CTR054521 American Lung Association of Arizona, A1 executed.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

TB Treatment Services

Effective upon signature by both parties is mutually agreed that the Contract referenced in this amendment is amended as follows:

1. Pursuant to the Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1, Amendments, the following changes are made under this Amendment One (1):

1.1. The Scope of Work is hereby amended with the new Scope of Work of this Amendment One (1). The changes include adding provision 5.2.2 to Section Five (5), Deliverables,

1.2. The Price Sheet is revised and replaced by the Price Sheet of this Amendment One (1). In the Arizona Procurement Portal (APP), the “Price list” tab of the Contract will be revised to reflect the revised pricing upon execution of this Amendment One (1),

1.3. Exhibit A is revised and replaced with Exhibit A of this Amendment One (1).

ALL CHANGES ARE REFLECTED IN RED

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date

The above referenced Contract Amendment is hereby executed this _____ day of __________ 20______ at Phoenix, Arizona

(To be filled out by Procurement Office)

Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

American Lung Association of Arizona

Contractor’s Name Procurement Officer Signature

11/22/21

Deborah P Brown, Chief Mission Officer

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

SCOPE OF WORK

1. Background

1.1 The Arizona Department of Health Services (ADHS) includes the Public Health Preparedness Tuberculosis Control Program. The purpose of establishing this Contract between ADHS and the American Lung Association in Arizona is to enhance the completion of therapy rate among homeless and other at-risk persons with active tuberculosis (TB) and to provide outreach and education to public health professionals and health care providers about TB.

1.2 Homeless individuals are often difficult to locate and treat successfully for TB. Completion of treatment is vital to healing the sick individual, preventing the spread of disease, and preventing the development of multi-drug resistant TB, which is a public health threat. Furthermore, TB is easily transmitted in a shelter or a congregate living situation. For these reasons, it is imperative that infectious homeless individuals be isolated and that the completion of treatment regimen be made a public health priority.

1.3 The State and local Arizona TB control programs are addressing TB in the homeless population by making it a priority to provide incentives and enablers to the homeless and other at-risk persons to complete treatment.

2. Objective

The objective of this Contract is to enhance the completion of curative therapy rate among homeless persons with active TB, support local health department activities in ensuring completion of treatment for TB cases, and provide TB outreach and education to public health professionals and health care providers.

3. Tasks

The Contractor shall:

3.1 As requested by local health departments and in accordance with the ADHS TB Control Program guidelines, allocate TB incentives and enablers including but not limited to, grocery gift cards and housing vouchers to individuals with active TB;

3.2. Sponsor and coordinate the Annual Four Corners TB & HIV Conference and other outreach and educational events; and

3.3. Prepare reports as defined in the Deliverables and submit to the ADHS TB Control Program.

4. Requirements

4.1 The Contractor shall provide a current and valid Certificate of Liability Insurance (COI) prior to commencement of the Contract and yearly throughout the term of the Contract. A Purchase Order will not be issued by ADHS for the Contractor to perform services without the COI on file in the Contract.

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

4.2 The Contractor shall have proven experience (a minimum of five (5) years) and expertise in providing tuberculosis education, advocacy and research support to government policy to translate the national TB objective into reality. The Contractor shall recognize that public policy at all levels of government is essential to achieve the mission and objectives of TB prevention and control.

4.3 The level of funding for this Contract is not guaranteed and is dependent on the availability of funds. The funding for this Contract originates from a grant the ADHS received from the Centers for Disease Control and Prevention (CDC). Correspondingly, the following are requirements ADHS has been made subject to and, as such, the Contractor shall also be subject to.

4.3.1. Funds may not be used for the following:

4.3.1.1. To supplant local health department funds;

4.3.1.2. For inpatient care;

4.3.1.3. For construction of facilities; or

4.3.1.4. To purchase drugs for treatment.

4.3.2 The following Additional Requirements (AR) are hereby by incorporated by reference and may be found in their entirety at http://www.cdc.gov/od/pgo/funding/grants/additional_req.shtm:

4.3.2.1. AR-1 Human Subjects Requirements;

4.3.2.2. AR-2 Inclusion of Women and Racial and Ethnic Minorities in Research;

4.3.2.3. AR-4 HIV/AIDS Confidentiality Provisions;

4.3.2.4. AR-5 HIV Program Review Panel Requirements;

4.3.2.5. AR-5 Patient Care;

4.3.2.6. AR-7 Executive Order 12372 Review;

4.3.2.7. AR-9 Paperwork Reduction Act Requirements;

4.3.2.8. AR-10 Smoke-Free Workplace Requirements;

4.3.2.9. AR-11 Healthy People 2010; and

4.3.2.10. AR-12 Lobbying Restrictions.

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

5. Deliverables:

The Contractor shall:

5.1 Submit reports to the ADHS TB Control Program. The required reports are:

5.1.1 One (1) Annual Work Plan that includes:

5.1.1.1 Program objectives; and

5.1.1.2 Staff funded by supplemental funds, including position descriptions.

5.1.2 One (1) Annual Progress Report that includes a summary of program objectives and activities performed, and

5.1.3 A Contractor’s Expenditure Report (CER) to be submitted monthly.

5.2 Sponsor and coordinate the Annual Four Corners TB & HIV Conference.

5.2.1 If this Contract is not renewed, the unspent funds and records for the planning for the Annual Four Corners TB & HIV Conference shall be returned to the ADHS TB Control Program; and

5.2.2 If ADHS is the party that decides to cancel the Annual Four Corners TB and HIV Conference, a portion of certain unavoidable and reasonable cancelation fees may be considered for reimbursement.

6. Deliverable Schedule

6.1 Reports should be submitted to the ADHS TB Control Program based on the schedule below:

Name of Report Time Period Final Due Date Annual Work Plan July 1 – June 30 July 31

Annual Progress Report July 1 – June 30 30 days after the end of the period

7. Notices, Correspondence, Reports and Invoices

7.1. Notices, correspondence, reports, invoices and program specific requests relative to this Contract from the Contractor to ADHS shall be sent to:

Arizona Department of Health Services Program Manager, TB Control Section 150 N 18th Ave., Suite 110 Phoenix, AZ 85007 Email: tb@azdhs.gov Phone: (602) 364-4750 Fax: (602) 364-4267

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

7.1.1 Invoices shall be submitted to: invoices@azdhs.gov

7.2. AUTOMATED CLEARING HOUSE. ADHS may pay invoices for some or all Orders through an Automated Clearing House (ACH). In order to receive payments in this manner, the Contractor must complete an ACH Vendor Authorization Form (form GAO-618) within 30 (thirty) days after the effective date of the Contract. The form is available online at: https://gao.az.gov/sites/default/files/GAO- 618%20ACH%20Authorization%20Form%20101019.pdf

7.2.1. ACH Vendor Authorization Form shall be emailed to Vendor.Payautomation@azdoa.gov

7.3. Notices and correspondence from the ADHS to Contractor shall be sent to:

American Lung Association in Arizona Attn: Stacey Mortenson 102 W. McDowell Rd.

Phoenix, AZ 85003 Phone: (602) 258-7507 Email: Stacey.Mortenson@Lung.org

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

PRICE SHEET

LINE ITEM YEARLY BUDGET AMOUNT

1. Personnel Services and ERE $16,632.00

2. Professional and Outside Services $0.00

3. Travel Expenses $0.00

4. Other Operating Expenses $82,217.00

5. Capital Outlay Expenses $0.00

6. Equipment $1.00

7. Other $11,151.00

ANNUAL TOTAL (Not to Exceed) $110,000.00

Note: With prior approval from the ADHS TB Program Manager, the Contractor is authorized to transfer up to a maximum of thirty-five percent (35%) of the total budget amount between line items. Transfers of funds are only allowed between funded line items. Transfers exceeding thirty-five percent (35%) or to a non-funded item shall require a written Contract Amendment.

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

Exhibit A – 2 CFR 200.332

Prime Awardee: Arizona Department of Health Services

DUNS # 804745420

Federal Award Identification (Grant Number): NU52PS910175

Subrecipient name (which must match the name associated with its unique entity identifier): American Lung Association of Arizona

Subrecipient's unique entity identifier (DUNS #): 86-0111676

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU52PS910175

Federal Award Date (see the definition of Federal award date in § 200.1 of this part) of award to the recipient by the Federal agency: 12/15/2020

Subaward Period of Performance Start and End Date: 01/01/2021-12/31/2021

Subaward Budget Period Start and End Date: 01/01/2021-12/31/2021

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $110,000.00

Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation (how much is available for contracts): $110,000.00

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity: $330,632.00

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act

(FFATA):

93.116- Project Grants & Cooperative Agreements for Tuberculosis Control Programs

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity: Centers for Disease Control and Prevention

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR054521 AMENDMENT NO.: 1

Kailee Gray

Procurement Officer

Assistance Listings number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement: 93.116

Identification of whether the award is R&D: n/a

Indirect cost rate for the Federal award (including the de minimis rate is charged) per § 200.414: 13%