's records. The Subgrantee further
agrees not to divulge any information concerning any individual to any
unauthorized person without the written consent of the individual employee,
client or responsible parent or guardian.
(12) The Subgrantee agrees to comply with all applicable provisions of the Americans
with Disabilities Act (ADA) and any relevant federal and state laws, rules and
regulations.
35. Property Management Standards. The Subgrantee agrees:
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A. That all non-expendable personal property purchased, in total or in part, with funds
received from the CSRA RC during the term of this agreement and all previous
agreements is property of the CSRA RC and is subject to the rules and regulations of
the CSRA RC throughout the life and disposition of said property. Said property
cannot be transferred or otherwise disposed of without prior written approval of the
CSRA RC.
B. To adhere to all policies and procedures as promulgated in the State of Georgia's
Department of Human Resources' DHS Administrative Policy and Procedures
Manual, Part IX, the Property Management Manual, and, if applicable, the Vehicle
Management Manual, which are by reference made a part of this agreement.
Subgrantee understands that the requirements for inventory of property (at least every
two years) and a control system to safeguard against loss, damage or theft as
contained in the property manual shall be followed.
C. That property records shall be maintained accurately and reported on Form #5111,
Detailed Equipment Listing, within 30 days after acquisition of such property, to the
CSRA RC as indicated below:
CSRA Regional Commission
Attn: Property Control
3626 Walton Way Ext, Suite 300
Augusta, GA 30909
D. In the event that this agreement is terminated prior to expiration or is not renewed,
Subgrantee agrees to properly dispose of all CSRA RC property as follows:
1. Prepare Form 5086, Equipment Status Change form listing all CSRA RC
equipment in the Subgrantee's possession and send this form to the CSRA RC
for final disposal determination.
2. Upon notification by the CSRA RC, Subgrantee agrees to transport the RC's
property to the CSRA RC's facility. Expenses incurred by the Subgrantee in
transporting this equipment may be charged to the terminated agreement.
36. Federal Prohibitions and Requirements Related to Lobbying: Pursuant to Section 1352 of
Public Law 101-221, the Subgrantee agrees that:
(a) No Federally appropriated funds have been paid or will be paid, by or on behalf of the
Subgrantee, to any person for influencing or attempting to influence an officer or
employee of any Federal 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.
(b) As a condition of receipt of any Federal contract, grant, loan, or cooperative agreement
exceeding $100,000, the Subgrantee shall file with CSRA RC a signed "Certification
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Regarding Lobbying."
(c) If any funds other than Federally 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 the Federal contract, grant, loan, or cooperative
agreement, the Subgrantee shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instruction.
(d) A disclosure form will be filed at the end of each calendar quarter in which there occurs
any event that requires disclosure or that materially affects the accuracy of the
information contained in any disclosure form previously filed by the Subgrantee under
subparagraphs (B) or (C) of this paragraph. An event that materially affects the
accuracy of the information reported includes:
(1) A cumulative increase of $25,000 or more in the amount paid or expected to be
paid for influencing or attempting to influence a covered Federal action; or
(2) A change in the person(s) or individual(s) influencing or attempting to influence a
covered Federal action; or,
(3) A change in the officer(s), employee(s), or member(s) contacted to influence or
attempt to influence a covered Federal action.
Any Subgrantee who makes a prohibited expenditure or who fails to file or amend the
disclosure form, as required, shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such expenditure.
An imposition of a civil penalty under this action does not prevent the United States from
seeking any other remedy that may apply to the same conduct that is the basis for the
imposition of such civil penalty.
The Subgrantee shall require that the prohibitions and requirements of this paragraph
included in the award documents for all subawards at all tiers (including subcontracts,
purchase of service agreements, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly.
37. Debarment. In accordance with Executive Order 12549, Debarment and Suspension, and
implemented at 45 CFR Part 76, 100-510, the Subgrantee shall certify that neither it nor its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this agreement by any federal department or agency.
The Subgrantee further agrees that it will include the requirement for the "Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion—Lower Tier Covered
Transaction," without modification, in all lower tier transactions and in all solicitations for lower
tier covered transactions.
38. Compliance with Requirements of the Georgia Department of Human Resources (DHS).
The Subgrantee shall be bound by the applicable terms and conditions of the purchase of service
contract between CSRA RC and DHS, which is on file in the offices of CSRA RC and is hereby
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made a part of this agreement as fully as if the same were attached hereto. If any of the terms
and conditions of this agreement conflict with any terms and conditions of the purchase of
service contract, the Subgrantee agrees to abide by the terms and conditions of the contract,
which shall be controlling unless prior written consent to the contrary is received from CSRA
RC.
39. Documentation of Rent Costs. All Subgrantee budgeted rent line items or maintenance in lieu
of rent line items on privately owned buildings must be supported by three (3) separate
Statements of Comparable Rent, DHS Form#5465 (copies available from the Department).
Public facility maintenance in lieu of rent budgeted by the Subgrantee will be supported by a
Local Statement of Service and Maintenance Cost in Lieu of Rent in Public Buildings, DHS
Form #5464, and by three separate Statements of Comparable Rent, DHS Form #5465 (copies
available from the Department). Rent per se is not applicable for publicly owned
facilities/buildings unless newly occupied on or after October 1, 1980, in accordance with OMB
Circular A-87.
40. Criminal Records Investigation:
(a) The Subgrantee agrees that, for the filling of positions or classes of positions having
direct care/treatment custodial responsibilities for services rendered under this agreement,
applicants selected for such positions shall undergo a criminal record history
investigation that shall include a fingerprint record check pursuant to the provisions of
Code Section 49-2-14 of the Official Code of Georgia Annotated. In order to initiate this
requirement, the Department will provide forms, which will include the required data
from the applicant. The Subgrantee agrees to obtain the required information (which will
include two proper sets of fingerprints on each applicant) and transmit said fingerprints
directly to the Georgia Crime Information Center together with the fee as required by said
Center for a determination made pursuant to Code Section 49-2-14 of the Official Code
of Georgia Annotated or any other relevant statutes or regulations.
(b) After receiving the information from the Georgia Crime Information Center or any other
appropriate source, the Department will review any derogatory information and, if the
crime is one which is prohibited by duly published criteria within the Department, the
Subgrantee will be informed and the individual so identified will not be employed for the
purpose of providing services under this agreement.
(c) The provisions of this paragraph of the agreement shall not apply to persons employed in
day-care centers, group day-care homes, family day-care homes, or child-caring
institutions which are required to be licensed or registered by the Department or to
personal care homes required to be licensed,permitted, or registered by the Department.
41. Other Requirements. In addition to other requirements of this agreement, the Subgrantee
agrees to comply with, and shall be bound by, the applicable terms and conditions of all State
and Federal laws or regulations governing and defining resources, project administration,
allowable costs and associated procurement standards including but not limited to 41 CFR 29-70,
or 45 CRR 74, or 45 CFR 92, as appropriate.
The Subgrantee agrees that, if costs incurred by the Subgrantee are not in conformity with the
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above requirements and are subsequently disallowed as a result of an audit pursuant to the
Paragraph titled Audits hereinabove or by CSRA RC, Georgia Department of Human Services,
U.S. Department of Health and Human Services, the Comptroller General of the United States,
or any of their duly authorized representatives, then, upon written demand by CSRA RC, the
Subgrantee shall reimburse CSRA RC in full for any payment made by CSRA RC to the
Subgrantee for such disallowed costs within thirty days of receipt of such written demand.
42. State of Georgia Ethics Code Violations. The Subgrantee understands that the State of
Georgia's Department of Human Resources' Division of Aging Services (the Department) is the
primary source of funds for this subgrant agreement. Under Subsection 93.11 (§93.11) of the
Division of Aging Services' Compliance with Contractor Responsibilities, Rewards and
Sanctions publication, entitled Ethics Code Violations, all contractors, including the Area
Agency on Aging and their sub-contractors are expected to abide by the Code of Ethics for
Government Service (See Appendix 93-B of the above-referenced publication for a copy of the
current Code of Ethics). Accordingly, any violations of the Ethics Code requirements will be
investigated by the Department and referred by the Department to the appropriate law
enforcement agency. Ethics violations may result in criminal prosecution and may be pursued
based on the provisions pertinent laws and regulations. When conducting such investigations, the
Department will inform the contractor of the exact nature of the complaint and may require the
contractor to conduct its own internal investigation. The Department will document its
investigation's findings and conclusions and inform the contractor and the complainant of the
results. If an investigation indicates there is a substantiated situation in which there is a question
of ethics code violations, the Department will require the contractor to take corrective action
and/or refer the complaint to appropriate law enforcement agencies.
43. CSRA RC Ethics Hotline. The Central Savannah River Area Regional Commission has
initiated and established an ethics hotline. All recipients of subgrants, contracts, subcontracts,
and/or cooperative agreements are required to take proactive steps to ensure that employees
within their agencies are aware of the CSRA RC's ethics hotline. To this end, the subgrantee
must provide its employees with a copy of the CSRA RC's ethics hotline information brochure
and each employee must sign an acknowledgement that the information has been provided to
him/her. Copies of all acknowledgements must be maintained in the records associated with this
agreement and are subject to review by the CSRA RC at all times.
44. Termination.
A. Due to non-availability of funds. Notwithstanding any other provision of this agreement, in
the event that any of the funding sources of for payments to the CSRA RC for services under
this agreement no longer exist, or in the event the sum of all obligations of the Center
incurred under this and all other agreements entered into for this program exceeds the
balance of such agreement sources, then this agreement shall immediately terminate without
further obligation of the CSRA RC as of that moment. The certification by the Commissioner
of the Department of Human Services of the occurrence of either of the events stated above
shall be conclusive.
B. Due to default or for cause. This agreement may be terminated for cause, in whole or in
part, at any time by the CSRA RC for failure of the Subgrantee to perform any of the
provisions hereof. Should the CSRA RC exercise its right to terminate this agreement under
the provisions of this paragraph, the termination shall be accomplished in writing and specify
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the reason and termination date. The Subgrantee will be required to submit the final
agreement expenditure report not later than 45 days after the effective date of written notice
of termination. Upon termination of this agreement, the Subgrantee shall not incur any new
obligations after the effective date of the termination and shall cancel as many outstanding
obligations as possible. The above remedies are in addition to any other remedies provided
by law or the terms of this agreement.
C. For Convenience of the Subgrantee. This agreement may be cancelled or terminated by the
Subgrantee without cause; however, the Subgrantee must give written notice of its intention
to do so to the CSRA RC at least sixty (60) days prior to the effective date of cancellation or
termination.
D. For Convenience of CSRA RC. This agreement may be cancelled or terminated by the
CSRA RC without cause; however, the CSRA RC must give written notice of its intention to
do so to the Subgrantee at least thirty (30) days prior to the effective date of cancellation or
termination.
E. Notwithstanding any other provision of this paragraph, this agreement may be immediately
terminated without any opportunity to cure, if any of the following events occurs:
1. Subgrantee becomes insolvent or liquidation or dissolution or a sale of the Subgrantee's
assets begins.
2. Subgrantee or any of its subgrantees violates or fails to comply with any applicable
provision of federal or state law or regulation.
3. Subgrantee or any of its subgrantees knowingly provides fraudulent, misleading or
misrepresentative information to any consumer/customer/client of the CSRA RC or the
Department of Human Services or to the CSRA RC or DHS's representatives.
4. Subgrantee has exhibited an inability to meet its financial or services obligations under
this agreement.
5. A voluntary or involuntary bankruptcy petition is filed by or against the Subgrantee under
the U.S. Bankruptcy Code or any similar petition under any state insolvency law.
6. An assignment is made by the Subgrantee for the benefit of creditors.
7. A proceeding for the appointment of a receiver, custodian, trustee, or similar agent is
initiated with respect to the Subgrantee.
8. The CSRA RC deems that such termination is necessary if the Subgrantee or any fourth
party Subgrantees falls to protect or potentially threatens the health or safety of any
consumer/customer/client and/or to prevent or protect against fraud or otherwise protect
the CSRA RC or the State of Georgia's personnel, consumers/customers/clients,
facilities, or services.
9. A court with competent jurisdiction, or an arbitrator(s) conducting an arbitration
involving the CSRA RC by consent, issues an order or decision that causes the contract to
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1-,... AAA FY 2019 PROVIDER CONTRACT
be rendered voidable or null and void and/or prohibits the CSRA RC from contracting
with the Subgrantee, or otherwise invalidates the procurement process and/or the
contractual relationship with the Subgrantee.
10. Subgrantee is debarred or suspended from performing services on any public contracts
and/or subject to exclusion from participation in the Medicaid or Medicare programs.
45. Subgrantee/Fourth-Party License Requirements. The Subgrantee agrees to maintain any
required city, county and state business licenses and any other special licenses required, prior to
and during the performance of this agreement. The Subgrantee is responsible to ensure that
fourth party(sub-subgrantees) contractors are appropriately licensed. The Subgrantee agrees that
if it loses or has sanctioned any license, certification or accreditation required by this agreement
or state and federal laws, that this agreement may be terminated immediately in whole or in part.
46. AIDS Policy. Subgrantee agrees, as a condition to provision of services to the CSRA RC's
and/or DHS's consumers/customers/clients/patients, not to discriminate against any
consumer/customer/client/patient who may have AIDS or be infected with Human
Immunodeficiency Virus (HIV). The Subgrantee is encouraged to provide or cause to be
provided appropriate AIDS training to its employees and to seek AIDS technical advice and
assistance from the appropriate division or office of DHS, as the Subgrantee deems necessary.
The Subgrantee further agrees to refer those consumers/customers/clients/patients requesting
additional AIDS related services or information to the appropriate county health department.
Notwithstanding subparagraph A above, if the Subgrantee is a county board of health it agrees to
comply with the Joint Advisory Notice, entitled "Protection Against Occupational Exposure to
Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)," dated October 30, 1987
from the Department of Labor/Department of Health and Human Services and which has been
made available to the board. The board further agrees that in the implementation of the
Department's programs it will follow those standard operation procedures developed and
identified by the appropriate program division of the Department as applicable to the specific
programs and as provided to the board by the program division.
Subgrantee agrees, as a condition to provision of services to the CSRA RC's and/or DHS's
consumers/customers/clients/patients, not to discriminate against any consumer/cus-
tomer/client/patient who may have AIDS or be infected with Human Immunodeficiency Virus
(HIV). The Subgrantee is encouraged to provide or cause to be provided appropriate AIDS
training to its employees and to seek AIDS technical advice and assistance from the appropriate
division or office of DHS, as the Subgrantee deems necessary. The Subgrantee further agrees to
refer those consumers/customers/clients/patients requesting additional AIDS related services or
information to the appropriate county health department.
Notwithstanding subparagraph A above, if the Subgrantee is a county board of health it agrees to
comply with the Joint Advisory Notice, entitled "Protection Against Occupational Exposure to
Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (H IV)," dated October 30, 1987
from the Department of Labor/Department of Health and Human Services and which has been
made available to the board. The board further agrees that in the implementation of the
Department's programs it will follow those standard operation procedures developed and
identified by the appropriate program division of the Department as applicable to the specific
programs and as provided to the board by the program division.
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AAA FY 2019 PROVIDER CONTRACT
47. Indemnification of CSRA RC. Subgrantee hereby waives, releases, relinquishes, discharges and
agrees to indemnify, protect and save harmless the State of Georgia (including the State Tort
Claims Trust Fund), DHS, DOAS, the Central Savannah River Area Regional Commission and
the Central Savannah River Area Regional Commission's Area Agency on Aging, their officers
and employees (collectively "indemnitees") of and from any and all claims, demands, liabilities,
loss, costs or expenses for any loss or damage for bodily injury (including but not limited to
death), personal injury, property damage, or contract rights, attorneys' fees caused by, growing
out of, or otherwise happening in connection with this agreement, due to any act or omission on
the part of Subgrantee, its agents, employees, fourth party Subgrantees, or others working at the
direction of Subgrantee or on Subgrantee's behalf: or due to any breach of this agreement by
Subgrantee; (collectively, the "Indemnity Claims").
This indemnification extends to the successors and assigns of the Subgrantee, and this
indemnification and release survives the termination of this agreement and the dissolution or, to
the extent allowed by law, the bankruptcy of the Subgrantee.
If and to the extent such damage or loss as covered by this indemnification is covered by the
State Tort Claims Fund or any other self-insurance funds maintained by the Department of
Administrative Services (collectively, the "funds"), the Subgrantee agrees to reimburse the
Funds for such funds paid out by the Funds. To the full extent permitted by the Constitution and
the laws of the State of Georgia and the terms of the Funds, the Subgrantee and its insurers waive
any right of subrogation against the State of Georgia, the Indemnitees, and the Funds and
insurers participating thereunder, to the full extent of this indemnification.
Subgrantee shall, at its expense, be entitled to and shall have the duty to participate in the
defense of any suit against the Indemnitees. No settlement or compromise of any claim, loss or
damage asserted against Indemnitees shall be binding upon Indemnitees unless expressly
approved by the Indemnitees.
48. Conformance of Agreement with the Law. It is the intent and understanding of the parties to
this Agreement that each and every provision of law required to be inserted in this Agreement
shall be and is inserted herein. Furthermore, it is hereby stipulated that every such provision is
deemed to be inserted herein, and if through mistakes or otherwise, any such provision is not
inserted in correct form, then this Agreement shall upon application of either party, be amended
by such insertion so as to comply strictly with the law and without prejudice to the rights of
either party. If this Agreement contains any unlawful provisions, not an essential part of the
Agreement and which appears not to have been a controlling or material inducement to the
making hereof, the same shall be deemed of no effect, and shall upon the application of either
party be stricken from the Agreement without affecting the binding force of the Agreement as it
shall remain after omitting such provision. The parties agree that this Agreement shall be
reformed to replace such stricken provision or part thereof with a valid and enforceable provision
which comes as close as possible to expressing the intention of the stricken provision.
49. Enforcement. This Agreement shall be governed and construed in accordance with the laws of
the State of Georgia. In any action or proceeding arising under this Agreement, the Superior
Court of Richmond County, Georgia shall have and may exercise exclusive personal jurisdiction
over all parties hereto, and in any such action or proceeding in said venue shall be proper. In any
such action or proceeding, service of process upon any party may be perfected, in addition to any
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' AAA FY 2019 PROVIDER CONTRACT
other manner provided by applicable law, by personal delivery or by mail, with an appropriate
return of service being made in writing and filed with said Court.
IN WITNESS WHEREOF, the Subgrantee and the CSRA RC have executed this agreement as of the
day first,above written: '' "' ` "`°
TTE �' ' �0'�� Augusta, Georgia, a political sub-division of the State of
;:. ��i�J �o�l,���s� � Georgia
.T ,.4,, Address for Official Notices:
i
535 Telfair Street Suite 200
1 �C ,'0 �' :i , '. Augusta, GA 30901
„ mat % .''
Ntigat a W.3'4'''' ,r.' /�
,P,,. I By:
i. ,641 M4retit DAVIS, �"e.
� !PO Mayer
Title
DATE
ATTEST: CSRA REGIONAL COMMISSION
3626 Walton Way Ext, Suite 300
Augusta, Georgia 30909-2016
C----___ L-C..._. By:
Executive Director
DATEl\ / / q /7
6
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INSERT ATTACHMENT A
PROGRAM AND SERVICE
PERFORMANCE REQUIREMENTS
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III. Work Services: As a provider under this agreement, the Subgrantee shall be responsible for the
following general activities:
1. The Subgrantee shall submit quarterly narrative reports that document efforts to develop
new sources of community support,both public and private, during the agreement period.
Reports are due on the 10`h of the succeeding month.
2. The Subgrantee shall attend all regularly scheduled and/or called CSRA RC-sponsored
meetings and training sessions.
3. The Subgrantee shall be responsible for developing, maintaining, and fulfilling all written
working agreements called for in each cost center.
4. The Subgrantee shall maintain and distribute an updated agency brochure describing
available services within its service area. In addition, the Subgrantee shall develop and
implement publication strategies that foster high visibility and promote positive public
awareness of the aging program and issues facing older adults.
5. The Subgrantee shall encourage and document efforts to generate the program income
budgeted in each sub-element.
6. The Subgrantee shall implement the automated client tracking system and shall do so
consistent with the policies and procedures promulgated by the Division of Aging
Services for MIS or CSRA RC.
7. The Subgrantee shall notify CSRA RC promptly of any changes in service delivery,
organization or sites.
8. The Subgrantee shall do, perform, and carry out, in a satisfactory manner, as determined
by CSRA RC's cognizant department director, the goals and objectives required to fulfill
this agreement.
9. The Subgrantee shall implement customer satisfaction feedback and provide annual
evaluations. The Subgrantee shall do, perform, and carry out, in a satisfactory manner, as
determined by CSRA RC's cognizant department director, the following specific work
and services.
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a; A AAA FY 2019 PROVIDER CONTRACT
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ATTACHMENT B
PROGRAM AND SERVICE REPORTING REQUIREMENTS
Reporting Requirements: As a provider under this contract, the Subgrantee shall be responsible
for implementing the following reporting requirements.
I. Intake,Assessment and Record Maintenance Basics for All Non-Medicaid Clients
1.1 The Title III-SSBG Operations Manual is superseded in part by these policies and
procedures.
1.2 Basic intake and assessment information for all new clients entering the service
delivery system shall be gathered using the following forms:
a. The Client Intake,Registration, and Tracking Form(Attachment 1)
b. DON-R-
c. The NSI"DETERMINE"Checklist(Attachment 6)
d. The (CBS) Income Determination Worksheet(Attachment 7)
1.3 The same information shall be gathered for all ongoing clients, at the time of annual
individual reassessment, and changes to these client files are to be entered in the
Harmony data bases as reassessments are completed.
1.4 Provider or AAA staff responsible for preparing individual client service plans shall
continue to use approved service plan forms until further notice.
1.5 Provider or AAA staff responsible for preparing client notification forms shall
continue to use approved forms until further notice.
1.6 Staff shall continue to include narrative entries in client records using approved
documentation formats.
1.7 Clients receiving HCBS home care services must come through the Gateway/ADRC
for an initial screening and assessment by the AAA staff. In cases where
subcontractors are authorized to admit clients directly, a comprehensive assessment
utilizing the Determination of Need-Revised (DON-R) and the Nutritional Screening
Initiative (NSI) must be performed at the provider level in accordance with Policy
114 Guideline and Requirements for Client Assessment. Refer to the Georgia
Department of Human Services' Division of Aging Services Division of Aging
Services' Requirements for Non-Medicaid and Community Based Services. In case
where the client is served by more than one agency/organization, the AAA will
designate which provider will be responsible for conducting reassessments and
making appropriate referrals. Providers are expected to review Harmony reports and
records to ensure effective coordination of services.
II. Client Intake,Registration and Tracking Form
2.1 All affected providers, and/or Area Agencies will use the Client Intake, Registration
� y
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and Tracking Form to collect,record and enter into Harmony certain basic individual
client data.
2.2 Required data elements:
(a) Items 1-25 on the front of the form
(b) Items 34 and 35, on the reverse side, regarding NSI Checklist Scores. (NAPIS)
(c) Items 47 and 48 (reverse side), regarding number of ADLs and IADLs (NAPIS)
(d) Items 52, 53 and 54 (reverse side), regarding service dates and case
disposition/termination
(e) Agency/Provider information
2.3 When form is to be completed or information is to be updated:
(a) Effective July 1, 1997, for all new clients being registered with Harmony
(b) At the time of the first or subsequent annual reassessment for ongoing clients
(c) At any time that there is a change in any of the required data for any client
(d) When a client is moved from a waiting list to active service status
(e) Upon closure or termination of the case.
2.4 Retention and distribution of the form:
(a) Keep the original form completed for initial registration of the client in the
client record.
(b) Provide a copy of the original form, and of any updated information, to the data
entry staff for processing.
(c) If adding or changing information after initial registration, complete a new form
if necessary, or add or change the information (suggestion: Use a `highlighter'
marker to enter changes on the data entry copy.) Retain the original in the client
record.
III. Checklist of Activities of Daily Living and Instrumental Activities of Daily Living
3.1 When form is completed:
(a) Effective July 1, 1997, all affected providers of Non-Medicaid Home and
Community Based Services, regardless of fund source, or Area Agencies, will
complete the check list for all clients applying for services, including those who
will be placed on a waiting list.
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AAA FY 2019 PROVIDER CONTRACT
(b) At the time of first reassessment following implementation for each ongoing
client.
(c) At any time that there is a significant change in any client's situation which
affects functional status and the need for services.
3.2 Use of information
(a) Effective July 1, 1997, the information from the ADL-IADL Checklist, along
with information captured on Poverty Level and the NSI "DETERMINE"
Checklist, will, in part, replace the ESENI in evaluating the client's priority for
receiving services.
(b) Clients at or below poverty, with significant impairments in ADLs and IADLs,
and with Nutrition Risk Scores of 6 or higher, shall be given preference for
services.
(c) Ongoing clients shall be reassessed at the annual review date and decisions
regarding continued service needs will be based on this reassessment, using the
same criteria as in III.2 (b), in conjunction with other significant information
about the client's situation and need for support.
IV.Nutrition Screening Initiative"DETERMINE" Checklist
4.1 Effective July 1, 1997, the NSI "DETERMINE" Checklist shall be used to determine
nutritional risk status for each client applying for non-Medicaid home and
community based services.
4.2 The initial NSI Checklist Score shall be entered into the Title II ISSBG Subsystem,
using the Client Intake, Registration and Tracking form.
4.3 For each client who begins receiving nutrition services on or after July 1, 1997, either
at home or in a congregate setting, the NSI "DETERMINE" Checklist will be
administered again within the first three months of service. This score, whether the
same or different, shall be entered into the Title III/SSBG Subsystem, using the
Tracking form to update the information. {See 11.4 (c.)}
4.4 Baseline NSI "DETERMINE" Checklist Scores shall be determined for all current
nutrition service clients and recipients of homemaker, in-home respite, and adult day
health services (regardless of fund source) at the time of the next scheduled
reassessment, and entered into the Title III/SSBG Subsystem, using the Tracking
form to capture the information.
(See II.4 (c).}
4.5 The risk status for all clients in the specified services shall be tracked for the duration
of their participation in the service program using the Checklist and Tracking forms
for data collection and data entry on an annual review basis.
•
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AAA FY 2019 PROVIDER CONTRACT
4.6 Wherever feasible, nutrition service applicants/participants with risk scores of 6 or
higher shall be referred for additional individualized nutrition screening (Level I
Screening) and counseling by a registered dietician.
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Ec',L�Eqs.
( �� MA FY 2019 PROVIDER CONTRACT
ATTACHMENT C—COST AND FINANCIAL REPORTING REQUIREMENTS
Compensation: The compensation is shown by cost center and resource category on the
Distribution of Resource, Supplemental Fiscal Year exhibit and on the following individual cost
center pages, which are attached to and made a part of this agreement for financial reporting,
monitoring, and audit purposes. The maximum amount of CSRA RC's compensation to the
Subgrantee by cost center is equal to the total federal and state funds as outlined in Section I of
this agreement.
The Subgrantee's request for payment described in the "Method of Payment" paragraph in the
main body of the Agreement shall delineate charges to be applied to each service. In no event
will total payments under each service exceed the maximum amounts listed on the "Distribution
of Resources" exhibit, nor shall CSRA RC's payment to the Subgrantee exceed the total federal
and state funds as outlined in Section I of this agreement.
Any deviation from or changes to the approved budget shall be handled as follows:
A. Deviations between Expenditure Object Class Categories (except FOOD or
EQUIPMENT) within the same service are permitted if the cumulative absolute total of
such transfers does not exceed ten (10) percent of the total amount for that service shown
on individual cost center pages. Subgrantee must promptly submit written notice of such
deviation to CSRA RC. No deviation in the FOOD or EQUIPMENT Expenditure Object
Class Categories is permitted, under this ten percent provision.
B. If the Subgrantee's proposed deviations exceed the tolerances identified in A. above, or if
transfers of funds are proposed from one or more services to another, a formal agreement
amendment must be requested by the Subgrantee, approved by CSRA RC, and executed
by both parties.
II. Matching Share: In addition to the requirements specified herein, the Subgrantee specifically
agrees to comply with, and shall be bound by, the applicable terms and procedures for
determining the allowability of non-federal contributions by the Subgrantee or other non-federal
parties in satisfying the cost sharing and matching requirements of this agreement, if any,
including but not limited to 45 CFR 74 and 45 CFR 92 as appropriate.
The Subgrantee further agrees that if non-federal contributions provided by the Subgrantee or
other non-federal parties to fulfill the matching share requirements of this agreement, if any, are
not in conformity with the above and are subsequently disallowed as a result of an audit by
CSRA RC, the funding agencies, the Comptroller General of the United States, or any of their
duly sworn representatives, then, upon written demand by CSRA RC, the Subgrantee shall,
within thirty (30) calendar days of receipt of such written demand, reimburse CSRA RC the
amount of compensation previously paid by CSRA RC to the Subgrantee that became unearned
because of such disallowance.
III. Program Income. Program income, as defined in 4 CFR 74 and 45 CFR 92 as appropriate, is
further defined as follows:
Funds projected to be contributed by participant(s) or person(s) on behalf of a particular
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t
participant(s) of the program during the period of this subgrant agreement. Expenditure of this
resource is limited to funds actually received, up to the amount shown on the "Distribution of
Resources" exhibit. If program income is generated in excess of the amount shown on the
"Distribution of Resources" exhibit, an agreement amendment executed by both parties is
required prior to expenditure.
All program income is bound by the same guidelines and requirements governing the
expenditure of all funds in this agreement. It is a resource to be budgeted and accounted for by
service.
V. General:
A. The Subgrantee agrees that the "year to date" percent of annual budget expended (by
service or by category, and/or by Part, as appropriate) shall be in approximate alignment
with the "year to date"percent of units of service delivered.
B. The Subgrantee agrees that Match and Program Income collected shall be expended
monthly or at intervals such that state and federal funds are not expended at an
accelerated rate (e.g. 10 percent match to 90 percent state and federal funds in Title III;
and 12 percent match to 88 percent state and federal funds in SSBG).
C. The Subgrantee agrees to furnish annual cost/cash contribution or in-kind match for Title
III, as appropriate, which represents 10 percent of the total cost of this agreement. The
certified cost/expenditures or in-kind match values will be expended/recorded by the
Subgrantee monthly at 10 percent of the total monthly project expenditures for each
service claimed for reimbursement.
D. The Subgrantee agrees to furnish annual cost/cash contribution or in-kind match for
SSBG which represents 12 percent of the total cost of this agreement. The certified
cost/expenditures or in-kind match values will be expended/recorded by the
Subgrantee monthly at 12 percent of the total monthly project expenditures for each
service claimed for reimbursement. The Subgrantee agrees that CSRA RC may withhold
reimbursement if compliance is not maintained with A., B., and C. above or if
satisfactory explanations are not provided regarding the provision of units of service
and dollars expended.-
€� Any advance under this agreement must be returned to CSRA RC prior to end of the
agreement period. The Subgrantee further agrees that upon termination of this agreement
for any reason, all unexpended funds held by the Subgrantee shall revert to CSRA RC.
The Subgrantee further agrees that the "advance of funds" will be repaid in three equal
installments during March, April, and May of this agreement period unless CSRA RC's
Director of Finance and Administration gives written approval for another repayment
schedule. Should any interest be earned on funds that were advance by CSRA RC, the
Subgrantee will apply the interest to the cost of this agreement prior to making a
reimbursement/payment request to CSRA RC.
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tri:.
F �. AAA FY 2019 PROVIDER CONTRACT
Security and Immigration Compliance Affidavits
Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3)
By executing this affidavit, the undersigned subcontractor verifies its compliance with
O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in
the physical performance of services under a contract with CSRA Regional Commission on behalf of the
Georgia Department of Human Services has registered with, is authorized to use and uses the federal
work authorization program commonly known as E-Verify, or any subsequent replacement program, in
accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91.
Furthermore, the undersigned subcontractor will continue to use the federal work authorization program
throughout the contract period and the undersigned subcontractor will contract for the physical
performance of services in satisfaction of such contract only with sub-subcontractors who present an
affidavit to the subcontractor with the information required by O.C.G.A. § 13-10-91(b). If the
undersigned subcontractor receives notice that a sub-subcontractor has received an affidavit from any
other contracted sub-subcontractor, the undersigned subcontractor must forward, within five business
days of receipt, a copy of the notice to the contractor. Subcontractor here by attests that its federal work
authorization user identification number and date of authorization are as follows:
Federal Work Authorization User Identification Number
Date of Authorization
Name of Sub-subcontractor
Name of Project
Georgia Department of Human Services
Name of Public Employer
I hereby declare under penalty of perjury that the forgoing is true and correct.
Executed on ,_,201_in (city), (state).
Signature of Authorized Officer or Agent
Printed Name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE DAY OF ,201_.
NOTARY PUBLIC
My Commission Expires:
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SECTION D -ASSURANCES
•
Contractual and Administrative Assurances • '
The following assurances must be signed and included with the response.
➢ General Financial Requirements and Assurances
➢ Contractual and Standard Program Assurances
➢ Assurance of Compliance with Title VI of the Civil Rights Act of 1964,As Amended
➢ Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973,As Amended and the
Americans' with Disabilities Act of 1990,As Amended
➢ Certification Regarding Debarment,Suspension, and Other Responsibility Matters
➢ Disclosure of Lobbying Activities
➢ Health Insurance Portability Act Business Associate Agreement
➢ Certification of Non-Collusion
➢ Conflict of Interest Disclosures
➢ E-Verify Certification
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Version:2019-Aging
M.
GENERAL FINANCIAL REQUIREMENTS AND ASSURANCES
The Responder/provider assures that the following general financial conditions are understood and will be met as a
requirement for entering into a contract with the CSRA Regional Commission (CSRA RC),Area Agency on Aging for
aging services:
Initial Each:
1. I understand that the CSRA Regional Commission,Area Agency on Aging shall have the right to
suspend/withhold payment if conditions of the contract are notmet.
2. I understand that CSRA RC shall not be liable for non-payment or late payment for services rendered if
aging funds are not available or have not been received from the Georgia Division of Aging or Federal
Administration on Aging.
3. I understand that CSRA RC shall base all payments to contractors upon unit costs developed utilizing the
Uniform Cost Methodology except in those cases where services have been exempted by the DHS Division
of Aging Services.
4. I understand that required monthly program reports must be submitted on the 5th businessday following
the end of the month of service and that failure to do so may result in a delay in payment.
5. I understand that the financial reports must be submitted by the end of business on the 5th following the
end of the month of service. Failure to submit reports by this date can jeopardize timely reimbursement.
6. I understand that federal,state,and program income are restricted funds and must be spentduring this
fiscal year. Minimum required match is the minimum non-federal fundsnecessary to earn the federal and
state funds for the program.
7. I understand that program income is funds voluntarily donated by the participants ofthe program to
increase or maintain services. Included in the budget is an estimate of the funds to be collected during
this next fiscal year and is based on past history of such collections of program income from participants
of the program.
8. I understand this budget is for a period that runs from July 1, 2018 to June 30,2019.
9. I understand that I will provide no less than 250 days of service per year for the nutrition program (if
applicable to this response).
10. I understand that all other services will be available no less than 250 days per year and will be based on
client or caregiver needs and/or care plans.
I HAVE REVIEWED,UNDERSTAND AND AGREE TO ABIDE BY THE FINANCIAL CONDITIONS AS STATED ABOVE.
41Nardi P navi g, Jr
I
Name of Responder(typed or printed)
MAYOR
Title(typed or printed)
.1\,fr(e. Ag41-1), jef,
Signature of Legally Au'IMPRIPIllsOn
Date
Version:2019—Aging
CONTRACTUAL AND STANDARD PROGRAM ASSURANCES
The Responder/provider assures the following general conditions will be met as a requirement for entering a
contract with for aging services:
1. Assures compliance with Older Americans Act,Social Services Block Grant,Community Care Services Program,and
other funding sources as well as all federal,state laws,standards, policies and procedures.Also assures the
compliance with Area Agency on Aging Administrative, Program,and Gateway requirements regarding
administration and delivery of aging services.
2. Assures the provision of training to staff and volunteers as needed and/or required.
3. Assures the priorities established by the Area Agency on Aging for serving older persons with greatest economic or
social need are met.
4. Assures the establishment of an opportunity for recipients of services the opportunity to contribute toward
services provided. Documentation of program income must be kept on file and reported monthly to Area Agency
on Aging.
5. Assures that aging services will not be denied to any older person because they cannot or will not contribute
toward the cost of the service for Title Ill services.
6. Assures that funds received through voluntary contributions from program participants will not be used to replace
funds from other non-federal sources, but will be used to maintain or expand aging services provided under this
contract.
7. Assures support from private or public sources to expand services funded through the Area Agency on Aging.
8. Assures that criminal record checks are performed for all employees who have direct contact with program
participants.
9. Assures that it will supply an annual audit in accordance with the provisions of the 1359 Audit Law. Copies of all
reports resulting from said audits shall be furnished to the Area Agency on Aging no later than 180 days after the
fiscal year ends as detailed in the current contract.
10. Assures records relating to the aging programs are kept on file for at least six(6)years after the end of the contract
period.
11. Assures all services provided under this program will meet current state and local licensure safety and insurance
requirements for the provision of those services.
12. Assures contracts for subcontracted services are submitted to Area Agency on Aging for review and approval prior
to the service beginning.
Version:2019—Aging
M.
13. Assures written personnel policies affecting agency staff have been developed to include, but not limited to,
written job descriptions for each position;evaluations of job performance,annual leave,sick leave, holiday
schedules, normal working hours,and compensatory time. Personnel policies and hiring policies are in compliance
with federal and state laws regarding employment and payroll practices.
14. Assures Responder has written client grievance and personnel grievance procedures have been developed,posted,
and distributed to clients and personnel.
15. Assures Responder has policies prohibiting the release of any client's name, medical records or conditions,or other
identifying information to any persons outside the agency without first obtaining the expressed consent of the
client.The agency shall also require all subcontracting agencies performing services to adhere to similar policies
concerning client confidentiality.
16. Assures coordination with other aging programs and services in thecommunity.
17. Assures effective financial management of funds allocated to the aging programs utilizing the Uniform Cost
Methodology.
18. Assure compliance with existing regulations and all relevant and current circulars from the Office of Planning and
Budget for determination and allowableness of costs in connection with federal/state contracts and grants.
19. Assures the accurate and timely reporting of programmatic and financial information to the Area Agency on Aging,
state and federal government as required.
20. Assures a method is implemented to obtain client feedback on services provided to maintain quality of programs.
21. Assures access to all program and agency records by the Area Agency on Aging, DHS Division of Aging Services and
other federal or state officials or auditors as needed.
22. Assures cooperation in the use of any facility,equipment or resources owned or operated by DHS which may be
required in the event of a declared emergency ordisaster.
23. Assures cooperation in the transition of any service subsequently contracted to another vendor/contractor.
I HAVE REVIEWED, UNDERSTAND,AND AGREE TO ABIDE BY ALL CONDITIONS(1—23)ASSTATED.
Hardie nevi s, Jr..
Vame of Responder(typed or printed)
MAYOR
Title typed o .
r
, ,
Signature of Legally Authorized Person Date
4
114, 1?
Version:2019-Aging
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE
CIVIL RIGHTS ACT OF 1964, AS AMENDED
THE RESPONDER HEREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964, as
amended,and all requirements imposed by or pursuant to the Regulation of the Department of Health and
Human Services (45 CFR Part 80) issued pursuant to that title,to the end that, in accordance with Title VI
and the Act and the Regulation, no person in the United States shall,on the ground of political affiliation,
religion, race, color, sex, handicap, age,or national origin, be excluded from participation in, be denied the
benefits of or be otherwise subjected to discrimination under any program or activity financed in whole or in
part by federal funds,which the RESPONDER provides or participates directly through a contractual or other
arrangement.
The RESPONDER agrees to make no distinction on the ground of political affiliation, religion, race, color,sex,
handicap, age, or national origin with respect to admission policy or procedure or in the provision of any aid,
care, service or other benefits to individuals admitted or seeking admission to the RESPONDER.
This assurance is given in consideration of and for the purpose of receiving any and all payments from state
agencies receiving federal grants.The RESPONDER recognizes and agrees that state agency financial
payments will be extended in reliance on the presentations and agreements made in this assurance, and
that the United States shall have the right to seek judicial enforcement of this assurance.
The assurance is binding on the RESPONDER, its successors,transferees, and assignees, and the persons
whose signatures appear below are authorized to sign this assurance on behalf of the RESPONDER.
Hardie Davis, Jr.
Name of Responder (typed or printed)
MAYOR
Title (typed or printed)
te
A Signat re of Legall -. zed Person Date
Va(114
Version:2019-Aging
ASSURANCE OF COMPLIANCE WITH SECTION 504 OF THE
REHABILITATION ACT OF 1973,AS AMENDED,AND THE
AMERICANS WITH DISABILITIES ACT OF 1990,AS AMENDED
The RESPONDER HEREBY AGREES THAT it will comply with Section 504 of the Rehabilitation Act of 1973, as
amended,and the Americans with Disabilities Act of 1990, as amended, and all requirements imposed by
the applicable DHHS regulation (45 CFR Part 84)and all guidelines and interpretations issued pursuant
thereto.
Pursuant to sub-section 84.5(a)of the regulation (45 CFR 84.5(a)),the RESPONDER gives this Assurance in
consideration of and for the purpose of obtaining any and all federal grants, loans, contracts(except
procurement contracts and contracts of insurance or guaranty), property, discounts, or other federal
financial assistance extended by the Department of Health and Human Services after the date of this
Assurance, including payments or other assistance made after such date on Responses for federal financial
assistance that were approved before such date.
The RESPONDER recognizes and agrees that such federal financial assistance will be extended in reliance on
the representations and agreements made in this Assurance and that the United States will have the right to
enforce this Assurance through lawful means.This Assurance is binding on the RESPONDER, its successors,
transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign
this Assurance on behalf of the recipient.
This Assurance obligates the recipient for the period during which federal assistance is extended by it to the
Department of Health and Human Services or,where the assistance is in the form of real property,for the
period provided for in sub-section 84.5(b)of the regulation (45 CFR84.5(b)).
The RESPONDER: (check(a)or{b})
a. Employs fewer than fifteen (15)persons.
b. Employs fifteen (15)or more persons and, pursuant to sub-section 84.7(a) of the regulation (45
CFR 84.7(a)), has designated the following person(s)to coordinate its efforts to comply with the
DHHS regulation.
Name of Compliance Person Employer Identification#(IRS#)
I certify that this information is complete and correct to the best of my knowledge.
Hardie Davis, Jr.
Name of Responder(typed or printed)
MAYOR
Title (typed or printed)
44 Signature o egally . !zed Person Date
1/41/'1 Version:20 • -Aging
CERTIFICATION
REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS
Federal Executive Order 12549 requires the Area Agency on Aging(AAA)to screen each covered potential
contractor/grantee to determine whether each has a right to obtain a contract/grant in accordance with
federal regulations on debarment,suspension, ineligibility,and voluntary exclusion. Each covered
contractor/grantee must also screen each of its covered subcontractors/providers.
In this certification "contractor/grantee" refers to both contractor/grantee and subcontractor/sub-grantee:
"contract/grant" refers to both contract/grant and subcontract/subgrant. By signing and submitting this
certification the potential contractor/grantee accepts the following terms:
1. The certification herein below is a material representation of fact upon which reliance was placed when this
contract/grant was entered into. If it is later determined that the potential contractor/grantee knowingly
rendered an erroneous certification, in addition to other remedies available to the federal government,the
Department of Health and Human Services, United States Department of Agriculture or other federal department
or agency,the Georgia Department of Human Services„or the CSRA Regional Commission may pursue available
remedies, including suspension and/or debarment.
2. The potential contractor/grantee shall provide immediate written notice to the person to which this certification
is submitted if at any time the potential contractor/grantee learns that the certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
3. The words"covered contract," "debarred," "suspended,""ineligible,""participant," "person," "principal",
"response,"and "voluntarily excluded,"as used in this certification have meanings based upon materials in the
Definitions and Coverage sections of federal rules implementing Executive Order 12549. Usage is as defined in
the attachment.
4. The potential contractor/grantee agrees by submitting this certification that,should the proposed covered
contract/grant be entered into,it shall not knowingly enter into any subcontract with a person who is debarred,
suspended,declared ineligible,or voluntarily excluded from participation in this covered transaction, unless
authorized by the Department of Health and Human Services, United States Department of Agriculture or other
federal department or agency,the Georgia Department of Human Services and/or the CSRA Regional
Commission as applicable.
Do you have or do you anticipate having subcontractors/subgrantees under this proposed contract?
YES NO
Version:2019-Aging
5. The potential contractor/grantee further agrees by submitting this certification that it will include this certification
titled "Certification Regarding Debarment,Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts
and Grants"without modification,in all covered subcontracts and in solicitations for all covered subcontracts.
6. A contractor/grantee may rely upon a certification of a potential subcontractor/subgrantee that it is not debarred,
suspended, ineligible,or voluntarily excluded from the covered contract/grant, unless it knows that the certification
is erroneous.A contractor/grantee must,at a minimum,obtain certifications from its covered
subcontractors/subgrantees upon each subcontract's/subgrant's initiation and upon each renewal.
7. Nothing contained in all the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this certification document.The knowledge and information of a
contractor/grantee is not required to exceed that which is normally possessed by a prudent person in the ordinary
course of business dealings.
8. Except for contracts/grants authorized under paragraph 4 of these terms, if a contractor/grantee in a covered
contract/grant knowingly enters into a covered subcontract/subgrant with a person who is suspended,debarred,
ineligible,or voluntarily excluded from participation in the transaction, in addition to other remedies available to
the federal government, Department of Health and Human Services, United States Department of Agriculture,or
other federal department or agency,as applicable,the Georgia Department of Human Services,or other state
department or agency,as applicable,and/or the CSRA Regional Commission may pursue available remedies,
including suspension and or debarment.
CERTIFICATION REGARDING DEBARMENT,SUSPENSION,INELIGIBILITY AND VOLUNTARY EXCLUSION FOR
COVERED CONTRACTS AND GRANTS.
Indicate which statement applies to the covered potentialcontractor/grantee:
The potential contractor/grantee certifies, by submission of this certification,that neither it nor its principals is
presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from participation
in this contract/grant by any federal department or agency or by the State of Georgia.
The potential contractor/grantee is unable to certify to one or more of the terms in this certification. In this
Ti
instance,the potential contractor/grantee must attach the explanation for each of the above terms to which he is
unable to make certification.
NAME OF POTENTIAL CONTRACTOR/GRANTEE
VENDOR ID NO./FEDERAL EMPLOYER'S ID NO.
1, Hardie Davis, Jr.
AI �Signature of Authorized Representative. i Printed/Typed Name of Authorized Representative
impel .,,,, ,,,,,, v. ,
j7/7 MAYOR
Date M,' ev
e. u:c' Title of Authorized Representative
x
4 tyVers n:24,%—Ainw , f 1; 44bilp_suB . 1
444„40 f
i, '41x2saiuvzow-il"
M.
DISCLOSURE OF LOBBYING ACTIVITY
1.Type of Federal Action: 2.Status of Federal Action: 3. Report Type:
a.contract a.bid/offer/response a.initial filing
b.grant b.Initial award b.material change
c.cooperative agreement c.post-award For Material Change Only:
d.loan year quarter
e.loan guarantee date of last report
f.loan insurance
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 b. Individual Performing Services (including
(if individual, last name, first name, MI) : address if different from No. 10a)
(attach Continuation Sheet(s) (last name, first name, MI)
SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply) : 13. Type of Payment (check all that apply) :
$ actual planned
a. retainer
12. Form of Payment (check all that apply) : b. one-time fee
a. cash
c. commission
b. in-kind; specify: d. contingent fee
nature e. deferred
value f. other; specify:
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 ll:
(attach Continuation Sheet(s) SF-LLL-A, if necessary)
15. Continuation Sheet(s) SF-LLL-A I I
attached: Yes No
16. Information requested through this form is authorized by Signatpre:
title 31 U.S.C. section 1352. This disclosure of lobbying Print
activities is a material representation of fact upon which Name: Har e Davis, Jr.
reliance was placed by the tier above when this transaction
was made or entered into. This disclosure is required MAYOR
pursuant to 31 U.S.C. 1352. This information will be Title:
reported to the Congress semi-annually and will be
available for public inspection. Any person who fails to Telephone
file the required disclosure shall be subject to a civil No. : Date:
penalty of not less than $10,000 and not more than $100,000
for each failure.
Authorized for Local Reproduction
wig
� � Standard Form--LLL
Version:2010—Aging
INSTRUCTIONS FOR COMPLETION OF SF-ILL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity,whether subawardee of 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
of 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 SF-LLL-A 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 limited to subcontracts,subgrants and contract awards undergrants.
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 response/response control number assigned by the Federal agency).Include prefixes,e.g.,
"RFP-DE-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 reasonably 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 charge 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 SF-LLL-A Continuation Sheet(s)isattached.
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.
Version:2019—Aging
11M1h.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
BUSINESS ASSOCIATE AGREEMENT
The contractor,
, satisfactorily
assures the Central Savannah River Area Regional Commission Area Agency on Aging(CSRA RC AAA)that it is
in compliance with Health Insurance Portability and Accountability Act(HIPAA), Public Law No. 104-19 1, 110
Stat. 1936. (Kassenbaum, Kennedy),45 CFR 160, et seq. (HIPAA Privacy Regulations) and its regulations,
including but not limited to the Privacy rule promulgated in 45 CFR 160 and Part 164 subparts A and E,that
pursuant to HIPAA became effective April 14, 2003. The contractor(provider) understands and
acknowledges that the Georgia Department of Human Services is a covered entity as defined by HIPAA and
is required to adopt and implement standards and procedures for the handling of protected health
information by April 14, 2003. Further, as the CSRA RC Area Agency on Aging is for purposes of HIPAA, a
business associate of the Georgia Department of Human Services; its contractors that provide aging related
services and handle protected health information are business associates of both the CSRA RC AAA and the
Department. The contractor(provider) further understands and acknowledges that upon entering a
contract with the CSRA RC AAA, it is a business associate of the Georgia Department of Human Services and
the CSRA RC Area Agency on Aging as defined by HIPAA and is required to agree to comply with and abide by
the Department's and the CSRA RC Area Agency on Aging's privacy standards and procedures. The
contractor(provider)therefore agrees that any use of protected health information pursuant to this
contract will comply with all HIPAA and Department and CSRA RC AAA requirements and privacy standards
and procedures.
Further,the contractor agrees to provide training for its employees as required by HIPAA. It shall provide
the privacy, security, and electronic data interchange safeguards as outlined by federal law and regulations.
It shall provide clients' rights, notice of privacy policies, maintain minimum necessary and de-identified
information as required by HIPAA and will comply with any policies of the Georgia Department of Human
Services or the CSRA RC Area Agency on Aging.The contractor further acknowledges and agrees that the
Georgia Department of Human Services Division of Aging Services, including the Long-Term Care
Ombudsman, and the CSRA RC Area Agency on Aging provide functions that are considered health oversight
agencies in their funding, quality improvement and regulatory functions.As health oversight agencies,
protected health information must be shared with them and authorization is not required, according to
HIPAA.
I HAVE REVIEWED, UNDERSTAND AND AGREE TO ABIDE BY ALL CONDITIONS AS STATED HEREIN.
Name of Responder Hardie Davis, Jr. Date:
.ed)
b / Title: MAYOR
Em Signature o _•-• orized Person
X1 /1
f
Version:2019—Aging
CERTIFICATE OF NON-COLLUSION
FAILURE TO EXECUTE THIS CERTIFICATE WILL AUTOMATICALLY RESULT IN REJECTION OF RESPONSE
I certify that this bid and/or response is made without prior understanding, agreement, or connection with
any corporation, firm,or person submitting an response for the same materials,supplies, equipment,and/or
services and is in all respects fair and without collusion or fraud. I understand that collusive bidding and/or
applying is a violation of State and Federal Law and can result in fines, prison sentences,and civil damage
awards. I agree to abide by all conditions of this response and certify that I am authorized to sign this
response for the Responder.
I HAVE REVIEWED, UNDERSTAND AND AGREE THAT THIS RESPONSE HAS BEEN DEVELOPED AND SUBMITTED
WITHOUT ANY COLLUSION BETWEEN THE RESPONDER AND ANY OTHER RESPONDER.
Name of Responder: Hard i P Davis, Jr_ , Mayor Date:
(typed or printed)
•
AS/I/Signature of Legally Authorized Person
1/9f/1
Name:
(typed or printed)
Title:
(typed or printed)
/////////////////// This space left intentionally blank ////////////////////////
/////////////////// This space left intentionally blank ////////////////////////
Version:2019—Aging
CONFLICT OF INTEREST DISCLOSURES
The Central Savannah River Area Regional Commission is recognized as an Organization of Ethics under the Georgia Municipal
Association's ethics designation program.Additionally,the RC has established ethics policies that dictate that potential
conflicts of interest be clearly delineated by respondents seeking to do business with the RC or its component units.Such
disclosures do not necessarily prevent the Responder/respondent/Responder from being awarded contracts by the RC so
long as the disclosures take place in the Request for Proposal/Response/Bid process.This form must be submitted with all
responses to Central Savannah River Area Regional Commission Requests for Responses/Responses/Bids.
Name of Firm/Individual:
Form of Legal Entity(if applicable):
Address:
Phone:
Name and Title of Respondent:
Disclosure Certification:
If the owner(s)and/or any key personnel or immediate family members of all such personnel identified in this response have
been employed by the RC or served on any of the following Boards/Authorities/Councils currently or within the past five(5)
years,please check the appropriate box(es)below and attach supporting documentation2 you feel is necessary to address
potential conflict of interest questions which may be raised:
A former employee of the Central Savannah River Area RC
Central Savannah River Area Regional Commission's Council
CSRA RC Historic Preservation Advisory Council
CSRA RC Area Agency on Aging Advisory Council
CSRA Business Lending(to include the following companies): r.,r;,',
AC=ENCY
CSRA Local Development Corporation f°-°` -`tir
CSRA Rural Lending Authority
CSRA Resource Development Agency Eall3011111111
No owner,key personnel,or immediate family members I. E N D 6 N G
serve in any capacity on the entities listed above.
By signing below,I ackno - : . • .t the above disclosure is true and accurate as of the date signed.
I-v
ii Signature of Certifying Offi ial `- #c bovT 3-1-'i Mayo' Date Signed
"( . /W
//
Witness ,�9?`.:a1).t/ Date Signed
?All Respirdtps applying for funds through thfArea 4ency on Aging must a)identify the person or persons for whom a potential conflict of interest exists,b)the
Ielationshtcc,�ypurrent or ormer boarddm�/eurrent of former advisory council member,or current of former employee;and c)the nature of the potential
fonflict The Terson oP.person's f r who�r9 le potenVial conflict of interest exists shall certify that he/she will abide by all rules established by Subsection 102.12(Conflicts
,11
rof Interest)ofltr4Geortgia4Ceeriatriattght of HumVServices Division of Aging Services Administrative Guidelines.
'
i Version:2019 Atilt '"`-0
MINlb.
E-Verify Certification
Affidavit Under O.C.G.A. § 13-10-91(b)(4)
By executing this affidavit,the undersigned sub-subcontractor verifies its compliance with O.C.G.A. §
13-10-91,stating affirmatively that the individual, firm or corporation which is engaged in the physical
performance of services under a contract for the Coordinated Transportation System Services on behalf of
agencies of the State of Georgia has registered with, is authorized to use and uses the federal work
authorization program commonly known as E-Verify, or any subsequent replacement program, in
accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore,
the undersigned sub-subcontractor will continue to use the federal work authorization program
throughout the contract period and the undersigned sub-subcontractor will contract for the physical
performance of services in satisfaction of such contract only with sub-subcontractors who present an
affidavit to the sub-subcontractor with the information required by O.C.G.A. § 13-10-91(b).The
undersigned sub-subcontractor shall submit, at the time of such contract,this affidavit to (name of
subcontractor or sub-subcontractor with whom such sub-subcontractor has privity of contract).
Additionally,the undersigned sub-subcontractor will forward notice of the receipt of any affidavit from a
sub-subcontractor to(name of subcontractor or sub-subcontractor with whom such sub-subcontractor has
privity of contract). Sub-subcontractor hereby attests that its federal work authorization user
identification number and date of authorization are as follows:
Federal Work Authorization User Identification Number Date of Authorization
Name of Sub-subcontractor Name of Project
CSRA Regional Commission
Name of Public Employer
I hereby declare under penalty of perjury that the foregoing is true and correct.
Executed on . 201 in (city), (state).
ow Signature of Author' • 'icer or Agent SUBSCRIBED AND SWORN BEFORE ME
oio Hardie Davis, Jr. , Mayor ON THIS THE DAY OF 20_
(( Printed Name&Title of Authorized Officer or Agent
NOTARY PUBLIC
MY COMMISSION EXPIRES:
Version:2016-1A-NNS Page 62 of 66
In..
.
•
COMPLIANCE WITH CLEAN AIR AND WATER ACTS
The grantee certifies that:
This contract is subject to the requirements of the Clean Air Act, as amended, 42 USC 1857 et. seq., and
the regulations of the Environmental Protection Agency with respect thereto, at 40 CFR Part 15, as amended
from time to time.
In compliance with said regulations:
1.) The Contractor shall require of subcontractors that any facility to be utilized in the performance of any
nonexempt contract or subcontract is not listed on the List of Violating Facilities issued by the Environmental
Protection Agency (EPA) pursuant to 4C CFR 15.20.
2.) The Contractor will comply with all the requirements of Section 114 of the Clean Air Act, as amended,
(42 USC 1857c-8) and section 308 of the Federal Water Pollution Control Act as amended,(330 USC 1318)
relating to inspection, monitoring, entry, reports, and information, as well as all other requirements
specified in said section 114 and section 308, and all regulations and guidelines issued thereunder.
3.) The Contractor will provide prompt notice of any notification received from the Director, Office of
Federal Activities, EPA, indicating that a facility utilized or to be utilized for the contract is under
consideration to be listed on the EPA List of Violating Facilities.
4.) The Contract will include or cause to be included the criteria and requirements to paragraph (1)
through (4) of this section in every nonexempt subcontract and take such action as the Government will
direct as a means of enforcing such provisions.
A...4111111411W
Signature of Legally Authorized Person
401.
Nit(
Name: Hardie Davis, Jr.
(typed or printed)
Title: MAYnR
Version:2019--Aging