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HomeMy WebLinkAboutC05-364 NWCCOG_HHS
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NORTHWEST COLORADO COUNCIL OF GOVERNMENTS
ALPINE AREA AGENCY ON AGING
PURCHASE OF SERVICES CONTRACT
TITLE III PART C-l and PART C-2 OF THE OLDER AMERICANS ACT
CONTRACTING AGENCY Eagle County Health & Human Services
CONTRACT # 2006-C- Eagle
THIS AGREEMENT, entered into and effective this 1 st day of January, 2006 by and between the
NORTHWEST COLORADO COUNCIL OF GOVERNMENTS, ALPINE AREA AGENCY ON
AGING (hereinafter called the "Council") and EAGLE COUNTY HEALTH & HUN LAN SERVICES
(hereinafter called the "Contractor"), is for the provision of nutrition program services (including
information and assistance, education, outreach, congregate meals, home-delivered meals, nutrition
screening, nutrition education and nutrition counseling), for Older Americans Act/Older Coloradans
Act program eligible persons for their nut1-ition project.
WITNESSETH:
WHEREAS, the ALPINE AREA AGENCY ON AGING, a division of the Northwest Colorado
Council of Governments, is mandated under the provisions of the Older Americans Act to develop a
comprehensive coordinated service delivery system to help older persons maintain themselves in their
own homes with maximum independence, and, as such, is responsible for applying for and the
administration of the funding received from the Federal Government and from the State of Colorado
for aging services programs under Older Americans Act and/ or State Funding for Senior Services; and
WHEREAS, the Contractor was selected as an Older Americans Act program provider by the Alpine
Area Agency on Aging Regional Advisory Council and the Council following a competitive Request for
Proposal process; and
WHEREAS, the Council desires to engage the Contractor to render nutrition program services
hereinafter described in connection with the undertaking which is expected to be fmanced through the
State of Colorado either in part or fully through Tide III;
WHEREAS, the Contractor warrants that they have staff, knowledge, and skills for the proper and
efficient provision of nutrition program services for their nutrition project and desires to perform said
serv-ices pursuant to said Contract and its Exhibit( s);
NOW, THEREFORE, the parties hereto mutually agree as follows:
1
local cash and in-kind match.
F. Contractor agrees that Older Americans Act funds, local cash match, and in-kind match will be spent
equally throughout the contract period and in accordance with Federal, State, and Colorado Department
of Human Services' Staff Manual Volume 10 Services for the Aging (12 CCR 2510-1) program and fiscal
regulations. Specifically agreeing to abide by the dollar amounts as shown in the budget by program and
cost categories.
G. Contractor agrees to administer and conduct nutrition screening as required using the State Unit on
Aging's prescribed Colorado Nutrition Screening Tool that is part of the Consumer Information
Assessment Form.
H. Contractor agrees, when purchasing food products with U.S. Department of Agriculture's cash
commodity program funds (hereinafter referred to in this document as "Nutrition Services Incentive
Program"), to purchase only food products that are produced in the United States.
1. Contractor agrees to provide each participating individual a minimum of 33 1/3 percent of the
current daily recommended Recommended Dietary Allowances (RDA), Dietary Guidelines for
Americans published by the Secretary of Health and Human Services and the Secretary of Agriculture
when providing one (1) meal a day.
J. Contractor agrees to adhere to all applicable sanitation, safety, and food safety rules, regulations and
laws governing or affecting the nutrition program services to be rendered under this Contract.
GENERAL PROVISIONS
1.0 GENERAL COMPLIANCE
The Contractor agrees that the nutrition project will be carried out in accordance with program
and fiscal regulations of the Older Americans Act (Title 42, Chapter 35 et al) and the Older
Coloradoan's Act (eR.S. title 26 Article 11). The Contractor agrees to comply with the
applicable version of the Colorado Department of Human Services' Staff Manual Volume 10
Services for the Aging (12 CCR 2510-1) program rules (hereinafter referred to in this document
as "Volume 1 0"), and related policy guidance provided by the State Unit on Aging of the State
of Colorado.
The Contract shall also comply with 1) clarifications or guidance issued by the United States
Department of Health & Human Services; 2) the policies and procedures established for
contracts and grants by the State; 3) the terms and conditions of the project application
approved by the Northwest Colorado Council of Governments in making this award of funds;
4) and the requirements found at Code of Federal Regulations 45 CRF, Part 1321; 45 CRF Part
74; 45 CRF Part 92; and 45 CRF Part 95 and/or the applicable Office of Management and
Budget (OMB) Circulars for awards to non-profit organizations and local governments.
The Contractor agrees to incorporate any future changes in policies or conditions of the
Council as they relate to funding awarded or services provided under this Contract.
3
Colorado which \v-ill become effective July, 2006, the awarded Title III monies will be
allocated and available to the Contractor as follows:
a. Title III award monies up to, but not exceeding 50% of the total award
($14,232.00) available to the Contractor for the period of January 1, 2006
through June 30, 2006; and
b. the remainder of the Title III award monies to be available to Contractor
after July 1, 2006.
This award of Title III monies is subject to the availability of funds to Council from the
State of Colorado, pursuant to the Older Americans Act, as per Item 8.0 FINANCIAL
OBLIGATIONS of the Contract.
6.2 The parties hereby agree that the Nutrition Services Incentive Program payments to
Contractor shall be up to, but not exceeding, the sum of $3,800.00 (Dollars), subject to
the availability of funds to Council from the State of Colorado, pursuant to the cash
commodity payments from the U.S. Department of Agriculture.
6.3 The parties hereby agree that the cash match contribution from the Contractor shall
consist of $37,850.00 (Dollars), and the Contractor's contributed in-kind services match
shall be valued in the sum of $-zero- (Dollars) for the term of this Contract.
Supplies, volunteer services, and other contributions shall be valued as described under
Code of Federal Regulations 45 C.F.R. Part 74.50. Such valuation may include wages
and fringe benefits.
7.0 METHOD OF PAYMENT
The Contractor agrees to request reimbursed payment at the end of each month from the
Council for expenses incurred within that month by the 20th day of the next month of the
calendar year during the term of the Contract. The Contractor shall report the expenditures, the
number of clients served, the units of service provided, the actual project income earned, the
actual project income expended, and (if applicable) expenditures of the Nutrition Services
Incentive Program cash during the reporting period. It is expressly understood and agreed that
in no event will the total compensation and reimbursement, if any, to be paid hereunder exceed
the maximum amount of $32,264.00 (Dollars) for all services rendered under this Contract.
8.0 FINANCIAL OBLIGATIONS
It is agreed by both parties that should the Colorado State Legislature, Colorado Department of
Human Services, U.S Department of Health and Human Services, or U.S. Department of
Agriculture disapprove the Contract or refuse or fail to make these funds and other related
federal and state funds available by appropriation, budget, approval, or otherwise made
unavailable to provide the services specitied in this Contract or any funding either in total or in
part is not forthcoming to the Council, then this Contract shall be void and shall not be binding
on any parties to the Contract as of such date. The Council and the Contractor are released
from all liability whatsoever and will not be responsible for payment of any costs or expenses
incurred in reliance upon this Contract beyond that amount which has been appropriated and
made available to Council and neither party shall have any further liability hereunder.
5
AD~fINISTRA TIVE REQUIREMENTS
12.0 FINANCIAL MANAGEMENT
12.1 Accounting Standards: The Contractor agrees to adhere to generally accepted
accounting principles and procedures, utilize adequate internal controls, and maintain
necessary source documentation for all costs incurred.
13.0 REPORTING PROVIDED BY CONTRACTOR
13.1 Performance Reports: The Contractor shall submit to the Council monthly client and
service delivery data, due on or before the 20th day of the next calendar month,
containing information on the forms prescribed by the Council and in accordance with
guidelines issued by the State of Colorado and the Administration on Aging for the
Social Assessment Management Systems (SAMS), throughout the term of this Contract
and shall be in such complete form so that all pertinent information required is
contained herein. State Funding for Senior Services performance data shall be reported
separately from Title III performance data. The Council may withhold Contract
payments should the Contractor fail to meet said requirements.
13.2 Financial Reports: The Contractor shall submit to the Council a monthly fiscal report,
due on or before the 20th of the next calendar month, containing information in a form
prescribed by the Council and in accordance with guidelines issued by the State of
Colorado and the Administration on Aging, throughout the term of this Contract and
shall be in such complete form so that all pertinent information required is contained
herein. State Funding for Senior Services expenditures shall be reported separately from
Title III fund expenditures. The Council may withhold Contract payments should the
Contractor fail to meet said requirements.
13.3 Client Data: The Contractor shall submit monthly to the Council, on or before the 20th
day of the next calendar month, the Consumer Information Assessment Form (the form
required by the State of Colorado for the Social Assessment Management Systems
[SAMS]) for every eligible congregate and home-delivered meal client that receives
services through either the Older Americans Act or Older Coloradans Act
demonstrating the client's eligibility for services and characteristics of the client. The
Council may withhold Contract payments should the Contractor fail to meet said
reqUltements.
13.4 Other Reports
The Contractor agrees to submit other reports to Council as requested by the State or
Administration on Aging, specifically:
a. Contractor agrees to submit a copy of on-site inspection reports from the
Colorado Department of Public Health and Environment and copies of any
actions taken to correct any violations cited during the inspection.
b. Contractor agrees to submit a detailed and updated inventory for each nutrition site
of food, supplies, and equipment purchased with Title III funds within thirty (30)
days after the end of the Contract period.
7
transcripts. Any deficiencies noted in audit reports must be fully cleared by the
Contractor ,v'ithin thirty (30) days after receipt of notice by the Contractor. Failure of
the Contractor to comply with the above requirements ,vill constitute a violation of this
Contract and may result in the withholding of future payments.
14.5 On-Site Assessments: The Contractor understands that the Council is required to
conduct at least annually comprehensive program and financial on-site assessments of
the activ'ities conducted under this Contract and to monitor on an ongoing basis the
performance standards of nutrition program services and to ensure that the funds made
available by this Contract are expended in keeping with the purposes for which they
were awarded.
If costs are disallowed through audit or assessment, the proportion of Older Americans Act or
State Funding for Senior Sen'ices funds disallowed must be returned to the Council or to the
State.
15.0 CONTRIBUTIONS FOR SERVICE
Contractors providing Tide III services under this Contract shall provide older persons receiving
such services the opportunity to voluntarily contribute to all or part of the costs of services
provided or received; each individual recipient shall determine for themselves what, if anything,
he/ she is able to contribute towards the cost of the service. No older person shall be denied an
Older Americans Act or Older Coloradans Act program service because of his/her failure to
contribute to all or part of the cost of such services.
16.0 PROGRAM INCOME
All Program Income shall be reported monthly to the Council on the prescribed fmancial
reporting form for that period: this includes program income earned and program income
expended for the reporting period.
16.1 Contractor may use Program Income earned during the contract period for activities
permitted under this Contract and shall reduce request for additional funds by the
amount of any such project income balances on hand.
16.2 Carry-over (unexpended program income or "balance on hand") shall also be reported
to the Council as required by the State Unit on Aging. Unexpended Program Income
funds on hand at the date the Contract is terminated shall revert to the Council unless
the Contractor is awarded a purchase of services contract for a succeeding contract
period.
16.3 Earnings and Expenditures of Part C-l and Part C-2 Program Income:
a. All Program Income earned under Tide III of the Older Americans Act awards for
congregate meals and home delivered meals shall be accounted for by the additional
costs alternative as described in Code of Federal Regulations 4S CFR Part 74.24 and
shall be added to funds committed to the Contractor's nutrition services project.
9
Equipment purchased all or in part ,'vith funds under the Older Americans Act or State
Funding for Senior Services is subject to the transfer and equipment management
regulations set forth respectively in Sections 74: 136; 74: 139; and 74: 140 of the Code of
Federal Regulations, Title 45 CRF Part 74.
19.2 The Contractor agrees to secure written approval from the Council before:
a. The purchase of equipment made by the Contractor with Older Americans Act or
State Funding for Senior Services funds.
b. The transfer, sale, or disposal of any equipment or supplies purchased all or in part
with funds under the Older Americans Act or State Funding for Senior Services.
20.0 SUBCONTRACT
The Contractor may subcontract for preparation and delivery of meals served for the nutrition
project during the term of the Contract. If a subcontractor is used, Contractor must monitor the
execution of any subcontract agreement it makes to assure compliance with all applicable Older
Americans Act, Older Coloradans Act, and Volume 10 standards. It is also the responsibility of
the Contractor to ensure its subcontractor is informed of their obligations under this contract
and of all pertinent federal, state, and local regulations relative to food preparation and delivery.
The Council shall be notified in writing prior to any work or services covered by this Contract
that will be subcontracted and also indicate whether the subcontractor is a non-profit or for-
profit entity.
21.0 NON-ASSIGNABILITY
It is understood and agreed that the Contractor shall have no right of assignment under this
Contract.
22.0 OTHER TERMS AND CONDITIONS
22.1 Personnel: All of the nutrition program services required hereunder are to be performed
by staff/volunteers of the Contractor. The Contractor shall be responsible for
employing and directing such personnel and volunteers, as it requires, to perform the
services purchased hereunder. The Contractor shall exercise complete authority over its
personnel and volunteers, and shall be fully responsible for their actions. Such personnel
and volunteers shall not be employees of the Council.
22.2 Qualifications: All of the nutrition program services required herein under will be
performed by the Contractor or under their supervision, and all personnel and
volunteers engaged in work shall be fully qualified and shall be authorized under State
and local law to perform such services.
22.3 Nondiscrimination: Contractor agrees to comply with the letter and spirit of the
Colorado Anti-Discrimination Act, CRS 24-34-401 et seq., as amended, and all
applicable local, state, and federal laws respecting discrimination and unfair employment
practices.
11
resulting from the acts or omissions of Contractor, Contractor's agents, employees, volunteers,
or permitted subcontractors, during the performance of the work herein contracted for.
Similarly Contractor agrees to indemnify Council for loss or damage to any of Council's property
or equipment loaned or used in connection with the work or services to be performed under this
Contract.
25.0 NOTICES
F or purposes of the written notices required to be provided, and any such additional written
notices, all such notices be either sent by Certified U.S. Mail, return receipt requested, or hand-
delivered to the parties at the following addresses:
For the Council: Alpine .l1.rea Agency on Aging
via Certified Mail: Northwest Colorado Council of Governments
PO Box 1208
Silverthorne, CO 80498
via Hand-Delivery Northwest Colorado Council of Governments
249 Warren Avenue
Silverthorne, CO 80498
For the Contractor: Kathleen Forinash
via Certified Mail: Eagle County Health & Human Services
PO Box 660
Eagle, CO 81631
via Hand-Delivery Eagle County Health & Human Services
551 Broadway
Eagle, CO 81631
WHEREOF, the parties hereto have made and executed this Contract to be effective as of the 1st day
of January 2006.
NORTHWEST COLORADO COUNCIL OF GOVERNMENTS
ALPINE AREA AGENCY ON AGING
("COUNCIL")
Date:
EAGLE COUNTY HEALTH & HUMAN SERVICES
("CONTRACTOR")
By: . Date: id
Please Print Name of Contract Signer ,
13
Nov-15-Z0D5 D4:47pm F rom-EAGLE COU~!!'/'IEAL TH AND HUMAN SERV iCES 9703Z888Z9 T-931 P,OOZ F-757
Part 1. COVER PAGE
Title III, Part C-l & Part C- 2
Nutrition Services Meals Proposal
J 2-month period of January 1, 2006 - December 31, 2006
a. NAME OF APPLICANT AGENCY; Eagle County Health & Human Services
b. MAILING ADDRESS OF APPLICANT AGENCY: PO Box 660
Eagle, CO 81631
c. NAME and TITLE OF OFF/C/AL AUTHOR/ZED TO SUBMIT PROPOSAL FOR AGENCY:
Kathleen Forinash, HHS Director
d. CONTACT PERSON: Kathleen Forinash
e. TELEPHONE: Health & Human Services
P.O. Box 660
Eagle, CO 81631 (970) 328..8840 main number
(970) 328-8858 direct line
f. E-MAIL ADDRESS: Kathleen. forfnash@eagIecounty.us
g. FAX NUMBER: .(970) 328-8829
It is understood and agreed by the undersigned that, 1) funds awarded as a result ofthe proposal are to
be expended for the purposes set forth herein and in accordance with all applicable laws, regulations,
policies, and procedures of the State of Colorado, The Colorado Department of Human Services, the
Administration on Aging, and U.S. Department of Health and Human Services, and 2) the funds
awarded as a result of the proposal may be terminated at any time for violations of any tenns and
requirements specified by the award.
h. K: ! J : r- .. '
I f)"'Yr.. t e i1 T7.)(,,..JAS~
Kathleen L Forinash, Director, Eagle County Health & Human SelVices
Authorize to Submit Proposal for Agency
NWCCOG.A1pine Area Agency on Aging
Nov-15-20D5 04:47pm From-EAGLE HEALTH AND HUMAN SERVICES 9703288829 T-9S1 P.DDS/Ol0 F-TST
Part 2.. SERVICE PROGRAM INFORMATION
Title ill, Part C-l & Part C...2
Nutrition Services Meals Proposal
12-month period of January 1, 2006 - December 31, 2006
This document of the proposal is formatted so that as you type your response below the question, the text box will
automa.tically scroll to adjust to the length of your response. Please limit your responses to items a.-d. to no more than
the equivalent of three 8 Vz" X 11" total pages.
I a. Describe the full geographical serVice area where the proposal applicant will be I
providing nutrition services meals: Eagle County currently operates three Title III Nutrition Sites;
Minturn in the east, Eagle in the west, and Basalt in the Roaring Fork Valley. Congregate and Home
Delivered Meals are available to senior citizens as designated by the OAA from Vail to Dotsero, and
from the Bond/Burns/McCoy areas to Basalt and EI JebeL
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b. Describe fullv the details of the proposed nutrition services delivery.
Include location and description of nutrition site(s), type of nutrition services meal(s) to be
prOVided (congregate/home delivered), indicate the number of days per week each nutrition
site will serve meals, the type of complete meal service (breakfast, lunch, supper) at each
nutrition site, and the meal hours for each nutrition services' meal service. The Eagle County
Senior Services Program operates three Senior Activity/Nutrition Sites within the boundaries of Eagle
County.
The Minturn Senior Site is located at the Minturn Town Hall Community Room. This site is leased
through the Town of Minturn and has the capacity to seat up to 40 meal participants comfortably and
without posil'19 a safety hazard to participants. The Minturn Senior Site is staffed with one part time
employee, an on site coordinator. Transportation is provided by a full time employee who serves both
Minturn and Eagle. The Minturn Senior Site provides noon time (lunch) Congregate and Home
Delivered Meals, as well as activities mo days each week on Wednesday and Friday between the
hours of 10:00am and 1:00pm.
The Eagle Senior Site is located at the Golden Eagle Senior Center. The Golden Eagle Center
(currently undergoing an expansion) has a 125 person capacity, activity centers, and a fully
commercialized kitchen. The Eagle Senior Site currently employs two full time staff (site coordinator
and senior transportation driver), and provides noon time (lunch) Congregate and Home Delivered
Meals two days each week on Tuesday and Thursday between the hours of 10:30am and 1 :OOpm.
Activities are offered throughout the week.
The Basalt Senior Site is located at the Valley Pines Condominium Complex, Highway 82 in Basalt.
The Basalt Senior Site has a capacity to comfortably seat 40 participants, with a detached exercise
area. The Basalt Senior Site is staffed with two part time employees, an on site coordinator and a
senior transportation driver. The Basalt Senior Site provides noon time (lunch) Congregate and Home
, Delivered Meals, as well as activities two days each week on Tuesday and Thursday between the
I hours of 1 0:00am and 1 :OOpm.
c. Describe the proposal applicant'S organizational structure, the placement of the nutrition
services meals program in applicant's organization, and the staffing for nutrition services
program. Eagle County Senior Services is a division of the Eagle County Health & Human Services
and reports directly to the HHS Department Head on all matters concerning the program. The Nutrition
Program will be incorporated into the existing Senior Services Program as part of the OM Title III
program functions. Staffing would consist of one cook at each Nutrition Site and one Cook Assistant at
l the Eagle Nutrition Site. Cooks would be employees of HHS.
NWCCOG-A1plne Area Agency on Aging Page 1 of 2
Nev-1S-Z00S 04:47pm Frem-EAGLE HEALTH AND HUMAN SERVICES 970SZB8BZ9 T-9Sl p,a04/010 F-757
Part 2. SERVICE PROGRAM INFORMATION
r d. If re~~~;s are not available to se"';e all eligible individuals requesting congregate or i
. home-delivered meals, describe below how preference will be given to those of !
i greatest social or economic need, particularly individuals who are frail, homebound by I
i reasons of illness or incapacitating disability or otherwise isolated. The Eagle County Nutrition
I Program is not means tested. However, in the event that participation grows beyond resources, Senior
Services would, through the collection of senior data sheets, pre-identify low income, frail, homebound
I or geographically isolated senior citizens who would be given priority.
I
NWCCOG-A1pine Area Agency on Aging Fage 2 of 2
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Part 3. SERVICE DELIVERY OBJECTIVES !
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TITLE III, PartC-l & PartC-2 Nutrition Services Meals Proposal 12-Mollth Period of January I-December 31, 2006 ~
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51
PROPOSAL APPLICANT'S ESTIMATED UNITS OF SERVICE DELIVERY and REGISTERED CLIENTS
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....
~
C-1 Estimates ~
"'"
ToW TolalUndup. !~~IY.r1\f1'," :';Pii.~l-lP.:;~~:: \t~tJ.~~~~: ~
Name 01 Congregate Nutrition Site locations UnilsSelVlce Cliellls ;~~~!~.~: IiiW/i(ii'Mioo1i'iy ;;;:;::~u~:::~::
Min[urn SeniQr NutrilionfAclivilv Site 3132 29 .n!:li;,:~'n~[~:" ::~l;:;ii;';~}:';;;:;;:i;.: ;;;.;.;~;g~::ii;;~
Golden Eagle Senior Nulrilion/Aclivily Sile 5940 55 :;,:~~;i;~~'::..:::i;': .i:;~:::;:'.1~i!~::,::;:: ;;;::{~~;:.;~::..: ~
Basalt SEmi or Nutrition/Activity Site 3672 34 ;:~:Ei.:~:?'ii;];;;;;;:}~~;;:':} ~
>-
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:: 0
:2:
Total Estimated C-1 Registered CIiElnl~ 12744 118 71 27 118 ~
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(-2 Estimates ~
,0181 lolal Undup. :r~(I.!~~i.l: ;:~U,If!IU~;~-w..(:: 'T/lIJ!IL!tl!!i!l?i ~
Name of Home-Delivered Nutrilion Sile Locations Unils SBrviotI Clianas j(~~~!E, !!.i~#i~~~ijj~.iffY. :'::~~:~ilHir:::
Mlntum Senior NUlfiliontAclMly Site 432 4 T~!~;~1W'~'~'~; ~{,;::;,;,,~~.~:;:~::: :E~r~;f~~F;~:: ~
Golden Eagle Senior NutritlontAclivily Sile 324 3 ;~}~;:!~~~i~:~.j; ~~~:~~t;;iP:~~l;;f~ T;;;~~~~;;~j: ~
'" 86 8 ))H:)ii')~;:g:;: XT:U:(F<;;~i t~~;}fr~::f:j~ E
Basalt Senior N\JlritlonlAc{llllly Slla 4 :'::::':~:',::,."'. .:.:::''''''':''''"'''''' ":':" :.~ u:>
Total Estimated C.2 Reglstered Cllenh 1620 15 I 15 2 15
G TolaIs olAl~Undup Tola'~Undup. 1olaf& Undup. Totals Undup
Units SCiVice CU"M low-]ncOtJle ow-Inc. Mil'Iorll.l RUlal ..
Total C-1&C-2 Estimated Units and Clients 14364 133 86 29 133 ;
"
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NWCCOG.A1pine Area Agency on Aging
Ncv-15-Z005 04:49pm F rem-EAGLE coUt' 'lEAL TH ANO HUIMN SERV ICES S703Z888ZS T-S31 P,008/0l0 F-i5i
Part 4. SERVICES EXPENDITURE BUDGET
TITLE ill, Parts C 1 & C2 Nutrition Services Meals ProposallJ-Mollth Period 0/ January /-Decer/lbedl, 2006
TRANSFER OF FUNDS
Trarbtfcr Rev!""'"
AlIOCaUon Amount ll:equo5t ' AllOcath.n Amount .:0..
PART C-1 ALLOCATION $ 23..210 $ -+ W'!.('7~- . $ ~ Z <6 en'?
PART C-2 AL/...OCATION $ 5,254 $. -<-1'ifC,,7. ~ $ ~ 'S~1'~
PART C-1 (Congregate) NUTRITION SERVICES BUDGET
Service Costs Cost Projections by funding SOurce
Federal TItls III C-1 progmm '"como Local Cash In-KInd Total Line I(em lludllot
Line Item De5crlptlon Budgot Amounts E1udgl!!t Amounts Budget Amount: Budgot Amounts NSIP Coer
Personnel 24.066 19,574 2,000 ~ $ 4S;-44O' YS, ~l.\Oc
Food Purchase 2,596 29,216 3,'&00 $ 3.1-;812 :3S, ()x '2,,"
Site Supplies 4,812 $ 4,812
Equipment & Repairs 850 $ 850
atere<l Meals 565 435 $ 1.000
iraining & Materials 1,000 $ 1,000
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
Total Projected C-1 Budge
("otal at Fed.TlVe III colu.", refl~d!: "'lTl $ 28,077 $ 19,574 .$ 37.463 $ $ 3.800 $ 88,914
'i'ransrer ReQ~e50 -
PART Co.2 (Home-Delivered) NUTRITION SERVICES BUDGET
Service Costs Cost Projections b' Funding Source
federal T\'dl) \II C-:l Program Income Local Cash In.Klnd To!:1 UN> ltam ~udget
Une Item Description Budgo' Amounts Budget Amounts Budget Amount: Budget Amount3 MS'!" c....t
Mileage 387 387 $ 774
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
Total Projectad C-2 Budge
(iolel at F9d.T1~ III COltl1lllll'9lleels at\) $ 387 $ $ 387 $ $ $ 774
T roosfor Aequest) - . -
OTAL C-1 & C-2 BUDGE $ 28,464 $ 19,574- $ 37,850 $ - $ 3,800 $ 89 688
f-lWCCOG-Alplne ~ Ageo.:y on AgIt1g
Nav-1S-Z00S 04:48pm From-EAGLE caVil . HEALTH AND HUMAN SERV ICES 9703Z888Z9 T-931 PODS/OlD F-757
Part 5. STATEMENTS OF UNDERSTANDING
Title III, Part C-l & Part C-2
Nutrition Services Meals Proposal
12~month period of January /,2006 - December 31, 2006
NAME OF ORGANIZA TION: Eagle County Health & Human SeNices DA TE: Nov. 14, 2005
3. Do you agree that all individuals age 60 and older shall be eligible for nutrition services? YES NO
X
b. Do you understand that all targeting factors shall be considered to prioritize delivery of YES I NO
nutrition services in compliance with Title III rules: I
That, to the maximum extent feasible, preference and priority in the delivery of nutrition
services shall be given to older persons with the greatest social or economic need with
I particular attention to low-income minority individuals and individuals who are frai',
I
I homebound by reason of illness or Incapacitating disabillty or otherwise isolated as defined
below:
.The need caused by non-economic factors which include physical and mental disabilities,
language barriers, and cultural. social. or geographical (rural) isolation including that
caused by racial or ethnic status which restricts an individual's ability to perform normal
daily tasks or which threatens such individual's capacity to live independently. x:
ยท The need resulting from an income level at or below the Federal poverty levels.
C. Do you agree to establish and develop a waiting list for nutrition services that will be yeS NO
maintained and made readily available for review by the NWCCOG-Area Agency on Aging X
and/or the State Unit on Aging?
d. Do you agree to maintain the confidentiality of protected health information, Including the YES NO
consumer's individually identifiable health information, and ensure that no information about X
an elioible consumer is disclosed without the informed written consent of the consumer?
e. Do you agree, with the consent of the older person/or his or her legal representative, to bring YES NO
to the attention of appropriate officialS for fOllow-up, conditions or circumstances which place X
the older oerson, or the household of the older person. in imminent danaer?
f. Do you agree that all nutrition sites will meet with the regulatory compliance of The Colorado yes NO
Department of Public Health and Environment's (CDPHE's) "Colorado Retail Food
Establishments Rules and Regulations (6 CCR 1010-2)?
If a nutrition site has a variance from the CDPHE, please include and attached copies of both the
variance request and the approval or denial from the CDPHE with your completed proposal X
, aDo/leation to the NWCCOG-AIDine Area AQ'encv on AQ'ino.
g. Do you agree to use the standardi~ed Consumer Information and Assessment Form for YES NO
intake eligibility determination and conducting assessments for consumers that receive X I
conoreaate and home delivered meals thrOUQh the Order Americans Act?
h. Do you agree to proVide each eligible meal consumer with an opportunity to contribute YES NO
voluntarily to the cost of the service and to have procedures that provide for responsible and X
safeouarded collection while ensurinc the anonvmitv of the client?
i. Do you agree that no eligible meal consumer shall be denied service because of a decision YES NO
not to contribute. or because of a decision to not complete the Consumer Information and X
Assessment Form?
j. Do you agree to establish procedure(s) to ensure that non-elfgible recipient fees for nutrition YES NO
services are diligently collected, handled and safeguarded? X
I k. Do you agree to work cooperatively with the contracted Registered Dietician for the YES NO
I NWCCOG-Alpine Area Agency on Aging on specific registered dietician responsibilities and
expertise regarding nutrition services delivery, including but not limited to menu cycle
development, modified diets, nutrition screening, nutrItion education, and nutrition I
I counseling. , X I
NWCCOG-A1plne Area Agency on Aging Page 1 of 2
Nov-IS-ZOOS 04:48pm From-EAGLE AND HUMAN SERVICES 97n32888Z9 T-931 p.nDS/DID F-T5T
Part 5. STATEMENTS OF UNDERSTANDING
\1. 00 you agree to have an established complaint and appeals procedures ano mat you will YES NO
inform applicants to, or consumers of. nutrition services of their right to complain and to X
I receive a written response at the nutrition services orovider level?
m. Do you agree to inform consumers of their grievance rights and their right to request and YES NO
receive an informal hearing at the nutrition services provider level? X ,
n. Do you agree to conduct criminal background checks for aU employees, volunteers, and YES I NO
contractors who have direct contact with consumers through directly providing Home X
Delivered Meals? I
o. Do you agree to submit all required regular monthly andior quarterly financial and YES NO
program/performance reports? X
p. Do you agree to proVide expense detail and indude supporting documentation that YES NO
validates services were actually provided with reimbursement requests to the X
NWCCOG-A1pine Area Agency on Aqinq?
q. Do you agree to not bilVsubmit for reimbursement or count for service delivery "no--show YES NO
consumers of services"? X
r. Do you agree to assist the NWCCOG-Alpine Area Agency on Aging with the State Unit YES NO
on Aging's scheduled reviews and comparisons of service data reported to identify
outliers or inconsistencies, to determine possible causes, and where required develop a
olan to correct the issues/causes? I X
s. Do you agree to permit audits of all records of the nutrition services program to be made I YES NO
by Federal Auditors or Representatives of the State Unit on Aging or the NWCCOG- X
Alpine Area Aaency on Aging? .
t. Do you agree, where feasible and appropriate, to make arrangements for the availability of YES NO
nutrition services to older persons in weather related emergencies or other emergency X
situations?
u. Where will the program income funds for the nutrition services be deposited?
PROGRA.\1 INCOME FUNDS WILL BE DEPOSITED BY HEALTH & HUMAN SERVICES WITH THE COUNTY
TREASURER FOR THE SPECIFIC USE OF THE NUTRITION PROGRAM. NUTRITION PROGRAM DONATIONS
WILL BE MAINTAINED SEPERATEL Y FROM ALL OTHER TITLE m PROGRAM REVENUE.
,v. Who will be authorized to withdraw funds? Rita. Woods, HHS Operations Manager.
The undersigned certify that they have read and understand the questions above and indicated whether
they agree to abide by all the rules and regulations of the NWCCOG-Alpine Area Agency on Aging.
K:'. ,,' i ",-
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W. 1..;"",I'l'.;; ,; tc.:,.. .''1''''
Kathleen L. Forinash, Director, Health & Human Services
Person Authorized to Submit Proposal for Agency
~a-cft~~_
x.
Signatur~ f Contact Person
NWCCOG-Alpil1e Area Agency on Aging Page 2: of :2