HBCUs BH Support RFA_BPM044854_ 6.12.24.pdf

EXHIBIT A

STANDARD GRANT AGREEMENT (SGA)

REQUEST FOR APPLICATIONS (RFA)

(COMPETITIVE)

PROCUREMENT ID NUMBER – BPM044854/BHA-24-010

Issue Date: June 12, 2024

Historically Black Colleges and Universities (HBCU) Grant Funding Opportunity to Support Behavioral Health Needs of the Campus

Population

NOTICE

A Prospective Applicant that has received this document from the Maryland Department of Health, or that has received this document from a source other than the Procurement Officer, and that wishes to assure receipt of any changes or additional materials related to this RFA, should immediately contact the Procurement Officer and provide the Prospective Applicant’s name and mailing address so that addenda to the RFA or other communications can be sent to the Prospective Applicant.

Minority Business Enterprises Are Encouraged to Respond to this Solicitation

10/2019

STATE OF MARYLAND

MARYLAND DEPARTMENT OF HEALTH

RFA KEY INFORMATION SUMMARY SHEET

Request for Proposals: Historically Black Colleges and Universities (HBCU) Grant Funding Opportunity to Support Behavioral Health Needs of the Campus Population

Solicitation Number: BPM044854

1. RFP Issue Date:

RFP Issuing Office: Maryland Department of Health Behavioral Health Administration

Procurement Officer: Crystal Hack

Maryland Department of Health Behavioral Health Administration Finance & Procurement Division 55 Wade Avenue Catonsville, MD 21228 Phone: 410-627-6814 e-mail: crystal.hack@maryland.gov

Grant Monitor: Stephanie C. Slowly MSW, LCSW-C Maryland Department of Health Behavioral Health Administration 55 Wade Avenue Catonsville, MD 21228

Phone Number: (443) 844-5754 E-mail: stephanie.slowly1@maryland.gov

Applications are to be sent to: eMaryland Marketplace Only! (See section 1.5) eMMA is an electronic commerce system administered by the Maryland Department of General Services.

In order to receive a Contract award, a Contractor must be registered on eMMA.

Registration is free. Go to https://emaryland.buyspeed.com/bso/login.jsp, click on “Register” to begin the process, and then follow the prompts.

Closing Date and Time: July 03, 2024, Time 2:00 PM EST

SECTION 1 - GENERAL INFORMATION

1.1 Summary Statement

1.1.1 The Maryland Department of Health (MDH or the Department), Behavioral Health Administration (BHA) announces the opportunity to receive one-time grants for Historically Black Colleges and Universities (HBCUs) through this Request for Applications (RFA).

1.1.2 It is the State’s intention to award selected HBCUs with one-time grant funds, as specified in this RFA, from an Agreement between the selected Applicant and the State. The anticipated duration of services to be provided under this Agreement is for a 12-month duration from September 1, 2024, to May 31, 2025.

1.1.3 BHA has budgeted $2 million for this project and intends to make multiple awards as a result of this RFA.

1.1.4 Applicants, either directly or through their subcontractor(s), must be able to provide all services and meet all of the requirements requested in this solicitation and the successful Applicant shall remain responsible for performance regardless of subcontractor participation in the work.

1.2 Contract Type

The Agreement resulting from this solicitation shall be a firm fixed price.

1.3 Procurement Officer

The sole point of contact in the State for purposes of this solicitation prior to the award of any Agreement is the Procurement Officer at the address listed below:

Procurement Officer: Crystal Hack Maryland Department of Health Behavioral Health Administration Finance & Procurement Division 55 Wade Avenue Catonsville, MD 21228 Phone: 410-627-6814 e-mail: crystal.hack@maryland.gov

The Department may change the Procurement Officer at any time by written notice.

1.4 Grant Monitor

The Grant Monitor is:

Stephanie C. Slowly MSW, LCSW-C Maryland Department of Health Behavioral Health Administration 55 Wade Avenue Catonsville, MD 21228

Phone Number: (443) 844-5754 E-mail: stephanie.slowly1@maryland.gov

The Department may change the Grant Monitor at any time by written notice.

1.5 eMaryland Marketplace Advantage

Each Applicant is requested to indicate its eMaryland Marketplace Advantage (eMMA) vendor number in the Transmittal Letter (cover letter) submitted at the time of its Application submission to this RFA.

eMMA is an electronic commerce system administered by the Maryland Department of General Services. The RFA and associated materials, the solicitation and summary of the Pre-Proposal Conference, Applicant questions and the Procurement Officer’s responses, addenda, and other solicitation-related information will be provided via eMMA.

In order to receive a contract award, a vendor must be registered on eMMA. Registration is free. Go to https://procurement.maryland.gov/, click on “Register” to begin the process, and then follow the prompts.

1.6 Questions

Written questions from prospective Applicants will be accepted by the Procurement Officer. Questions to the Procurement Officer shall be submitted via to eMaryland Marketplace ONLY! Please identify in the subject line the Solicitation Number and Title.

Questions are requested to be submitted at least 7 days prior to the Application due date. The Procurement Officer, based on the availability of time to research and communicate an answer, shall decide whether an answer can be given before the Application due date. All questions and answers will be posted to eMaryland Maryland under the documents tab.

1.7 Application Due (Closing) Date and Time

Applications, in the number and form set forth in Section 4.2 “Applications” must be received by the Procurement Officer, via eMaryland Marketplace Advantage (eMMa), no later than 2:00 PM. Local Time on July 3, 2024, in order to be considered.

Requests for extension of this time or date will not be granted. Applications received after the due date and time listed in this section will not be considered. Questions regarding this solicitation should be submitted to eMMa only.

Applications may be modified or withdrawn by written notice received by the Procurement Officer before the time and date set forth in this section for receipt of Application. Multiple and/or alternate Applications will not be accepted.

1.8 Award Basis

The Grant shall be awarded to responsible Applicants submitting Applications that have been determined to be the most advantageous to the State, considering price and evaluation factors set forth in this RFA, for providing the activities as specified in this RFA. See RFA Section 5 for further award information.

https://procurement.maryland.gov/

1.9 Revisions to the RFA

If it becomes necessary to revise this RFA before the due date for Applications, the Department shall endeavor to provide addenda to all prospective Applicants that were sent this RFA or which are otherwise known by the Procurement Officer to have obtained this RFA. Addenda made after the due date for Applications will be sent only to those Applicants that submitted a timely Application and that remain under award consideration as of the issuance date of the addenda.

Acknowledgment of the receipt of all addenda to this RFA issued before the Application due date shall be included in the Transmittal Letter accompanying the Applicant’s Project Narrative. Acknowledgement of the receipt of addenda to the RFA issued after the Application due date shall be in the manner specified in the addendum notice. Failure to acknowledge receipt of an addendum does not relieve the Applicant from complying with the terms, additions, deletions, or corrections set forth in the addendum.

1.10 Cancellations

The State reserves the right to cancel this RFA, accept or reject any and all Applications, in whole or in part, received in response to this RFA, to waive or permit the cure of minor irregularities, and to conduct discussions with all qualified or potentially qualified Applicants in any manner necessary to serve the best interests of the State. The State also reserves the right, in its sole discretion, to award a Grant based upon the written Applications received without discussions or negotiations.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

SECTION 2 – MANDATORY REQUIREMENTS

2.1 Applicant Mandatory Requirements

The Applicant must provide proof with its Application that the following Mandatory Requirements have been met:

2.1.1 The Applicant shall be a Maryland Historically Black College and University (HBCU).

2.1.2 The Applicant shall submit only one application per HBCU.

SECTION 3 – SCOPE OF WORK

3.1 Background and Purpose

The Maryland Department of Health-Behavioral Health Administration (MDH-BHA) announces the opportunity to receive one-time grants for HBCUs through this Request for Applications (RFA). This one-time grant funding is for a 12-month duration from June 1, 2024 to May 31, 2025. BHA has budgeted $2 million for this project and intends to make multiple awards as a result of this RFA.

College student mental health has declined over the last decade. One study that surveyed 350,000 students at over 300 colleges between 2013 and 2021 found that depression increased by 135 percent and anxiety increased by 110 percent.1 That same study found that during the 2020-2021 school year, more than 60 percent of college students met the criteria for at least one mental health condition. Further, this study noted that students of the global majority were less likely to receive treatment than their white peers. An HBCU based in the Northeast surveyed students and found that 53 percent met the clinical criteria for depression and/or anxiety.2 According to the Centers for Disease Control and Prevention, suicide was the third leading cause of death for Black Americans ages 15 to 24 in 2021. The rising need and demand for services has outpaced the workforce and funding in many areas.

MDH-BHA recognizes the growing trend of compounding behavioral health (BH) challenges of today’s students across college campuses. This funding opportunity will allow HBCUs to propose innovative ideas to address the BH needs their campus is facing. Grant-funded activities could include but are not limited to:

A. Mental Health Workforce

a. Examples:

i. Funding positions to treat specific populations such as the Deaf and Hard of Hearing, LGBTQIA+, immigrant communities, or limited English proficiency.

ii. Creating programs or scholarship opportunities that will increase student engagement in the behavioral health field.

B. Mental Health First Aid or other training for Students and Staff C. Campus outreach for available resources

a. Example:

i. 9-8-8 promotion D. Subscription/start-up for mobile applications or telehealth services E. Retrofitting space for mental health services F. Prevention/Promotion activities

a. Examples:

i. anti-stigma campaigns, suicide prevention, overdose education, and naloxone distribution.

Ineligible use of funds:

● Indirect costs cannot exceed 10 percent of the Total Direct costs

● Sales tax for Non-profit and Governmental entities

● Building/land purchase

● Purchase of vehicles

● Any cash gifts or incentives

● Reimbursement of healthcare services otherwise covered by claims

● Naloxone and Fentanyl/Xylazine test strips o Provided for free by the Center for Harm Reduction Services here.

Lipson, S. K., Zhou, S., Abelson, S., Heinze, J., Jirsa, M., Morigney, J., ... & Eisenberg, D. (2022). Trends in college student mental health and help-seeking by race/ethnicity: Findings from the national healthy minds study, 2013–2021. Journal of Affective Disorders, 306, 138-147 Wang, S. X., & Goodman, J. (2021, January 1). Mental Health of HBCU College Students during the COVID-19 Pandemic. medRxiv.

https://www. tandfonline.com/doi/full/10.1080/17459435.2020.1871402 https://www.cognitoforms.com/MDH3/accessresourcesrequestform

3.2 Scope of Work - Requirements

The Applicant shall:

3.2.1 General Requirements

3.2.1.1 The purpose of these grants is to enable colleges receiving an award to establish or expand an existing behavioral health program or initiative. MDH-BHA is offering one-time grants for HBCUs.

3.2.1.2 The Applicant must carry out the activities as described in their proposal.

A. A Scope of Work will be further developed based on the proposal if the Applicant is selected to receive one-time grant funds.

3.2.1.3 Application Requirements

The application should be no more than 10 pages long, including the cover letter, executive summary, and project narrative (this does not include attachments). The application should be in 12-point font, Times New Roman, 1-inch margins, single-spaced, and each page numbered sequentially. For charts/graphs and footnotes, 10-point font may be used.

A. Cover Letter

a. Place on the organization’s letterhead a detailed cover letter that states the intent to submit an application for funding consideration. The purpose of the cover letter is to introduce the organization and the application. The authorizing official should sign and provide the contact name, title, email, and phone number.

B. Executive Summary

a. The executive summary should succinctly state why the program is important, who will be served and how many, what will be done, and how the success of the program will be determined. Please limit the executive summary to 1-2 pages.

C. Project Narrative

a. Key focus area(s) the proposed program will address

b. Target Population

i. This section should describe the population the proposed project aims to serve. This could be campus-wide or a specific community within the campus population.

c. Partnerships (if applicable)

i. This section should describe the partnerships that will be utilized to implement the project. A letter of commitment from any partner(s) should be submitted with the application. Each letter must be printed on the respective organization’s letterhead. Letters should indicate the specific contributions the partner or collaborator will provide to support the proposed project.

d. Goals and objectives

i. This section should consist of a description of the goal(s) and objectives of the proposed project. Objectives must follow the SMART approach. SMART objectives are Specific, Measurable, Attainable/Achievable, Relevant, and Time-bound.

e. Project management

i. This section should include a clear description of the roles and responsibilities of project staff and any subcontractors.

Provide resumes or biographical sketches for key project personnel and subcontractors. A description of how each individual or sub-recipient will contribute to achieving the project’s objectives and outcomes should be included. This section should specify key tasks such as the leadership of the project, monitoring the project’s progress, preparation and submission of reports, communications with partners and stakeholders, and evaluation of the project.

f. Timeline

i. Include a Gantt chart that details the timeline for each task associated with the proposed project.

g. Outcomes

i. This section must clearly identify measurable outcomes that will result from the proposed project. Projects that do not include measurable outcomes will not be funded. The measurable health outcomes that will be achieved by the program should be the SMART objectives.

h. Evaluation

i. This section should describe the methods you will use to evaluate whether or not the proposed project achieves the measurable outcomes.

D. Budget

a. Submit a one-year, 12-month line-item budget and an accompanying budget narrative. See Exhibit B.

3.2.2 Program Development

3.2.2.1 The Applicant will develop a new program or add to an existing program within the organization, that expands access to or generates more awareness of behavioral support services.

3.2.3 Staffing

3.2.3.1 The Applicant must identify a Project Manager and necessary support staff. Staff could include a variety of positions, including outreach and marketing staff.

3.2.3.2 The Applicant will provide a resume and a description of relevant experience for each staff member involved in grant activities.

3.2.3.3 The Applicant may employ or subcontract with other members as needed to satisfy all grant requirements.

3.2.3 Reports

3.2.3.1 The Applicant will be required to submit a quarterly report to the Department detailing program activities on the 15th of the month following the end of the quarter using a standardized form that covers:

a. Budget and expenditures

b. Project Management

c. Goals and Objectives

d. Outcomes

e. Evaluation

Quarterly Reports- All Subsequent Funding Periods 1st Quarter: June 1 - August 31 Report Due: September 15, 2024 2nd Quarter: September 1 – November 30 Report Due: December 15, 2024 3rd Quarter: December 1 – February 28 Report Due: March 15, 2025 4th Quarter: March 1 – May 31 Report Due: June 15, 2025

3.3 Invoicing

3.3.1 General

(a) All invoices for services shall be signed by the Grantee and submitted to the Grant Monitor. All invoices shall include the following information:

● Grantee name;

● Remittance address;

● Federal taxpayer identification number (or if sole proprietorship, the individual’s social security number);

● Invoice period;

● Invoice date;

● Invoice number

● State assigned Contract number;

● State assigned (Blanket) Purchase Order number(s);

● Goods or services provided; and

● Amount due.

Invoices submitted without the required information cannot be processed for payment until the Contractor provides the required information.

(b) The Department reserves the right to reduce or withhold Grant payment in the event the Grantee does not provide the Department with all required deliverables within the time frame specified in the Grant or in the event that the Grantee otherwise materially breaches the terms and conditions of the Grant until such time as the Grantee brings itself into full compliance with the Grant.

3.3.2 Invoice Submission Schedule

The Grantee shall submit invoices in accordance with the following schedule:

Invoices are due by the 15th of the month following the month in which services were performed.

SECTION 4 – APPLICATION FORMAT

4.1 Two Part Submission

Offerors shall submit Proposals in separate volumes:

▪ Volume I – Project Narrative

▪ Volume II – Budget Justification/Narrative

4.2 Proposals

4.2.1 Applications must be submitted via eMaryland Marketplace Advantage (eMMA). The Procurement Officer will not accept submission by any other means or after the date and exact time stated in the Key Information Summary Sheet. The date and time of submission is determined by the date and time of arrival in eMMA.

4.2.1.1 Two Part Submission:

A. Technical Proposal (See 4.3.)

B. Budget Narrative (See 4.4)

4.2.2 Applications will be shown only to State employees, members of the Evaluation Committee, or other persons deemed by the Department to have a legitimate interest in them.

*All information submitted as part of this proposal is subject to release under the Public Information Act (PIA). If you would like the Maryland Department of Health (MDH) to consider redactions in the event that your proposal is subject to a PIA request, submit a proposed PIA copy including justifications for each redaction and under what statute that justification is qualified for redaction.

4.3 Volume I – Project Narrative

Note: No pricing information is to be included in the Project Narrative (Volume 1). Pricing information is to be included only in the Budget Justification/Narrative (Volume II).

4.3.1 The Technical Proposal shall include the following documents and information in the order specified as follows:

4.3.1.1 Transmittal Letter:

● Applicant;

● Solicitation Title and Solicitation Number that the Proposal is in response to;

● Signature, typed name, and title of an individual authorized to commit the Applicant to its Proposal;

● Federal Employer Identification Number (FEIN) of the Applicant, or if a single individual, that individual’s Social Security Number (SSN);

● Applicant’s eMMA number;

● Applicant’s MBE certification number (if applicable);

● Applicant’s SBR number (if applicable) – please contact eMMA at 410-767-1492 if you don’t know your number.

4.3.1.2 The Project Narrative shall include the Scope of Work, including the Work Plan (as described in Section 3.2).

4.3.1.3 Mandatory Requirements Documentation

4.3.1.4 Applicant Technical Response to RFA Requirements and Proposed Work Plan:

a. The Applicant shall address each Scope of Work requirement (Section 3.2) in its Project Narrative and describe how its proposed services, including the services of any proposed subcontractor(s), will meet or exceed the requirement(s). If the State is seeking Applicant agreement to any requirement(s), the Applicant shall state its agreement or disagreement. Any paragraph in the Project Narrative that responds to a Scope of Work (Section 3.2) requirement shall include an explanation of how the work will be done. Any exception to a requirement, term, or condition may result in having the Application classified as not reasonably susceptible of being selected for award or the Applicant deemed non-responsive.

4.4 Volume II – Budget Narrative

4.4.1 Under separate sealed cover from the Project Narrative and clearly identified in the format identified in Section

4.2 “Applications,” the Applicant shall submit an original copy of the Budget Narrative. The Budget Narrative shall contain all price information in the format specified in Exhibit B. The Applicant shall complete the Budget Narrative Form only as provided in the Budget Narrative Form.

4.4.2 The Applicant shall attach to the Budget Form a Budget Narrative document that details the total cost of the proposed activities. The budget categories may include: Personnel (salary and fringe), Consultants; Travel;

Contractual; Supplies; Operating Costs; and Other project-related costs.

SECTION 5 – EVALUATION COMMITTEE, EVALUATION CRITERIA, AND

SELECTION PROCEDURE

5.1 Evaluation Committee

Evaluation of Applications will be performed by a committee established for that purpose and based on the evaluation criteria set forth below. The Evaluation Committee will review Applications, participate in Applicant oral presentations and discussions, and provide input to the Procurement Officer. The Department reserves the right to utilize the services of individuals outside of the established Evaluation Committee for advice and assistance, as deemed appropriate.

5.2 Project Narrative Evaluation Criteria

The criteria to be used to evaluate each Project Narrative listed below in descending order of importance.

● Key focus area(s) the proposed program will address

● Target Population

● Goals and objectives

● Outcomes

● Evaluation

● Project management

● Partnerships (if applicable)

● Timeline

5.3 Budget Narrative Evaluation Criteria

All Qualified Applicants will be ranked from the lowest (most advantageous) to the highest (least advantageous) based on the rating of the Project Narratives. The Budget Narrative (including the Budget Form and Budget Narrative), will be evaluated based on reasonable cost given the time and effort described in the Project Narrative.

The budget line items must be within the stated guidelines set forth in this RFA and as submitted on Exhibit C – Budget Narrative.

5.4 Selection Procedures

5.4.1 General

The Grant will be awarded in accordance with the Standard Grant Agreement method outlined in the Announcement.

The State may determine an Applicant to be non-responsive and/or an Applicant’s Application to be not reasonably susceptible of being selected for award at any time after the initial closing date for receipt of Applications and prior to Grant award. If the State finds an Applicant to be not responsive and/or an Applicant’s Project Narrative to be not reasonably susceptible of being selected for award, that Applicant’s Budget Narrative will be returned if the Budget Narrative is unopened at the time of the determination.

5.4.2 Award Determination

Upon completion of the Project Narrative and Budget Narrative evaluations and rankings, each Applicant will receive an overall ranking. The Procurement Officer will recommend award of the Grant to the responsible Applicant that submitted the Application determined to be the most advantageous to the State. In making this most advantageous Application determination, technical factors and financial factors will be weighted equally.

RFA ATTACHMENTS

EXHIBIT B – Budget Form This must be completed and submitted with the Project Narrative separately from Technical Proposal via eMaryland Marketplace Advantage (eMMA)

EXHIBIT C—Budget Narrative This must be completed and submitted with the Project Narrative, along with the Budget Narrative Form via eMaryland Marketplace Advantage (eMMA).

REFERENCE DOCUMENT A - Standard Grant Agreement “Sample” This is the sample grant agreement used by the Department. It is provided with the RFA for informational purposes and is not required to be submitted at Application submission time. Upon notification of recommendation for award, a completed standard grant agreement will be sent to the recommended awardee for signature. The recommended awardee must return to the Procurement Officer three (3) executed copies of the Standard Grant Agreement within five (5) Business Days after receipt. Upon award, a fully executed copy will be sent to the Grantee.

ATTACHMENT B – RFA Document Checklist Use this checklist to ensure that the required documents for the Project Narrative and Budget Narrative are completed.

EXHIBIT B – BUDGET FORM

FINANCIAL PROPOSAL FORM

The Budget Narrative shall contain all price information in the format specified on these pages. Complete the Budget Form only as provided in the Budget Form format. Do not amend, alter or leave blank any items on the Budget Form.

Failure to adhere to any of these instructions may result in the Budget Narrative being determined non-responsive and rejected by the Department.

Submitted By:

Authorized Signature: _______________________________________________ Date: ________________________

Printed Name and Title: ___________________________________________________________________________ Company Name : ________________________________________________________________________________ Company Address: _______________________________________________________________________________ Location(s) from which services will be performed (City/State): ___________________________________________

FEIN: _________________________________________

eMMA #: ________________________________________ Telephone: (_______) _______-- ____________________ Fax: (_______) _______--____________________ E-mail: _________________________________________

Budget Summary (SAMPLE)

Line Item Qty Unit Cost Total Cost

Salary

Fringe

Contractual

Travel

Operating Costs

Supplies

Other

Other

Other

Other

TOTAL

EXHIBIT C – BUDGET NARRATIVE

BUDGET NARRATIVE TEMPLATE

Sample Line Item Justification

Personnel (Preventionist): $15,600

Justification: The Preventionist will be responsible for: conducting project-related relationship-building activities with new and existing partners; developing informational materials for community leaders and the public, including fact sheets and social media posts related to the project topic; coordinating and facilitating monthly project meetings with partners; conducting awareness-building activities within key demographic areas in the community to engage the project target audience; developing and providing professional training at targeted local governmental agencies and private businesses; attending community events relevant to the project and the project’s partners. The Project Coordinator will also attend RISEMD meetings, collect data, conduct evaluation activities, prepare reports, and act as a liaison with the MDH Grant Monitor.

$30/hr x 520 hours = $15,600

Reference Document A - Standard Grant Agreement “Sample”

ORGANIZATIONS RECEIVING APPROPRIATIONS FROM THE STATE

STANDARD GRANT AGREEMENT

This Agreement, which is executed in compliance with Section 7-402 of the State Finance and Procurement Article of the Annotated Code of Maryland, is made this <enter day> day of <month, year> , between the State of Maryland (the “State”), acting through the Maryland Department of Health, (the “Department”), located at <enter MDH Address> and the <grantee name> (the “Grantee” ), located at <grantee address> in <county / city> County, <state, zip> , a Maryland Limited Liability Company / Corporation.

1. Effective on the date of execution of this Agreement, the State is extending to the Grantee a grant in the amount of <amount in words> Dollars ($ xx,xxx.xx) (the “Grant”), which the Grantee shall use only for the following purposes: <grant purpose>

2. Any expenditure of Grant funds that is not consistent with purposes stated in paragraph 1 may, at the sole discretion of the Department, be disallowed. Should any expenditure be disallowed or should the Grantee violate any of the terms of this Agreement, the State may require repayment to the State Treasury, an offset from any State Grant to the Grantee in the current or succeeding fiscal year, or other appropriate action. The Grantee shall repay to the State any part of the Grant that is not used for the purposes stated in paragraph 1 within 3 months after the date of this Agreement.

3. The Grantee may not sell, lease, exchange, give away, or otherwise transfer or dispose of real or personal property, or any part of or interest in real or personal property, acquired with Grant funds without the prior written consent of the Department. This includes transfer or disposition to a successor on the merger, dissolution, or other termination of the existence of the Grantee. The Grantee shall give the Department written notice at least 30 calendar days before any proposed transfer or disposition. Any proceeds from a permitted transfer or disposition shall be applied to repay to the State a percentage of that portion of the Grant allocable to the particular real or personal property transferred or disposed of, unless the Department and the Grantee agree to other terms and conditions. The percentage shall be equal to the percentage of the unadjusted basis of the property that would remain if the property had been recovery property placed in service after December 31, 1980 and if all allowable deductions had been taken up to the time of disposition under the Accelerated Cost Recovery System (ACRS) specified in the United States Internal Revenue Code, Section 168(b)(1).

4. For any item of real or personal property that is acquired with Grant funds and has an original fair market value of Five Thousand Dollars ($5,000) or more, the Grantee shall, at its own expense, and for the reasonable useful life of that item or for 5 years, whichever is less, obtain and maintain insurance. The insurance shall provide full protection for the Grantee and the State against loss, damage, or destruction of or to the real or personal property. The Grantee shall, on request, provide the Department with satisfactory evidence of its compliance with this requirement. Proceeds of insurance required by this paragraph shall be applied toward replacement of the real or personal property or toward the partial or total repayment of the State of the Grant, in the sole discretion of the Department.

5. The Grantee may not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, or any other characteristic forbidden as a basis for discrimination by applicable laws, and certifies that its Constitution or by-laws contains a non-discrimination clause consistent with the Governor’s Code of Fair practices.

6. The person executing this Agreement on behalf of the Grantee certifies, to the best of that person’s knowledge and belief, that:

A.) Neither the Grantee, nor any of its officers or directors, nor any employee of the Grantee involved in obtaining contracts with or grants from the State or any subdivision of the State, has engaged in collusion with respect to the Grantee’s application for the Grant or this Agreement or has been convicted of bribery, attempted bribery, or conspiracy to bribe under the laws of any state or of the United States;

B.) The Grantee has not employed or retained any person, partnership, corporation, or other entity, other than a bona fide employee or agent working for the Grantee, to solicit or secure the Grant or this Agreement, and the Grantee has not paid or agreed to pay any such entity any fee or other consideration contingent on the making of the Grant or this Agreement; the grantee understands and complies with the Conflicts of Interest provision of the Public Ethics Law, Maryland Code Annotated, General Provisions, Title 5, Subtitle 5.

C.) The Grantee, if incorporated, is registered or qualified in accordance with the Corporations and Associations Article of the Annotated Code of Maryland, is in good standing, has filed all required annual reports and filing fees with the Department of Assessments and Taxation and all required tax returns and reports with the Comptroller of the Treasury, the Department of Assessments and Taxation, and the Department of Labor, Licensing and Regulation, and has paid or arranged for the payment of all taxes due to the State; and

D.) No money has been paid to or promised to be paid to any legislative agent, attorney, or lobbyist for any services rendered in securing the passage of legislation establishing or appropriating funds for the Grant.

E.) Neither the Grantee, nor any of its officers or directors, nor any person substantially involved in the contracting or fund raising activities of the Grantee, is currently suspended or debarred from contracting with the State or any other public entity or subject to debarment under the Code of Maryland Regulations, COMAR 21.08.04.04.

7. Within 60 calendar days after the close of any grant period in which the Grantee receives funds under this Agreement, the Grantee shall provide to the Department an itemized statement of expenditures, showing how the funds were expended for that grant period. In addition, a copy of the statement shall be mailed to the Director, General Accounting Division, Office of the Comptroller of the Treasury, Room 200, Louis L. Goldstein Treasury Building, Annapolis, Maryland 21401. The Grantee shall retain bills of sale or other satisfactory evidence of the acquisition of any real or personal property for at least 3 years after the date of this Agreement. The Department, the Department of Budget and Management, the State Comptroller, and the Legislative Auditor, or any of them, may examine and audit this evidence, on request, at any reasonable time within the retention period.

8. The Grantee shall comply with Section 7-221, 7-402, and 7-403 of the State Finance and Procurement Article of the Annotated Code of Maryland, as applicable.

9. The laws of Maryland shall govern the interpretation and enforcement of this Agreement.

10. This Agreement shall bind the respective successors and assigns of the parties.

11. The Grantee may not sell, transfer, or otherwise assign any of its obligations under this Agreement, or its rights, title, or interest in this Agreement, without the prior written consent of the Department.

12. No amendment to this Agreement is binding unless it is in writing and signed by both parties.

13. The following items are incorporated by referenced and made a part of this Agreement .Appendix A & B, Attachment A, B, C, D, E.&F.

IN TESTIMONY WHEREOF, WITNESS the hands and seals of the parties.

GRANTEE

(Name of Corporation or Association)

By: .

SEAL

Name:

Title: .

DEPARTMENT

Maryland Department of Health.

(Name of Corporation or Association)

By: ________________________________________________

SEAL

Name: .

Title:

Date: .

Date: _________________________________________________

APPENDIX A

The Department’s Grant Monitor is: The Grantee’s Grant Monitor is:

<Name and Title of MDH grant monitor> <enter name, title, office, grantee agency, address, <Office> phone number and email > Maryland Department of Health 201 W. Preston Street Baltimore, Maryland 21201 Phone:

Email:

I. BACKGROUND INFORMATION OF AGREEMENT

<Enter background information of the agreement>

II. DUTIES OF THE GRANTEE

SCOPE OF WORK:

<Enter all duties and scopes of work for the grant agreement>

The Remainder of This Page is Left Blank

APPENDIX B (insert revised budget)

Cost Estimate for:

<Name of Project>

PERIOD OF PERFORMANCE - <Date of Project>

<Enter Budget>

II. DUTIES OF THE DEPARTMENT

Other than awarding the funds to the <grantee/sub-recipient/sub-awardee> for this project <MDH awarding agency> will:

● Provide necessary technical support and monitoring to <grantee/sub-recipient/sub-awardee> to ensure state and federal grant compliance.

This includes but is not limited to:

● Completion of the MDH Office of the Inspector General Risk Assessment

● Completion of the Standard Grant Agreement Checklist

● Determination of Good Standing with The State of Maryland

● Review for Debarment, Suspension, or any Exclusion from doing business with Maryland

● Determination regarding No Conflicts of Interest

● Review of Single Audits

● Review for Debarment, Suspension, or any Exclusion from doing business with the Federal Government

SECTION IV. INCORPORATION BY REFERENCE

Both parties hereby agree that the documents described below, if any, are hereby incorporated into and made an integral part of this Agreement: (Type "None", if none)

Exact Title of Document(s)

Number of Pages

Conditions of Award- Attachment A 2

Federal Funds- Attachment B 2

Debarment Affirmation- Attachment C 2

Certification Regarding Tobacco Smoke- Attachment D 1

Certification Regarding Lobby- Attachment E 5

Additional Information required for Prevention and Health Promotion Administration Grants – Attachment F

ATTACHMENT A

CONDITIONS OF AWARD

Maryland Department of Health (MDH)

<Enter Department Here> <Enter Federal Awarding Agency Here>

<Enter Name of Federal Award and Grant Number Here>

Period of Performance: <Enter From and To Dates Here>

Important Dates:

<Enter Date Here>: Quarterly progress report <Enter Date Here>: All funds obligated <Enter Date Here>: All funds must be spent <Enter Date Here>: Final progress and fiscal report due to MDH

The grantee/sub-grantee/sub-recipient (circle one), shall comply with these conditions. Consequences for failure to comply with these conditions may include: a point reduction in score for future competitive and non-competitive applications, a reduction of overall award, audit exceptions and/or reduction in future awards.

Program Requirements:

2. The grantee/sub-grantee/sub-recipient, <Enter Grantee Name Here > agrees to comply with MDH guidelines and initiatives with regards to their expenditures/purchases.

3. When procuring equipment, the recipient must comply with the procurement standards at 45 CFR Part 92.36 and 45 CFR 74.40 through 74.48, including 74.45, which requires the performance and documentation of some form of cost or price analysis with every procurement action.

4. The grantee/sub-grantee/sub-recipient, will perform activities that coordinate, integrate, prioritize and sustain improvements in public health emergency preparedness.

5. The grantee/sub-grantee/sub-recipient, shall cite < Enter Name of Federal Award > and the MDH <Enter Department Here> as a funding source when publishing or presenting data or programs partially or fully funded by MDH grants.

6. The grantee/sub-grantee/sub-recipient, should inform the MDH <Enter Department Here> as a courtesy when a presentation or publication is made public that involves programs or data partially or fully funded by MDH, and any federal grants. All reports, data, software, or presentations generated from federal funded projects must be made available to MDH for review and comment prior to release or distribution.

Fiscal Requirements:

1. The grantee/sub-grantee/sub-recipient, shall not use <Enter Name of Federal Award> to:

a. Support the costs of operating clinical trials of investigational agents, equipment or treatments;

b. Make payments directly to recipients of services, except for reimbursement of reasonable and allowable out-of-pocket expenses associated with consumer participation in State or consortia activities;

c. Support legal services;

d. Provide direct maintenance expenses of privately owned vehicles or any other costs associated with a vehicle, such as lease or loan payments, vehicle insurance, or license registration fees;

e. Purchase or improve land, or to purchase, construct, or make permanent improvements to any building, except for minor remodeling;

f. Pay property taxes;

g. Fund capital improvement projects;

h. Supplant personnel costs and/or other activities.

i. Prepare, distribute, or use of any material (publicity/propaganda) or to pay the salary or expenses of grants, contract recipients, or agents that aim to support or defeat the enactment of legislation, regulation, administrative action, or executive order proposed or pending before a legislative body.

2. The grantee/sub-grantee/sub-recipient will comply with all MDH and federal fiscal requirements for timely submission of detailed budgets and budget modifications, including monthly invoice requirements.

3. The grantee/sub-grantee/sub-recipient will return any unspent and unobligated funds to MDH and provide the necessary supporting documentation.

Audits:

The grantee/sub-grantee/sub-recipient shall submit audits in accordance with Federal OMB 2 CFR 200, Subpart F - Audit Requirements. An electronic copy of all audits (2 CFR 200 Subpart F, as well as independent auditors) performed against federal funding should be forwarded to the Department for review.

Site Visits and Surveys:

1. As requested, the grantee/sub-grantee/sub-recipient shall participate fully in the MDH <Enter Department Here> Quality Improvement and Technical Assistance activities, which may include, but are not limited to:

a. Comprehensive site visits at the Department’s request within the project period;

b. Interviews of staff, review of fiscal and program records, monitoring, risk assessment, review of inventory purchased against federal funding, interviews with administrators, and observation of program activities/facility.

Equipment Inventory Requirements:

Equipment purchased with federal funds may be recalled or requested to support local, regional and/or statewide emergency response efforts and must be catalogued for future reference and review. Cataloging of equipment should be updated and maintained throughout the project period.

Risk Assessment:

The grantee/sub-grantee/sub-recipient shall be required to participate in an MDH Risk Assessment in accordance with Federal OMB 2 CFR §200.205 (b) thru (d), §200.207, and §200.331 (b) thru (h). As part of this requirement, sub- recipients will be monitored based on a risk level of High, Medium or Low. Each risk level imposes certain monitoring requirements set by the MDH Office of the Inspector General in accordance with the above federal guidelines.

ATTACHMENT B

FEDERAL FUNDS

A Summary of Certain Federal Fund Requirements and Restrictions [Details of particular laws, which may levy a penalty for noncompliance, are available from the Maryland Department of Health.]

1. Form and rule enclosed: 18 U.S.C. 1913 and section 1352 of P.L. 101-121 require that all prospective and present subgrantees (this includes all levels of funding) who receive more than $100,000 in federal funds must submit the form “Certification Against Lobbying”. It assures, generally, that recipients will not lobby federal entities with federal funds, and that, as is required, they will disclose other lobbying on form SF- LLL.

2. Form and instructions enclosed: “Form LLL, Disclosure of Lobbying Activities” must be submitted by those receiving more than $100,000 in federal funds, to disclose any lobbying of federal entities (a) with profits from federal contracts or (b) funded with nonfederal funds.

3. Form and summary of Act enclosed: Sub-recipients of federal funds on any level must complete a “Certification Regarding Environmental Tobacco Smoke,” required by Public Law 103-227, the Pro-Children Act of 1994. Such law prohibits smoking in any portion of any indoor facility owned or leased or contracted for regular provision of health, day care, early childhood development, and education or library services for children under the age of 18. Such language must be included in the conditions of award (they are included in the certification, which may be part of such conditions.) This does not apply to those solely receiving Medicaid or Medicare, or facilities where WIC coupons are redeemed.

4. In addition, federal law requires that:

a) OMB 2 CFR 200, Subpart F, Audit Requirements requires that grantees (both recipients and sub-recipients) which expend a total of $750,000 or more in federal assistance shall have a single or program-specific audit conducted for that year in accordance with the provisions of the Single Audit Act of 1984, P.L.

98-502, and the Single Audit Act Amendments of 1996, P.L. 104-156. and the Office of Management and Budget (OBM) 2 CFR 200, Subpart F.

b) All sub-recipients of federal funds comply with Sections 503 and 504 of the Rehabilitation Act of 1973, the conditions of which are summarized in item (C).

c) Recipients of $10,000 or more (on any level) must include in their contract language the requirements of Sections 503 (language specified) and 504 referenced in item (B).

Section 503 of the Rehabilitation Act of 1973, as amended, requires recipients to take affirmative action to employ and advance in employment qualified disabled people. An affirmative action program must be prepared and maintained by all contractors with 50 or more employees and one or more federal contracts of $50,000 or more.

This clause must appear in subcontracts of $10,000 or more:

i. The contractor will not discriminate against any employee or applicant for employment because of physical or mental handicap in regard to any position for which the employee or applicant for employment is qualified. The contractor agrees to take affirmative action to employ, advance in employment and otherwise treat qualified handicapped individuals without discrimination based upon their physical or mental handicap in all upgrading, demotion or transfer, recruitment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship.

ii. The contractor agrees to comply with the rules, regulations, and relevant orders of the secretary of labor issued pursuant to the act.

iii. In the event of the contractor’s non-compliance with the requirements of this clause, actions for non-compliance may be taken in accordance with the rules, regulations and relevant orders of the secretary of labor issued pursuant to the act.

iv. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices in a form to be prescribed by the director, provided by or through the contracting office.

Such notices shall state the contractor's obligation under the law to take affirmative action to employ and advance in employment qualified handicapped employees and applicants for employment, and the rights of applicants and employees.

v. The contractor will notify each labor union or representative of workers with which it has a collective bargaining agreement or other contract understanding, that the contractor is bound by the terms of Section 503 of the Rehabilitation Act of 1973, and is committed to take affirmative action to employ and advance in employment physically and mentally handicapped individuals.

vi. The contractor will include the provisions of this clause in every subcontract or purchase order of $10,000 or more unless exempted by rules, regulations, or orders of the [federal] secretary issued pursuant to section 503 of the Act, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the director of the Office of Federal Contract Compliance Programs may direct to enforce such provisions, including action for non-compliance.

Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. Sec. 791 et seq.) prohibits discrimination on the basis of handicap in all federally assisted programs and activities. It requires the analysis and making of any changes needed in three general areas of operation-programs, activities, and facilities and employment. It states, among other things, that:

Grantees that provide health...services should undertake tasks such as ensuring emergency treatment for the hearing impaired and making certain that persons with impaired sensory or speaking skills are not denied effective notice with regard to benefits, services, and waivers of rights or consents to treatments.

D) All sub-recipients comply with Title VI of the Civil Rights Act of 1964 that they must not discriminate in participation by race, color, or national origin.

E) All sub-recipients of federal funds from SAMHSA (Substance Abuse and Mental Health Services Administration), NIH (National Institute of Health), CDC (Center for Disease Control and Prevention), and HHS (Health and Human Services) are prohibited from paying any direct salary at a rate of Executive Level II or more than $189,600 per year. (This includes, but is not limited to, sub-recipients of the Substance Abuse Prevention and Treatment and the Community Mental Health Block Grants and NIH research grants, Public Health and Emergency Preparedness and Hospital Preparedness Program Cooperative Agreements.)

F) There may be no discrimination on the basis of age, according to the requirements of the Age Discrimination Act of 1975.

G) For any education program, as required by Title IX of the Education Amendments of 1972, there may be no discrimination on the basis of sex.

H) For research projects, a form for Protection of Human Subjects (Assurance/Certification/Declaration) should be completed by each level funded, assuring that either: (1) there are no human subjects involved, or that (2) an Institutional Review Board (IRB) has given its formal approval before human subjects are involved in research.