HomeMy WebLinkAboutNutrition Program
RESOLUTION 2007-587
SCHEDULED
DOC ID: 2998
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2007-587 WAS
SCHEDULED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD
ON JULY 3, 2007:
RESOLVEDauthorizes and directs
that the Town Board of the Town of Southold hereby
Supervisor Scott A. Russell to execute the Agreement between the Suffolk County Office
for the Aging and the Town of Southold for the III-C Nutrition Program, IFMS No. SC
EXE 0000000-001-6790-4980-95284
, for the period January 1, 2007 through December 31,
2007 for Congregate Meals, and for the period April 1, 2007 through December 31, 2007 for
Home-Delivered Meals, with four one-year extensions at the County’s option, subject to the
approval of the Town Attorney.
Elizabeth A. Neville
Southold Town Clerk
.
Luw No. AG004M/0003.11 R
Rev. 6/20/07
mc Nutrition Program
IFMS No. SC EXE 0000000 11Q2. .
No. 001-6790-4980-95284- l-:J.q2..
Agr~ement
This Agreement (Agreement) is between the County of Suffolk (County), a municipal
corporation of the State of New York, having its principal office at the County Center, Riverhead,
New York 11901, acting through its duly constituted Office for the Aging (Aging), having its
principal office at the H. Lee Dennison Building - 3rd Floor, 100 Veterans Memorial Highway,
Hauppauge, New York (Mailing address: P.O. Box 6100, Hauppauge, New York 11788-0099),
and the Town of South old (Contractor), a New York municipal corporation, having its principal
place of busin.ess at 53095 Main Road, P.O. Box 1179, Southold, New York 11971.
The parties hereto desire to make a senior citizens nutrition program available to the
County. Sufficient funding exists in the 2007 Suffolk County Operating Budget.
Term of Agreement: Shall be January 1, 2007 through December 31, 2007 for
Congregate Meals, and April 1 , 2007 through December 31, 2007
for Home-Delivered Meals, with four one-year extensions at the
County's option.
Daily Congregate Meals: 57
Not to Exceed $70,965 Annually
Daily Home-Delivered Meals: 112
Not to Exceed $118,720 Annually
Total Cost of Agreement: Shall be on a fee-for- service basis, not to exceed $ 189,685 for the
current contract year, as set forth in Exhibits A, A 1 and C attached.
Terms and Conditions: Shall be as set forth in Exhibits A, A 1, B, C, D, Appendices K, L, M,
N, 0 and the Exhibit entitled "Suffolk County Legislative
Requirements Exhibit for Contracts" revised 1/4/07 attached.
In Witness Whereof, the parties hereto have executed this Agreement as of the latest date
written below.
Town of Southol
Total Meals:
By:
County of Suffolk
By: (Pa.J~
Paul Sabatino"
Chief De9~~ ?ounty Executive
Date: 112=!lJ ?-O</., .
Approved:
By: c;J:~ ~h~f~~ 7hJ~ate
Director, Office for the Aging
Recom nded:
Scott . Russell
Supervisor
Fed. Taxpayer ID #: 11-6001939
Date: ':;~d'[-O 1
Approved a to Form, Legality:
Samantha N. c achin
Assistant County Attorney
By:
e
na Prencipe
Food Service Supervisor
AG 4 (7/06)
00c7
1-'
~, .
Law No. AG004M/0003-11 R
Rev. 6/6/07
IIIC Nutrition Program
IFMS No. SCS EXE 0000000_
No. 001-6790-4980-95284-_
Exhibit A
1. Services to Be Performed - Payment by County
A. The Contractor shall furnish Aging with one or more nutrition programs for senior
citizens of Suffolk County (separately or collectively the "Program"), under (i) the
Nutrition Program for the Elderly pursuant to Title 111, Part C of the Federal Older
Americans Act (42 U.S.CA ~3030e et seq.) in accordance with the rules and
regulations of the Administration on Aging, United States Department 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
furnish the Program as further provided in this Exhibit A, Exhibit A 1, the Contractor's
Response to Section IV, paragraph 3 a through h, to the RFQ Request for Qualifications
No. 06/22987 -tp (the RFQ) and the following Appendices to the RFQ and additional
Exhibits, which are attached to and made part of this Agreement:
EXHIBIT A1 Standard Contract Clauses
EXHIBIT B Program Specifications
EXHIBIT B1 Special Clauses (if any)
EXHIBIT CRate Page(s) (Contractor's Response to Section V of the RFQ)
EXHIBIT D Grievance Procedures
Appendix K Technical Assistance Packet (revised 5/06)
Appendix L Policy and Procedure Manuals: Congregate Meals and
Home Delivered Meals (revised 5/06)
Appendix M Holiday Schedule
Appendix N Summary Form for each Catchment Area
Appendix 0 Comprehensive Assessment Tool (COMPASS - Form:
revised 5/5/00)
"Suffolk County Legislative Requirements Exhibit for
Contracts" revised 1/4/07
B. 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 this Agreement.
C. Payments will be made in accordance with the Rate Page(s) attached as Exhibit C
to this Agreement, but only as provided in Exhibit A 1.
D. If, under prior similar agreements with the County, the Contractor has received
nonconsumable furniture, equipment or other tangible personal property or funds to
purchase any such items, or received any of such items in connection with this
Agreement, the Contractor shall comply with Exhibit D annexed to and made part of
this Agreement.
E. The provisions of Exhibit B1 shall prevail over inconsistent provisions of any other
Exhibit, the provisions of this Exhibit A and of Exhibits A 1 and B shall prevail over
inconsistent provision of any other Exhibit except B1, and the provisions of A, A 1
and B1 shall prevail over any other document not specifically referred to in this
Agreement or made part thereof by this Exhibit A or by subsequent amendment in
writing and signed by both parties except to the extent that provisions of this Exhibit
A, or Exhibit A1 or B1 are specifically referred to and amended or superseded by
such amendment.
AG 4 (7/06)
Page 1 of 2 pages of Exhibit A
AG4M Sohld 3C NEW 07
f"
,
,'~ [
Law No. AG004M/0003-11 R
Rev. 6/6/07
IIIC Nutrition Program
IFMS No. SCS EXE 0000000_
No. 001-6790-4980-95284-_
F. Exhibit B is made part 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.
2. 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 A 1.
3. 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).
4. 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
connection with this Agreement and any matter arising therefrom for the contract year to
which such cover page relates.
5. Insurance
Subparagraph 13. (a) (i) of Exhibit A 1 is deleted and the following provision is substituted in
its place:
(i) COMMERCIAL GENERAL LIABILITY INSURANCE, including contractual
food products liability coverage, in an amount not less than Two Million
Dollars ($2,000,000.00) per occurrence for bodily injury and Two Million
Dollars ($2,000,000.00) per occurrence for property damage.
6. Extension of Term
The services of the contractor under this Agreement shall be subject to review by Aging
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 term (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 this 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 other modifications of the Agreement as may be agreed
upon between the parties.
7. Non-Responsible Bidder
The Contractor represents and warrants that it has read and is familiar with the provisions
of Suffolk County Code ~~143-5 through 143-9. Upon signing this Agreement the
Contractor certifies that he, she, it, or they have not been convicted of a criminal offense
within the last ten (10) years. The term "conviction" shall mean a finding of guilty after a
trial or a plea of guilty to an offense covered under the provision of Section 143-5 of the
Suffolk County Code under "NON RESPONSIBLE BIDDER."
- END OF TEXT OF EXHIBIT A-
AG 4 (7/06)
Page 2 of 2 pages of Exhibit A
AG4M Sohld 3C NEW 07
,
"
,
, ,
TABLE OF CONTENTS
Exhibit A 1 - Standard Contract Clauses ...............................................................1
1. Contractor Responsibilities .... .............. ..... ........ ............ ... ................. .... ............. .... .... 1
(a) Services .......................................................................................................... 1
(b) Qualifications and Licenses ............................................................................ 1
(c) County Review................................................................................................1
(d) level of Service .............................................................................................. 1
(e) Compliance with Law...................................................................................... 1
2. Governing Law... ................... ....................... .......... .......... ..................... ......... ............ 2
3. Term of Agreement....................................................................................................2
4. 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 ................................................... 3
(e) Taxes ..............................................................................................................3
(f) Agreement Subject to Appropriation of Funds ................................................ 3
(g) Payments Contingent upon State/Federal Funding ........................................ 3
(h) Payments Contingent upon Receipt of State/Federal Aid ............................... 3
(i) Other Governmental Funding.......................................................................... 3
G> Post-Audit ............................................................................... ........................ 3
(k) Set-Off Rights .................................................................................................4
5. Accounting Procedures............................. ........................ ................. ......... ............... 4
6. Financial Statements and Audit Requirements.......................................................... 4
7. Furniture, Fixtures, Equipment, etc. ........................................................"'................ 6
(a) Purchases, Etc. Requiring Prior Approval....................................................... 6
(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
8. Addresses for Notices, Claims and Reports .............................................................. 7
(a) Notices, Relating to Payments, Reports or Other Submissions. ..................... 7
(b) Notices Relating to Insurance .........................................................................8
(c) Notices Relating to Indemnification and Termination ...................................... 8
(d) Notices Relating to Litigation........................................................................... 9
AG A 1 F (3/07)
1lI.,F(1ee-I,slrev3-28.{}7
,
1" "
9. Statement of Other Contracts ....................................................................................9
10. Offset of Arrears or Default......................................................................................10
11. Confidentiality of Records........................................................................................ 10
12. Independent Contractor ........................................................................................... 10
13. Non Responsible Bidder .......................................................................................... 10
14. Certificate of Incorporation....................................................................................... 11
15. Insurance and Indemnification ................................................................................. 11
16. Incident Reporting.... .................. .................. ..................................... .......... ............... 13
17. Nondiscrimination in Employment............................................................................ 13
18. Nondiscrimination in Services.................................................................................. 13
19. Nonsectarian/Nonpartisan Declaration ....................................................................14
20. Suffolk County Living Wage Law............................................................................. 15
21. Child Sexual Abuse Reporting Policy...................................................................... 15
22. Certification........ .... ................. ...... ................... ................. .......... ....... ...................... 15
23. Use of Funds in Prosecution of Civil Actions Prohibited .......................................... 15
24. Prohibition Against Contracting with Corporations that Reincorporate Overseas ............. 15
25. Local Law No. 26-2003............................................................................................16
26. Gratuities....................................................... ................................... ....................... 16
27. Public Disclosure .....................................................................................................16
28. Work Experience Participation.................................................................................17
29. Publications, Copyrights and Patents ...................................................................... 17
30. Qualifications of Personnel......................................................................................17
31. Lawful Hiring of Employees Law.............................................................................. 17
32. Certification Regarding Lobbying.............................................................................18
33. Cooperation on Claims ............................................................................................19
34. Assignment and Subcontracting .............................................................................. 19
35. Termination......... ............... ........ ............... ......................... ........... ........................... 19
36. Force Majeure..... ............ .......... ..... ....... ........ ..................... ................ ..... ........... ...... 20
37. Severability; No Implied Waiver ...............................................................................20
38. Merger; No Oral Changes........................................................................................ 20
AG A 1 F (3/07)
IgalF (fee+f.s) revJ..2&.{l1
,
,'.
,
," .
Exhibit A1 - Standard Contract Clauses
1. Contractor Responsibilities
(a) Services
The Contractor shall perform such services 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 8, in a skillful manner and to the best of its ability.
(b) 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 subcontractors have and shall possess,
the required education, knowledge, experience and character necessary to qualify them individu-
ally for the particular duties they perform 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), Iicense(s), certificate(s) or permit(s) required by State, County or
local authorities for the Services (hereinafter called "License"). The Contractor shall immediately
notify Aging in writing of any disciplinary proceedings against the holder of any License by the
New York State Department of Education or the New York State Department of Health or other
issuer of a License. In the event that the Contractor or such other holder of a License is no longer
licensed for anyone or more of the Services, the Contractor must immediately so notify Aging. It
is understood that the Contractor shall not be reimbursed 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 those as to which said License has been terminated, shall
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.
(c) 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
representatives, 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 of service is not provided as set forth in
Exhibit 8, Aging may require the reduction of Contractor staff and costs or terminate this Agreement
after giving notice in accordance with the provisions headed, "Termination", of Exhibit A 1.
(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 State
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 expenditure controls heretofore adopted or to be adopted by the County, New York
State and the Federal government pursuant to law.
AG A 1 F (3/07)
Page 1 of 20 pages of Exhibit A 1 F
aga1F (fee-f-s) rev 3-28-07
,'.
2. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the
State of New York, without regard to conflict of laws. Venues shall be designated in Suffolk
County, New York or the United States District Court for the Eastern District of New York.
3. Term of Agreement
This Agreement shall cover the period provided on the first page thereof, unless sooner
terminated as otherwise provided in this Agreement.
4. Payment for Services
(a) Claims
(i) The Contractor shall prepare and present 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 close 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 Period, if any, for which the claim shall be submitted as
provided in paragraph B below.
(ii) All claim forms must be signed in ink by duly authorized persons, and certifica-
tion of such authorization with certified specimen signatures thereon must be
filed with Aging by a Contractor official empowered to sign this Agreement.
(iii) Monthly vouchers shall be submitted directly to the Suffolk County Office for
the Aging at H. Lee Dennison Building, 100 Veterans Memorial Highway,
P. O. Box 6100, Hauppauge, New York 11788-0099.
(iv) No claims shall be payable until the Contractor complies with all require-
ments in this Agreement that should have been complied with on or before
submission of such claims and also submits 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 claim for payment shall be submitted no later than thirty (30) days after 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 after
audit and approval by the 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 of Suffolk.
AG A 1 F (3/07)
Page 2 of 20 pages of Exhibit A 1 F
aga1F(fee.f-s)rev3-28..o7
,"
, .
(d) Payments Not To Exceed Net Expenditures
The Contractor agrees that if, for any reason whatsoever, the Contractor shall spend dur-
ing the term of the Agreement for the purposes set forth herein an amount less than agreed, the
total County payment herein shall be reduced to the amount of approved actual Contractor ex-
penditures made for such purposes, and that the total amount to be paid by the County during the
contract term shall not exceed approved actual net expenditures or the Total Cost of the Agree-
ment on the cover page and in the Budget, whichever is less.
(e) Taxes
The charges payable to the Contractor under this Agreement are exclusive of federal,
state and local taxes, the County being a municipality exempt from the payment of such taxes.
(f) Agreement Subject to Appropriation of Funds
This Agreement is subject to the amount of funds appropriated and any subsequent 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 the program
covered by this Agreement.
(g) Payments Contingent upon State/Federal Funding
Payments under this Agreement are subject to and contingent upon continued funding by the
State and/or Federal Government(s). If, for any reason, the full 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 Contractor prior to such termination 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 Agreement 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 during the term of this Agreement
because of any act, omission or negligence on the part of the Contractor, then the County may
deduct and withhold from any payment due to the Contractor an amount equal to the reimburse-
ment denied by such 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 reimburse the County the
amount of the balance due the County by check to the order of the Suffolk County Treasurer. The
provisions of this subparagraph shall survive the expiration or termination of the Agreement.
(i) 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 extent that the local funding from all
such sources exceeds the total expenditures of the Contractor for the program.
(j) Post-Audit
All payments made under this Agreement are subject to audit by the Suffolk County Comptrol-
ler 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, excerpt, copy or tran-
scribe any pertinent transactions or other records relating to services under this Agreement. If such an
AG A 1 F (3/07)
Page 3 of 20 pages of Exhibit A 1 F
aga1 F (fo&-f-I) rev 3-28-07
, ,
. '
. '
audit discloses overpayments by the County to the Contractor, within thirty (30) days after the issu-
ance of an official audit report by the Comptroller or his duly designated representatives, the Contrac-
tor shall 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 there is no response or if satisfac-
tory repayments are not made, the County may recoup overpayments from any amounts due or be-
coming due to the Contractor from the County under this Agreement or otherwise.
(k) Set-Off Rights
The County shall have all of its common law, equitable, and statutory rights of set-off.
These rights shall include, but not be limited to, the County's option to withhold, for the purposes
of set-off, any moneys due to the Contractor under this contract up to any amounts due and ow-
ing to the County with regard to this contract and/or any other contract with any County depart-
ment or agency, including any contract for a term commencing prior to the term of this contract,
plus any amounts due and owing to the County for any other reason including, without limitation,
tax delinquencies, fee delinquencies or monetary penalties relative thereto. The County shall ex-
ercise its set-off rights in accordance with normal County practices including, in cases of set-off
pursuant to an audit, the finalization of such audit by the County agency, its representatives, or the
County Comptroller, and only after legal consultation with the County Attorney.
5. 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 County, 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 other municipal cor-
porations, only as they relate to this Agreement). Such records shall be maintained for a period of
seven (?) years from the date of termination or expiration of this Agreement. Specific 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 Department
of Audit and Control of Suffolk County, and any amendments during the Term of this Agreement.
6. Financial Statements and Audit Requirements
(a) Notwithstanding 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 statements for each
Contractor fiscal year in which the Contractor has received, or will receive, $300,000 or more
from the County, whether under this Agreement or otherwise, and shall submit a report on the
overall financial condition and operations of the Contractor, including a balance sheet and state-
ment of income and expenses, attested by the Auditor as fairly and accurately reflecting the ac-
counting records of the Contractor in accordance with generally accepted accounting principles.
The Contractor is encouraged to solicit requests for proposals (RFPs) from a number of qualified
accounting firms and to review carefully the costs of, and qualifications for, this type of work be-
fore selecting the Auditor.
(b) The Auditor should be required to meet the following minimum requirements:
(i) a current license issued by the New York State Education Department;
AG A 1 F (3/0?)
Page 4 of 20 pages of Exhibit A 1 F
ag81 F (Iee-'-sl rev 3-26-07
. '
. ,
. .
(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 to conduct the audit.
(c) The audit must be conducted in accordance with generally accepted governmental
auditing standards (GAGAS). Financial statements must clearly differentiate between
County-funded programs and other programs that the Contractor may be operating. The use of
subsidiary schedules should be encouraged for this purpose. The Auditor must also prepare a
management letter based on the audit.
(d) Furthermore, if the Contractor is a non-profit organization or unit of local govern-
ment and expends $500,000 or more of Federal monies, whether as a recipient expending awards
received directly from Federal awarding agencies, or as a sub recipient expending Federal awards
received from a pass-through entity, such as New York State or Suffolk County, during any fiscal
period within which it receives funding under this Agreement ("fiscal year"), the audit must be con-
ducted, and the audit report ("Single Audit Report") must be, in accordance with OMB Circular No.
A-133 (revised June 27,2003). Single Audit Reports must also be submitted to the designated
clearinghouse, cognizant agency and/or pass-through entity, to the extent required by the OMB
Circular just referred to.
(e) The Contractor must submit a statement in writing, certified by its chief financial
officer, which states the amount of Federal funding expended by the Contractor during such fiscal
year. The Contractor must mail or deliver the certified statement to Aging and to the Executive
Director of Auditing Services, Suffolk County Department of Audit and Control, H. Lee Dennison
Building, 100 Veterans Memorial Highway, P. O. Box 6100, Hauppauge, New York 11788-0099,
as soon as possible after the end of the Contractor's fiscal year. The statement should include
ALL Federal funding received directly from the Federal government and ALL Federal funds
passed through from the County and other pass-through entities
(f) Copies of all financial statements, management letters, Single Audit Reports (if ap-
plicable) and other audit reports, if required, must be transmitted to Aging and to the Executive
Director at the address just set forth. The reports must be submitted within thirty (30) days after
completion of the audit, but in no event later than nine (9) months after the end of the Contrac-
tor's fiscal period to which the audit relates.
(g) These requirements do not preclude Aging or the Suffolk County Comptroller or
their authorized representatives or Federal or State auditors from auditing the records of the Con-
tractor. Therefore, the records of the Contractor must be made available to authorized represen-
tatives of Federal, State or County government for that purpose.
(h) All payments made under this Agreement are subject to audit by the Suffolk 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 to suspend or partially with-
hold payments under this Agreement or under any other agreement between the parties until such
cooperation is forthcoming. If such an audit discloses overpayments by the County to the Con-
tractor, within thirty (30) days after the issuance of an official audit report by the Comptroller or his
duly designated representatives, the Contractor shall 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 there is no response or if satisfactory repayments are not made, the County
AG A 1 F (3/07)
Page 5 of 20 pages of Exhibit A 1 F
agatF (fee-f-s)rBV 3-28-Q7
'.
. .
may recoup overpayments from any amounts due or becoming due to the Contractor from the
County under this Agreement or otherwise.
(i) The provisions of the foregoing subparagraphs (a) through (h) shall survive the expi-
ration or termination of the Agreement.
7. Furniture, Fixtures, Equipment, etc.
(a) Purchases, Etc. Requiring Prior Approval
Prior to placing any order to purchase, rent or lease any furniture, fixtures, or equip-
ment, (i) valued in excess of five hundred dollars ($500.00) per unit, or (ii) included but not item-
ized, in the Budget, the Contractor shall submit to the County a written request for approval to
make such a proposed purchase, rental, or lease, with a list showing the quantity and description
of each item, its intended location and use, estimated unit price or cost, extended price or cost
and estimated total cost of the proposed order. Written approval of the County is required before
the Contractor may proceed with the proposed purchase, rental, or lease of furniture, fixtures, or
equipment. All items purchased will be new unless specifically described otherwise in the Budget.
(b) Purchase Practices
The Contractor agrees to follow all of the general practices that are designed to ob-
tain furniture, fixtures, equipment, materials or supplies at the most reasonable price or cost pos-
sible. The County reserves the right to purchase or obtain for the Contractor furniture, fixtures,
equipment, materials or supplies which shall be in accordance with the programmatic needs of
this Agreement. If the County exercises this right, the amount budgeted for the items so pur-
chased or obtained by the County for the Contractor shall not be available to the Contractor for
any purpose whatsoever. Title 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 ownership if the County has not done so.
(c) Proprietary Interest of County
The County shall retain a proprietary interest in all furniture, removable fixtures,
equipment, materials or supplies purchased or obtained by the Contractor and paid for or reim-
bursed to the Contractor pursuant to the terms of this Agreement or any prior agreement. Upon
the termination 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
bankruptcy of the Contractor, an assignment for the benefit of its creditors, or the failure of the
Contractor to satisfy any judgment against it within thirty (30) days of filing, the County shall
have the right to take title to and possession of all such furniture, removable fixtures, equipment,
materials and supplies, and the same shall thereupon become the property of the County without
any claim for reimbursement on the part of the Contractor. As directed by the County, the Con-
tractor shall attach identifying labels on all furniture, removable fixtures and equipment indicating
the proprietary interest of the County.
(d) Inventory Records, Controls and Reports
The Contractor shall maintain proper and accurate inventory records and controls
for all such furniture, removable fixtures and equipment acquired pursuant to this Agreement and
all prior agreements, if any, covering 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 its custody, checking each item against the aforesaid inventory records.
AG A 1 F (3/07)
Page 6 of 20 pages of Exhibit A 1 F
aga1F (Iee-f-a) rev 3-28-07
, .
, '
. .
A report setting forth 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 the 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.
(e) Protection of Property in Contractor's Custody
The Contractor shall maintain vigilance and take all reasonable precautions to pro-
tect the furniture, fixtures, equipment, materials or supplies in its custody against damage or loss
by fire, burglary, theft, disappearance, vandalism or misuse. In the event of burglary, theft, van-
dalism or disappearance of any item 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. In the event of loss of or damage to
any item of furniture, fixtures, equipment, materials or supplies from any cause, the Contractor
immediately shall send the County a detailed, written report thereon.
(f) Disposition of Property in Contractor's Custody
Upon termination of the County's funding of the Program covered by this Agree-
ment or by any renewal hereof, or at any other time that the County may direct, the Contractor
shall make access available and render all necessary assistance for physical removal by the
County or its designee of any or all furniture, removable fixtures, equipment, materials or supplies
in the Contractor'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 dis-
position, settlements or adjustments connected with such property shall be in accordance with the
rules and regulations of the County and the State of New York.
8. Addresses for Notices, Claims and Reports
(a) Notices, Relating to Payments, Reports or Other Submissions.
Any communication, notice, claim for payment, report, or other submission neces-
sary or required to be made by the parties regarding this Agreement shall be in writing and
shall be given to the County or the Contractor or their designated representative at the fol-
lowing addresses or at such other address that may be specified in writing by the parties
and must be delivered as follows:
For AQinQ:
By Registered or Certified Mail in Postpaid Envelope or
by Nationally Recognized Courier Service
Holly S. Rhodes-Teague, Director
Suffolk County Office for the Aging
H. Lee Dennison Building
100 Veterans Memorial Highway
P.O. Box 6100
Hauppauge, New York 11788-0099
AG A 1 F (3/07)
Page 7 of 20 pages of Exhibit A 1 F
aga1F(lee-f-s)rev 3-2e-07
'.
and
For the Contractor:
By Registered or Certified Mail in Postpaid Envelope or
by Nationally Recognized Courier Service
At the address set forth on page one of this Agreement, attention of the person who
executed this Agreement or such other designee as the parties may agree in writing.
(b) Notices Relating to Insurance
Any communication, notice or other submission regarding insurance requirements
under this Agreement shall be in writing and shall be given to the County or the Contractor
or their designated representative at the following addresses or at such other addresses
that may be specified in writing by the parties and must be delivered as follows:
For Aaina:
By Registered or Certified Mail in Postpaid Envelope or
by Nationally Recognized Courier Service
Holly S. Rhodes-Teague, Director
Suffolk County Office for the Aging
H. Lee Dennison Building
100 Veterans Memorial Highway
P.O. Box 6100
Hauppauge, New York 11788-0099
and
Christine Malafi, County Attorney
Suffolk County Department of Law
H. Lee Dennison Building
100 Veterans Memorial Highway
P.O. Box 6100
Hauppauge, New York 11788-0099
and
For the Contractor:
By Registered or Certified Mail in Postpaid Envelope or
by Nationally Recognized Courier Service
At the address set forth on page one of this Agreement, attention of the person who
executed this Agreement or such other designee as the parties may agree in writing.
(c) Notices Relating to Indemnification and Termination
Any communication or notice regarding indemnification or termination shall be in
writing and shall be given to the County or the Contractor or their designated representative
at the following addresses or at such other addresses that may be specified in writing by
the parties and must be delivered as follows:
For the County:
By Registered or Certified Mail in Postpaid Envelope or
AG A 1 F (3/07)
Page 8 of 20 pages of Exhibit A 1 F
aga1F (fee-f-s) rev 3-28-07
by Nationally Recognized Courier Service
Holly S. Rhodes-Teague, Director
Suffolk County Office for the Aging
H. Lee Dennison Building
100 Veterans Memorial Highway
P.O. Box 6100
Hauppauge, New York 11788-0099
and
Christine Malafi, County Attorney
Suffolk County Department of Law
H. Lee Dennison Building
100 Veterans Memorial Highway
P.O. Box 6100
Hauppauge, New York 11788-0099
and
For the Contractor:
By Registered or Certified Mail in Postpaid Envelope or
by Nationally Recognized Courier Service
At the address set forth on page one of this Agreement, attention of the person who executed
this Agreement or such other designee as the parties may agree in writing.
Notices sent under paragraphs a, b, and, c above shall be deemed to have been duly given
(i) if mailed by registered or certified mail, upon the seventh business day after the mailing thereof;
or (ii) if by nationally recognized overnight courier service, upon the first business day subsequent
to the transmittal thereof.
Each party shall give prompt written notice to the other party of the appointment of succes-
sor(s) to the designated contact person(s) or his or her designated successor(s).
(d) Notices Relating to Litigation
i. Any notice by either party to the other with respect to the commencement of
any lawsuit or legal proceeding against the other, shall be effected pursuant to and
governed by the New York-State Civil Practice Law and Rules or the Federal Rules
of Civil Procedure, as applicable.
ii. In the event the Contractor receives a notice or claim or becomes a party
(plaintiff, petitioner, defendant, respondent, third party complainant, third part defen-
dant) to a lawsuit or any legal proceeding related to this Agreement, the Contractor
shall immediately forward to the County Attorney, at the addresses set forth in sub-
paragraph b above, copies of all papers filed by or against the Contractor. Notices
shall be as provided in paragraph (c) above.
9. Statement of Other Contracts
The Contractor has attached, and in the event of any change, will attach to any extension
agreement/amendment of this Agreement, a Statement of Other Contracts in the form annexed to this
Agreement. The Contractor represents and warrants that any such Statement of Other Contracts is
AG A 1 F (3/07)
Page 9 of 20 pages of Exhibit A 1 F
aga1F (lee-f-s)rev3-2e-07
and will be a complete list of all other contracts (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 of New York or other municipalities or funding organizations.
10. 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 taxes or upon debt or contract and is not, and shall not be during the
term of this Agreement, in default as surety, contractor or otherwise on any obligation to the
County, and the Contractor agrees that the County may withhold the amount of any such ar-
rearage or default from amounts payable to the Contractor under this Agreement.
11. Confidentiality of Records
(a) The Contractor expressly agrees to preserve the confidentiality of all data and in-
formation shared, received, collected, or obtained as a result of this Agreement. No disclosure,
redisclosure or release of such data or information is to be made, permitted, or encouraged by the
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 to be used for personal benefit. The Con-
tractor further agrees that its employees shall be specifically instructed in regard to their obliga-
tion to keep such data and information in confidence and their liability upon breach of confidential-
ity to all the penalties prescribed by law.
(b) The Contractor further agrees to implement such procedures for safeguarding in-
formation as the Aging shall require. The Contractor further agrees to indemnify and hold the
County and Aging harmless against any loss, damage, cost or expense arising out of any suit,
claim or demand 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 laws and regulations.
12. 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 will hold itself or
themselves out as, or claim to be, an officer or employee of the County by reason of this Agree-
ment, 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.
13. Non Responsible Bidder
The Contractor represents and warrants that it has read and is familiar with the provisions
of Suffolk County Code Chapter 143, Article II, 99143-5 through 143-9. Upon signing this Agree-
ment the Contractor certifies that he, she, it, or they have not been convicted of a criminal offense
within the last ten (10) years. The term .conviction" shall mean a finding of guilty after a trial or a
plea of guilty to an offense covered under the provision of Section 143-5 of the Suffolk County
Code under "Nonresponsible Bidder."
AG A 1 F (3/07)
Page 10 of 20 pages of Exhibit A 1 Fd
aga1F (Iee-f.s) rev 3-28-07
.'
14. Certificate of Incorporation
The Contractor (if not a town or other municipal corporation) shall furnish Aging with certi-
fied copies of its Certificate of Incorporation and by-laws, including any amendments thereto, at
the time it signs this Agreement, to the extent not already on file with Aging, and any amend-
ments thereto during the term of this Agreement promptly upon their adoption, and a list of the
board members governing the Contractor from time to time. The Contractor shall not dissolve
any existing corporation or establish any new corporation with the responsibility for the operation
of the program without the prior written approval of Aging.
15. Insurance and Indemnification
(a) The Contractor agrees to procure, pay the entire premium for and maintain through-
out the term of this Agreement, insurance in amounts and types specified by the County. The
Contractor agrees to require that all of its subcontractors, in connection with work performed for
the Contractor related to this Agreement, procure, pay the entire premium for and maintain
throughout the term of this Agreement insurance in amounts and types equal to that specified by
the County for the Contractor. Unless otherwise specified by the County and agreed to by the
Contractor, in writing, such insurance will be as follows:
i. COMMERCIAL GENERAL LIABILITY insurance, including contractual liability
coverage, in an amount not less than Two Million Dollars ($2,000,000.00) per
occurrence for bodily injury and Two Million Dollars ($2,000,000.00) per oc-
currence for property damage.
ii. AUTOMOBILE LIABILITY insurance (if any vehicles are used by the Contrac-
tor in the performance of this Agreement) in an amount not less than Five
Hundred Thousand Dollars ($500,000.00) per person, per accident, for bodily
injury and not less than One Hundred Thousand ($100,000.00) for property
damage per occurrence.
iii. WORKER'S COMPENSATION and EMPLOYER'S LIABILITY insurance in
compliance with all applicable New York State laws and regulations and DIS-
ABILITY BENEFITS insurance, if required by law. Contractor shall furnish to
the County, prior to its execution of this Agreement, the documentation re-
quired by the State of New York Workers' Compensation Board of coverage
or exemption from coverage pursuant to 9957 and 220 of the Workers' Com-
pensation Law. In accordance with General Municipal Law 9108, this Agree-
ment shall be void and of no effect unless the Contractor shall provide and
maintain coverage during the term of this Agreement for the benefit of such
employees as are required to be covered by the provisions of the Workers'
Compensation Law.
iv. PROFESSIONAL LIABILITY insurance in an amount not less than Two Mil-
lion Dollars ($2,000,000.00) on either a per occurrence or claims made cov-
erage basis.
(b) All policies providing such coverage shall be issued by insurance companies with an
A.M. Best rating of A- or better.
(c) The Contractor shall furnish to the County Declaration Pages for each such policy
of insurance and upon request, a true and certified original copy of each such policy, evidencing
compliance with the aforesaid insurance requirements. In the case of commercial general liability
AG A 1 F (3/07)
Page 11 of 20 pages of Exhibit A 1 F
agalF(lee-f-s)rev3-2S-Q7
, '
insurance, the County of Suffolk shall be named as an additional insured and the Contractor shall
furnish a Declaration Page and endorsement page evidencing the County's status as an addi-
tional insured on said policy.
(d) All such Declaration Pages, certificates and other evidence of insurance shall pro-
vide for the County of Suffolk to be notified in writing thirty (30) days prior to any cancellation, non-
renewal or material change in said policies. Such Declaration Pages, certificates, policies and
other evidence of insurance and notices shall be mailed to the Department at its address set forth
in the paragraph entitled "Notices and Contact Persons" or at such other address of which the
County shall have given the Contractor notice in writing.
(e) In the event the Contractor shall fail to provide the Declaration Pages or certificates of
insurance or to maintain any insurance required by this Agreement, the County may, but shall not be
required to, obtain such policies and deduct the cost thereof from payments due to the Contractor
under this Agreement or any other agreement between the County and the Contractor.
(f) If the Contractor is a town or other municipal corporation and has a self-insurance
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 in lieu of insurance
issued by insurance companies.
(g) Indemnification
i. The Contractor agrees that it shall protect, indemnify and hold harmless the
County and its officers, officials, employees, contractors, agents and other persons from
and against all liabilities, fines, penalties, actions, damages, claims, demands, judgments,
losses, costs, expenses, suits or actions and reasonable attorneys' fees, arising out of the
acts or omissions or the negligence of the Contractor in connection with the services de-
scribed or referred to in this Agreement. The Contractor shall defend the County and its of-
ficers, officials, employees, contractors, agents and other persons in any suit, including ap-
peals, or at the County's option, pay reasonable attorney's fees for defense of any such suit
arising out of the acts or omissions or negligence of the Contractor, its officers, officials,
employees, subcontractors or agents, if any, in connection with the services described or
referred to in this Agreement.
ii. The (Contractor) hereby represents and warrants the (Contractor), will not in-
fringe upon any copyrighted work or material in accordance with the Federal Copyright Act dur-
ing the performance of this (Contract). Furthermore, the (Contractor) agrees that it shall pro-
tect, indemnify and hold harmless the County and its officers, officials, employees, contractors,
agents and other persons from and against all liabilities, fines, penalties, actions, damages,
claims, demands, judgments, losses, costs, expenses, suits or actions and reasonable attor-
ney's fees, arising out of the acts or omissions or the negligence of the Contractor in connec-
tion with the services described or referred to in this Agreement. The Contractor shall defend
the County and its officers, officials, employees, contractors, agents and other persons in any
suit, including appeals, or, at the County's option, pay reasonable attorney's fees for defense of
any such suit arising out of the acts or omissions or negligence of the Contractor, its officers,
officials, employees, subcontractors, lessees, licensees, invitees or agents, if any, in connec-
tion with the services described or referred to in this Agreement.
AG A 1 F (3/07)
Page 12 of 20 pages of Exhibit A 1 F
8ga1F (fee-f-s) rev 3-28-07
16. Incident Reporting
The Contractor agrees to provide Aging with reports of all instances of claims, costs, dam-
ages, and injuries to persons or property of whatsoever kind arising out of services provided under
this Agreement. All such notifications should be given to Aging immediately after the incident, if pos-
sible, but in no case longer than five (5) days after the incident. The Contractor further agrees to
send Aging copies of all "notices of claim" relating to the program covered in this Agreement.
17. Nondiscrimination in Employment
(a) The Contractor agrees in connection with the performance of this Agreement as follows:
(i) The Contractor shall not discriminate against employees or applicants
for employment because of race, creed, color, national origin, sex,
sexual preference, age, disability, military status or marital status, and
will undertake or continue existing programs of affirmative action to en-
sure that women and minority group members are afforded equal em-
ployment opportunities without discrimination. Affirmative action shall
mean recruitment, employment, job assignment, promotion, upgrad-
ings, demotion, transfer, layoff, or termination and rates of payor other
forms of compensation.
(ii) The Contractor shall require each employment agency, labor union or
authorized 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, sexual preference, age, disability, military status or marital status
and that such union or representative will affirmatively cooperate in the
implementation of the Contractor's obligations herein.
(iii) The Contractor shall state, in all solicitations or advertisements for
employees, that, in the performance of this Agreement, all qualified
applicants will be afforded equal employment opportunities without dis-
crimination because of race, creed, color, national origin, sex, sexual
preference, age, disability, military status or marital status.
18. Nondiscrimination in Services
(a) Furthermore, the Contractor, in providing services under this Agreement, shall not,
on the grounds of race, creed, color, national origin, sex, sexual preference, age, disability or
marital status:
(i) Deny an individual any services or other benefits provided under the
program:
(ii) Provide any services or other benefits to an individual which are differ-
ent, or are provided in a different manner, from those provided to oth-
ers under the program;
AG A 1 F (3/07)
Page 13 of 20 pages of Exhibit A 1 F
aga1F (lee-f'5) rev 3.26~7
(iii) Subject an individual to segregation or separate treatment in any mat-
ter related to his/her receipt of any services or other benefits provided
under the program;
(iv) Restrict an individual in any way in the enjoyment of any advantage or
privilege enjoyed by others receiving any services or other benefits
provided under the program;
(v) Treat an individual differently from others in determining whether or not
the individual satisfies any eligibility or other requirements or conditions
which individuals must meet in order to receive any aid, care, services,
or other benefits provided under the program.
(b) The Contractor shall not utilize criteria or methods of administration which have the ef-
fect of subjecting individuals to discrimination because of their race, creed, national origin, sex, sexual
preference, age, disability or marital status or have the effect of defeating or substantially impairing
accomplishment of the objectives of the program in respect to individuals of a particular race, creed,
national origin, sex, sexual preference, age, disability or marital status, in determining:
(i) The types of services or other benefits to be provided under the pro-
gram, or
(ii) The class of individuals to whom, or the situations in which, such ser-
vices or other benefits will be 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 applicable Federal Regulations contained
in 45 CFR, Part 84 and Part 85 entitled "Non-Discrimination on the Basis of Handicap in Program
Activities 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 S 306(a)(5)(A)(ii) of the Older Americans Act, as added by P. L. 100-175,
42 U.S.C.A. S 3026(a)(5)(A)(ii), the Contractor shall
(i) specify how the Contractor intends to satisfy the service needs of
low-income minority individuals in the area served by the Contractor;
and
(ii) attempt to provide services to low-income minority individuals in at
least the same proportion as the population of low-income minority
older individuals bears to the population of older individuals of the area
served by the Contractor.
19. Nonsectarian/Nonpartisan Declaration
The Contractor agrees that all services performed under this Agreement are secular and
nonpartisan in nature and that no funds received pursuant to this Agreement will be used for sec-
tarian purposes or to further the advancement of any religion, candidate or partisan effort. Fur-
thermore, the Contractor agrees that all program services are and will be available to all eligible
individuals regardless of religious belief or political affiliation.
AG A 1 F (3/07)
Page 14 of 20 pages of Exhibit A 1 F
aga1F(fee-f-s)rev 3-2S-07
, .
20. Suffolk County Living Wage Law
This Agreement is subject to the Living Wage Law of the County of Suffolk. The law requires
that, unless specific exemptions apply all employers (as defined) under service contracts and recipi-
ents of County financial assistance, (as defined) shall provide payment of a minimum wage to em-
ployees as set forth in the Living Wage Law. Such rate shall be adjusted annually pursuant to the
terms of the Suffolk County Living Wage Law of the County of Suffolk. Under the provisions of the Liv-
ing Wage Law, the County shall have the authority, under appropriate circumstances, to terminate this
Agreement and to seek other remedies as set forth therein, for violations of this Law.
The Contractor represents and warrants that it has read and shall comply with the requirements
of Suffolk County Code Chapter 347, Suffolk County Local Law No. 12-2001, the Living Wage Law.
Required Forms: Suffolk County Living Wage Form LW-1; entitled "Suffolk County De-
partment of Labor - Living Wage Unit Notice of Application for County
Compensation (Contract)"
Suffolk County Living Wage Form LW-38; entitled "Suffolk County De-
partment of Labor - Living Wage Unit Living Wage Certifica-
tionlDeclaration - Subject To Audit"
21. Child Sexual Abuse Reporting Policy
The Contractor has read and agrees to comply with Chapter 577, Article IV, of the Suffolk County
Code, entitled "Child Sexual Abuse Reporting Policy" as now in effect or amended hereafter or of
any other Suffolk County Local Law that may become applicable during the term of this
Agreement with regard to child sexual abuse reporting policy. Suffolk County Local Laws, Rules
and Regulations can be found on the Suffolk County web site at www.co.suffolk.nv.us Click on
"Laws of Suffolk County" under "Suffolk County Links".
22. Certification
The parties to this Agreement hereby certify that, other than the funds provided in this
Agreement and other valid Agreements with the County, there is no known relationship within the
third degree of consanguinity, life partner or business, commercial, economic, or financial relation-
ship between the parties, the signatories to this Agreement, and any partners, members, directors,
or shareholders of five percent (5%) (or more) of any party to this Agreement.
23. Use of Funds in Prosecution of Civil Actions Prohibited
Pursuant to the Suffolk County Code Section 9590-3, the Contractor represents that it shall
not use any of the moneys received under this Agreement, either directly or indirectly, in connec-
tion with the prosecution of any civil action against the County of Suffolk or any of its programs,
funded by the County, in part or in whole, in any jurisdiction or any judicial or administrative forum.
24. Prohibition Against Contracting with Corporations that Reincorporate Overseas
The Contractor represents that it is in compliance with Suffolk County Local Law No. 20-
2004, entitled" A Local Law To Amend Local Law No. 5-1993, To Prohibit The County of Suffolk
From Contracting With Corporations That Reincorporate Overseas." Such law provides that no
contract for consulting services or goods and services shall be awarded by the County to a busi-
ness previously incorporated within the U.S.A. that has reincorporated outside the U.S.A.
AG A 1 F (3/07)
Page 15 of 20 pages of Exhibit A 1 F
8ga1F{fee-f'5)rev3-2B~7
. .
25. Local Law No. 26-2003
This Agreement may be subject to Local Law No. 26-2003 of Suffolk County conceming Union
Organizing Activities. The Contractor represents and warrants that it has read and is familiar with the
requirements of Article 1, Chapter 466 of the Suffolk County Local Laws, "Use of County Resources to
Interfere with Collective Bargaining Activities". County Contractors (as defined) shall comply with all
requirements of Local Law No. 26-2003 including the following prohibitions:
(a) The Contractor shall not use County funds to assist, promote, or deter union organizing.
(b) No County funds shall be used to reimburse the Contractor for any costs incurred
to assist, promote, or deter union organizing.
(c) The County of Suffolk shall not use County funds to assist, promote, or deter union
organizing.
(d) No employer shall use County property to hold a meeting with employees or super-
visors if the purpose of such meeting is to assist, promote, or deter union organizing.
If Contractor services are performed on County property the Contractor must adopt a
reasonable access agreement, a neutrality agreement, fair communication agreement, nonin-
timidation agreement and a majority authorization card agreement.
If Contractor services are for the provision of human services and such services are not to
be performed on County property, the Contractor must adopt, at the least, a neutrality agreement.
Under the provisions of Local Law No. 26-2003, the County shall have the authority, under
appropriate circumstances, to terminate this Agreement and to seek other remedies as set forth
therein, for violations of this Law.
26. 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 or intent of securing an agreement or securing favorable treatment with respect to the
awarding or amending of an agreement or the making of any determinations with respect to the
performance of any agreement, and that the signer of this Agreement has read and is familiar with
the provisions of Chapter 386 of the Suffolk County Code (Suffolk County Local Law No. 32-
1980). Suffolk County Local Laws, Rules and Regulations can be found on the Suffolk County
web site at www.co.suffolk.nv.us Click on "Laws of Suffolk County" under "Suffolk County Links".
27. Public Disclosure
The Contractor represents and warrants that it has filed with the Comptroller of Suffolk
County the verified public disclosure statement required by Suffolk County Administrative Code
Article V, Section A5-7 and shall file an update of such statement with the said Comptroller on or
before the 31st day of January in each year of this Agreement's duration. The Contractor ac-
knowledges that such filing is a material, contractual and statutory duty and that the failure to file
such statement shall constitute a material breach of this Agreement, for which the County shall be
entitled, upon a determination that such breach has occurred, to damages, in addition to all other
legal remedies, of fifteen percent (15%) of the amount of the Agreement.
Required Form: Suffolk County Form SCEX 22; entitled "Contractor'sNendor's Public
Disclosure Statement"
AG A 1 F (3/07)
Page 16 of 20 pages of Exhibit A 1 F
aga1F (188-I-s) rev 3-28-07
. .
28. Work Experience Participation
If the Contractor is a nonprofit agency or institution, each of the Contractor's locations in
Suffolk County at which services are provided under this Agreement shall be a work site for pub-
lic-assistance clients of Suffolk County pursuant to Local Law No. 15-1993 at all times during the
term of this Agreement. 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-
ment, the Contractor, if it is a nonprofit agency or institution, shall enter into such MOU as soon
as possible after the execution of this Agreement and failure to enter into or to perform in accor-
dance with such MOU shall be deemed to be a failure to perform in accordance with this Agree-
ment, for which the Contractor may withhold payment, terminate this Agreement or exercise such
other remedies as may be appropriate in the circumstances.
29. 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 prior written permission from the County.
Any such publication shall bear a statement acknowledging the cooperation andlor funding by the
County of Suffolk - Steve Levy, County Executive.
(b) If the work of the Contractor under this Agreement 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-
nated by the County, a royalty-free, nonexclusive license to produce, reproduce, publish, trans-
late or otherwise use any such materials.
(c) If the Contractor under this Agreement makes any discovery or invention in the
course of or as a result of work performed under this Agreement, the Contractor may apply for
and secure for itself patent protection. However, the County reserves, and the Contractor hereby
gives to the County, and to any other municipality or government agency or body designated by
the County, a royalty-free, nonexclusive license to produce or otherwise use any item so discov-
ered or patented.
30. Qualifications of Personnel
The Contractor agrees that it will provide the County with relevant policies regarding the
personnel qualifications for professional employees and that these policies shall be subject to ap-
proval by Aging. ...
31. Lawful Hiring of Employees Law
This Agreement is subject to the Lawful Hiring of Employees Law of the County of Suffolk
(Local Law 52-2006). It provides that all covered employers, (as defined), and the owners thereof,
as the case may be, that are recipients of compensation from the County through any grant, loan,
subsidy, funding, appropriation, payment, tax incentive, contract, subcontract, license agreement,
lease or other financial compensation agreement issued by the County or an awarding agency,
where such compensation is one hundred percent (100%) funded by the County, shall submit a
completed sworn affidavit (under penalty of perjury), the form of which is attached, certifying that
they have complied, in good faith, with the requirements of Title 8 of the United States Code Sec-
tion 1324a with respect to the hiring of covered employees (as defined) and with respect to the
alien and nationality status of the owners thereof. The affidavit shall be executed by an authorized
AG A 1 F (3/07)
Page 17 of 20 pages of Exhibit A 1 F
aga1F (fee-f-5) rev 3-28-07
.. ..",
.
representative of the covered employer or owner, as. the case may be; shall be part of any exe-
cuted contract, subcontract, license agreement, lease or other financial compensation agreement
with the County; and shall be made available to the public upon request.
All contractors and subcontractors (as defined) of covered employers, and the owners
thereof, as the case may be, that are assigned to perform work in connection with a County con-
tract, subcontract, license agreement, lease or other financial compensation agreement issued by
the County or awarding agency, where such compensation is one hundred percent (100%)
funded by the County, shall submit to the covered employer a completed sworn affidavit (under
penalty of perjury), the form of which is attached, certifying that they have complied, in good faith,
with the requirements of Title 8 of the United States Code Section 1324a with respect to the hiring
of covered employees and with respect to the alien and nationality status of the owners thereof, as
the case may be. The affidavit shall be executed by an authorized representative of the contrac-
tor, subcontractor, or owner, as the case may be; shall be part of any executed contract, subcon-
tract, license agreement, lease or other financial compensation agreement between the covered
employer and the County; and shall be made available to the public upon request.
An updated affidavit shall be submitted by each such employer, owner, contractor and sub-
contractor no later than January 1 of each year for the duration of any contract and upon the re-
newal or amendment of the contract, and whenever a new contractor or subcontractor is hired un-
der the terms of the contract.
The Contractor acknowledges that such filings are a material, contractual and statutory duty
and that the failure to file any such statement shall constitute a material breach of this agreement
Under the provisions of the Lawful Hiring of Employees Law, the County shall have the au-
thority to terminate this Agreement for violations of this Law and to seek other remedies available
under the law.
The Contractor represents and warrants that it has read, is in compliance with, and shall
comply with the requirements of Suffolk County Code Chapter 234, Suffolk County Local Law No.
52-2006, the Lawful Hiring of Employees Law.
Required Forms: Suffolk County Lawful Hiring of Employees Law Form LHE-_; entitled
"Suffolk County Department of Labor -"Notice Of Application To Certify
Compliance With Federal Law (8 U.S.C. SECTION 1324A) With Re-
spect To Lawful Hiring of Employees"
"Affidavit Of Compliance With The Requirements Of 8
U.S.C. Section 1324a With Respect To Lawful Hiring
Of Employees"
32. 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 or as
amended during the Term of this Agreement.
AG A 1 F (3/07)
Page 18 of 20 pages of Exhibit A 1 F
aga1F (fee.f.s) rev 3-28-07
. .
33. Cooperation on Claims
The Contractor agrees to render diligently to the County any and all cooperation, without
additional compensation, that may be required to defend the County against any claims, demand,
or action that may be brought against the County in connection with this Agreement.
34. Assignment and Subcontracting
(a) The Contractor shall not assign, transfer, convey, sublet, or 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 writing of the County, and any attempt 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 contemplated un-
der this Agreement without obtaining prior written approval of Aging. Such subcontracts shall be sub-
ject to all 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 otherwise pro-
vided in this Agreement, such prior written approval shall not be required for the purchase of articles,
supplies, equipment and services which are incidental to, but necessary for, the performance of the
work required under this Agreement. No approval by Aging of any subcontract shall provide for the
incurrence of any obligation by the County in addition to the total agreed upon price. The Contractor
shall be responsible for the performance of any subcontractor for the delivery of service.
35. Termination
(a) If the Contractor fails to fulfill in a timely and proper manner its obligations under
this Agreement, or if the Contractor becomes bankrupt or insolvent or falsifies its records or re-
ports, or misuses its funds from whatever source, the 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) If the County shall deem it in its best interest to terminate this Agreement in whole
or with respect to any identifiable part of the program, it shall have the right to do so by giving not
less than thirty (30) days' prior written notice to the Contractor.
(c) The Contractor may terminate this Agreement by giving not less than sixty (60) days'
prior written notice (or thirty (30) days' prior written notice if substantial breach of contract is involved)
to the Director of Aging, specifying the reasons for termination and the effective date of termination.
(d) The County shall be released from any and all responsibilities and obligations aris-
ing from the Program covered by this Agreement, effective as of the date of termination, but the
County shall be responsible for payment of all claims for services provided and costs incurred by
the Contractor prior to termination of this Agreement, that are pursuant to, and after the Contrac-
tor's compliance with, the terms and conditions of this Agreement.
(e) Notice of termination must be in writing, signed by an authorized official, and sent to
the other party by certified mail, or by messenger, and receipt shall be requested. Notice of termi-
nation shall be deemed delivered as of the date of its posting by certified mail or at the time it is
delivered to the other party by messenger.
AG A 1 F (3/07)
Page 19 of 20 pages of Exhibit A 1 F
B~1F(fee-f-slrev3-28-o7
" ' '
36. Force Majeure
Neither party shall be held responsible for any delay or failure in performance hereunder to
the extent such delay or failure is caused by fire, flood, explosion, war, strike, embargo, civil or
military authority, act of God, act or omission of carriers, power failure or similar causes beyond its
control ("force majeure conditions"). If any force majeure condition occurs, the party delayed or
unable to perform shall give immediate notice to the other party.
37. Severability; No Implied Waiver
(a) It is expressly agreed that if any term or provision of this Agreement, or the applica-
tion thereof to any person or circumstance, shall, to any extent, be held invalid or unenforceable,
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 unenforceable, 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 permitted by law.
(b) No waiver shall be inferred from any failure or forbearance of the County 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.
38. Merger; No Oral Changes
It 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 written and executed by both parties.
- End of Text of Exhibit A 1 -
AG A 1 F (3/07)
Page 20 of 20 pages of Exhibit A 1 F
aga1F (fee-f-s) rev 3-2B.o7
Certification Regarding Lobbying
For Contracts, Grants, Loans and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No State or Federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, 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 the awarding of any contract, the making of
any grant, the making of any loan, the entering of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any contract, grant
loan, 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 all 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 material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification 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.
By:
~/~
Date: ~~
Signature of Official Authorized
To Sign Application
For:
Town of Southold
Name of Grantee
Certification Regarding Lobbying 04
STATEMENT OF OTHER CONTRACTS
CONTRACTOR NAME
Town of Southold Senfuor Services
ADDRESS
750 Pacific Street, P.O. Box 85, Mattituck, NY
11952
CONTACT
Karen McLaughlin
PHONE NUMBER
631 298-4460
PROGRAM AGREEMENT CONTRACT WITH' TERM OF AGREEMENT AMOUNT
NUMBER
CSE Residential Repair SCS EXE No. 001 Suffolk County Office for
~Hl-4980-95285 the Aging 4/1/06 - 3/31/07 $ 20,400.00
Program
SNAP Supplemental Nutrit' on SCS EXE No.OO Office 4/1/04 - 3/31/07 $409,578.00
~~2~-4980-95284 Suffolk County {$147,037.00 for
Assistance Program ". .., nninn ';'''''~:'?nn7
No.OOl 6790 Suffolk County Office 1/1/04 - 12/31/06 $190,441. 00
III-C Nutrition Program 4980 95284 9288 for the Aging ($67,275.00 for 2)1
(SPAP) 001 EXE 6804 4980 New.YdltkC:State Office 4/1/05 - 9/30/05 $ 5,000.00
State pharmaceutical 95285 - 10087 for the Aging 19,600.00
,~~. 10/1/05 - 9/30/06 $
Transportation Assistanc SCS EXE 001389 Suffolk County Office for
Program (TAP) N .001 6806 4980 the Aging 4/1/06 - 3/31/07 $ 4,600.00
95~~~-l.j~~
:
06)
L Indicate (a) type of organization - County, State, Federal or Other and (b) name of Department, Agency or Organization.
updated 4/07
07ll7nl' 17:15 H:\MUHLAWlAHtfIOTHWST.WF'D
Exhibit B
Program Specifications for Nutrition Programs
1. Goals of Program
The intended outcome of the Nutrition Program for the Elderly is to improve, maintain or
delay the decline in the nutritional status of persons 60 years of age and older and help them
to remain independent in 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 will 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 low
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 140oF, salad and other cold items served at 41 of or below, and
horne-delivered meals delivered in 2 hours or under.
C. All 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 testing purposes. All 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
participants 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 printed materials used for the program must include the
sources of funding for the Program and must include the following information:
Contributions to this (these) service(s) are free and voluntary. Service will not be
denied because of inability or unwillingness to contribute. Any contribution you
wish to make will be used to expand the program and will be greatly appreciated.
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 confidentiality of
program participants' identities and the amount which they contribute. The suggested donation
AG 4 (7/06)
Page 1 of 7 pages of Exhibit B
AG4M Sohld 3C NEW 07
amount will be determined through consultation with the Suffolk County Office for the Aging
and the Site 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 participants, The Contractor must provide envelopes for the
suggested meal donations of the participants in order to protect the confidentiality of the
program participants' identities and the amount which they contribute.
4. Targeting and Outreach
The Contractor must give preference to providing services to older individuals with the
greatest economic or social needs with particular attention to low-income minority individuals,
(42 U.S.C. S3025 (a) (1) (E)). The term "greatest economic need" is defined as the need
resulting from an income at or below the poverty levels as established annually by the Office of
Management and Budget. The term "greatest social need" refers to the need caused by non-
economic factors which include physical and mental abilities, language barriers, social or
geographical isolation including that caused by racial or ethnic status which restricts an
individual's ability to perform normal daily tasks or which threatens such individual's capacity to
live independently (42 U.S.C.S302(21)).
The following four target groups have been identified as having the greatest economic
and social needs: minorities, low 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 other resource data, translated printed materials, location of services in catchment areas for
targeted populations, publicity to community-based groups, and minority staff/volunteers.
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, entering 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.
6. Congregate Meal Program
A. The nutrition site shall be open as stated on the Summary Sheet, which is attached
and made part of this Agreement; fully staffed, during regular business hours based
on local need and available funding. Holiday 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, information and referral,
outreach, public information, recreation, shopping assistance, socialization and
volunteer activities.
AG 4 (7/06)
Page 2 of 7 pages of Exhibit B
AG4M Sohld 3C NEW 07
. .
When viewed as a whole, transportation services must be accessible to 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 (P.L.
101-336) and the regulations thereunder (28 CFR Parts 35 and 36) which require
that all programs and facilities (buildings, restrooms, etc.) must be accessible 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.
7. Home-Delivered Meal Program
A. Eligibility must be determined prior to the delivery of service by using the
standardized Comprehensive Assessment Tool (COMPASS - Form) (see also
Policy & Procedures Manual - Appendix L). Each client receiving home-delivered
meals must be reassessed at appropriate intervals based on each client's
situation, but in no instance less 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 meal 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 last business day before the holiday
or weather emergency. In addition, an emergency supply of shelf-stable food
should be made available twice a year for weather related emergencies. A list of
suggested food items is available from Aging. (see Policy & Procedure Manuals)
8. Reporting Requirements
A. The following forms and reports are required by the County to meet the
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 targeting results,
(Nutrition or S.NAP. Services) 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.
AG 4 (7/06)
Page 3 of 7 pages of Exhibit B
AG4M Sohld 3C NEW 07
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).
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; activities of daily living
(ADL) (eating, bed/chair transfer, dressing, bathing, toileting and
continence); instrumental activities of daily living (IADL) (meal
preparation, housekeeping, shopping, medications, telephone,
travel and money management).
Live Alone.
Rural.
Low Income - The need resulting from an income level at or below
the poverty threshold, as established by the Bureau of the Census,
and updated annually as follows:
100 % of Poverty Threshold
Size of Family Unit (for mc Nutrition Program(s))
(2)
(3)
.
.
.
150% of Poverty Threshold
(for SNAP Program(s))
1 $10,210/year $15,315/year
2 $13,690/year $20,535/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 Minority - Those minority persons whose income is at
or below the poverty threshold.
9. 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 an orderly, punctual and reliable manner. Personnel involved in all
aspects of food handling and preparation are to be in good health and trained to
ensure the safety standards of the food prepared and served. A full-time
AG 4 (7/06)
Page 4 of 7 pages of Exhibit B
AG4M Sohld 3C NEW 07
. .
manager/supervisor will direct and coordinate the daily operations. All 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.
B. The County shall have the right to prior approval of the filling of any site manager
position and the home-delivered meal assessor, and shall be advised by the
Contractor of the duties and compensation of all personnel assigned to the
Nutrition Program for the Elderly Program.
10. Confidentiality
A. The Contractor agrees that no personal information obtained from an individual in
conjunction with this program shall be disclosed in a form in which it is identified
with the individual without such individual's written consent to such disclosure,
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 information 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.
11. Administration
A. Overall administration of this program will be the responsibility of the Contractor.
The Contractor or its designee will insure proper implementation and direction of the
service, act as liaison between Aging and the actual service and insure accuracy
and timeliness of submission of all reporting 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 transportation services to the Program.
12. Grievance Procedures
In accordance with S306 (a) (6) (P) of the Older Americans Act, as amended (OM),
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 D -
Grievance Procedures and the Policy and Procedures Manuals.
13. Monitoring
A. Financial Transactions
Aging's staff and staff of the New York State Office for the Aging may examine
or review evidence regarding the existence, timing and classification of financial
transactions that are charged to the program for reimbursement. To obtain this
evidence, such staff may examine documentary evidence, including financial
statements, financial reports, etc., and original records. Such staff may make physical
verification by actually observing or counting certain assets (e.g., cash, equipment and
supplies) to establish their physical existence. The Contractor shall cooperate in
Aging's periodic physical verification of cash, food, equipment, supplies and other
assets of the program.
AG 4 (7/06)
Page 5 of 7 pages of Exhibit B
AG4M Sohld 3C NEW 07
.'
B. Program
The Contractor agrees to permit Aging's staff and staff of the New York State
Office for the Aging to review program records and to monitor training, supervision and
services at any time.
14. Miscellaneous
A. It is the responsibility of the Contractor to have an identifying logo 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: Purchased with State/County Funding:
Funding provided by the Funding provided by [the}
Suffolk County Office for the Aging
and the Suffolk County [Office for the Aging]
U.S. Dept. of Health and Human Services
Through the New York State Office for the [through the New Y~rk ~tate Office for the
Aging 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.
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 officers and directors,
partners, trustees or other members of its governing body and personnel
employed to render services under this Agreement, to comply with all applicable
rules, regulation and requirements of law, including without limitation, the
Americans with Disabilities Act, and the applicable Policy and Procedure Manual
issued by Aging, and the Technical Assistance Packet, which have been made
part of this Agreement.
B.
C.
.
Omit the words that are not applicable.
AG 4 (7/06)
Page 6 of? pages of Exhibit B
AG4M Sohld 3C NEW 07
'. .
GENERAL FOOD SPECIFICATIONS
FOOD SPECIFICATIONS 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.
Veqetables 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
y, cup represents drained weight of fruits and vegetables
Frozen Vegetables - Grade A - Fancy (USDA)
Canned Vegetables - Grade A - Fancy (USDA)
Marqarine - from liquid vegetable oil and fortified with Vitamin A
Bread/Alternate - whole grain or enriched
Instant Mashed Potatoes must be fortified with Vitamin C
Milk - Vitamin A & D fortified skim or low-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)
All foods shall be obtained from State or Federal inspected plants.
- END OF TEXT OF EXHIBIT B -
AG 4 (7/06)
Page 7 of 7 pages of Exhibit B
AG4M Sohld 3C NEW 07
Law No. AG004M/0003-11 R
Rev. 6/6/07
IIIC Nutrition Program
IFMS No. SCS EXE 0000000_
No. 001-6790-4980-95284-_
Exhibit C
Rate Page
(Response to Section V ofthe RFQ No. 6/22987-tp)
TOWN OF SOUTHOLD
Proposed Schedule of Fees for Services
Congregate
Midday Meals
Home-Delivered
Meals
First Contract Year 2007
$5.00
$5.30
AG 4 (7/06)
AG4M Sohld 3C NEW 07
Exhibit D
Grievance Procedures
1. Purpose
In accordance with 3306 (a) (6) (P) of the Older Americans Act, as amended (OM), the
Suffolk County Office for the 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.
2. Notifying Participants of the Right to File a Grievance
(a) The Contractor shall 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 languages other than English where required to
serve the clienUapplicant 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 or applicant who is denied Title III services by the Contractor 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 to 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 right 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 thirty (30) days of denial, reduction or
termination of services, or of the event or circumstances with which the
participant is dissatisfied. 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 date, time and
circumstances that are he basis of the complaint.
(b) Investigation and Response to Grievance:
i. The designated reviewer who performs the initial review shall investigate
the grievance, including, as appropriate, meeting with the grievant 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 OM and or State laws,
regulations and policies) and supported by the facts.
Rev. 5/21/03
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 within fifteen (15) days after the
grievance is filed. The response shall set forth the circumstances 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/Decision
i. The grievant may initiate a request for subsequent review by Aging's
Director within twenty (20) calendar days following receipt of notification
by the Program Administrator of the decision.
ii. Aging's Director shall request copies of the initial file on the complaint in
question. Aging's Director will review the materials to ensure that
pertinent policies and procedures have been applied and followed. If
appropriate, Aging's Director or his/her designee will meet with the older
person to allow the grievant an opportunity to present information about
the grievance.
iii. If the policies and procedures have been adhered to, Aging's Director will
not overturn the decision of the Program 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 for six years following
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 submitted by any party;
the written Initial Response of the agency, and, if applicable. the notice to the grievant of the
right to an appeal.
5. Confidentiality
No information, documents or other records relating to a grievance shall be disclosed by
program staff or volunteers in a form that identifies the grievant without the written informed
consent of the grievant, unless the disclosure is required by court order or for program
monitoring by authorized agencies.
- End of Text-
Rev. 5/21/03
Page 2 of 2 pages of Exhibit D
LEGAL HOLIDAYS
2007 HOUDAYS
2008 HOLDAYS
Monday, January I-New Years Day
Monday, January 15-M.L.K. Day
Monday, February 13-Lincoln's Birthday
Monday, February 19-Washington's Birthday
Monday, May 28-Memorial Day
Wednesday, July 4-Independence Day
Monday, September 8-Labor Day
Monday, October 8-Columbus Day
Tuesday, November 6-Election Day
Monday, November 12-Veterans Day
Thursday, November 22- Thanksgiving
Tuesday, December 25-Christmas
Tuesday, January I-New Years Day
Monday, January 21-M.L.K. Day
Monday, February 12-Lincoln's Birthday
Monday, February 18-Washington's Birthday
Monday, May 26-Memorial Day
Friday, July 4-Independence Day
Monday, September I-Labor Day
Monday, October 13-Columbus Day
Tuesday, November 4-Election Day
Tuesday, November II-Veterans Day
Thursday, November 27- Thanksgiving
Thursday, December 25-Christmas
2009 HOUDAYS
2010 HOLIDAYS
Thursday, January I-New Years Day
Monday, January 19-M.L.K. Day
Wednesday, February 12-Lincoln's Birthday
Monday, February 16-Washington's Birthday
Monday, May 25-Memorial Day
Friday, July 3-Independence Day
Monday, September 7-Labor Day
Monday, October 12-Columbus Day
Tuesday, November 3-Election Day
Wednesday, November II-Veterans Day
Thursday, November 26- Thanksgiving
Friday, December 25-Christmas
Friday, January I-New Years Day
Monday, January 18-M..L.K. Day
Thursday, February 12-Lincoln's Birthday
Monday, February 15-Washington's Birthday
Monday, May 3 I-Memorial Day
Monday, July 5-lndependence Day
Monday, September 6-Labor Day
Monday, October II-Columbus Day
Tuesday, November 2-Election Day
Thursday, November II-Veterans Day
Thurday, November 25- Thanksgiving
Friday, December 24-Christmas Eve
(Christmas falls on Saturday)
Friday, December 31-New Years Eve (New Years
Day falls on Saturday)
2011 HOUDAYS
2012 HOLIDAYS
Monday, January 17-M.L.K.Day
Friday, February II-Lincoln's Birthday
Monday, February 21-Washington's Birthday
Monday, May 30-Memorial Day
Monday, July 4-Independence Day
Monday, September 5-Labor Day
Monday, October I Olh -Columbus Day
Tuesday, November 8-Election Day
Friday, November II-Veterans Day
Thursday, November 24- Thanksgiving
Monday, December 26-Day after Christmas (Christmas falls on Sunday)
Monday, January 2-New Years Day Observed
(New Years Day falls on Sunday)
Monday, January 16-M.L.K. Day
Monday, February 13, Lincoln's Birthday
Monday, February 20, Washington's Birthday
SUMMARY - RFQ FOR NUTRITION PROGRAMS 2006
PROPOSER:
Town of Southo1d
GEOGRAPHIC CATCHMENT AREA:
Town of Southo1d (2000 U.S. Census Tracts 1700.01, 1700.02, 1701.01, 1702.01,
1702.02)
PROVIDE ONE COPY OF THIS SUMMARY SHEET FOR EACH PROGRAM CATCHMENT
AREA. YOU MAY MAKE PHOTOCOPIES OF THIS FORM.
TARGET COMMUNITY: Town of Southo1d; in"luding the Village of Greenport (1701.01)
low income/minority elderly and Kosher communities.
GJ CONGREGATE
GJ HOME-DELIVERED D CATERED ~ COOK ON SITE
57 Number of meals to be selVed each day - Congregate
_liL Number of meals to be selVed each day - Home-Delivered
5 Number of days per week for program
Circle days of program @ CJ @ @ 0
8AM-4: 30P~ours of operation each day
SA
SU
Location for congregate site:
southold Town Human Resource Center, 750 Pacific Street, Mattituck, NY
11952
Location of program administration, if difference from congregate site:
same
Please state any additional information affecting selVice delivery:
"
OFFICE USE ONLY:
Southo1d Town
SENIOR SERVICES
750 Pacific Street
P.O. Box 85
Mattituck, N.Y. 11952
Phone #: (631) 298-4460
R~~;:;91241067 (. / 'J/
)'<('1 L~ u:-
.-1~1i" <';;~~~lV-'-~ Q)5/0"
SUMMARY SHEET 06
Suffolk County Legislative Requirements Exhibit for Contracts; last rev. 1/04/07
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 Department of Labor - Living Wage Unit
Notice of Application for County Compensation Form LW-1 (consists of 1 page)
Suffolk County Department of Labor - Living Wage Unit
Certification/Declaration - Subject to Audit Form LW-38 (consists of 1 page)
1/ Contractor'sNendor's Public Disclosure Statement Form SCEX 22; rev.
3/30/04 (form consists of three pages; requires signature & notarization)
Note: The Contractor'sNendor's Public Disclosure Statement Form SCEX 22;
rev. 3/30/04,
III Union Organizing CertificationlDeclaration - Subject to Audit; rev. 6/05
Form L01 (consists of 2 pages)
IV Lawful Hiring Compliance Requirements
Notice of Application to Certify Compliance with Federal Law (8 U.S.C.
Section 1324A) with Respect to Lawful Hiring of Employees (consists of 1
page)
Affidavit of Compliance with the Requirements of (8 U.S.C.
Section 1324A) with Respect to Lawful Hiring of Employees (consists of 1
page)
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 5/12/04
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 5/12/04
Pursuant to Section 6 of Chapter 347 of the Suffolk County Local Law No. 12-2001, "A
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 to the law
shall contain the following two paragraphs or substantially equivalent language:
This Agreement is subject to the Living Wage Law of the County of Suffolk. The law
requires that, unless specific exemptions apply 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 set forth in the Living Wage
Law. Such rate shall be adjusted annually pursuant to the terms of the Suffolk
County Living Wage Law of the County of Suffolk.
Under the provisions of the Living Wage Law, the County shall have the authority, under
appropriate circumstances, to terminate this Agreement and to seek other remedies as
set forth therein, for violations of this Law.
Suffolk County Local Law No. 18-2002, "A Local Law to Implement Living Wage Policy for the
County of Suffolk" provided for certain 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 (Contract)
Form LW-1 (consists of 1 page)
. Suffolk County Department of Labor - Living Wage Unit
CertificationlDeclaration - Subject to .Audit
Form LW-38 (consists of 1 page) (Replaces LW2, LW3 and LW33)
. 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)
1 of 2 pages
Suffolk County Living Wage Requirements Exhibit
As Last Revised by the Suffolk County Department of Labor on 5/12/04
Note: Pursuant to Section 7 of Local Law NO.18- 2002, "A Local Law to
Implement Living Wage Policy for County of Suffolk", all covered employers
subject to the provisions of the Living Wage Law shall submit a completed and
sworn (under penalty of perjury) Certification/Declaration - Subject to Audit Form
LW-38, signed by an authorized representative, as part of an executed contract
with the County of Suffolk. The complete Certification/Declaration - Subject to
Audit Form LW-38 shall be made a part of any executed contract or project
agreement and made available to the public upon request.
-----------------------------------------------------------------------------------------------------------------
. To certify Living Wage compliance: Return Forms LW-1 and LW-38.
or
. To certify non-applicability of Living Wage law: Return Form LW-38.
or
. To request and document a general living wage exemption: Return Forms LW-1,
LW-38 and LW-4.
or
. To request and document a specific living wage exemption: Return Forms LW-1,
LW-38 and LW-5.
-------------------------------------------------------------------------------------------------------------------------
. In the event that there is a change in circumstances, it is the Contractor's
responsibility to submit to the County additional Living Wage forms which
either replace or supplement prior submissions of Living Wage forms.
. 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.nv.us
Click: Department Directory
Labor
Living Wage Law Info
· Suffolk County 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 5/12/04
2 of 2 pages
Suffolk County Form 22
Contractor'sNendor's Public Disclosure Statement
Pursuant to Section A5-7 of the Suffolk County Administrative Code, this Public Disclosure Statement
must be completed by all contractors/vendors that have a contract with Suffolk County. In the event
contractor/vendor is exempt from completing paragraphs numbered I through II below, so indicate at
paragraph number 12 below setting forth the reason for such exemption. Notwithstanding such exempt
status, you must execute this form below before a notary public.
I. Contractor's/Vendor's Name Town of Southo1d
Address 53095 Main Road , P.O. Box 1179
City and State Southo1d, New York Zip Code 11971
2. Contracting Department's Name Senior Services
Address 750 Pacific Street, P.O. Box 85, Mattituck 11952
3. Payee Identification or Social Security No.
4. Type of Business_Corporation _Partnership_Sole Proprietorship ~ Other
5.3 Is contractor/vendor entering into or has contractor/vendor entered into a contract with Suffolk
County in excess of$I,OOO? _Yes_No.
5.b Has contractor/vendor entered into three or more contracts, including the one for which you are
now completing this form, with Suffolk County, any three of which, when combined, exceed
$I,OOO? Yes_No.
6. Table of Organization. List names and addresses of all principals; that is, all individuals serving
on the Board of Directors 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 additional sheet if
necessary. )
7. List all names and addresses of those individual shareholders holding more than five percent
(5%) interest in the contractor/vendor. Conspicuously identify any shareholder who is also an
officer or an employee of Suffolk County. (Attach additional sheet if necessary).
8. Does contractor/vendor derive 50% or more of its total revenues from its contractual or vendor
relationship with Suffolk County?_ Yes_No.
9. If you answered yes to 8 above, you must submit with this disclosure statement, a complete
fiiiiincial statement listing all assets and liabilities as well as a profit and loss statement. These
statements must be certified by a Certified Public Accountant. (Strike this out ifnot applicable.)
10. The undersigned shall include this Contractor'sNendor's Public Disclosure Statement with the
contract. (Describe general nature of the contract.)
Page I of 3 Public Disclosure Form
"
II. Remedies. The failure to file a verified public disclosure statement as required under local law
shall constitute a material breach of contract. Suffolk County may resort, use or employ any
remedies contained in Article II of the Uniform Commercial Code of the State of New York. In
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.
12. If you are one of the entities listed below at a) through c) or you qualify under d) below, you are
exempt from completing paragraphs numbered 1 through 11 herein:
_ a) Hospital
----'L- b) Educational or governmental entities
_ c) Not-for-profit corporations
_ d) Contracts providing for foster care, family day-care providers or child protective
services
Please check to the left side of the appropriate exemption.
13.
Verification. This section must be signed by an officer or principal of the contractor/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 hislher own knowledge, true.
Signed:#?I-f1 Ii fJ;'f>8f/
Scott A. Russell
Southold Town Supervisor
Southold Town (Senlar serV1CeS)
Dated: (p- ?%-~I
Printed Name of Signer:
Title of Signer:
Name of Contractor/Vendor:
UNIFORM CERTlFICA TE OF ACKNOWLEDGMENT
(Within New York State)
STATE OF NEW YORK)
COUNTY OF ) ss.:
On the (;l'b day of -.::; LA..n ~ in the year 2007 hefore me, the undersigned, personally appeared
-Y ~ _ R l..\S5e( ( personally known to me or proved to me on the basis of satisfactory evidence
to be the individualC;t) whose name(;l1 is C~ subscribed to the within instrument and acknowledged to
me that he/sh~/tlley executed the same in hislftsf.'tlleir capacitypes-) and that by his/11'eIi4fleir signature~
on the instrument, the individual ), or the erson upon behalf of which the individualC~ acted, executed
the inslr ~nt.
LYNDA M. BOHN
NOTARY PUBLIC, State of New Yortl
No. 01 B06020932
Qualified in Suffolk County
Term Expires March 8, 20 ~
Page 2 of3 Public Disclosure Form
Iii'
...!
lito'! wtll'l'
s~
Y'
__ v~', t6 ,. ,',
"
t.- ,~r.' "'J
; VrlK.i'Oa
',1
'I
'.
..\..- -,
UNIFORM CERTIFICATE OF ACKNOWLEDGEMENT
(Without New York State)
STATE OF
)
)ss.:
)
COUNTY OF
On the day of in the year 2007 before me, the undersigned, personally
appeared personally known to me or proved to me on the basis of
satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies) and that by
his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the
individual(s) acted, executed the instrument, and that such individual(s) made such appearance before
the undersigned in
(Insert the city or other political subdivision and the state or country ur uther place the acknowledgement
was taken)
(signature and office of individual taking acknowledgement)
Contractor's/Vendor's Public Disclosure Statement Form (Rev. 3/04)
Page 3 of 3 Public Disclosure Form
1I:\TBlumcnautr\masler rnrms.labrls\pub disc rorm22.doc
\",' .
SulTolk County. New York
Department of Labor
SUFFOLK COUNTY DEPARTMENT OF LABOR- LABOR MEDIATION UNIT
UNION ORGANIZING CERTIFICA TlONIDECLARA TION - SUBJECT TO AUDIT
If the following definition of UCounty Contractor" (Union Organizing Law Chapter ~66-2) applies to the
contractor's/bencficiary's business or transaction with Suffolk County, the contractor/beneficiary must complete Sections I,
III, and IV below. If the following definitions do not apply, the contractor/beneficiary must complete Sections II, III and IV
below. Completed forms must be submitted to the awarding agency.
County Contractor: "Any employer Ihat receives more Ihan $50,000 in Counly funds for supplying goods or services pursuanl to a
wrillen conlract with Ihe Counly of Suffolk or any of ils agencies; pursuanl to a Suffolk County grant; pursuant to a Suffolk County
program; pursuant to a Suffolk County reimbursement for services provided in any calendar year; or pursuant to a subcontract \vith
any of the above."
Section I
The Union Organizing Law applies to this contract. I/\\'e hereby agree to comply with all the provisions of Surfolk
County Local Law No. 26-2003, the Suffolk County Union Organizing Law (the law) and, as such shall not use
County funds to assist, promote, or deter union organizing (Chapter 466-3 A), nor seek reimbursement from the
County for costs incurred to assist, promote, or deter union organizing. (Chapter 466-3 B)
Check if
Applicable
I/we further agree to take all action necessary to ensure that County funds are not used to assist, promote, or deter
union organizing. (Chapter 466-3 H)
D
I/we further agree that if any expenditures or costs incurred to assist, promote, or deter union organizing are made,
IIwe shall maintain records sufficient to show that no County funds were used for those expenditures and, as
applicable. that no reimbursement from County funds has been sought for such costs. I/we agree that such records
shall be made available to the pertinent Counly agency or authority, the County Comptroller, or Ihe County
Department of Law upon request. (Chapter 466-3 I)
IIwe further affirm to the following:
. 1/"~.'e will not express to employees any false or misleading information that is intended to influence the
determination of employee preferences regarding union representation;
. 1/\\'e will not coerce or intimidate employees, explicitly or implicitly, in selecting or not selecting a bargaining
representative;
. 1/we will not require an employee, individually or in a group, to attend a meeting or an event that is intended to
influence his or her decision in selecting or not selecting a bargaining representative;
. 1/wt: um.lt:rslalllJ my/our obligation to limit disruptions caused by prerecognition labor disputes through the
adoption of none on fro ntationa I procedures for the resolution of pre recognition labor disputes with employees
engaged in the production of goods or the rendering ur st:rvkt:s for the County; and
. I/we have or will adopt any or all of the above-referenced procedures, or their functional equivalent, to ensure
the efficient, timely. and quality provision of goods and services to the County. I/we shall include a list of said
procedures in such certification.
l/we further agree that every County contract for the provision of services, when such services will be performed on
County property. shall include a requirement that I/we adopt a reasonable access agreement, a neutrality agreement,
fair communication agreement, no intimidation agreement, and a majority authorization card agreement.
I/we further agree that every County contract for the provision of human services, when such services are not to be
performed on County property, shall include a requirement that I/we adopt, at the least, a neutrality agreement.
IIwe understand that the efficient, timely. and nondisruptive provision of goods and services is a paramount financial
interest oflhe County of Suffolk and as such, Ihe County expects the potential County contractor to protect the
County's financial inlerest by adopling nonconfrontational procedures for the orderly resolution of labor disputes,
including. but not limited to. neutrality agreements, majority authorization card agreements, binding arbitration
agreements, fair communication agreements, nonintimidation agreements, and reasonable access agreements,
DOL-LOI (6/05)
,
\'.j, .1'
Suffolk County, New York
Department of Labor
Scction II
The Union Organizing Law does not apply to this contract for the following reason{s):
D
Check if
Applicable
Scction III
Contractor Name:
Town of Southold
Federal Employer 10#: 11-6001939
Contractor Address:
53095 Main Road/P.O. Box 1179
Amount of Assistance: $189,685.
Southold, NY
11971
Vendor #:
Contractor Phone #:
631 298-4460
Description of project or service:
III-C Nutrition Programs for the Elderly
Section IV
I declare under penalty of perjury under the Laws of the State of New York that the undersigned is authorized to provide this
certification, and that the ave is true and correct.
Authorized Signature
Scott A. Russell, Southold Town Supervisor
Print Name and Title of Authorized Representative
Date
6 /~p I<.Y)
" I
DOL-LOt (6/05)
."'." .,... .
. :. -
IV Suffolk County's Lawful Hiring of Employee's Law Compliance
Requirements
The following forms may be necessary for certify compliance to with
Federal Law (8 U.S.C. Section 1324A) with Respect to Lawful Hiring of
Employees Suffolk County's Lawful Hiring of Employees Law.
Forms:
. LHE-1-Lawful Hiring of Employees
. LHE-2-Affidavit of Compliance
. LHE-3-Submission
. LHE-4-Complaint
. LHE-5-Appeal
. LHE-6-Non-Applicability
. LHE-7-Sign-in Sheet
NOTIFICATION OF RIGHTS UNDER
THE LIVING WAGE LAW
According to the provisions of Local Law #12-2001 (the Living Wage law) enacted
by Suffolk County in July of 2001, a living wage rate was established. The Living
Wage shall be adjusted each year in proportion to the increase of the area
Consumer Price Index. The increase in the area Consumer Price Index for 2006 is
3.8%. Effective July 1,2007, the Living Wage will increase to $10.40 per hour
with health benefits and $11.84 per hour without health benefits for covered
employees of an agency receiving financial compensation through the County.
The law also mandates that full time workers receive at least 12 compensated days
off per year through any combination of sick, vacation or personal leave and
includes paid holidays provided by the employer.
The Suffolk County Department of Labor has been designated as the agency to
administer this law and to this end has established a Living Wage Unit. Further
information concerning the parameters of the Living Wage law may be obtained by
contacting this Unit (631 853-3808) or accessing the Suffolk County web page at
www.co.suffolk.nv.us/labor and following the link to the Living Wage section. All
inquiries will remain confidential.