The URL can be used to link to this page

Home My WebLink AboutNutrition Program (2)Tow~ ~la~l, 53095 Ma~n Road P.O. Box 1179 Southold, New York 11971 F~x (631) 766-6145 T~lephone (631) 76~-1800 OFFICE OF TIlE TOWN CLERK TOWN OF SOUTHOLD TH~S IS TO CERTIFY THAT TI]EE FOLLOWING RESOL[~FION NO. 430 OF 2004 WAS ADOPTED AT THE REGULAR MEETING OF IH ~; SOU'£HOLD TOWN BOARD ON JUNE 1, 2004: RF~SOLVED that the Town Board of the Town of Southold authorizes and directs Supervisor Joshua Y./&orton to execute the agreement with Suffolk County Office for the A~in~ regarding the III~C Nutrition Plx~gram for the elderly on a fee-for-service basis not to excex~l $57, 878.00~ for the period January 1 2004 to December 31, 2004, s~bject to lhe approval of the Town Attorney. Elizabeth A. Neville Southold Town Clerk ELIZABETH A. NEVrLLE TOWN CLEP~K REG ISTI~k~ OF VITAL STATISTICS Towa~ Hall, 63095 Main Road P.O. Box 1179 Southald, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1500 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Ame 4, 2004 Leonor Humor, Fiscal Administrator County of Suffolk Office for the Aging Post Office Box 61 O0 Hauppauge, New York 11788-0099 Dear Ms. Hun.er: The Southold Town Board at their mgnlar meeting on June I, 2004 adopted resolution number 430 authorizing the IIIC Nutrition Program, a certified copy of which is enclosed. Also enclosed are three (3) copies of the agreement that have been signed by the Supervisor Hortou. Please return a fully executed copy to my offiee for fflfug. Thank yom Very truly yours, Elizabeth A. Neville Southotd Town Clerk Enclosures (3) cc: K. McLaughlm Tovm Attorney Town ComlYaoller ELIZABETH A. TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor thfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD July 19, 2004 Leonor Hunter, Fiscal Administrator County of Suffolk Office for the Aging Post Office Box 6100 Hauppauge, New York 11788-0099 Dear iMs. Hunter: Enclosed please find the three (3) copies of the agreement for the IIIC Nutrition Program for the Town of Southold including the SCEX Form 22 Public Disclosure Statement that have been signed by the Supervisor Horton. I have circled Except Governmental Entities and wrote NA/on the bottom of the form in accordance with telephone instructions in your office. Please return a fully executed copy to my office for filing. Thank you. Very truly yours, Elizabeth A. Nevi~lle~ Southold Town Clerk County of Suffolk Office for the Aging May- 11, 2004 The Honorable Joshua Y. Horton Supervisor Town of SouthoM 53095 M~in Road, P.O. Box 1179 Southold, New York 11971 P,E: IIIC Nu)rition lh-ogram Dear Supe~wisor Horton: Three copies ofthe Agreement referenced above are encloscd. Please sign all throe copies of the Agrc~rnent and retttrn them as soon as possible. In addition, a current copy of yom' Cer~F~cste of Insurance must be subn~itted to this of'rice upon renewal. Inciffded s~q part of' the "Suffolk Cotmty l.egSslahve Reqn/~mnents Exhibit for Contracts" is SCFX 22, the Suffolk County Disclosure £orm. Please be sure to complete tiffs 1btm in each contract, ff applicable. If this fora does no~t apply to your organization, plcasc mark it 'Saot applicable" and in/hat. One fully executed Agr~em~t will be forwarded to you as soon as the signature proccss has been completed. / If you rcqa/re any £urther information, please contact Mary-Valcqqe Kempthski at 853-8209. Sincerely, Leonor i-luntcr Fiscal Admin[sl~ator LH:MVK:Iw Fmclosures cc: Karen McLauglllin ~'~ CERTiFICAT~ OF LI~ILI~ INSU~NCE ~ ~c~w~= ~ ~. ~ OHLY AND CO~E~ ~0 ~ UPON THE ~UR~ ~N~U~RA: ~umn~ Corpo~on ~ H~n~er .... ~SU~R E: 300,000 4158 Thomas A, Dicke~son ~_aw No. AG004M/0003-06R Rev. 515104 IIIC Nutrition Program IFMS No, SCS EXE 0000000 No. 001-67g0-4980-95284- Agreement This Agreement [Agreement) is between the County of Suffolk (County), a municipal cor3oration of the State of New York. having its prindpal office at the County Center, ~iverhead, New York 11901. acting through its duly constituted Office for the Aging {Aging), having its principal office at the H. Lee Dennison Building - 3r" Floor 100 Veterans Memorial Highway, Hauppauge, New York (Mailing address: Box 6100, Hauppauge, New York ' 1788- 0099. and the Town of Southold (Contractor), a New York municiea] corporation, having its 3nncipa[ place of business at 53095 Main Road P.O. Box 1179, Southolo, New York 11971 The parties hereto desire to make a senior citizens nutrition program available to the County. Sufficient funding exists in the 2004 Suffolk County Oeerat~ng Budget. Term of Agreement: Shall be January 1. 2004 through December 31, 2004 with two one-year extensions at the County's option. Total Meals: Daily Congregate Midday Meals: 52 Not to Exceea $57,878 Annually Total Cost of Agreement: Shall be on a feeZor- service basis, not to exceed $57,878 for the current contract year. as set forth in Exhibits A A1 and C a[~ached. Terms and Conditions: Shall be as set forth in Exhibit A through E and the Exhibit entitles "Suffolk County Legislative Requirements Exhibit for Contrac[s" revised 2/5/04, attached, In Witness Whereof, the parties hereto have executed this Agreement as of the latest date written below. Town of SoLl~nold ~SuDervisor Fed. Taxgayer JO #: 11-6001939 _h q Approved as to Legally: Christine Malafi Suffolk Coun~ AEorney By: Jonathan Bloom Assistant County Attorney County of Suffolk By: Date Paul Sabatino II Chief Depu[~ County Executive Date: Approved: By: Holly S. Rhodes-Teague Director Office for the Aging Recommended: Anna Prencipe Assistant Food Service Supervisor By: Date AG 4 (7/03) AG4 $ohld 3c04 raw NO. AGOO4M/OO_-O617Y IFMS No. SCS EXE 0000000 Rev. 4/7/04 No. 001-6790/6774-4980-95284- IIIC Nutrition Program (Supplemental Nutrition Assistance Program) Exhibit A Services To Be Performed - Payment By County A. Tl~e Contractor shall furnish Aging with one or more nutrition programs tor senior citizens of' Suffolk County (separately or collectively the "Program'), under (i) the Nutrition Program for the Elderly pursuant to Title III, Part C of the Federai Older Americans Act (42 U.S.C.A. §3030e et seq.) in accordance with the roles and regulations of the Administration on Aging, United States Departroenl of Health and Human Services, or (ii) the New York State Supplemental Nutrition Assistance Program (SNAP), as indicated on the cover page of this Agreement. The Contractor shall furaish the Program as further provided in this Exhibit A, Exhibit Al, the Contractor's Response to Section IV, paragraph ~ a through h, to the RFQ Request for Quali~cations No. 3/15524VH (the RFQ) and the following Appendices to the RFQ and additional Exhibits, which are attached to and made part of this AG 4 {9/oo) Agreement: EXHIBIT Ai EXHIBIT B EXHIBIT B1 EXHIBIT C EXHIBIT D EXHIBIT Appendix K Appendix L Appendix M Appendix N Appendix 0 Standard Contract Clauses Program Spesi~cations Special Clauses (if any) Rate Page(s) (Contractor's Response to Section V of the RFQ) Grievance Procedures Suffolk County Legislative Requirements Exhibit fo; Contracts' revised 2/5/04 Technical Assistance Packet (revised 7/03) Policy and Procedure Manuals: Congregate Meals and Home Delivered Meals (revised 7/03) Holiday Sciledule Summary Form for each Catchment Area Client Assessment Provider Data System (PDS - Form: revised 5/5/00) The approximate daily number of Congregate and/or Home-delivered Meals included in the Program shall be as set forth on the cover page of thisAgreement Payments will be made in accordance with the Rate Page(s) attached as Eyd~ibit C to this Agreement, but only as provided in Exhibit At. Il', under prior similar agreements with the County, the Contractor has received nonconsumable furniture, equipment or other tangible peraonal propedy or funds to purchase any such [tams, or received any of such items in connectios with this Agreement, the Contractor shall comply with Exhibit D annexed to and made part this Agreement. The provisions of Exhibit B1 shall prevail over inconsistent provisions of any other Exhibit, the provisions of this Exhibit A and of Exhibits A1 and B shall prevail over inconsistent provision of any other Exhibit except B 1, and the provisions of A, A1 and B1 shall prevail over any other document not specifically referred to in this Page I of 2 pages of Exhibit A Law No. AG004M/00__-061?Y IFMS No. SCS E×E 0000000__ Rev. 4/7/04 No. 001-6~'90/6774.4980-95284- IgC Nutrition Program (Supplemental Nutrition Assistance Program) Agreement or made part thereof by this Exhibit A or by subsequent arnendment in writing and signed by both parties except to the extant that provisions of this Exhibit A, or Exhibit Af or B1 are specifically referred to and amended or superseded by' such amendment. F. Exhibit B is made parL of this Agreement for the contract year to which it relates and for any contract period thereafter unless it is modified by Extension Agreement or Amendment. Contract Year The term of this Agreement shall be as set forth on the cover page, unless extended as provided below or terminated as provided in Exhibit Al. Reports The Contractor shall submit reports as reasonably requested by the County, including without limitation those required by the Technical Assistance Packet (Appendix K to the RFQ), and the Policy and Procedure Manuals (Appendix L to the RFQ). Limit Of County's Obligations The maximum amount to be paid by the County as set forth on the cover page of this Agreement or any amendment thereof shall constitute the full obligation of the County in copnection with this Agreement and any matter adsing therefrom for the contract year to which such cover page relates. Insurance Subparagraph 14.A (1) of Exhibit A1 is deleted and the following provision is su0stituted in its place: (1) . COMMERCIAL GENERAL LIABILITY INSURANCE, including contractual and food products liabili~ coverage, in an amount not less than Two Million Dollars ($2,000,000.00) combined single limit for bodily injury and property damage per occurrence. Extension Of Term The services of the contractor under this Agreement shall be subject to review by Agiog not less often than annually. If Aging, in its sole discretion, is satisfied with the Contractor's services, Aging shall notify the Contractor in writing on or before the expiration of the tem~ (as same may have been extended), and the parties shall negotiate an Extension Agreement, which shall take effect for the extension period specified therein, but in no event beyond the time limits specified on the cover page of thio Agreement, upon signature on behalf of the County. Such Extension Agreement shall include the Total Cost of Agreement for the extension period, adjustment of the annual and daily average number of meals, if necessary, and such o~her modifications of the Agreement as may be agreed upon between the parties. - END OF TEXT OF EXHIBIT A - AG 4 (9/00) Page 2 of 2 pages of Exhibit A Exhibit A1 1. 8. 9. 10. 11. 12. TABLE OF CONTENTS - Standard Contract Clauses ............................................................... 1 Contractor Responsibilities ......................................................................................... (a) Services ................................................................... ; ....................................... 1 (b) Qualifications and Licenses ............................................................................. 1 (c) County Review ................................................................................................. 1 (d) Level of Service ............................................................................................... (e) Compliance with Law ....................................................................................... 1 Term of Agreement...: ................................................................................................. 2 Payment for Services ........................................................ : ........................................ 2 (a) Claims ......................................... '. ................................................. : .................. 2 (b) Final Request for Payment .......................... : ................................................... 2 (c) Payment of Claims ........................................................................................... 2 (d) Payments Not To Exceed Net Expenditures .................................................... 2 (e) Taxes ......................... : ................................................ ' ..................................... 3 (f) Agreement Subject to Appropriation of Funds ................................................. 3 (g) Paymehts Contingent upon State/Federal Funoing ......................................... 3 (h) Payments Contingent upon Receipt of Stata/Federal Aid ................................ 3 (i) Other Governmental Funding ......................................................................... 3 0) Post-Audit ........................................................................................................ 3 Accounting Procedures .............................................................................................. 4 Financial Statements and Audit Requirements ........................................................... 4 Furniture, Fixtures, Equipment, otc ....................................................................... ::....5 (a) Purchases, Etc. Requiring Prior Approval ........................................................ 5 (b). Purchase. Practices ......................................................................................... 6 (c) Proprietary Interest of County .......................................................................... 6 (d) Inventory Records, Controls and Reports ........................................................ 6 (e) Protection of Property in Contractor's Custody ........................... : .................... 7 (f) Disposition of Property in Contractor's Custody ............................................... 7 Addresses for Notices, Claims and Repods ............................................................... 7 Statement of Other Contracts ..................................................................................... 7 Offset of Arrears or Default ......................................................................................... 7 Confidentiality of Records ........................ · ................... : ............ ; ................ : ................. 7 Independent Contractor ...................... ~ ....................................................................... 8 Certificate of Inoorp0ration ...... .................................................................................... 8 AG A1F (5/00) 1 ;3. Insurance and Indemnification ....... i ........................................... : ................................ 8 14. Incident Reporting .......................... i ......................................................................... 10 15. Nondiscrimination in Employment ........................................................................ 16. Nondiscrimination in Services ...................... : ....................................................... ~....'10 17. Nonsectarian/Nonpartisan Declaration ..................................................................... 11 18. Su[folk County Living' Wage Law.i ........................................................................... 11 19. Child Sexual Abuse Reporting Policy ............................ : .......................................... 12 20. Gratuities .................................................................................................................. 12 21. Public Disclosure ................ i .................................... : ................................................ 12 22, Work Experience Participation .................................................................................. 12 23, Publications, Copyrights and Patents ....................................................................... 24. Qualifications of Personnel .................................................... ~ ............... i.......: .......... 13 25. Certification Regarding Lobbying ............................................................................. 13 · 26. Cooperation On Claims ............................................................................................ I3 27. Assignment and Subcontracting ............................................................................... 13 28. Termination ............................................................................................................... 14 29. Severabilib/; No Implied Waiver......:.. ............................................. t .......................... 14 30. Merger; No Oral Changes ........................................................................................ 14 AG AIF (5/00) Exhibit A1 - Standard Contract Clauses 1. Contractor Responsibilities · · la) Services The Contractor shall perform such ~ervices as may be necessary to accomplish the work required to be performed under and in accordance with this Agreement, as more particularly pro- vided in Exhibits A and B, in a skillful manner and to the best of its ability. lb) Qualifications and Licenses The Contractor specifically represents and warrants that it has and shall possess, and that, to the extent applicable, its employees, agents and subcontractars have and shall ~3ossess, tire required education, know[edge, experience and character necessary to qualifythem individu- ally for the particular duties they perforro and that the Contractor has and shall have, and, to the extent applicable, its employees, agents and subcontractors have and shall have, all required au- thorization(s), registration(s), license(s), certificate(s) or permit(s) required by State, County or local authorities for the Services (hereinafl~er called "License"). The Contractor shall immediately notify Aging in writing 0f any disciplinary proceedings against the holder of any License by the New York State Department of Education or the New York State Depadment or Health or other issuer of' a License. In the event that the Contractor er such other holder of a License is no longer licensed for any one or more of the Services, the Contractor must immediately so notify Aging. it is understood that the Contractor shall not be reirubursed for any Services rendered after the ef- fective date of termination of such License. The remainder of this Agreement, or its application to persons or circumstances other than these aa to which said License has been terminated, shell not be affected thereby, and every other term and provision of this Agreement shall be valid and enforceable to the fullest extent permitted by law. lc) County Review It is agreed that the nature and extent of the services provided pursuant to this Agreement shall be subject to the general supervision of Aging and that Aging, through its duly authorized represe~tatives, has the right to monitor and evaluate the program. Aging shall be the sole arbiter as to what constitutes acceptable performance under this Agreement. (d) Level of Service The Contractor agrees that where a minimum level el" service is not provided as set forth in Exhibit B, Aging may require the reduction of Contractor staff and costs or terminate this Agreement after gNing notice ie accordance, with the provisions headed, "Termination", of Exhibit Al. (e) Compliance with Law The Contractor shall comply with all applicable local, County, State and Federal laws, rules and regulations, including without limitation the rules and regulations of the New York Sta~e Office for the Aging, Suffolk County local preference and other applicable Suffolk County local laws and resolutions of the Suffolk County Legislature and the rules, regulations, criteria, and guidelines for e~(penditure controls heretofore adopted or to be adopted by the County, New York State and the Federal government pursuant to law. AG A1F (2/04) Page 1 of 14 pages of Exhibit A1F ~,. 2. Term of Agreement This Agreement shall cover the period provided on the first page thereof, unless sooner terminated as otherwise provided in this Agreemerff. 3. Payment for Services (a) Claims (i) The Contractor shall prepare and preser]t claim forms supplied by the County (standard Suffolk County Payment Voucher and any other form(s) required by Aging or the Department of Audit and Control) within eight (8) days after the dose of the month in which the expenditure was made, except the claim for the last month of the initial Term of Agreement and of each suc- ceeding Extension Pedod, if any, for which the claim shall be submitted as provided Jr] paragraph B below. (ii) All claim forms must be signed in ink by duly authorized persons, and certifica- t~or] of such authoriza'LJon w'~th certified specimen signatures thereon must be tiled with Aging by a Contractor o~cial empowered to sign this Agreement. (iii)Monthly vouchers shall be submit[ed direcLly to the Suffolk County Office for the Aging at H. Lee Dennison Building, 100 Veterans Memodal Highway, P. O. Box 6100, Hauppauge, New York 11788-0099. (iv) No c~aims shall be payable until the Contractor complies with all require- merits il~ this Agreement that should have been complied with on or before submission of such claims and also sobmits evaluative and such other data in the manner and form as shall be required and accepted by Aging, the County, State or Federal Government. (v) The amount of the Total Cost of the Agreement to be paid by the County as set forth on the cover page of this Agreement or of any extension or amend- ment thereof shall constitute the full obligation of the County in connection with this Agreement for the period there indicated. (b) Final Request for Payment A final clairn for payment shell be submitted no later than thirty (30) days a~[er the end of the initial Term of Agreement and of each succeeding Extension Period, if any, unless otherwise directed by Aging. (c) Payment of Claims The County agrees to pay the Contractor monthly for services provided and costs in- curred pursuant to this Agreement up to the maximum agreed amount as provided in paragraph 3(a)(5) above, upon receipt of monthly claims in such form as prescribed by the County and alter audit and approval bythe County. Claims shall be documented by sufficient, competent and evi- dential matter. Payment by the County shall be made within thirty (30) days after approval by the Comptroller of the County 9f Suffolk. (d} Payments Not 're Exceed Net Expenditures The Contractor agrees that if, for any reason whatsoever, the Contractor shall epend dur- lng the term of the Agreement for the purposes set forth herein an amount less than agreed, the AG Af F (2/04) Page 2 of '14 pages of Exhibit A'i F .~.,, total County payment herein shall be reduced to the amount of appreved actual Contractor ex~ pendifures made for such purposes, and that the total amount to be paid by the County during the contract teml shall not exceed approved actual net expenditures er the Total Cost ct the Agree- · merit on the cover page and in the Budget, whichever ts less. (e) Taxes The charges payable to the Contractor under this Ag~;eement are exclusive of federal, state and local taxes, the County being a municipality exempt from the payment of such taxes. (f) Agreeroent Subject to Appropriation of Funds This Agreement is subject'to the an~ount of funds appropriated and any subscqucnt modifi- cations thereof by the Suffolk County Legislature, and no liability shall be incurred by the County under this Agreement beyond the amount of funds appropriated by the Legislature for tile program covered by this Agreement. (g) Paymeats Contingent upon State/Federal Funding Payments under this Agreement are subject to and contingent upon conitausd funding by the State and/or Federal Government(s). If, for any reason, the fuji amount of such funding is not made available to the County, this Agreement may be terminated in whole or in part, or the amount payable to the Contractor may be reduced, at the discretion of Aging, provided that any such termination or reduction shall not apply to allowable costs incurred by the CoJltractor prior to such terminafion or reduction to the extent that funds are available to Aging for payment of such costs, (h) Payments Contingent upon Receipt of State/Federal Aid. If any State or Federal government department or agency funding this Agreemen~ in whole or in part should fail to approve aid in reimbursement to the County for payments made here- under by the County to the Contractor for expenditures made dudng the term of this Agreement because of any act, omission or negligence on the part of the Contractor, then the County may deduct a nd withhold from any payment due to the Contractor an amount equal to the reimburse- ment denied by sucl~ department or agency, and the County's obligation shall be reduced by any such amounts. In such an event, if there should be a balance due to the County after it has made a final payment to the Contractor, the Contractor agrees promptly to reimbume the County the amouat of the balance due the County by check to the order of the Suffolk CountyTreasurer. The provisions ct this subparagraph shall survive the expiration or terminatioJ~ of the A§reement. (J) Other Governmental Funding If the program of the Contractor which is the subject of this Agreement is funded in whole or in part by contracts with other governmental agencies, it is agreed that the funds of the County under this Agreement shall be refunded to the.County to the exlent that the local ~ndin~ from such sources exceeds the total expenditures of the Contractor for the program. (j) Post-Audit, .' mi payments made under this Agreement am subject to aud~ by the Suffolk Ccun~ Conlptrol- let pursuant to Article V of the Suffolk County Charter. The Contractor further agrees that the County Comptroller and Aging shall have access to and the right to examine, audit, e×cergt, copy or tran- scribe any pertinent transactions or other records relating to aery[cee under this Agreement. If such an audit discloses overpayments by the County to the Contractor, within thirty (30) days after the issu- AG A1 F (2/04) Page 3 of 14 pages of Exhibit AIF ~,~ anco of an official audit r~port by the Comptroller or his duly designated representatives, the Contrac- tor shall i-epay the aroount of such overpayment by check to the order of tt)e Suffolk County Treasurer or shall submit a proposed plan of repayment to the Compboller. If tl~ere is no response or if satisfac- tory repayments are not rhade, [he County may recoup overpayments from any amounts due or be- . coming due to the Contractor from the County uader this Agreement or otherwise. 4. Accounting Procedures (a) The Contractor shall maintain separate records of account concerning all costs in- curred by the Contractor in the performance of this Agreement and all income relating to the pro- gram funded under this Agreement and consents to audit and inspection by the C0nnty, New York State and the Federal Government of all facilities, books and other financial and statistical data, whether related to this Agreement or otherwise (in the case of towns or otller municipal cor- porations, only as they relate to this Agreement). Such records shall be maintained tar a period of seven (7) years From the date of termination or expiration of this Agreement. Spec~c records shall be kept as to the hours of all personnel. (b) The Contractor shall comply, For the program funded under this Agreement, with the "Regulations for Accounting Procedures for Contract Agencies," promulgated by the Depadment of Audit and Control of Suffolk County, and any amendments during the Term of this Agreement. 5. Financial Statements and Audit Requirements (a) No[withstanding any other reporting or certification requirements of Federal, State or local authorities, the Contractor shall obtain the services of an independent licensed public ac- countant or certified public accountant (the "Auditor") to audit its financial stateme~its for each Contractor fiscal year in which [he Contractor has received, or will receive, $500,000 or more from the County, whether under ti)is Agreement or otherwise, and shall submit a report on the overall financial conditJoa and oporetions of the Contractor, including a balance sheet and state- ment of income and expenses, attested by the Auditor as faidy and accurately reflecting the aa- counting r~cords of the Contractor in accordance with generally acaepted accounting pdncipres. The Contractor is encouraged to solicit requests for proposals (RFPs) from a number of qualified accounting firms and to review carefully the costs o¢, and qualifications .for, this type of work be- fore selecting the Auditor. (b) The Auditor should be required to meet the fo[lowing minimum requirements: (i} a current license issued by the New York State Education Department; (ii) sufficient auditing experience in the nonprofit, governmental or profit-making areas, as applicable; and (iii)a satisfactory peer review issued within not more than three years prior to the date when the Auditor was selected ~o conduct the audi[. (c~ The audit must be conducted Jn accordance with generally accepted governmental · auditing standards (GAGAS). Financial statements must clearly differentiate between County-funded programs and othar programs that tile Contractor may be operating. Tile use of subsidiary schedules should be encouraged for this purpose. The Audifor must als0 prepare a management letter based on the audit. (d) Furthen'nore, if the Contracior is a non-profit organization or unit of local gc,~ern- men[ and expends $500,000 or more of Federal monies, whether as a recipient expending awards AG A1F (2/04) Page 4 of ! 4 pages of Exhibit A1F ~,~ received directly from Federal awarding agerJcies, or as a subrecipient expending Federal awards received from a pass-through entity, such as New York State or SuffoIk County, during any fiscal period within which it receives funding under this Agreement ("[isca[ yea¢'), the audit must be con- duc[ed, and the audit report ("Single Audit RepoK") must be, in accordance with 0[~B Circurar No. A-133 (revised June 24, 1997'). Single Audit Reports must also be submitted to the designated clearinghouse, cognizant agency and/or @ass-through en!i[~, to the extent required by the OMB Circular just referred to. (e) The Cont"actor must submit a statement in wdting, certified by its chief fit~ancial officer, which states the amount of Federal funding expended by the Contractor during such fiscal year. The Con[rector'must mail or deliver the certified statement to Agrng and to Etizabeth Tesodere, Executive Director of Auditing Services, Suffolk County Department of Audit and Contrel, H. Lee Dennison Building, 100 Veterans Memodal Highway, P. O. Bo× 6100, Hauppaugs, New York 11788-0099, as soon as possible affer the end of the Contractor's fiscal year. The statement should include ALL Federal funding received directty from the Federal g0vemment and ALL Federal runds passed through from the County and other pass-[brough enfities (t) CoDies of all financial sta[ements, management iefters, Single Audit Reports (if ap- plicable) and other audit reports, if required, must be transmitied to ,Aging and to Ms. Tesodero at the address just set forth. The reports must be submitted within [hirty (30) days after completion of the audit, but in ilo event later than nine (9) months after [he end of the Contractor's fiscal pe- riod to which the audit relates. (g) These requirements do not preclude Aging or the Suffolk County Corcptrol[er or their authorized representatives or Federal or State auditors h-om auditing the records of the Con- tractor. Therefore, the records of the Contractor must be made available to authorized represen-. tatives of Federal, Sta~-e or County government for that purpose. (h) All payments made under this Agreement are subject to audit by the surfolk County Comptroller pursuant to Article V of the Suffolk County Charter. If the Contractor fails to cooper- ate with an audit by the Comptroller, the County shall have the right [o suspend or partially with- hold payments under this Agreement or under any other, agreement between the parties until such cooperation is fofthcomJng, if such an audit discloses overpaymen[s by the Countyto thc Con- tractor, within thJr[y (30) days after the issuance of an official audit report by the Comptroller or hfs duly designated representatives, the Contractor shalr repay the amount of such overpayment by check to the order of the Suffolk County Treasurer or shall submit a proposed plan of repayment to the Comptroller. If [here is I~o response or if satisfactory ~:epayments are not made, the County may recoup overpayments from any amounts due or becoming due to the Con[rector from the County under this Agreement or otherwise. (i) The provisions of this paragraph shall survive the expi~'ation.or terminafion of the Agreement. 6. Furniture, Fixtures, Equipment, etc. (a) Purchases, Etc. Requiring Prier Approval Prior to placing any order to purchase, rent or lease any furniture, fixtures, or equipment, (i) valued i~3 excess of five hundred dollars ($500.00) per unit, or (ii) included but not itemized, in the Budget, the Contractor shall submit to the County a written request far approval ts make such a proposed purchase, rental, or lease, with a list showing the quantity and description of each item, AG A1F (2/04) Page 5 of 14 pages of Exhibit A1F ~¢,r its intended k~cati0n and use, estimated unit pri(~e or cost, extended price or cost and estimated total cost of the proposed order. Written approval of the County is required before ihe Contrac- · tot may proceed with the proposed purchase, rental, or lease of furniture, fixtures, or equipment. All items purchased will be new un[ess ~pecifically described otherwise in the Budget. (b) Purchase Practices The Contractor agrees to follow all of the general practices that are designed to obtain fur- niture, fixtures, equipment, materials or supplies at the most reasonable price or cost possible. The County reserves the right to purchase or obtain for the Contractor furniture, f~xture~, equip- merit materials or supplies whicb shall be in accordance with the P~grammatic needs of this Agreement. If the County exercises this right, the amount budgeted tor the items so purchased or obtained by the County for the Contractor shall not be available to the Contractor for any pur- pose whatsoever. Tit]e to any such items purchased or otherwise obtained by the County for the Program and entrusted to the Contractor shall remain in the County, and the Contractor shall attach labels indicating the County's ownemhip if the County has not done so. (c) Proprietary Interest of County The County shall retain a proprietary interest in ali furniture, removable fixtures, eqhip- merit, materials or supplies purchased or obtained by the Contractor and paid for0r reimbursed to the. Contractor pursuant to the terms of this Agreement or any prior agreement. Upon the ter- mination of this Agreement, or of any renewal thereof, the discontinuance of the business of the Contractor, the failure of the Contractor to comply with the terms of this Agreement, the bank- ruptcy of the Contractor, an assignment for the benefit of its creditors, or the failure of the Con- tractor to satisfy any judgment against it within thJtty (30) days of filing, the County shall have the right to take title to and possession of ail such furniture, removable fixtures, equipment, materials and supplies, and the same shall thereupon become the propeKy of the County without any claim for reimbursement on the part of the Contractor. As directed by the County, the Contractor shall affach identifying labels on all furniture, removable fixtures and equipment indicafine the pro- prietary interest of the County. - (d) Inventory Records, Controls and Reports The Contractor shall maintain proper and accurate inventory records and c0ntrols for all sa. ch furniture, removable fixtures and equipment acqu red pursuant to this Agreement and all · poor agreements if any, cover 3g the Program. Three (3) months before the termination date of this Agreement, the Contractor shall make a physical count of all items of furniture, removable fixtures and equipment in [ts custody, checking each item against the aforesaid inventory records. A report setting todh the results of such physical count shall be prepared by the Contractor on a form or forms designated by the County, certified and signed by an authorized official of the Con- tractor, and one (1) copy thereof shall be delivered to tho County within five (5) days after the date set for the aforesaid physical count. Within five (5) days after the termination date of this Agreement, the Contractor shall submit to the County six (6) copies of the same report updated to the termination date of this Agreement, certified and signed by an authorized official of the Con- tractor, based on a physical count of all items of furniture, removable fixtures and equipment on the aforesaid termination date, and revised, if necessary, to include any inventory changes during the last three (3) months of the term of this Agreement. AG A1F (2104) Pa~e 6 of 14 pages of Exhibit AIF (e) protection of Property in.contractor's Custody The Contractor shall maintain.vigilance and take all reasonable precautions to protect the fure[ture, fixtures, equipment, materials or supplies in its custody against damage or loss by fire, burglary, theE, disappearance, vandalism or misuse. In the event of burglary, thor{, vandalism or disappearance of any itere of furniture, fixtures, equipment, materials or supplies, the Contractor shall immediately notify the police and.make a record thereof, including a record of the results of any investigation which may be made thereon. Jn the event of loss of er damage to any item ef lure[tufa, fixtures, equipment, materials or supplies from any cause, the Contractor immediately shall send the County a detailed, written raped thereon. (f) Disposition of Property in Contrac!or'e Custody Upon termination of the County's funding of the Program covered by this Agreement or by any renewal hereof, or et any other time that [he County may direct, the Contractor shall make access available and render all necessary assistance for physical removal by ~Lhe County or its designee of any or all furniture, removable fixtures, equipment, materials or supplies in the Con- tractor's custody in which the County has a proprietary interest, in the same condition as such property was received by the Contractor, reasonable wear and tear excepted. Any disposition, settlements or adjustments connected with such properbj shall be in accordance with the rules and regulations of the County and the State of New York. 7. Addresses for Notices, Claims and RePOrts The Contractor shall mail any communication, notice, claim for payment, reports, or other submission to: Suffolk County Office for the Aging at its address on the cover page cf this Agree- '' reent, er such other address of which the County shall have given the Contractor writtsn notice. · The County shall mail any communication, notice, or other submission to the Contractor at its address on the cover page of this Agreement or such other address of which the Contractor shall have given the County written notice. 8. Statement of Other Contracts Tile Contractor has attached, and in the event of any change, will attach to any extension agreereen~amendment of this Agreement, a Statement of Other Contracts th the form al~nexed to this Agreereent. The Contractor represents and warrants that any such Statement of Other Contracts is . and will be a complete list of all other conbacts (i) which are currently in effect or (ii) which have ex- pired within the past 12 months and have not been renewed, and under which funds have been, are being or will be received by the Contractor from any department or agency of the County, the United States of America, the State e[ New York ~r other municJpaBies or funding organizations. 9, Offset of Arrears or Default The Contractor warrants that it is not, and shall not be during the term of this Agreement, in arrears to the County for tax~s or upon debt or contract and is not, and shall notbe dudng the term of this Agreement, in default as surety, contractor er otherwise on any obliga~Jon to the County, and the Contractor agrees that tile County reay withhold the amount of any such ar- rearage or default from amounts payable to the Contractor under this Agreement. 10. Confidentiality of Records (a) The Contt:actor expressly agrees to preserve the con{identiality of all data and in- formation shared, received, collected, or obtained as a result of this Agreement. No disclosure, AG Al F (2/04) Page 7 of 14. pages of Exhibit A1F ,~-,, redtscfosum or release of si Job data or information is to be made, Penniffed, or encouraged bythe Contractor or its officers or employees, except as expressly authorized by law. It is further under~ stood and agreed that no such data or information is fo be used for personal benefit. The Con- tractor further agrees that its employees shall be specifically instructed in regard to their- oblige- tion to keep such data and information in confidence and the!r liability upon breacl~ of confidential- ity to all the penalties prescribed by law. (b) The Contractor further agrees to implement such procedures for safeguarding formation as the Department shall require. The Contractor further agrees to inde~nify and hold the County and Aging harmless against any loss, damage, cost or expense arising eut ~f any suit, claim or de!'nsnd which may be brought or made against the County or Aging by reason of a breach of these provisions. (c) In addition, the Contractor agrees to maintain the confidentiality of all information in conformity with the provisions of applicable local, State and Federal taws and regulations. 11, Independent Contractor The relationship of the Contractor to the County shall be that of an independent contrac- tor. The Contractor, in accordance with its status as an independent contractor, covenants and agrees that neither the Contractor nor any of its officers, directors or employees v~ill hold itself or themseIves out as, ar claim to be, an officer or employee of the County by reason of this Agree- meet, and that neither it nor any of them will, by reason thereof, make any claim, demand or appli- cation to or for any right or privilege applicable to an officer or employee of the County, including, but not limited to, Workers' Compensation coverage, unemployment insurance benefits, Social Security coverage, or retirement membership or credits. ;12. Certificate of Incorporation The Contractor (if not a town or other municipal corporation) shall furnish Aging with certi- fled copies of its Certificate of Incorporation and by-laws, including any amendments thereto, al the time it signs this Agreement, to the extent not already on fife with Aging, and any amend- meets thereto du~ing the term of this Agreement promptly upon their adoption, and a list of the board members governing the Contractor from time to time. The Oontractor shall not ~issolve any existing corperafion or establish any new corporation with the responsibility for the operation of the program without the prior written approval of Aging. 13.. Insurance and Indemnification (a) The Contractor agrees to procure, pay the entire premium for and maintain throughout the term of this Agreement insurance in amounts and types specified by the County. Unless otherwise specified by the County and agreed to by the CeE]tractor, in wrJi~ng, such in- surance will be as follows: (i) COMMERCIAL GENERAL LiABiLITY INSURANCE, includingcontrac- tual coverage, in an amount not less than Two Million Dollars ($2,000,000.00) combined single limit for bodily injury and property damage per occurrence. (ii) AUTOMOBILE LIABILITY INSURANCE (if any vehicles are used in the ' perfo?mance of this Agreement) in an amount not less than Three AG A1F (2/04) Page 8 of 14 pages of Exhibit A1F' ~,,,~ Ht~ndred Thousand Dollars ($300,000.00) combined single lirnlt for bodily injury and property damage par occurrence. . (iii!PROFESSIONAL LIABILITY/ERRORS AND OMISSIONS INSUR- ANCE in an amount not ]ess than Two Million Dollars ($2,000,000.00) on either a per occurrence or claims made basis. (iv) WORKERS' COMPENSATION and EMPLOYER'S LIABILITYINSUR- ANCE in compliance with all applicable New Yod< State laws aud regu- lations and DISABILITY BENEFITS INSURANCE if required by law and shall have fomished to the Couoty pdor to its execution of this Agreement the documentation required by the State of New York Workers' Compensation Board o[ coverage or exemption frpm cover- age pursuant to §§ 57 and 220 of the Workers' Compensation Law. In accordance with General Municipal Law § 108, this Agreement shall be void and of no effect unless the Contractor shall provide and maintain co~,erage during the term of this Agreement for the bone[it of such em- ployees as are required to be covered by the provisions of theWork- ers' Compensation Law. (v) FIDELITY BONDS (if a Budget and payment schedule are attached to this Agreement) providing comprehensive coverage, in an amount not less than the greater of (i) Five Thousand Dollars ($5,000) or (ii) the amount of the advance to the Contractor under this Agreement, against dishonesty, disappearance and destruction of money and se- curities for all personnel who have access to or sign checks, or have care, custody or control of funds or properly entrusted to the Contrac- tor under the terms of the Agreement. (b) All policies providing such coverage shall be issued by insurance companies ac- ceptab]e to the County. (c) The Contractor shall furnish to the County certificates of insurance or, on request, original policies, evidencing compliance with the aforesaid insurance requirements, In the case of commercial general liability insurance, said certificates or other evidence of insurance shall name the County of Suffolk as an additional insured. All such certificates or other evidence of insurance shall provide for the Counb/of Suffolk ~o be a certificate holder and to be notified in wdting thirty · (30) days prior to any cancellation, nonrenewal or material change. Such certificates, policies or other evidence of insurance and notices shall be mailed to Agleg at the address atthe head of this Agreement or at such other address of which the County shall have given the Contractor no- tice in wdting. If the Contractor is a town or other municipal corporation and has a eel(-Jnsurance program under which it acts as a self-insurer for any of such required coverage, it may provide self-funded coverage and certificates or other evidence of such self-insurance [n lieu of insurance issued by insurance companies. (d) Furthermore, to the extent permitted by law, the Contractor shall indemnify and hold · harmless the County, its consultant (if any), employees, agents and other persons from and against all losses, claims, costs, judgments, liens, encumbrances and expenses, including attor- ' nays' fees, by reason of liability imposed by law, for damage because ef bodily injury, including death at any time resulting therefrom, sustained by any person or persons, or on account of dam- AG A1F (2/04) Page g of 14 pages of Exhibit AIF . ,,.,F age to property, arising out of the acts or omissions or negligence of the Contractor, its agents, employees or subcontractors or of other persons, in connection with the services described or re- ferred to in this Agreement, even if such injuries to persons or damage to property are due, or are dlaimed to be due, to passive negligence of the County, its employees, agents or subcentractora or other persons, except (~n[y in cases of the County's sole active negligence. 14. ·Incident Reporting The Contractor agrees to provide Aging with reports of all instances of claims, costs, damages, and injuries to persons or property of whatsoever kind adsing nut of services provided under this Agreement. All such notifications should be given to Aging immediata[y after the inci- dent, if possible, but in no case longer than five (5) days after the incident. The Contractor fur- thor agre?s to send Aging copies of ali "notices of claim" relating to the program covered in this Agreement. 15, Nondiscrimination in Employment (a) The Contractor agrees in connection with the perfon~ance of this Agreement as fo]lows: (i) The Contractor shall not discriminate against employees or applicants for ·. employment because of race, creed, color, national origin, sex, age, disability, Vietnam Era Veteran status or marital status, and will undertake or continue existing programs of affirmative action to ensure that women and minority group members are afforded equal employment oppoKunitiee without dis- crimination. Affirmative action shall mean recruitment, employtnent, job as- signment, promotion, upgradings, demotion, transfer, layoff, or terrr, inafion and rates of pay or other forms of compensation. (ii) The Contractor shall require each employment agency, labor union or ~uthorized representative of workers, with which it has a collective bargaining or other agreement or understanding, to furnish a written statement that such employment agency, labor union or representative will not discriminate on the basis of race, creed, color, national origin, sex, age, disability, Vietnam Era Veteran status or marital status and that such union or representative will affirmatively cooperate in · the implementation otthe Contractor's obligations herein. ([ii)The Contractor shall state, tn all solicitations or adventisements for employ- ees, that, in the performance of this Agreemem, ali qualified applicants will be afforded equal employment opportunities without discrimination because ef race, creed, color, national origin, sex, age, disabiliiy, Vietnam Era Veteran status or marital status. 16. Nondiscrimination in Services (a) Furthermore, the Contractor, in providing services under this Agreement, shall not, orJ the grounds of race, creed, color, national odgin, sex, age, disability or marital status: (i) Deny an individual any services or (~ther benefits provided under the program: (ii) Provide any services or other benefits to an individual which are difrerent; or are prbvided in a different manner, from those provided to others under the program; (iii)Subject an individual to segregation or separate treatment in any rnaEei' related to his/her ref:eipt of any services or other benefits provided underthe program; AG A1 F (2/04) Page 10 of 14 pages of Exhibit A1F ,~,,r (iv) Restrict an iedividual in any way in the enjoyment of any advantage or privi- lege enjoyed by others ?eceiving any se~vi.ces or other benefits provided u? der the program; .tv) Treat an individual differently from other~ in determining whether ar not the individual satisfies any eligibility or other requirements or conditions which in- dividuals must meet in order to receive any aid. care, services, or other bone- ~ts provided under the program. (b) The Contractor shall not utilize criteria or methods of administration which have the effect of subjecting individuals to discdminafion because of their race, creed, nagcnal origin, sex, age, disability or marital status or have the effect of defeating or substantially impairing accom- plishment of the objectives of the program in respect to individuals of a particular race, creed, na- tional origin, sex, age, disability or marital status, in determining: ti) The types of services or other benefits to be provided under the program, or (it) The class'of individuals to whom, or the situations in which, such services ur other benefits will b~ provided under the program, or (iii) The class of individuals to be afforded an opportunity to participate in the program. (c) The Contractor also agrees to observe all appiiceb[e Federal Regulations contsined in 45 CFR, Part 84 and Par[ 86 entitled "Non-Discrimination on the Basis of Handicap ia Program Acfivities Receiving or Benefiting from Federal .Financial Assistance." (d) The Contractor agrees to comply with the requirements of the Civil Rights Act of 1964. (e) In addition (unless otherwise indicated, or not applicable to the Program described, in Exhibit B), pursuant to § 306(a)(5)(A)(ii) of the Older Americans Act, as added by P. t_. 'J 00-1 42 U.S.C.A. § 3026(a)(b)(A)(ii), the Contractor shall ti) specify how the Contractor intends to safisry the service needs of Iow-income minority individuals in the area served by the C;ontracter; and (ii) attempt to provide services to Iow-income minority individuals in aL least the same proportion as the population of low-income minodty older indMduals bears to the population of older individuals of the area served by the Contractor. '17.Nonsectarian/Nonpartisan Declaration The. CQatractor agrees that all services performed under thio Agreement are secular and nonpartisan in nature and that no funds received pursuant to this Agreement will be used tar sec- tadan purposes or to further the advancement of any religion, candidate or partisa~ effort. Fur- thermore, the Contractor agrees that ali program services are and will be available to ali eligible individuals regardless of religious belief or political affiliation. 18. Suffolk County Living Wage Law The Contractor r~presents and wan'ants that it has read and is familiar with t~e requirements of Se,~tion 6 of Chapter 347 of the Suffolk County Code, the Living Wage Law, aEached hereto as par[ of the ~Suffolk County Legislative Requirements Exhibit for eantracts'.an~ made a part hereof. AG Al F (2/04) Page 11 of 14 pages of Exhibit. Al F ,_~,, 19. · Chil'd Sexual Abuse Reporting Policy The Contractor agrees to comply with the Suffolk County Child Sexual Abuse Reporting Policy, Chap[er 577, Article IV, of the Suffolk County Code, attached hereto as pad of the "Suffolk County Legislative Requirements Exhibit for Contracts".and made a part hereof, as net~ in effect or amended hereafter or of any other Suffolk County Local Law that may become appticable dur- ing the term of this Agreement with regard to child sexual abuse reporting policy. 20. Gratuities The Contractor represents and warrants that it has not offered or given any gratuity to any official, employee or agent of Suffolk County or New York State or of any political party, with the purpose of intent of securing favorable treatment with respect to the awarding or a~nending of an agreement or the making of any detem~ina[ions with respect to the performance of an agreement, and tbat the signer of this Agreement has read and is familiar with the provisions of Local Law No. 32-1980 of Suffo]k County (Chapter 386 of the Suffolk County C?de). · 21. Public Disclosure The Contractor represents and warrants that, unless exempt, it has flied with the Comptroller of Suffolk County the verified public disclosure statement, required by Local Law No. 14 of 1976. as amended (§A5-7 el~ the Suffolk County Code) and acknowledges thst such filing is a material, contractual and statutory duty and that the failure to file such statement shall constitute a matedal breach of this Agreement, for which the County shati be entitled dpon a determination that such breach has occurred, to damages, in addition to all other Iegal remedies, of fi[teen per- cent (15%) of the amount of the Agreement. (Such filing is not required ir the Contractor is a not-for-profit corporation.) . 22. Work Experience Participation If the Contractor is a nonprofit agency or institution, each of tbs Contractor's locations in Suffolk County at which services are provided under this Agreement shall be a work site for pub- · lie-assistance clients of Suffolk County pursuant to Local Law No. 15-1993 at ail times during the term of this Agreemeab If no Memorandum of Understanding ("MOU') with the Suffolk County Department of Labor for work experience is in effect at the beginning of the term of this Agree- meat, the Contractor, if it is a nonprofit agency or institution, shati enter into such I~OU as soon as possibl~ after the execution or this Agreement and failure to enter into or to perr0rm in accor- dance with such MOU shall be deemed to be a failure to perform in accordance wi~h this Agree- meat, for which the Contractor may withhold payment, terminate [his Agreement or exercise such other remedies as may be appropriate in the circumstances. 23. Publications, Copyrights and Patents (a) The Contractor shall not issue or publish any book, article, announcement, report or other publication relating to the subject program without pdor written permission from the County. Any such publication shall bear a statement acknowledging the cooperation and/or funding by the County of Suffolk- Steve Levy, County Executive. (b) . If the wori< of the Contractor under this Ag~-eement should result in the production of original books, manuals, films or other materials for which a copyright may be granted, the Con- tractor may secure copyright protection. However, the County reserves, and the Contractor hereby gives to the County, and to any other municipality or government agency or body desig- AG A1F (2~04) Page 12 of '14 pages of Exhibit A1F · ,~, hated by the County, a royal[y-free, nonexc[usive [iceqse to produce, reproduce, publish, trans- late or otherwise use any such materials. (c) If the Contractor under this Agreement roakes any discovery or invention in the course of or as a result of work performed under this Agreement, the Contractor may apply for end secure for tself patent protection. However, the County reserves, and the.Contractor hereby gives to the County, and to any other municipali[y'or government agency or body designated by the County, a royalty-free, nonexclusive license to produce or otherc¢ise us~ any item so dfscov- bred or patented. 24. Qualifications of Personnel 1;he Contractor agrees that it will provide the County with relevant policies regarding the personoel qualifications for professional employees and that these po!icies shall be subject to ap- proval by Agin~l. 25, Certification Regarding Lobbying Together with this Agreement and as a condition precedent to its execution by the County, the Contractor shall have executed and delivered to Aging the Certification Regarding Lobbying (if payment under this Agreement may exceed $100,000 - SEE FORM ATTACHED) required by 31 U.S.C. Section 1352 and regulations thereunder, shall promptly advise the County of any ma- terial change in any of the information reported on such Certification and shall otherwise comply with, and shall assist the County in complying with, said regulations as now in effect 0fas amended during the Term of this Agreement. 26. Cooperation On Claims The Contractor agrees to render diligently to the County any and all cooperation, without additional compensation, that may b8 required to defend the County against any claims, demand, or action that may be brought against the County in connection with this Agreement. 27. Assignment and Subcontracting (a) The Contractor shall not assign, transfer, convey, sublet, ct otherwise dispose of this Agreement, or any of its right, title or interest therein, or its power to execute this Agreement, or assign all or any portion of the monies that may be due or become due thereunder, to any other person or corporation, without the prior consent in wdting of the County, and any a[[empl~ to do any of the foregoing without such consent shall be of no effect. · . (b) The Contractor shall not enter into subcontracts for any of the work contempl~:ted un- der this Agreement without obtaining pdor written approval of Aging. Such subcontrads shall be sub- ject to ali of the provisions of this Agreement and to such other conditions and provisions as Aging may deem necessary; provided, however, that notwithstanding the foregoing, unless oBe~vise pro- vided in this Agreement, such prior wdtten approval shall not be required rot the purchase of ar[ides, supplies, equipment and services which are inddental to, but necessary for, the performance of the work required under this Agreement. No approval by Agthg of any subcontract shall provide [or the incurrance of any obligation by the County in addition to the total agreed upon pdce. 7he Contractor shall be responsible for the performance of any subcontractor for the delivery of service. AG A1F (2/04) Page 13 of i4'pages of Exhibit At F ,,,,r 28. Termination (ai If the Contractor fails t~) falfill a timely and proper manner its obligations ueder this Agreement, or if the Contractor becomes bankrupt or insolvent or falsifies its rec0r~s or re- pods, or misuses ils funds from whatever source, tl~e County may terminate this Agreement in whole or with respect to any identifiable part of the program, effective immediately, or, at its op- tion, effective at a later date specified in the notice of such termination to the Contractor.. (b) I1: the County shall deem it in its best interest to terminate this Agreement in whole · or with respect to any identifiable part of tbs program, it shall have the right to do so by [,lying not less than thirty (30) days' prior written notice to the Contractor. (c) The Contractor may terminate this Agreemeat by giving nat less than sixty (6(3) days' . prior written notice (or thirty (30) days' prior wri~en notice if substantial breach of contra~ is involved) to the Director of Aging, specifying the reasons for termination and the effective date 0fterminafion. (d) The County shall be released from aey and all responsibilities and obligstions aris- ing from the Program covered by this Agreement, effective as of the date of termination, bat the County shall be responsible for payment of all claims for services provided and costs incurred by the Contractor prier [o termination of this Agreement, that are pursuant to, and at,er the Contrac- tor's compliance with the terms and conditions of this A§reement. (e) Notice of termination must be in wdting, signed by an authorized e~cial, and sent to the other party by certified mail, er by messenggr, and receipt shall be requested. Natic~ of termi- .nation shall be deemed delivered as of the dote of its posting by certified mail or atthe time it is delivered to the other party by messenger. 29. Severability; No Implied Waiver (a) It is expressly agreed that if any term or provision of.this Agreement, or the app ca- tion thereof to any person or circumstance, shall, to any extent, be held invalid or unenfcrceable, the remainder of this Agreement, or the application of such term or provision to persons or cir- cumstances other than those as to which it is held invalid or unenrcrceable, shall not be affected thereby; and every other term and provision of this Agreement shall be valid and shall be enforced to the fullest extent permiEed by law. (b) No waiver shall be inferred from any failure or forbearance of the Couaty to enforce any provision of this Agreement in any particular instance or instances, but the same shall other- wise remain in full force and effect notwithstanding any such failure or forbearance, 30, Merger; No Oral Changes I¢: is expressly agreed that this Agreement represents the entire agreement of the parties, that all previous understandings are merged in this Agreement, and that no modification of this Agreement shall be valid unless wdtten and executed by both parties. END OF TEXT OF EXHiBiT Al AG A1F (2/04) Page 14 of 14 pages of Exhibit A1F .~.~, L;~w No. AG004M/00._-06/7Y IFMS No. SCS EXE 0000000 Rev; 417/04 No. 001-6790/6774-4980-95284- IIIC Nutrition Program (Supplemental Nutrition Assistance Program) Exhibit B Program Specifications For Nutrition Programs 1. Goals Of Program The intended outcome of the Nutrition Program for the Eldedy is to improve, maintain or delay the decline in the nutritional status of pemons 60 years of age and older and help them to remain independent tn their own homes and communities. 2. General In general, but without limitation, the Contractor shall be required to meet the criteria listed below: A. The Contractor wit1 adhere to the requirements of the Suffolk County Office for the Aging Policy and Procedure Manuals and the Technical Assistance Packet. B. Each meal must meet 1/3 of the recommended dietary allowance. Special Iow salt and basic diabetic diets must be provided to those clients requiring such upon physician's order. The meal pattern and the amounts must follow those set forth by the New York State Office for the Aging. All aspects of food preparation and service must meet the standards of the Suffolk County Department of Health Services, e.g., safe temperature of food - hot entree always served at a minimum of 140°F, salad and other cold items served at 42°F or below, and home-delivered meals delivered in 2 hours or under, C. Ali nutrition programs which cook on site must hold a complete sample of each day's meal(s), including all components except milk and bread, in the refrigerator for 5 days for tesdng purposes. Afl nutrition programs which serve catered meals must hold a complete sample of each day's meal(s), including all components except milk and bread, if possible, or hold 3 tablespoons of each meal component, in the refrigerator for 5 days for testing purposes. D. All congregate sites will develop and maintain a Site Council to operate in an advisory capacity for the program. The Site Council shall be composed of partJcipaets in the nutrition program. 3. Contributions The Contractor has the obligation to inform each recipient of the service of the opportunity to make a free, willing and anonymous contribution toward the cost of the service, Service may not be denied if a person is unable or unwilling to make a contribution. The Contractor must maintain an audit trail of all incoming contributions and make monthly reports of any contributions received. All contributions must be used to enhance services. All pdnted materials used for the program must include the sources of funding for the Program and must include the following in[ormati0n: Contributions to this (these) service(s) ara free and vo]untary. Any contribution you wish to make will be used to expand the program and will be greatly appreciated. AG 4- (7/03) Page 1 of 8 pages of Exhibit B L;~w No, AGOO4MIOO__.OCITY IFMS No. SCS EXE 0000000 Rev. 4/7/04 No. 001-6790/6774-4980o95284- IIIC Nutrition Program (Supplemental Nutrition Assistance Program) Each recipient of service must be informed in writing of the opportunity to contribute at least annually. In the congregate setting, the Contractor must provide a locked box and envelopes for the suggested meal donations for the participants in order to protect the confldentialiby ef program participants' identities and the amount which they contribute. The suggested donation amount will be determined through consultation with the Suffolk County Office for the Aging and the Silo Council. (1) All sites must post the suggested contribution for program participants. (2) Price of the meal for guests must be posted. (3) The above two amounts are to be posted near the locked box. For home-delivered meal patticipants, The Contractor must provide envelopes for tile suggested meal donations of the participants in order to protect the confidentiality of the program parUcipants' identities and tile amount which they contribute. 4. Targeting And Outreach The Contractor must give preference to providing services to older individuals with tile greatest econoraic or social needs with particular attention to iow-income minority bdividuals, (42 U.S.C. §3025 (a) (1) (E)). The term "greatest economic need" is defined as the need resulting from an income at or below the povetty levels as established annually bythe O',~ice of Management and Budget. The term 'greatest social need" refers to the need caused by non- economic factors which include physical and mental abilities, languege barriers, social or geographical isoration incrudthg 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 (42 U.S.C.§302(21)). The following four target groups have been identified as having the greatest economic and social needs: minorities, Iow income, frail and vulnerable. In order to comply with Targeting requirements, the Contractor must employ Outreach Strategies which may include, but are not limited to, locating target populations using Census or ether resource data. translated printed materials, location of services in catchment areas for targeted populations, publicity to community-based groups, and minority staff/vorunteers. 5. Coordination The Contractor must coordinate the delivery of services with other providers and organizations to provide the most suitable outcomes and minimize possible duplication of effort. In order to accomplish this, the Contractor will undertake activities such as, but not limited to, participation in inter-agency meetings, coordination of referrals and follow-ups with other local service providers, entedng into agreements with other organizations for joint efforts and/or funding, centralized assessment and maintaining up-to-date resource materials both within and outside the Contractor's organization. AG 4. (7/03) Page 2 of 8 pages of Exhibit B Law No. AG004M/00__-06/7Y IFMS No. SCS EXE 0000000 Rev. 4/7/04 No. 001-6790/6774-4980-95284- lilt Nutrition Program (Supplemental Nutrition Assistance Program) = Congregate Meal Program A. The nutrition site shall be open as stated on the Summary Sheet, which is aEached and made part of this Agreement; fully staffed, du~ing regular business hours b_~sed on local need and available funding. Ho]iday schedules are to be posted one month in advance at the nutrition site. The Contractor shall submit copies of all holiday schedules and staff vacations to Aging. B. The Contractor must provide participant transportation as needed and supportive services as appropriate to the needs and abilities of each participant. Supportive services mean education and training, inrorrnation and referral, outreach, public information, recreation, shopping assistance, socialization and volunteer activities. When viewed as a who]e, transportation services must be accessib]eto people with disabilities as required by the Americans with Disabilities Act of 1990 (P.L. 101-336) and the regulations thereunder (49 CFR part 37). C. The Contractor must abide by standards set forth under both Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 101-336) and the regulations thereunder (28 CFR Parts 35 and 36) which require that all programs and facilities (buildings, bathrooms, etc.) must be acceesib]e to the handicapped. D. The site manager shall work closely with Aging's staff and other local agency staff to provide a full array of supportive services For participants. Home-Delivered Meal Program A. Eligibitity must be determined prior to the delivery of service by using the standardized Client Assessment Provider Data System (PDS) (see Form - Appendix O and Policy & Procedures Manual - Appendix L). Each client receiving home-delivered meals must be reassessed at appropriate inte~'~als based on each client's situation, but in no instance [ess frequently than at least once in each twelve-month period. The Contractor will also make a six-month contact in the Form of a home visit or a telephone call. B. The packaging of meals must meet the standards of the Suffolk County Department of Health Services. Aluminum foil partitioned containers are recommended, in order to maintain safe food temperatures in delivery, equipment approved by the National Sanitation Foundation must be purchased. Menus, whenever possible and feasible, should be sent to the clients. C. The Contractor must provide supportive services to the homebound client according to his or her specific needs. The frequency of the supportive services will be determined by the individual assessment. Nutritional counseling and education must be included in this service. D. The Contractor shall provide a mea] for those holidays and/or weather emergencies that fall on a weekday. The holiday/emergency meals may be frozen or canned and must be delivered the ]est business day before the holiday AG 4 (7/03) Page 3 of 8 pages of Exhibit B L~w No. AGOO4MIOO__-O61'[Y IFMS No. SCS EXE 0000000 Rev. 4~7~04 No. 001-6790/fi774-4980-95284. IIIC Nutrition Program (Supplemental Nutrition Assistance Program) or weather eme~ency. In addition, an emergenc~ supply of shelf-stable food should be made available twice a year for weag~er related emen~encie$. A iisi of suggested toed items Js available frum Aging. (see Policy & Procedure Manuals) 8. Reporting Requirements A. T~e following forms and reports are required by the County to meet ihe standards of the Nutrition program: (1) Monthly Program Reports Copies of the participant daily sign-in sheets must be received in Aging by the eighth day following month's end. The units of service/unduplicated count report, including targelJng results, (Nutrition or S.N.A.P. Sauces) is due the eighth day following month's end. The activity report is due one week prior to the month reported. Menu forms are due four weeks prior to the serving cycle. (2) Monthly Fiscal Reports SCOFA Forms NPAG 2 (congregate), NPAG 3 (home-delivered), NPAG 4 and NPAG 5 are due the eighth day following month's end. NPAG 4 and 5 are to be signed in ink by the site manager where indicated. The forms listed above are found in the Policy and Procedure Manual (Appendix L). (3) Demographics The Contractor must at a minimum determine and maintain the following specific type of demographic information for each individual receiving services: · Name. · Sex.. · Age. · Disabled/FraiL Disabled -Any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment. This includes alcoholism and drug addiction. Frail - A person with one or more functional deficits in the following areas: physical functions; mental functions; acfivities of daily living (ADL) leafing, bed/chair transfer, dressing, bathing, toileUng and continence); instrumental activities of daily living (IADL) (meal preparation, housekeeping, shopping, medications, telephone, travel and money management). · Live Alone. AG 4 (7/03) Page 4 of 8 pages of Exhibit B Law No, AG004M/O0__-06/TY IFMS No. SCS EXE 0000000 Rev. 417/04 No. 001-6790/6774-4980-95284- IIIC Nutrition Program (Supplemental Nutrition Assistance Program) Size of Family Unit 1 2 Rural. Low Income - The seed resulting from an income level at or below the pover[y threshold, as established by the Bureau of the Census, and updated annually as follows: 100 % of poverty Threshold (for IlIC Nutrition program(s)) $9,310/year $12,490/year 150% of Poverty Threshold (for SNAP Program(s)) $13,965/year $18,735/year · Minority - Those individuals belonging to one of the following groups: Native American/Alaskan Native, Asian, Black, Native Hawaiian/Pacific Islander and Hispanic. · Low Income Minodty - Those minority persons whose income is st or below the poverty threshold. Contractor's Staff A. The Contractor agrees to employ adequate numbers of qualified staff and supervisory personnel to meet all the specifications and responsibilities of the program in a ordedy, punctual and reliable manner. Personnel involved in aspects of food handling and preparation are to be in good health and trained to ensure Lhe safety standards of the food prepared and served. A full-time manager/supervisor will direct and coordinate the daily operations. Ali meetings and trainings required by the County are to be attended by the appropriate staff. The Contractor will have on file with Aging the procedures to be followed by workers and other staff in case of emergency. The County shall have the right to pdor approval of the filling of any site manager position and shall be advised by the Contractor of the d[~ties and compensation of all personnel assigned to the Nutrition Program for the Eldedy Program. 10. 11. AG 4 (7~03) Confidentiality A, The Contractor agrees that'no personal information obtained from an individual in conjunction with this program shall be disclosed in a fom~ in which it is identified with the individual without such individual's wdtten consent to such disd0sure, except to Aging. B. In the case of a request by Aging for names and addresses of individuals participating in the program, the Contractor shall furnish such information as requested. Failure to comply with a request by Aging for such infon'nation shall be deemed a material breach of this Agreement and shall result in a freeze on all monies due and owing to the Contractor until compliance by the Contractor. Administration A. Overall admthistration of this program will be the responsibility of the Contractor. The Contractor or its designee will insure proper implemcntafion and direction of the Page 5 of 8 pages of Exhibit B Law No. AG004M/00__-0617Y IFMS No. SCS EXE 0000000 Rev. 4/7/04 No. 001-6790/6774-4980-95284- ffiC Nutrition Program (Supplemental Nutrition Assistance Program) service, act as liaison be~een Aging and the actual service and insure accuracy and timeliness of submission of all repo~ng forms and expenditures, B. Program Staff shall attend meetings and training as requested by Aging. C. Attendance by site managers at site managers' meetings and training sessions is mandatory. Transportation to these meetings must be accomplished without decreasing transportagon services to the Program. 12. Grievance Procedures In accordance with §306 (a) (6) (P) of the Older Americans Act, as amended (OAA), Aging has established a process for resolving complaints from older persons who are dissatisfied with or denied services funded under Title III of the Act. The Contractor shall comply with the requirements of the Grievance Procedures as set forth in Exhibit E- Grievance Procedures. 13, Monitoring A. Financial Transactions Aging's staff and staff of the New York State Office for the Aging may examice or review evidence regarding the existence, liming and classificafion of financial transactions that are charged to the program for reimbursement. To obtain f~is evidence, such staff may examine documentary evidence, including financial statements, financial reports, etc., and ofiginal records. Such staff may make physical verificafion by actually observing or counting certain assets (e.g., cash, equipment and supplies) to establish their physical existence. The Contractor shall cooperate Jn Aging's periodic physical verification of cash, food, equipment, sappHes and other assets of the program. B. Program The Contractor agrees to permit Aging's staff and staff of the New York Stale Office for the Aging to review program records and to monitor training, supervision and services st any time. 14. Miscellaneous A. It is He respoesib[lity of the Contractor to have an identifying Iago in equal sized lettering on any printed materials and on all brochures, flyers, and advertisements (including without limitation television graphics), and on Program vehicles, as follows: Purchased with Federal Funding: Funding provided by the Suffolk County Office for the Aging and the U.S. Dept. of Health and Human Services Through the New York State Office for the Aging AG 4 (7/03) Purchased with State/County Funding: Funding provided by [the} Suffolk County [Office for the Aging] [through the New York State Office for the Aging]* Any announcement of the Program on radio or television must identify funding by [the] Suffolk County [Office for the Aging]*, the U.S. Department of Health and Human Services and/or through the New York State Office for the Aging, as applicable. Page 6 of 8 pages of Exhibit B Law No. AG004M/00__-06/7Y IFNIS No. SCS EXE 0000000 Rev. 417104 No. 001-6790/6774,-4980-95284- IIIC Nutrition Program (Supplemel~tal Nutrition Assistance Program) The Contractor must establish a formal system of soliciting comments from the participants concerning meals, transportation and supportive services. The Contractor shall comply, and shall require its officem and directors, partners, trustees or other members of its governing body and personnel employed to render services under this Agreement, te comply with all applicable rules, regulation and requirements of law, including w;thout limitation, the Americans with Disabilities Act, and the applicable Policy and Procedure n~anual issued by Aging. and the Technical Assistance Packet, which have been made part of this Agreement, Omit the words that are not applicable. AG 4 (7/03) Page 7 of 8 pages of Exhibit B Law No. AG004M/00__-06/7Y IFMS No, SCS EXE 0000000 Rev, 4/7/04 No, 001-67'90/6774-4980-95284- IIIC Nutrition Program (Supplemental Nutrition Assistance Program) GENERAL FOOD SPECIFICATIONS FOOD SPECIF CAT ONS FOR CYCLE MENUS Meat or Alternate Meats - USDA Choice or Better Preservatives, tenderizers, or coloring agents may not be added to any fresh meat or fresh meat product, .Ve~qetables and Fruits All fresh fruits and fresh vegetables must not contain bisulfates. All fresh fruits and fresh vegetables must be washed. Fresh Fruit Minimum Size Oranges 113 Apples 120 Bananas 150 ¼ cup represents drained weight of fruits and vegetables Frozen Vegetables - Grade A - Fancy (USDA) Canned Vegetables .- Grade A - Fancy (USDA) Marqadne -from liquid vegetable oil and fortified with Vitamin A Bread/Altematff -- whole grain or enriched Instant Mashed Potatoes must be fortified with Vitamin C Milk - Vitamin A & D fortified skim or Iow-fat milk - 3 days lead time from day of service Desserts Gelatin - fortified with Vitamin C Milk-based puddings used for pudding mix Canned Fruits - Grade A - Fancy (USDA) Canned Fruit Juices - Grade A - Fancy (USDA) - fortified with Vitamin C Frozen Fruits - Grade A - Fancy (USDA) Ail foods shall be obtained from State or Federal inspected plants. - END OF TEXT OF EXHIBIT AG 4 (9/00) Page 8 of 8 pages or Exhibit B Law No. AG004M/0003-06R Rev. 515104 I[IC Nutrition Program IFMS No. SCS EXE 0000000 No. 001-6790-4980-95284- CONTRACTOR'S RESPONSE TO SECTION IV RFQ No. 3/15524VH AG 4 (7/03) SC Purchasin~ R~Q ]No. 3/1~524VH SC Law No. AG RFQ For Nutr'rllon Programs for the Elderly Section IV Tcclmical Services Response Form PROGRAM DESIGN, FACILITIES, DOCUMEI~TATION, SERVICES AND ACTIVITIES: 1. Program Design with Sttff~lk County O~ice ~r the Aging ibr prior approval. B. 1. Congregate M'eal Program: Since safety is a higfl prioffny, tl~ Sonior Cealer is fully equipped w~ fire and smoks deteetioa alarms aad ]C Purchasing RFQ No. 3/15524VH SC Law No. AG RFQ For Nutrition Programs for the Elderly Section IV Technical Services Response Form PROGRAM DE$IGN~ FAC~LI t LES, DO CIYMENTATION, SER~qCES AND ACTI V[T1ES: ~V.L B. 2. ttomeDelivered MealProgram: thc Supplememal Nu~ition Assistance Program (5~V.4P). Priority is given to ~he flail, mafi~o,mlly at~risk 2. Program Descrilofion & Mothodoloev A. Food Service: SC Purchasing RFQ No. 3/15524VH SC Law No. AG _~ RFQ For Nutrition Programs for the ~lderl~ Section IV Technical Services Response Form PROGRAM DESIGN, FACI]~ITI~;S, DONATION, SERVICES AND ACTIIrlTIES: IV.2. B. Supporiive Ser,,Sces: Transportation: D. Targeting: SC Pm.chasing RFQ No. 3/15524Vtt SC Law No. AG RFQ For Nutrition Programs for the Elderly Section IV Technical Services R~ponse Form PROGRA]~! DESIGN, FACILI'I'IES, DOCUMENTATION, SERVICES AND ACTIV/TIES: E. Coordination: provided to our proem participm~t~ by our sta~ F. Clicnt Assessment Provider Data Syslem (PDt: SC ]Law N0. AG For Nutrition Programs forlhe E]ldetty IV.2. F. _. Addendum: ................ CHent Ass~sment provider Dstn System (IDS) ~-~urchnslng RFQ No. 3/15524VH SC Law No. AG__ RFQ For Nutrition Programs for the Elderly Section IV Tcelmieal Services Response Form PROGRA~I DESIGN, FACH~IT~ES, DOCUM~NTATIOIg, SERVICES AND ACTIV~I~IES: OtherResources: an away of senior ~ps and recreational activities that our sen~or~ pa~cipa~ im Taey a~so havc ~vo yep/active Senior CifiT~n Clubs that meet regularly and are pol~cally active. Mmay of our Supeivisor is veff supportive of our pm~a~ns ~ud hat.es all public notices and real. es our depa~txnent in his quarterly ~own-wid~ ne~letter. SC Purchasing RFQ No. 3/15524VH SC Law No. AG__ RFQ For Nutrition Programs for the Elderly Section IV Technical Services Response Fo~-m PROG1L&M DESIGN', FACILI~i ii~S, DOCUMENTATION, SERVICES ANq~ ACTIVITIES: IVY,. H. Contribution Policy: 3. Documentation: SC Purchasing ITAVQ No. 3/IS$24VI~I SC Law No, AG__ RFQ For Nutrition Programs for th~ Elderly Section IV' · Techflir. al Services Re~pon~e Farm pROGRAM DESIGN, FACILITIES, I)OCUM~NTATION~ $Ft,~VICES AND ACTI~'I'E~S: IV.]. B, 1, C. EmergencyMJmagement: KAREN MCLAUGHL~N SENIOR CH'~,N PROGRAM DIRECTOR l~own of Southold P.O. Box 85 750 Pacer S~ M~m~ ~ 11952 Tel. (631 ) 29g~60 E~ (6~ l) 298~62 Attachment IV.3/$6 October 27, 2003 Chief Edward Hanus lvlattituck Fire Dept, 1000 Pike S~reet Mattituck, NY 11952 Dear Chief Flanus: In compliance with our regulations from the Suffolk County Office for the Aging, I am notifying you in writing of the nature and location of our Seamier Center. Southold Town Human Resource Center, located at 750 Pacific Street, Mattituck serves as a multipurpose center for senior residents of Southold Town. We offer a variety of program~ including a congregate dining program, community education and outreach, recreational activities, home delivered meals program and tmnspor tetious sen, ices. Our social model Senior Adult Day Care Program operates in our annex called "Katinka House" and serves 20 frail elderly participm~ts. Our hours cd operation are 8am to 4:30pm Monday through Friday. Our center's fire system is monitored at a central station and regularly maintained by Suffolk Secttrity System. Our fire suppression system ~s also closely monitored and maintained by All Island Fire Pro~ion~ Please contact me at 298-4460 if you have any questions or would like m~re hifarmation about the Senior Canter. Thank you. Director of Senior Services Law No. AG004M/0003-06R Rev. 5/5/04 IllC Nutrition Program IFMS No. SCS EXE 0000000 No, 001-6790-4980-95284- Exhibit C Rate Page (Response to Section V of The RFQ) TOWN OF SOUTHOLD CONGREGATE PROGRAM Proposed Schedule of FeeF for Services First Contract Year Second Contract Year Third Contract Year Congregate Meals $4.47 $4.60 $4,74 AG 4 (7/03) Exhibit D Grievance Procedures 1. Purpose Ir] accordance with {}306 (a) (6) (P) of the Older Americans Act, as amended (OAA), thc Suffolk County Office for the Aging has established a process for resolving complsints from older persons who are dissatisfied with or denied services funded under Title Ill of lhe 2. . Notifying Participants of the Right to File a Grievance (a) The Contractor shag inform all participants in the program of the right to file a grievance. A summary of the procedures, including a statement that assistance to file shall be provided to older persons, must be prominently posted at service delivery sites or offices at which participants and service applicants apply for services. Summaries must be in a format approved by Aging and shall also be written in la~:~guages other than English where required to serve the client/applicant population. Service participants shall be informed of the grievance procedures through written and verbal statements provided to them upon assessment and/or reassessment for services. (b) A participant er applicant who is denied Title III services by the Contrsctor and the Aging program monitor must be given the reasons for the denial The denial shall be confirmed in writing and the applicant informed of the right to file a grievance and ta whom the grievance shall be addressed. For services which are applied for by telephone or verbally, in person, the client may be told of the dght to file a grievance verbally. 3. Grievance Process (a) Filing of grievances must follow the Following process: i. Participants must submit their grievances in writing to Aging's Program Administrator. ii. The grievance should be filed within thidy (30) days of denial, reduction or termination of services, or of the event or circumstances with which the participant is dissatisited. Aging's Program Administrator may grant an extension for good cause shown. iii. The grievance should be filed on the form approved by Aging, which shall include a written statement setting forth in detail the d~te, time and circumstances that are he basis or the complaint. (b) Investigation end Response to Grievance: i. The designated reviewer who performs the initial review shall investigate the grievance, including, as appropriate, meeting with the gdevant and other persons involved in the action(s) complained of or in the denial of services. ii. The reviewer shall review all pertinent facts and/or documents, and shall determine whether the agency action was made in accordance with lawful procedures (that is, consistent with applicable OAA and or State laws, regulations and policies) ~nd supported by the facts. Page 1 of 2 pages of Exhibit D iii. The designated reviewer shall prepare and send a written response to the · grievant and to Aging's Director wtthin fifteen (15) days after the · grievance is filed. The response shall set forth the circurnstances relating ' to the grievance, the action requested by the grievant, the findings of the reviewer, a proposed remedial action, if any, and reason(s) for and facts relied on in the determination, (c) Appeal of Initial Response/Dec!sion . i. The gdevant reay initiate a request for subsequent review by Aging's Director within twenty (20) calendar days following receipt of notification by the Prograre Adreinistrator of the decision. ii. Aging's Director shall request copies of the initial file on the c0mp]aint in question. Aging's Director will review the materials to ensure that pertinent p?licies and procedures have been applied and follo~ved. If appropriate, Aging's Director or his/her designee will reeet with the older person to allow the grievant en opportunity to present inforcnatbn about the grievance. iii. . if the policies and procedures have been adhered to, Aging's Direcl.orwill not overturn the decision of the Prograre Administrator. If proper policies and procedures have not been applied, Aging reserves the right to overturn the decision. The subsequent review shall be completed within forty-five (45) days of receipt of the request by the older individual and the grievant will be notified in writing of the result of the subsequent review. 4. Record Keeping Aging shall keep the records of the grievance and its handling tar six years fol~owJng the conclusion of the calendar year of the occurrence. The file shall contain, at a minimum, but not limited to the initial grievance, any investigative reports; any written response submitted by Aging or the service provider aging; any documents or other records subreitted by any party; the written Initial Response of the agency, and, if applicable, the notice to the gdevaat of the · right to an appeal 5. Confidentiality No in[ormetion, documents or other records relating to a grievance shall be disc[esed by program staff or volunteers in a form that identifies tile grievant without the written Jnfomled consent of the grievant, unless the disclosure is required by court order or for prograre monitoring by authorized agencies. -- End of Text -- Page 2 of 2 pages of Exhibit D SEC. 20. HOLIDAYS Full-time employees shall be entitled to the following holideya offwith pay, .wit: the ftrst day of January, known ~.s New. year's Day the third Monday o f Janum-y, known as Martin Luther King, Jr. Day the twelfLh day of February, kno,am ns Lincoln's Birthday (dele3e. effective January 1, 2000) the third Monday in February, known as (President's Day) Waahington's Birthday the last Monday in May, known es Memorial Day the fourth day of July, known az Independence Day the fzmt Monday in Septgmber. lmown ~ Labor Day tho ~eoond Monday in October, known as Columbus Day lite Tuesday .4ext sue*eeding the first Monday m November, known as Election Day . tho eleventh da5' o£November, known ns Veteran'~ Day tho fotfrth Thursday in November, known is Thanksgiving Day the day aider Thanksgiving Day. excqx for employees assig-qed to the Landfill, who shall receiYe a floating holiday to be ~chaduled es though it were a pcrsonal day (effective Janum'y I, 2000) the twenty-fi.ffil day of December, known as Chrislmss Day the eve o£Thanksgiving Day, ¼ day the eve of Cllristmas Day. Va day ' the eve of New Year's Day, Va day SUMMARY - RFQ FOR NUTRITION PROGRA[~S 2Q03 PROPOSER: .~own of eouthold -(ee=£or' eer-$ices) GEOGRAPHICCATCHMENTAREA: ' · .... PROVIDE ONE COPY OF THIS SUMMARY SHEET FOR EACH PkOGRAM CATCHMENT AREA.· YOU MAY MAKE PHOTOCOPiES.OF THIS FORM. TARGETCOMMUNITY: soutnoza TOWn ( includes Village of Greenpo£t (i701,01) [~'CONGREGATE 52 105 Number of days per weP~'-for proaram CJrc,e days of progranP'O 'Q Hours ofoperaUen each Location for congregate site: ~ HOME-D.ELIVERED Number of meals [o be sen/ed each day- cong{egate Number of meals to be served egch day - Home-Delivered U CATERED .[~] COOK ON SITE SA 8U Southold ToWn Huma~ Resource Center, 750 Pacific Street, M~ttituck N-Y. 11952' Location of program administration, if~Cifference iron3 congregate Please state any additional infommtion affecting service delivery: OFFICE USE ONLY: Southold Town Senior Services · 750 Pacific Street Mattituck, New York 11952 Phone # 631 298-4460 · Agency Name: Intake Date: .~LIE NT INFORMATION Address: City:. DOB: Marital Status: [] Divorced [] Married E~ Separated [] Single Agei Living Status: [] Alone [] With Non-Relet E~ With Re[afJves [] With Spouse Apt. #: CD Code: Cross Street: goroughlCount~. Gender: Num in house: RaC~ I EthnJcit~: ~ Amer. lnd[anIN~t,Alas [] Other If yes, Disabled? (Rale abtlily Fluen~ Moderate, or Basic.) Speaks Reads: Understands: Country of Origin: Does Client Have A Medicare.Card? [] Yes ~J No Does Client Have A Medicaid Card? [] Yes ~ No Is the Client Receiving Medicaid Homecam? I~ Yes [~ NO ~;ONTACT LIST Please note the follo~ng contact classifications here: ~contact list con§nued') Relationship: Relationship: C]a$$i~cation~; ' Classiticaflons: Address: Address: Relationship: Relationship: Relationship: ~.elationship: I ~EDICA~ONS Medication Dose/Frequency Comments Client Assessment Date: 04/21/2003 L2 cost of Medi~on ' [J None ~J Obtaining Medications · LJ Olher How is medication administered? [] Admin by HealLh Professional [] Admin/Mon[tored by Lay Person If client can~ot administer nlcdicafion, who will? Who obtains medication? Name: Name; Addrcss: Address: [] Alzhe[mcrs [~ Anemia LJ Hyperglycemia [] Hypoglycemia [] Incontinence [] Liver disease Low blood pressure [] Osteoporosis [] Respirator), pmbtems S~ke Ulcer Name: Address: Phor~e Number: Doctor/Health Care Provider: PhoneNumbe~ Client Assessment ' Date: Current Problems: Signlflcsnt History: PRI HospE~l Visit Doestheclienf~vJsltthedoctorlessthanonceayear? [~ Yes [] NO Fl~tilDisabled: [] Yes [] No Does the client require a c~mprehensive medical exam? J~ Yes [] No Assistive Devices? I Does the client require training on assistive devices? [] Yes [~ No Profile: L~ Hallucinations · ' [] Wg~ed or anxious . Client Assessment ale: o tJ2oo3 Comments; · L~ Ye~ [] No INUTPJTION Height: Any weight cha~lges within ~he last six months? Weight: [~ Yes: Howmuch?: [~ No Body Mass Index: How many meals does the client eat daily? Does the client have adequate food in the house? [] Yes [] No Does the client have a m0dified/therapeutts or ethltts diet? L~ Yes: Special:' [] No [f client has modified therapeutic'diet, does the client foitow it? L~ Yes [] No Nutrition Problems: ($electallthatapply) Nutfltion Profile: ($elocfallthatappfy.) [] Appetite [] ~nadequ~te mfdgeratorffreezer and cooidng ~cilities [] Dehydration [] Requires nutr~onal supplemez]ts L~ Has a physician-presedbed mod~ed/thempeutle diet [] Digestive problems [] Overweight · [] Taste Impairment. [] Underweight Nutrition PJsk Screenthq [] Eats fewer than 2 m~als/day. Eats fewer than two daiIy servings of t~e ~311owing food groups. [] Fruits [] Vegetables ]~ MIll( Product [] Has 3 or more ddnks of beer, liquor orwine aln}ost everyday. [] Has tooth or mouth problems [nat ma~e it hard to ~at. L~ Does not always have enough money to buy food needed. [] Takes 3 or more prescribed or over the-counter drugs a day. ~J Without wanting to, lost or ga]ned 1 0 pounds In the pas~ s~x mon~s. L~ Not a~vays physically able to shop, coo]< and/or teed self. 2 3 2 2 2 2 4 2 2 · Client Assessment D~D: 04121/2003 Comments/Additional Notes: :UNCTIONAL STATUS S~at~Js Codes: 1. Totally Able 3. NEeds max[ma[ asst. 4. Unwilling to pe~furm Needs Met: mental Activities of Daily Living re~are and Cook meals ~repare light meals/Reheat ~dmin. of Ue~,ca~ Use telephone Use Transpodafion Met by ~sslstive Device: (~ACDt LS) · Ba~ng e~nal Hygi~l)e · ' Client Assessment D.~.: 04/21/2003 ~DL Comments: ADL's: [mpslred ActM~ies: . Mat by Info,mat Supp0~: Met by Formal Suppo~: ~J31-/ADL CAREG~VER LIMITATIONS Activity N~me: Con[act name; Does ~he client appear to have a good relationship with d]i$ caregiver? [] Yes [] No Any factors which migl~t limit involvement? Iscaregiverreiiefneeded? [] Yes [] No if yes, when? . . Could other informal supports provide mitaC? ~OUSINC Type of Housing: Owner$]iTp Status: [] Mu[~ family UnJt [] Single Fami!y Unit [] Own dwelling [] Other · ' · Client Assessment ' Date: 04121/2003 · ' [J Yes [] NO Is r~eighborhood safety an issue? Landlord: (if available) Nama[ Phone Number: I Super: (if available) Name: A~dress: Phone Number: SENEFITS Code Status as fcllows: HB = Has Bcne~t ME -- May Be Ellgible · . PA.= Refuses to Apply AP = Application Pending D = Denied NE -- Not Eligible -- Benefit S~tas code/I Benefit Food Stamps f ][~aJlroad Refirement Health Insurance ~ j~eal Pm~: Tax Exemption HEAP t J~everse Mortgage IT214 ~ J~SCRIE I Long te~-m care insurance ~dicaid = J ~ ~ocial Securi~ Medicare I ~SD ~digap ]nsuran~HM~~ p~te Health Insurance ~A Ben0fib II'si ~ J ~ I Notes; Insurance Comtiany Identification Plan # I ' Client Assessment . Da~: 04~1~003 C[CU RRENT SERVICES service I Fulzding erg. Provider/Contact .' Units Freq. · Auth, Date I End Date II ' ~ ;SESSMENT SUMMARY Evaluate Informal Support System: [J Adequate Can Expand [] Adequate Not Expand [~ Inadsquatc,'Limded []. Temp Unavailable Would client accppt help from the family?. Other Uncertain [] Ne¢6s Suppod [] Resistbe Disposition: : [] Eligible forAAA in-home LJ OfoCr ~ Refer to CHHA [] Refer to Medicaid H~3me~'.are ~ Refer to Nursing Home [~ Refer to Self-Pay service · Could neighborhood/community/religious affiliations provide essistance? Summary: L~ ~,=.s [] No Care Plan Objectives: Client Outcomes; II .. . . Client Assessment · ' Date: 0412112003 Pro~oscdTime Frame: ' ' * ': Client self-directing/able lo direct home care staff? Client Preferences Regarding Service: [] Yes O No I~LANNED SERVICES ~ )LANNED TASKS Task Comments Due Date OK to discuss plans with informal supports? . Plans discussed and/or accepted by client]informal suppods? . ~ Yes [~ No [] Yes [] No. Date of Review: '.. Client Assessment Dgte: 0~I21!2003 ~I_NAN CIAL [nfo ~ceived From: [] ~unt [] ~rofher-in-law .~HHA [~ J,Cousin E-J paugMer ~J ~DauQht~r-in law ~ [DFTA ~ LDoctor [~ ~)omes[ic Par[nar E~ ~'riend E~ IGr~nd Dmlghter L' lGrand Son L~ [Grandfather [~ [Grandmomer [] rHosp[tsl [~ IHo~ing [] [Husband [~ ~Jeighhor [] ~Nephew [3 ~iher [] ~eliglous Org. [] ~ocial Serv Agc Worker r~ J$on [] JStep Daughter [] ~Slep Father ' Mother [Financial Information: Mor~tbl¥ Hausinq Exp. S8N2: · ~ng/Cooking F~$ ' ~ 1°~er ~ I$ ~entJMo~t9 age/C~$ ~. Faxes ~hone I$ Is ~Nnter/Sewage ~ J$ ~)lvidends from I nv(~_ I~ J Ilnterest ~ ~ JNon-cllent Inc.not ,~ IS IPension/Refiremenj~ ES [Social Security ~$ is i u~upplemantal Sec_u~ ~$ I Monthly Medical Exm $$N1: SSN2: I~ealth Ins. Premiur$ I,s [ Iom.r tS L 1 ~;hecldng ~i 881,~ 1 [Jfe In_sura_nce - Fa(~ rs · ~Dther Cash Accts. ~$ [Stocks,Bonds,MutL~ [$ ] Client Assessment Date: 04!2~!2003 [] ~Visiting Nurse ~Others Information: ~.~ j [~ventBased ~JlFollow-upAssessment · r~alAssessment · I I [] IReview prior to Discharge J Client's Signature Case Worker's Signature St~ffolk county Legislative Requirements Exhibit for Contracts; last re~.2/5/a4 Suffolk County Legislative Requirements Exhibit for Contracts This exhibit is attached to and is made part of the Contract executed with the County. Suffolk County Living Wage Requirements "Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffo!k County Department of Labor on 10/22/02" (2 pages). Child Sexual Abuse Reporting Policy Chapter 577, Ar[Me IV, of the Suffolk County Code entitled "Child Sex~ial Abuse Reporting Policy" (3 pages). III iV · Gratuities · Chap[er 386 of the Suffolk County Code, entltl,~d Poht[cal Part~es, Gifts to Officials Off' (2 pages). Cotffractor's/Vendor's Public Disclosure Statement Form SCEX 22; rev. 7It 6/02 (form consists of two pages; requires signa[u~-e & notarization) Note: The Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev. 7/16/02, references the following law, which is included with this Exhibit. · Suffolk County Administrative Code Section A5-7 (consists of 3 pages). I Suffolk County Living Wage Docur~ents Suffolk County Living Wage Requirements Exhibit As' Last Revised by the Suffolk County Departmeut of Labor on ~10/22/02 Suffo!k County Living Wage Requirements Exhibit As Last Revised by the SUffolk County Department of Labor on 10/2~/02 pursuant to Section 6 of Chapter 347 of the Suffolk County Local Law No. t2-2001, Local Law to Implement Living Wage Policy for the County of Suffolk" (the "Living Wage Law"), all RFPs, County contracts and financial assistance agreements subject lo [h~ law shall con[ain the following two paragraphs or substantially equivalent language: This Agreement is subject to the Living Wage Law of the County of Suffolk. The requires that, unless specific exemptions apply, or a waiver is granted, all employers (as defined) under service contracts and recipients of county financial assistance, (as · defined) shall provide payment of a minimum wage to employees (as de, ned) of $9.00 par hour with heal[h benefits of et least $1.25 per hour or otherwise $10.25 per hour. Such rate shall be adjusted annually pursuant to tho terms of the Suff01k County Living Wage Law, of the County of Suffolk. Under the provisions o~ the Living Wage Law, the County shall have the authority, under appropriate circumstances, to terminate this Agreement and to seek other remedies as set fodh therein, for violations of this Law. Suffolk County Local Law No. 18-2002, "A Local Law [o Implement Living Wage Policy for the County of Suffolk" provided for cedain amendments to the Living Wage Law. Forms for Completion and/or Signature (as applicable) Suffolk County Department of Labor- Living Wage Unit Notice of Application for County Assistance (Cpntract) . Form LW-I (consists of'l page) Suffolk County Department of Labor - Living Wage Unit Certification of Compliance Form LW-2 (consists of I page) Suffolk County Depaffment of Labor- Living Wage Unit Certification of the Non-Applicability of the Living Wage Law Form LW-3 (consists of 2 pages) Suffolk County Department of Labor ~- Living Wage Unit Request for General Living Wage Exemption Form LW-4 (consists of 1. page) Suffolk County Department of Labor- Living Wage Unit Request for Specific Living Wage Exemption Form LW-5 (consists of 2 pages) lofl pages SuffOlk County Living Wage Requirements Exhibit As Last Revised by. the Suffolk County Department of Labor on 10/22/02 * Suffolk County Department of Labor - Living Wage Unit Declaration of Corepliance - Subject to Audit Form LW-33 (consists of I page) Note: Pumuant to Section 7 of Local Law No.18- 2002, "A Local Law to Implement Living Wage Policy for County of Su[folk", all covered employers subject to the provisions of the Living Wage Law shall submit a completed and swam (under penalty of perjury) Certification of Compliance Subject to Audit form, signed bY an authorized representative, as part of an executed contract with the County of Suffolk. The complete Declaration of Compliance form shall be · made a part of any executed contrast or project agreement and made available to the public upon request. To certify Living Wage compliance: Return Form LW-I, Form LW-2 and Form LW-33. or .To cert fy non-applicability of Living Wage'law: Relurn Form LW~3. er To request and document a general living wage exemption: Return Form LW-1, LW-2 and Form LW-4. or · To request and document a specific living wage exemption: Return Form LW-1, LW-2 and Form LW-5. In the event that there ~s a change in c~rcumstances, ~t ~s the Contracto, s responsibility to submit to the County additional Living Wage forms which either rep ace or supp ement pdor subm ss[ohs of Living Wage fo ms Living Wage Law Information Fact Sheet, text of the Local Law, Frequently Asked Questions, Forms, and Rules and Regulations can be found on the Suffolk County web site at www.co.suffolk.ny, us Click Department Directory Labor Living Wage Law Info · Suffolk Cour~ty Department of Labor Living Wage Unit Tel. (631) 853-3808 End of Text for Suffolk County Living Wage Requirements Exhibit As Last Revised by the Suffolk County Department of Labor on 10/22/02 2 of 2 pages II Child Sexual Abuse RepOrting Policy III Gratuities §386-1 GIFTS TO PARTY OFFICIALS · · §386;t CHAPTER 386 ' POLITICAL PARTIES, GIFTS TO OFFICIALS OF § 386-1. § 386-2. § 386-3. § 386-4. § 386-5. · Definitions. Prohibited acts. · Clause required in all contracts. Penalties for offenses. Excepted contdbufions. [HISTORY: Adopted by the Suffolk County Legislature 12-9-80 as L.L. No. 32-1980. Amendments noted where applicable.] §386-1. Definitions. As used in this chapter, the following tenThS shall have meanings indicated: AGREEMENT -Any written or oral contact or any implied contract, including but not Iimited to a contract for the sale of goods or services, a construction contract or a lease or contract relating to real or personal property. The term "agreement" shall also include any transaction whereby a person agrees to sell goods or services, or both, to the county pursuant to a successful bid. GRATUITY -Any money, benefit, entertainment', gift or any other consideration whatsoever. OFFICIAL OF A POLITICAL PARTY -A party officer as defined by §1-164, Subdivision 5, of the Election Law. PERSON -Any individual, partnership, firm; corporation or other legal entity, as well as their employees, agents or representatives. POLITICAL pART"( -A party as defined by § 14104, Subdivision 3, of the Election Law. § 386-2. Prohibited acts. It shall be a crime for any pemon to offer or give any gratuity to an official of any political party with the purpose of intent of secudng or obtaining an agreement with the County of Suffolk or secudng favorable treatment with respect to the awarding or amending of such agreement or the making ef any deterrnina[ion with respect to the performance of an agreement. Page 1 of I B. l{ shall be a cdr'ne for an official of a political party to solicit, receive oraccept a gratuity in connection with securing or obtaining an agreement with tile County of Suffolk or securing favorable treatment with respect to the awarding or. amending of such agreement or the making of a determination with respect to tt)e performance of such agreement. § 386-3. '- Clause required in ail contracts. In ali agreements with the County of Suffolk made after the effective date of this chapter, there shall be written representation by the person entering the agreement with the county that he has not offered or given any gratuity to any official, employee or agent of Suffolk County or New York State or of ~ny political pa~', with the purpose or intent of securing an agreemedt or securing favorable treatment with respect [o the awarding or amending of an agreement or the making of any determinations with respect to the pen~orrnance of an agreement, and that such person has read and is familiar with the provisions Of this chapter. § 386-4. Penalties for offenses. Criminal. A violation of §386-2 of this chapter shall be a'Class A misdemeenor add shall be punishable by a sentence of not more than one (1)year in prison or a fine of not more than one thousand dollars ($1,000) or by both such fine and imprisonment. B. Civil remedies. A violation of § 386-2 or 386-3 of this chapter shall give the county the option, among other civil remedies, of either tem~inating the agreement or deducting the value of the gratuity from any amount due or to become due from the county thereunder. §386-5. Excepted contdbutior}s. This chapter shall not apply to contributions to political parties, committees or candidates as defined by § 44-100, Subdivision 9, of the Election Law. Such contributions shall be excluded from and shall not be in violation of this chapter. Page 2 of 2 IV Contractor's/Vendor's Public Disclosure Statement Documents ~ ' Suffolk County SCEX Form 22 Contractor's/Vendor's Pubfic Disclosure Statement · Pursuant to Section AS-~ of the Suffolk Coun~ Administrative Code, to be completed by all providers which have a contract with Suffolk County in Excess of $1,000 or have throe or more contracts with Suffolk County any t~e of~v-hich~, ~z~n combined exceed $1,000 except: (1) Hospitals, (2) Educational or~-.~p~. __e. mme~al En~tie.~(3) Not-For-Prefit Corporations, or (4) Providers of Foster Care, Farley Day Care or Ci~l[d Protective Cbnsult[ng Services. 1. Contractor's/Vendor's Hame· Address City and State Contracting Dep~dment's Name Address .Zip Code · 3. Payee Identification or Social Security No. 4. · Type of Business__Corporation__Partnership__Sole Proprietorship__Other. 5.a Is your ~rm entering into or has your firm entered into a contract with Suffolk County in excess of $'1,000 Yes No. $.b Has your firm entered into three or more contracts, including the one for which you am now completing this form, wiLh Suffolk County, any three of which, when combined, exceed $1,000 Yes No. if you answered yes to either part 5a er 5b, you must complete pads 6 through 9. in any event you must answer parts 10 and 11. 6. Table of Organiza'don. List names and addresses of all principals; that is, ali individuals serving on the Board of Directars or comparable body, names and addresses of all partners, and names and addresses of all corporate officers. Conspicuously identify any person in this table of organization who is also an officer or an employee of Suffolk County. (Attach add!tional sheet if necessary.) List ali names and addresses of those individual shareholders ho[ding mcm than five · percent (5%) interest in the firm. Conspicuously identify any shareholder who is also an o~cer or an employee of Suffolk County. (Attach additional sheet if necessary). 10. Dges your firm derive 50% or more of its total revenue from your contractural or vendor relationship with Suffolk County?_ Yes__No. If Yes, you must submit with this disclosure statement, a complete financial statement listing afl assets and liabilities as well as a profit and loss statement. These statements must be certified by a Cedified Public Acoountant. (Strika this out if not applicable.) The undersigned shall include this Contractor'sNendor's Public Disc]0sure Statement with the contract (describe general nature of the contract). · Page '1 of 2 SCEX Form 22 11. 12. Dated: 7/13/04 Printed Name of Signor: Title of Signor: Name of Firm: Remedies. The failure to file a verified public disclosure statement as required under this local law shall constitute a material breach of contract. Suffolk County may resod, use or employ any remedies contained in Article II of the Uniform Commercial Code of the State of New York. n addition to all legal remedies, Suffolk County shall be entitled, upon a determination that a breach has occurred, to damages equal to fifteen percent (15%) of the amount of the contract. Verification. This section must be signed by an officer or pnncipal of the contractor or vendor authorized to sign for the company for the purpose of executing contracts. The undersigned being sworn, affirms under the penalties of perjury, that he/she has read and understood the foregoing statements and that they are. to his/her own knowledge, Signed: . . Joshua Hort~'n Supe~-,~isor Town of Southold Individual Proprietorship or Partnership Acknowledgement State of ) ) County of ) SS: On the day of ,20__, before me personally came ., to me known and known to me to be the person described in, and who executed the foregoing instrument, and duly acknowledged that he/she executed the same. Notary Public Corporate Acknowledgement State of New York ) ) County of Suffolk ) SS: Onthe 13th dayof July , 2004 , before me personally came Joshua Y. Horton , to me known, who being duly sworn, did dispose and say that he/she<resides in Greenport, New York , that he/~h~is the Supervisor of Town of Southold corporation described in and which executed the foregoing instrument; that he/she knew the seal of said corporation; that the seal affixed to said instrument was such corporate seal; that it was so affixed by the order of the board of directors of such corporation, and that he/she signed his/her name thereto by like order. SCEX Form 22 (Rev. 7/16102) Reference: ~lro-tary Public Suffolk County Administrative Code Section A5-7 Page 2 of 2 SCEX Form 22 SUFFOLK COUNTY ADMINISTRATIVE CODE SECTION A5-7 § A5-7. Contractors and vendors required to submit full disclos'ure statement. [Derived from L.L. No. 14-1976, as amended 2-27-1979 bY L.L. No. 6-1979] A. Definitions. As used in this section, the foll~)wing, terms shall have the meanings indicated: CONTRACT - Any wdtten agreement between Suffolk County and a contractor or vendor to do or per[orm any kind of labor, service, purchase, construction or public work, unless the con[rsc[ is for a federally or stats- aided, in whole or in part, program required to. be bid pursuant to § 103 of the New York General Municipal Law. [Amended 6-29-1993 by L.L No, · 28.1993~] NOTE: LL. No. 28-1993 also provided as follows: Section 1. Legislative Intent. This Legislature hereby finds and dctermines that Suffolk County's comprehensive Contractor/Vendor Public Disclosure Statement Law currently applies to a broad array of contracts that exceed one thousand dollars ($1,000.) in value, suhjec~ to exemptions for contractors doing business with the County Department of Social Services; hospitals; educational, medical~ and governmental entities; and not-for-profit corporations. This Legislature further finds and determines that these exemptions prevent fulJ disclosure of important information that may be useful to elected county officials in determining whether or not specific types of contracts are in the public interest, especially in light of recent trends towards pdvafizafion and use of outside consultants on an increased basis by municipalities. Therefore, the purpose of this law is to eliminate many of the exemptions from completing and filing verified public disclosure statements with the County Comptroller available to certain contractors providing social services or health services oontracts. CONTRACTOR or VENDOR [Amended 12-18-1990 by L.L. No. 41- 19902; 6-29-1993 by L.L. No. 28-'19933] - Any proprietorship, partnership or closely held corporafiod which has a contract with Suffolk County. in excess of one thousand dollars ($1,000.) or which has three (3) or more contracts with Suffolk County, any three (3) of which, when combined, exceed one thousand do]lars ($1,000.), except: (1) Hospitals. (2) Educational or governmental entities. t Editor's Note: This local law was adopte~ by the legislature after disapproval l)y the Executive on $-26-1993. . . 2 E~itor's Note; This local law was adopt~,d by the Legislature after disapproval by the Executive on 12-13-1 gg0. See the note at § A4-12. · 3 Editor's Note: T~ls local law was adopted by the Legislature after disapproval by the Executive on 5-26-1993. See note above. Page 1 of 3 · (3) Not-for-pml~t ~.orporations. · (4) ContracLs providing for foster care, family day-care providers or child prbtactive consulting services. FULL DISCLOSURE cLAUsE ~ A proviso to be included as. a materi~l par[ of a contract imposing upon the contractor or ve.ndor a material, contractual and statutory duty to file a verified public disclosure statement. VERIFIED ·PUBLIC DISCLOSURE. STATEMENT - A declaration, the coptents of which are acknowledged before a notary public, containing information required under this section. B. A full disclosure clause is to be included in all future con(rads be'~veen Suffolk County and a contractor or vendor. Such full disclosure clause sh~ll constitute a material par[ of the contract. C. Notice ef the full disclosure clause shall be included and made a par[ of the specifications, if any, which are submitted to interested potential bidders. D. Each contractor or vendor shall file a vedfied public disclosure statement with the Comptroller of Suffolk County as soon as practicable prisr to being awarded the contract. An updated disclosure statement shall be filed by the contractor or vendor with the Comptroller by the 31st day of January in each year of the contract's duration. It shall be the duty of the Comptroller to accept and file such statements. E. No contract shall be awarded to any contractor or vendor, as defined in this section, unless prior to such award a verified public disclosure statement is filed with the Comptroller as provided in this section. Any verified public disclosure statement containing fraudulent information shall constitute, for all purposes, a failure to file such statefnent in the first instance. F. The verified public'disclosure statement required by this section shall include: (1) A cpmplete list of the names and addresses of those individual shareholders holding moro than five-percent [nterast in the firm. (2) The table of organization for the company shall include the names and addresses of all individuals serving on the board of direc[0rs or comparable body, the names ahd addresses of all partners and the names and addresses of all corporate officers. The contractor or vendor shall conspicuously identify any such person in this table of organization who is an officer or an employee of Suffolk County. Page 2 of 3 (3) A complete financial statement listing all assets and liabilities as well as a profit-and-loss statement, certified by a certified public accountant. Such statement shall be the most current available and in no event shall have been prepared more than six (6) months prior to · the date of the filing of the bid. No financial statement or profit-anc!-Ioss statement shall be required from any contractor or vendor having fifty · percent (50%) or mere of their gross revenues from sources otherthan the County of Suffolk. G. A separate folio for each company shall be ma!ntaieed alphabetically for public inspection by the Comptroller. H. Remedies. The failure £o file a vedfied public disclosure statame~lt as required under this section shall constitute a matedal breach of contract. · Suffolk County may resorl, use or 'employ any remedies contained in A~de 2 of the Uniform Commercial Code of the State of New York. in ad'dition to ell legal remedies, Suffolk County shall be entitled, upon a determination that a breach has occurred, [o damages equal to f~fteen percent (15%) of the amount of the contract. 1. Under no circumstances shall the county be precluded from invoking any remedy contained in the preceding section by reason of its failure to invoke promptly its remedies. Page 3 of 3 · Certification Regarding Lobbying For Contracts, Grants, Loans and Cooperative.Agreements The undersigned certifies, to the be~t or his or her knowledge and belief, that: (1) No State or Federal appropriated funds t~ave been paid or will be paid, by or on behalf of the undersigned, to any person fcr influencing or attempting to influence legislation or appropriation actions pending before local, State and Federal executive and/or legislative bodies in connection with the awarding of any contract, the making of any grant, the making of any loan, the entering of any cooperative agreement, and the exLension, continuation, renewal, amendment, or modification of any contract, grant Ioaa, or cooperative agreement. (2) If any funds other than State or Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence legislation or appropriation actions pending before local, State and Federal executive and/or legislative bodies in connection with this contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at ail tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a matedal representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certiticat[on is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Failure to file the required certification shall be subject to civil penalty by the Federal government of not less than $10,000 and not more than $100,000 for each such failure. Signature of Official Authorized To Sign Application For: Name of Grantee CONTP~ICTOR NAdME STATEMENT OF O I'Ht;R CONTRACTS ADDRESS CONTACT Karen McLaughlin, Dire,~tx£ P~ONENUMBER 631 29S-4460 001-6790-4980- · ~II-C Nutrition 95284-7152 Suffolk County office for Supplemental Nur-rition 001-6774-4980- Assistance Proqram SNAP 95284-6931 SCO~A 4/1/'02 - 3/31/04 ~ 222~S59,06 CSE Residentl&l Repair 95285- 6676 SCOFA 4/1/03 - 4/31/04 $ 1, Indicate (a) type of organlzation- Count, State, Federal cr Lither and (D) name of Department, Agency or Orgm~izativn,