Agenda Item - 2023-09-05 - Number 6.1 - Resolution 23-38, Intergovernmental Agreement with the Clackamas County Health, Housing, and Human Services Department's Social Services Division 6.1
COUNCIL REPORT
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Subject: Resolution 23-38, Accepting the 2023-2024 Intergovernmental Subrecipient Grant
Agreement with Clackamas County Social Services Division.
Meeting Date: September 5, 2023 Staff Member: Maria Bigelow, Manager
Report Date: August 22, 2023 Department: Parks & Rec—Adult Community Center
Action Required Advisory Board/Commission Recommendation
❑ Motion ❑ Approval
❑ Public Hearing ❑ Denial
❑ Ordinance ❑ None Forwarded
❑X Resolution ❑X Not Applicable
❑ Information Only Comments:
❑ Council Direction
❑X Consent Agenda
Staff Recommendation: Adopt Resolution 23-38, Authorizing the City Manager to sign the
2023-2024 intergovernmental subrecipient grant agreement with Clackamas County Social
Services Division, to allow for reimbursement to the City for services provided.
Recommended Language for Motion: Move to adopt Resolution 23-38.
Project/ Issue Relates To: Funding Lake Oswego Adult Community Center social services
Issue before Council (Highlight Policy Question):
❑Council Goals/Priorities ❑Adopted Master Plan(s) ❑X Not Applicable
Respect. Excellence. Trust. Sevice.
503-635-0215 380 A AVENUE PO BOX 369 LAKE OSWEGO, OR 97034 WWW.LAKEOSWEGO.CITY
Page 2
BACKGROUND
The 2023-24 grant agreement with Clackamas County Social Services describes the scope of
services, compensation, manner of performance, general conditions and various service
agreements for services delivered by the Lake Oswego Adult Community Center.The County's
grant funds are from the Older Americans Act. Services include information and reassurance,
case management, transportation and nutrition.
This is a cost reimbursement grant and disbursements will be made in accordance with the
requirements contained in the agreement on page 20 of 46, Budget and Units of Services and
page 22 of 46, Reporting Requirements.
DISCUSSION
This 2023-24 agreement provides a grant budget at $132,170 for the cost of services through
June 30, 2024.
Resolution 23-38 authorizes the City Manager to sign the agreement for FY 2023-24
intergovernmental subrecipient grant agreement with Clackamas County, for $132,170, for
ongoing delivery of services for FY 2023-24, and thereby allowing the Lake Oswego Adult
Community Center to submit documentation for reimbursement of those additional funds for
social services.
FISCAL IMPACT
The FY 2023-24 maximum, not to exceed, grant amount that Clackamas County will pay is
$132,170, which would allow for reimbursement to the City for costs for service.
RECOMMENDATION
Adopt Resolution 23-38.
ATTACHMENTS
1. Resolution 23-38, with Exhibit A Clackamas County Subrecipient Grant Agreement
— Respect. Excellence. Trust. Sevice.
503-635-0215 380 A AVENUE PO BOX 369 LAKE OSWEGO,OR 97034 WWW.LAKEOSWEGO.CITY
ATTACHMENT 1
RESOLUTION 23-38
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF LAKE OSWEGO AUTHORIZING THE CITY
MANAGER TO EXECUTE AN INTERGOVERNMENTAL AGREEMENT WITH THE CLACKAMAS
COUNTY HEALTH, HOUSING, AND HUMAN SERVICES DEPARTMENT'S SOCIAL SERVICES
DIVISION FOR FISCAL YEAR 2023-2024.
WHEREAS, there is a need to provide social services to the residents of Lake Oswego; and
WHEREAS, Clackamas County has the funding available to provide social services to the
community in Lake Oswego through the Older Americans Act; and
WHEREAS, the City and Clackamas County have previously entered into intergovernmental
agreements whereby the City has provided social services;
NOW THEREFORE, BE IT RESOLVED, that: by the City Council of the City of Lake Oswego that
the City Manager is authorized to execute on behalf of the City of Lake Oswego an
intergovernmental agreement with Clackamas County Health, Housing and Human Services,
Social Services Division for fiscal year 2023/2024, substantially in the form attached as Exhibit
A.
This resolution shall be effective upon its adoption by the City Council.
Approved and adopted by the City Council of the City of Lake Oswego at a regular meeting held
on the 5th day of September 2023.
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[Signatures on Next Page]
Resolution 23-38
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Considered and enacted at the regular meeting of the City Council of the City of Lake Oswego on
the 5th day of September, 2023.
AYES:
NOES:
EXCUSED:
ABSTAIN:
Joseph M. Buck, Mayor
ATTEST:
Kari Linder, City Recorder
APPROVED AS TO FORM:
Ellen Osoinach, City Attorney
Resolution 23-38
Page 2 of 2
EXHIBIT A
CLACKAMAS COUNTY, OREGON
SUBRECIPIENT GRANT AGREEMENT 24-006
Project Name: Older Americans Act
Project Number: multiple
This Agreement is between Clackamas County, Oregon, acting by and through its
Health Housing & Human Services Department, Social Services Division—Area Agency on Aging,
("COUNTY"), and City of Lake Oswego("SUBRECIPIENT"), acting by and through its Lake Oswego Adult
Community Center,a Municipal Corporation.
Clackamas County Data
Grant Accountant: Kara Taylor Program Manager: Tonia Hunt
Clackamas County—Finance Clackamas County—Social Services Division
2051 Kaen Road 2051 Kaen Road
Oregon City, OR 97045 Oregon City, OR 97045
(503)742-5430 503-655-8330
KTaylor@clackamas.us THunt@clackamas.us
Subrecipient Data
Finance/Fiscal Representative: Program Representative:
Maria Bigelow, Center Manager Same
PO Box 369, 505 G Avenue
Lake Oswego, OR 97034
503-635-0215
mbigelow@ci.oswego.or.us
UEI: YJJFCP3HM9L6
RECITALS
1. Clackamas County's fastest growing population segment is adults aged 60 years and older. The
goal of Aging and Disability Services within Clackamas County Social Services is to provide
services, supports, and information that allow older adults (and in some cases depending on
program guidelines, younger persons with disabilities)to live independently in the community of
their choosing.
2. SUBRECIPIENT has provided nutrition, transportation, wellness, recreation and information
support to Lake Oswego's older adult community since 1970. SUBRECIPIENT was identified as
the exclusive qualified provider for older adult services in the Lake Oswego area through a 2023
Request for Qualifications process.
3. This project is a cooperative effort by SUBRECIPIENT and COUNTY in providing the Area
Agency on Aging's designated services of nutrition services, outreach, assessment, information
and assistance, case management, reassurance, transportation, and health promotion for
Clackamas County residents aged 60 and older.
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NOW THEREFORE, according to the terms of this Subrecipient Grant Agreement (this "Agreement")the
COUNTY and SUBRECIPIENT agree as follows:
AGREEMENT
1. Term and Effective Date. This Agreement shall become effective on the date it is fully executed and
will terminate on June 30, 2027, unless sooner terminated or extended pursuant to the terms hereof.
Eligible expenses for this Agreement may be charged during the period beginning July 1, 2023 and
expiring June 30, 2027, subject to additional restrictions set forth below and to the exhibits attached
hereto, and unless this Agreement is sooner terminated or extended pursuant to the terms hereof. No
grant funds are available for expenditures after the expiration date of this Agreement.
2. Program. The Program is described in the attached Exhibit A: Subrecipient Statement of Program
Objectives & Performance Reporting. SUBRECIPIENT agrees to carry out the Program in
accordance with the terms and conditions of this Agreement and according to SUBRECIPIENT scope
of work in Exhibit A.
3. Standards of Performance. SUBRECIPIENT shall perform all activities and programs in
accordance with the requirements set forth in this Agreement and all applicable laws and regulations.
Furthermore, SUBRECIPIENT shall perform all activities and programs in accordance with the
requirements of the Older Americans Act, 42 U.S.C. § 3001 et. seq., and 45 CFR 1321 (collectively
"OAA")that are the source of the grant funding and other required information in Exhibits A- I, which
are attached to and made a part of this Agreement by this reference. SUBRECIPIENT shall further
comply with any and all terms, conditions, and other obligations as may be required by the applicable
local, State or Federal agencies providing funding for performance under this Agreement, whether or
not specifically referenced herein. SUBRECIPIENT agrees to take all necessary steps, and execute
and deliver any and all necessary written instruments, to perform under this Agreement including, but
not limited to, executing all additional documentation necessary to comply with applicable State and
Federal funding requirements.
4. Grant Funds. COUNTY's funding for this Agreement is a combination of Federal, State and Local
dollars as specified below by title and Assistance Listing Number("ALN") number as appropriate.
The maximum, not to exceed, grant amount COUNTY will pay for one year is $132,170. Payments
will be made on a reimbursement basis in accordance with the rates set forth in Exhibit B, and the
award is conditional upon compliance with the terms herein and disbursements will be made in
accordance with the schedule and requirements contained in Exhibit D: Reimbursement Request.
Failure to comply with the terms of this Agreement may result in withholding of payment.
4.1.Grant Funds: COUNTY's funding of$116,150 in grant funds for this Agreement is the Older
Americans Act (ALN: 93.043, 93.044, 93.052, 93.053) issued to COUNTY by the State of
Oregon, Department of Human Services ("ODHS"), Adults and People with Disabilities ("APD"),
Community Services & Solutions Unit("CSSU").
4.2.Grant Funds: COUNTY's funding of$16,020 for transportation services outlined in this
agreement are from Elderly and Disabled Transportation funds issued to COUNTY by Ride
Connection, Inc. and TriMet;
5. Amendments. The terms of this Agreement shall not be waived, altered, modified, supplemented, or
amended, in any manner whatsoever, except by written instrument signed by both parties.
SUBRECIPIENT must submit a written request including a justification for any amendment to
COUNTY in writing at least forty five (45) calendar days before this Agreement expires. No
payment will be made for any services performed before the beginning date or after the expiration
date of this Agreement. If the maximum compensation amount is increased by amendment, the
amendment must be fully executed before SUBRECIPIENT performs work subject to the amendment.
6. Termination. This Agreement may be suspended or terminated prior to the expiration of its term or
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with 30 days' notice from either party by:
a. At COUNTY's discretion, upon thirty (30) days' advance written notice to SUBRECIPIENT;
b. Written notice provided by COUNTY resulting from material failure by SUBRECIPIENT to
comply with any term of this Agreement, or;
c. Mutual agreement by COUNTY and SUBRECIPIENT.
d. Written notice provided by COUNTY that ODHS has determined funds are no longer available
for this purpose; or
e. Written notice provided by COUNTY that it lacks sufficient funds, as determined by COUNTY
in its sole discretion, to continue to perform under this Agreement.
Upon completion of improvements or upon termination of this Agreement, any unexpended
balances shall remain with COUNTY.
7. Effect of Termination. The expiration or termination of this Agreement, for any reason, shall not
release SUBRECIPIENT from any obligation or liability to COUNTY, or any requirement or obligation
that:
a. Has already accrued hereunder;
b. Comes into effect due to the expiration or termination of the Agreement; or
c. Otherwise survives the expiration or termination of this Agreement.
Following the termination of this Agreement, SUBRECIPIENT shall promptly identify all unexpended
funds and return all unexpended funds to COUNTY. Unexpended funds are those funds received by
SUBRECIPIENT under this Agreement that (i) have not been spent or expended in accordance with
the terms of this Agreement; and (ii) are not required to pay allowable costs or expenses that will
become due and payable as a result of the termination of this Agreement.
8. Funds Available and Authorized. COUNTY certifies that it has received an award sufficient to fund
this Agreement. SUBRECIPIENT understands and agrees that payment of amounts under this
Agreement is contingent on COUNTY receiving appropriations or other expenditure authority
sufficient to allow COUNTY, in the exercise of its sole administrative discretion, to continue to make
payments under this Agreement.
9. Future Support. COUNTY makes no commitment of future support and assumes no obligation for
future support for the activity contracted herein except as set forth in Section 8.
10. Federal and State Procurement Standards
a) All procurement transactions, whether negotiated or competitively bid and without regard to dollar
value, shall be conducted in a manner so as to provide maximum open and free competition. All
sole-source procurements must receive prior written approval from COUNTY in addition to any
other approvals required by law applicable to SUBRECIPIENT. Justification for sole-source
procurement should include a description of the project and what is being contracted for, an
explanation of why it is necessary to contract noncompetitively, time constraints and any other
pertinent information. Interagency agreements between units of government are excluded from
this provision.
b) COUNTY's performance under the Agreement is conditioned upon SUBRECIPIENT's compliance
with, and SUBRECIPIENT shall comply with, the obligations applicable to public contracts under
the Oregon Public Contracting Code and applicable Local Contract Review Board rules, which
are incorporated by reference herein.
c) SUBRECIPIENT must maintain written standards of conduct covering conflicts of interest and
governing the performance of its employees engaged in the selection, award and administration
of contracts. If SUBRECIPIENT has a parent, affiliate, or subsidiary organization that is not a
state, local government, or Indian tribe, SUBRECIPIENT must also maintain written standards of
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conduct covering organizational conflicts of interest. SUBRECIPIENT shall be alert to
organizational conflicts of interest or non-competitive practices among contractors that may
restrict or eliminate competition or otherwise restrain trade. Contractors that develop or draft
specifications, requirements, statements of work, and/or Requests for Proposals ("RFP")for a
proposed procurement must be excluded by SUBRECIPIENT from bidding or submitting a
proposal to compete for the award of such procurement. Any request for exemption must be
submitted in writing to COUNTY.
d) Contracting with Small and Minority Businesses, Women's Business Enterprises, and
Labor Surplus Area Firms. SUBRECIPIENT shall take all necessary affirmative steps to assure
that small & minority businesses, women's business enterprises, and labor surplus area firms are
used when possible when contracting for services or soliciting for potential resources, per 2 CFR
200.321.
11. General Agreement Provisions.
a) Non-appropriation Clause. If payment for activities and programs under this Agreement
extends into COUNTY's next fiscal year, COUNTY's obligation to pay for such work is subject to
approval of future appropriations to fund the Agreement by the Board of County Commissioners.
b) Indemnification.
SUBRECIPIENT agrees to indemnify, defend, and hold COUNTY, and its elected officials,
officers, employees, and agents, harmless with respect to any claim, cause, damage, action,
penalty or other cost (including attorney's and expert fees)arising from or related to (1)
SUBRECIPIENT's negligent or willful acts or those of its employees, agents, or those under
SUBRECIPIENT's control; or(2) SUBRECIPIENT's acts or omissions in performing under this
Agreement including, but not limited to, any claim by State or Federal funding sources that
SUBRECIPIENT used funds for an ineligible purpose. SUBRECIPIENT is responsible for the
actions of its own agents and employees, and COUNTY assumes no liability or responsibility with
respect to SUBRECIPIENT's actions, employees, agents or otherwise with respect to those under
its control.
SUBRECIPIENT agrees to indemnify, defend, and hold the State of Oregon and its officers,
employees and agents, harmless with respect to any claim, cause, damage, action, penalty or
other cost(including attorney's and expert fees) arising from or related to (1) SUBRECIPIENT's
negligent or willful acts or those of its employees, agents, or those under SUBRECIPIENT's
control; or(2) SUBRECIPIENT's acts or omissions in performing under this Agreement including,
but not limited to, any claim SUBRECIPIENT used funds for an ineligible purpose.
Ride Connection/Tri-Met funds: To the fullest extent permitted by law, SUBRECIPIENT agrees to
fully indemnify, hold harmless and defend Ride Connection, Inc. ("Ride Connection") its directors,
officers, employees and agents, Tri Met, its officers employees and agents, and the State of
Oregon, its officers, employees and agents, from and against all claims, suits, actions of
whatsoever nature, damages or losses, and all expenses and costs incidental to the investigation
and defense thereof including reasonable attorney's fees resulting from or arising out of the
activities of SUBRECIPIENT, its officers, directors, employees, agents, subcontractors and
volunteers under this Agreement.
Non-Medical rides for Medicaid clients funds: SUBRECIPIENT shall defend, save, hold harmless,
and indemnify the State of Oregon, Human Services Division and their officers, agents, and
employees from and against all claims, suits, actions, losses, damages, liabilities, costs and
expenses of any nature whatsoever resulting from, arising out of, or relating to the activities of
SUBRECIPIENT or its officers, employees, subcontractors, or agents, in performance of this
Agreement.
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c) Assignment. This Agreement may not be assigned in whole or in part without the prior express
written approval of COUNTY.
d) Independent Status. SUBRECIPIENT is independent of COUNTY and will be responsible for
any federal, state, or local taxes and fees applicable to payments hereunder. SUBRECIPIENT is
not an agent of COUNTY and undertakes this work independent from the control and direction of
COUNTY excepting as set forth herein. SUBRECIPIENT shall not seek or have the power to bind
COUNTY in any transaction or activity.
e) Notices. Any notice provided for under this Agreement shall be effective if in writing and (1)
delivered personally to the addressee or deposited in the United States mail, postage paid,
certified mail, return receipt requested, (2)sent by overnight or commercial air courier(such as
Federal Express), (3) sent by electronic mail with confirming record of delivery confirmation
through electronic mail return-receipt, or by confirmation that the electronic mail was accessed,
downloaded, or printed. Notice will be deemed to have been adequately given three days
following the date of mailing, or immediately if personally served. For service by facsimile or by
electronic mail, service will be deemed effective at the beginning of the next working day.
f) Governing Law. This Agreement is made in the State of Oregon, and shall be governed by and
construed in accordance with the laws of that state without giving effect to the conflict of law
provisions thereof. Any litigation between COUNTY and SUBRECIPIENT arising under this
Agreement or out of work performed under this Agreement shall occur, if in the state courts, in the
Clackamas County court having jurisdiction thereof, and if in the federal courts, in the United
States District Court for the State of Oregon.
g) Severability. If any provision of this Agreement is found to be illegal or unenforceable, this
Agreement nevertheless shall remain in full force and effect and the provision shall be stricken.
h) Counterparts. This Agreement may be executed in any number of counterparts, all of which
together will constitute one and the same Agreement. Facsimile copy or electronic signatures
shall be valid as original signatures.
i) Third Party Beneficiaries. Except as expressly provided in this Agreement, there are no third
party beneficiaries to this Agreement. The terms and conditions of this Agreement may only be
enforced by the parties.
j) Binding Effect. This Agreement shall be binding on all parties hereto, their heirs, administrators,
executors, successors and assigns.
k) Integration. This Agreement contains the entire Agreement between COUNTY and
SUBRECIPIENT and supersedes all prior written or oral discussions or Agreements.
I) No Attorney Fees. In the event any arbitration, action or proceeding, including any bankruptcy
proceeding, is instituted to enforce any term of this Agreement, each party shall be responsible
for its own attorneys'fees and expenses.
m) Debt Limitation. This Agreement is expressly subject to the limitations of the Oregon
Constitution and Oregon Tort Claims Act and is contingent upon appropriation of funds. Any
provisions herein that conflict with the above referenced laws are deemed inoperative to that
extent.
12. Exhibits and Attachments.
This document is comprised of the following exhibits and attachments:
• Exhibits A-1 &A-2: SUBRECIPIENT Scope(s)of Work& Performance Reporting
• Exhibit B: SUBRECIPIENT Program Budget
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• Exhibit C: Lobbying Certificate
• Exhibit D: Required Reporting and Payment Request
• Exhibit E: General Administrative and Federal Terms and Conditions
• Exhibit F: SUBRECIPIENT Insurance Requirements
• Exhibit G: Final Financial Report
• Exhibit H-1 to H-5: 2 CFR 200.332(a) Required Information
• Exhibit I: Business Associate Agreement
• Exhibit J: Provider Application Recertification
In the event of a conflict between the terms of any exhibits to this Agreement, interpretations shall be
based on the following order of precedence:
• This Agreement
• Exhibit I
• Exhibit E
• Exhibit C
• Exhibit F
• Exhibits A-1 &A-2
• Exhibit D
• Exhibit B
• Exhibits H-1 to H-5
• Exhibit J
• Exhibit G
(Signature Page Follows)
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SIGNATURE PAGE TO SUBRECIPIENT GRANT AGREEMENT
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their duly
authorized officers.
CLACKAMAS COUNTY City of Lake Oswego
By: By:
Its: Its:
Dated: Dated:
Approved to Form
By:
County Counsel
Dated:
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EXHIBIT A-1
SUBRECIPIENT SCOPE OF WORK AND PERFORMANCE REPORTING
PROGRAM NAME: AGREEMENT No. 24-006
Older Americans Act
SUBRECIPIENT: City of Lake Oswego — Lake Oswego Adult Community Center
1. PURPOSE OF THE SERVICES
The purpose of this Agreement is the cooperation of both parties in providing the Area Agency on
Aging's designated services of nutrition services, outreach, assessment, information and assistance,
case management, reassurance,transportation, health promotion and legal consultation for Clackamas
County residents aged 60 and older ("Work"). The goal in providing these services is to assist older
residents in meeting their individual needs by linking them with County resources.
2. DESCRIPTION OF SERVICES
SUBRECIPIENT will provide the following Work:
a. Case Management: Is an in-depth interview with a client to provide access to an array of
service options to assure appropriate levels of service and to maximize coordination in the
service delivery system. Case management must include four general components: access,
assessment, service implementation, and monitoring:
i. Access &Assessments:
(1) Informing clients of available services and, where appropriate, developing a goal-
oriented service plan.
(2) Utilize an approved County-wide standardized assessment/intake form.
(3) Assessment is re-done with a change in client life situation/condition - every six to
twelve months.
(4) May be billed upon submission of assessment/intake form.
(5) Double billing for Case Management Assessments and Home Delivered Meal
Assessments is not allowed.
ii. Service Implementation & Monitoring:
(1) Provide early identification of current or potential problem areas.
(2) Assess the need for changes/improvements in service.
(3) Identify any gaps/unmet needs.
(4) Review intervention results to determine if what was done achieved the desired
result.
(5) Determine if services should be discontinued.
(6) Case monitoring services are available to frail but mobile elderly as well as
homebound individuals.
b. Reassurance: Regular friendly telephone calls and/or visits to physically, geographically or
socially isolated registered clients that are receiving services to determine if they are safe and
well, if they require assistance, and to provide reassurance. A unit is one contact.
c. Information &Assistance: Consists of request for assistance locating resources to meet a
specific need, or assistance prioritizing and locating resources to meet multiple needs.
Inquiries require:
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i. Informal assessment of the client's needs.
ii. Evaluation of appropriate resources.
iii. Assistance linking the client to the resources.
iv. Completion of an intake form to document background information on the client, the
client's needs and what actions or referrals were made.
v. Follow up with the client or agency to see if the needs were met.
vi. Documenting any unmet needs including recording the request, resources tried and the
reason unable to help.
d. Public Outreach/Education: Is a service or activity to provide information to groups of
current or potential clients and/or aging network partners and other community partners
regarding available services for the elderly.
e. Transportation: Is the service that provides one-way rides for older persons and younger
persons with disabilities. The goal is to ensure that transportation needs are met for those
who are unable to meet their transportation needs independently. OAA-funded rides are
scheduled for persons who are aged 60 and older for trips to medical appointments, clinics,
personal business and to senior center activities. Ride Connection and COUNTY STIF-
funded rides are scheduled for individuals aged 60 and older and for persons with disabilities
age 18 and over for medical appointments, personal business, shopping, nutrition and
recreation activities.
i. Lake Oswego Adult Community Center Transportation Consortium Goals:
(1) Increase replacement reserve fund with separate accounting.
(2) Ensure all drivers meet Ride Connection training and eligibility requirements as
defined in the Operations Manual for Transportation Coordinators.
(3) Continue regular publicity/marketing efforts regarding transportation program.
(4) Continue to explore ways to increase ridership, including contact with long term care
facilities in the area.
(5) Attend all scheduled Transportation Consortium meetings.
ii. Guidelines for Non-Medical Transportation for Waivered Medicaid Clients
(1) This funding source is available for Medicaid clients who are receiving "waivered"
services. Medicaid clients with a case manager who reside in all types of living
situations except nursing facilities are waivered Medicaid clients.
All rides must be authorized in writing on a NON MEDICAL RIDE REFERRAL FORM
FOR WAIVERED MEDICAID CLIENT form by an Aging and Disability Services case
manager before reimbursement may be requested for them. SUBRECIPIENT must
keep the client ride authorizations on file—faxed forms are adequate. Case Managers
will authorize rides yearly, at a minimum and will note the need for non-medical
transportation in the client's signed case plan. COUNTY will coordinate completion and
distribution of forms for SUBRECIPIENT and case managers through the
Transportation Reaching People ("TRP") program.
(2) Services shall be billed by SUBRECIPIENT according to the following rate scale:
One-person, one-way ride: $17.00 per ride
(3) Clients receiving the rides will not be asked or expected to contribute to the cost of
the ride.
(4) Trips will be tracked daily by client and type of ride. This information will be sent
monthly to COUNTY and be available for State and Federal representatives for audit
purposes.
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(5) Medical rides are not allowed under this funding.
iii. SUBRECIPIENT will be responsible for:
(1) recruitment of volunteer and/or paid drivers who will qualify for insurance coverage or
who are willing to provide proof of coverage as drivers and maintaining an adequate
number of qualified volunteer and/or paid drivers to provide services.
(2) orientation of drivers to the transportation program and informing them of other
specialized training opportunities required to maintain safety of operations.
(3) submission of criminal record check requests on all potential drivers and receiving
satisfactory reports back prior to scheduling them to transport any client.
(4) drug and alcohol testing on all potential paid drivers prior to hiring them is
recommended for all drivers of Center-owned mini vans and buses, including
volunteers.
f. Food Service: Is the production of meals for the congregate and home delivered meal
recipients of SUBRECIPIENT. Each meal must contain at least one-third of the
Recommended Dietary Allowance ("RDA") as established by the Food and Nutrition Board,
National Research Council - National Academy of Science. A unit is one meal prepared and
served, delivered, or a home delivered meal ("HDM") "late-cancel."
g. Meal Site Management: Meal Site Management includes such tasks as: supervising final
on-site preparation and serving/delivery of meals to eligible congregate and home-delivered
participants; recruiting, training, scheduling and monitoring program volunteers; determining
eligibility of participants; collecting and accounting for participant donations; completing and
submitting required budget and program reports, providing events and activities for meal site
participants; meeting with meal site Advisory Committee; and publicizing meal site in the local
community to enhance visibility and encourage participation. One unit is one meal served.
h. OAA HDM Assessment: a means of determining a homebound older person's eligibility for
home-delivered meals per the Oregon Nutrition Service Program standards.
i. Evidence-based Health &Wellness Program —The provision of Evidence-based Health &
Wellness Programs that either focus on strength, balance, and flexibility exercise to promote
physical activity and/or prevent falls or focus on disease self-management/stress
management. Any program under this service must be demonstrated to be evidence-based
and effective with older populations.
j. Caregiver Respite—Services that offer temporary, substitute supports or living
arrangements for care recipients in order to provide a brief period of relief or rest for unpaid
caregivers served under the Family Caregiver Support Program. To be eligible for caregiver
respite, the care recipient must either: (1) be unable to perform at least two activities of daily
living (ADL's)without substantial human assistance, including verbal reminding, physical
cueing OR (2)due to a cognitive or other mental impairment, require substantial supervision
because the individual behaves in a manner that poses a serious health or safety hazard to
the individual or another individual.
3. SERVICE OBJECTIVES
a. Case Management
Objective: To provide contracted units of service throughout the contract period for County
residents aged 60 and older who are identified as needing assistance from County agencies.
Elements:
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i. SUBRECIPIENT Client Services Coordinator("CSC") assesses clients within two weeks
following their request for services or referral from another source (outreach effort,
gatekeeper, neighbor, family member, etc.).
ii. SUBRECIPIENT CSC completes assessment on a COUNTY-approved
assessment/intake form.
iii. SUBRECIPIENT CSC writes case plan, as appropriate, for the client from the
information gathered on the assessment form.
iv. SUBRECIPIENT CSC re-assesses clients' service needs/eligibility every six months or
when their condition or life situation dramatically changes.
v. SUBRECIPIENT CSC reviews client case plans quarterly, at a minimum, and provides
follow up contact by phone or home visits.
vi. SUBRECIPIENT CSC (upon request from client, other agency or family member)
provides additional follow up to coordinate services.
vii. SUBRECIPIENT CSC consults with SPD Case Manager(if client has one)to maximize
coordination of services. Consultations will be annotated on Case Monitoring forms
within 2 work days.
viii. SUBRECIPIENT CSC documents all reviews and additional follow ups on case
monitoring contact forms which are kept in client record file.
ix. SUBRECIPIENT CSC keeps all client information in a secured area, accessible to only
authorized personnel.
b. Reassurance
Objective: To provide contracted units of service throughout the contract period for County
residents aged 60 and older who are registered clients and identified as needing assistance
from County agencies.
Elements:
i. SUBRECIPIENT CSC assesses clients and provides follow up contact by phone to
ensure that services outlined under case plan are meeting clients need.
ii. SUBRECIPIENT CSC documents all reviews and additional follow ups on case
monitoring contact forms which are kept in client record file.
iii. SUBRECIPIENT CSC keeps all client information in a secured area, accessible to only
authorized personnel.
c. Information and Assistance -COUNTY Responsibilities
Objective: To provide participating SUBRECIPIENT with training, technical assistance, resource
development, networking and information sharing. Elements:
i. COUNTY will provide orientation on COUNTY's Information & Referral program to
SUBRECIPIENT Information &Assistance staff.
ii. COUNTY will notify SUBRECIPIENT's I &A Specialist of"Networking" I & R Breakfast
Meetings and schedule speakers to meet interests expressed by SUBRECIPIENT.
d. Information and Assistance -SUBRECIPIENT Responsibilities
Objective 1: Have a system in place which enables SUBRECIPIENT to provide referral services
to link people with needs to the appropriate resources. Elements:
i. SUBRECIPIENT will designate a single individual (paid or volunteer)who is at least 0.5
FTE with SUBRECIPIENT as an I &A Specialist.
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ii. SUBRECIPIENT will notify COUNTY I &A Coordinator and Contract Specialist within 30
days of any change in SUBRECIPIENT's designated I &A Specialist and will schedule
an on-site training with COUNTY I &A Coordinator for the new designee within 60 days
of appointment.
iii. SUBRECIPIENT's I &A Specialist will attend a minimum of 3 bi-Monthly County
"Networking" l&R meetings each year and attend Scheduled CSC meetings.
iv. SUBRECIPIENT's I &A Specialist will update center information for the COUNTY's
Community Resources Guide, initiate notification to COUNTY's l&R program regarding
any changes to SUBRECIPIENT programs and notify COUNTY's 's l&R program of any
significant changes in local community resources.
Objective 2: To provide contracted units of service throughout the contract period for County
residents aged 60 and older who need help identifying resources to meet their individual needs.
Elements:
i. SUBRECIPIENT Director or CSC annotates name, Medicaid status, address, phone
number, date of request, and nature of request/need.
ii. SUBRECIPIENT makes referral and follows up with client within a 2-day work period.
iii. SUBRECIPIENT annotates follow up taken and number of referrals needed on Referral
Log.
iv. SUBRECIPIENT keeps completed Referral Logs in a secured area, accessible to only
authorized personnel.
e. Public Outreach/Education
Objective: To provide information to groups of current or potential clients and community partners
about available services for Lake Oswego area residents aged 60 and older. Elements:
i. SUBRECIPIENT schedules and makes presentations to local groups throughout the
contract year.
ii. SUBRECIPIENT keeps a record of information given to groups such as:
(1) outline of presentation
(2) copies of flyers, brochures, etc. distributed
(3) names and number of people in group presented to
f. Transportation
Objective: To provide contracted units of service throughout the contract period for County
residents aged 60 and older, and to younger persons with disabilities who are unable to
meet their transportation needs. Elements:
i. SUBRECIPIENT designates one person to be coordinator for the transportation
program. This person will be responsible for:
(1) Recruiting drivers.
(2) Submitting criminal background checks.
(3) Ensuring all drivers meet Ride Connection training requirements.
(4) Scheduling road tests for all drivers.
(5) Conducting periodic/seasonal driver safety training.
(6) Providing a copy of written procedures for transportation services to each driver.
(7) Scheduling vehicle maintenance.
(8) Maintain daily Pre- and Post-trip Reports.
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ii. SUBRECIPIENT provides transportation as scheduled each day.
iii. SUBRECIPIENT maintains system to document each trip of each day.
g. Food Service
Objective 1: To produce contracted number of second entrée option for congregate dinners
throughout the contract period.
Elements:
a. SUBRECIPIENT submits each month's menu to COUNTY's contracted Registered Dietitian
("RD") by the first day of the preceding month unlike a like item is being substituted. "Like
for Like" replacements of food items do not require RD approval. Menus must meet the
following standards:
i. Each meal must contain at least 1/3 of the Dietary Reference Intakes (DRI)as
established by the Food and Nutrition Board, National Research Council - National
Academy of Science, for Male 70+ or Female 70+, whichever is greater. (Milk is
part of Site Management.) Nutrition providers are strongly encouraged to use
computerized nutrient analysis to assure meals are in compliance with nutritional
requirements.
ii. The cycle for the cycle menu system must be at least nine weeks long.
iii. A Registered Dietitian (RD) must review and sign the menus to certify that they
meet the one-third recommended daily intake. They should also incorporate the
whole grains, fruits, vegetables and low-fat dairy products that meet the current
Dietary Guidelines for Americans; specifically persons 70 years of age and older.
iv. Menus should reflect the tastes and appetites of the current elderly population.
v. Menus should incorporate a variety of foods and preparation methods with contrasts
in color, texture, sizes, shapes, and flavors. Food items should not be repeated two
days in a row, or on same day of consecutive weeks. Menus should reflect
seasonal availability of fresh fruits and vegetables.
vi. All items must be specifically identified in the menu. Listing such things as "Fruit in
Season", "Vegetable" or"Cookie" does not provide enough information. Each menu
item should be easily identified by its name.
vii. A special meal should be planned for major holidays, such as Thanksgiving and
Christmas. These meal dates will be coordinated with meal site staff. A special
food and/or meal planned for lesser holidays, such as Valentine's Day and Mother's
Day would also be encouraged.
viii. Menus should be served as written and approved. If changes are necessary, they
must be of comparable nutrient value. Each change is to be recorded on the
working and/or file copy of the menu and initialed and dated by a supervisor.
Updated menu must be posted for meal participant's information.
Objective 2: To provide Special Diet Meals to meet participants' needs. Menus shall be planned
and meals available for the modified diets listed below:
Elements:
i. Uncalculated Diabetic. Eliminates items high in sugar by substituting products or recipes
that use artificial sweeteners. The carbohydrate content of the meal should represent
approximately 50% of the total calories.
H. Moderate Sodium Restricted. Eliminates menu items or foods that are naturally high in
sodium (not to exceed 1.2 grams per meal).
iii. Low Cholesterol. Eliminates menu items or foods that are naturally high in cholesterol
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and/or fat(not to exceed 100 mg per meal).
Objective 3: To use standardized recipes and portion control.
Elements:
i. Recipes used by SUBRECIPIENT should be adapted to the requirements of a Title III
Senior Nutrition meal.
ii. Recipes should be standardized for the kitchen, equipment, ingredients, and skills of
personnel using them.
iii. Recipes should be adjusted for yield based on portion size and the number of people being
served that particular meal.
iv. Food service employees must understand and be able to use standardized recipes and
produce standard portions.
Objective 4: To procure food from sources that comply with all federal, state and local laws that
relate to food production, manufacturing, packaging and labeling. Donated food that meets the
above standards may be used.
Objective 5: To comply with all federal, state and local laws and regulations pertaining to sanitation
requirements and practices in food production, storage, transportation, and service.
Elements:
i. A sanitation inspection by a Registered Sanitarian from the State Health Division or local
health department is required every six months.
ii. A copy of each inspection report is to be mailed to County within five working days of
receipt, along with a written plan (including timelines)of any required corrective action.
iii. Subrecipient must establish and use sanitary procedures for packaging and transporting
food from kitchen for home delivered meals. This will include procedures for maintaining
proper temperatures and cleaning and sanitizing all transport equipment.
iv. Food temperatures shall be taken and recorded as the food is panned to leave the
production area for transport. Records of these temperature checks shall be maintained
in the Subrecipient's files.
v. Oregon Nutrition Program Standards and Oregon Administrative Rules, Chapter 333,
Food Sanitation Rules must be followed.
Objective 6: To employ qualified, trained personnel to assure satisfactory performance.
Elements:
i. SUBRECIPIENT must have at least one employee in the kitchen who has completed a
community college-level food service sanitation course.
ii. SUBRECIPIENT must have a new employee orientation.
iii. SUBRECIPIENT must have a training plan that includes training for employees and
supervisory staff.
iv. SUBRECIPIENT must ensure all staff and volunteers successfully pass a criminal
background check.
h. Meal Site Management
Objective 1: To supervise preparation of meals, serving meals to congregate participants, and
delivery of meals to home delivered clients.
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Elements:
i. Procurement of milk is part of meal site management.
H. Packaging of home delivered meals is part of site management.
Objective 2: To organize and supervise the recruiting, training, scheduling and monitoring of
program volunteers.
Objective 3: To determine eligibility of congregate participants and target services to individuals
who are in the greatest economic or social need, with particular attention to low-income minority
individuals.
Elements:
i. Economic need is defined as income equal to, or less than, the poverty level as
determined by the Department of Commerce.
ii. Persons with social need are those persons who have at least two of the following
characteristics:
(1) be 75 years or older
(2) live alone
(3) have a physical or mental impairment which prevents proper functioning within
society
(4) be of a minority group
(5) have no significant other(s)
Objective 4: To offer a range of events and activities to enhance daily living efforts of older people
or to provide opportunity for their participation in community life.
Elements:
i. SUBRECIPIENT plans educational presentations in areas such as nutrition, health,
safety, utilization of community services and programs, and other topics of interest to
participants.
ii. SUBRECIPIENT provides opportunities to promote personal growth and self-image.
iii. SUBRECIPIENT provides opportunities for a variety of types and levels of involvement.
(1) Small and large group activities.
(2) Active and spectator participation.
(3) Participation with the general community and other generations.
iv. SUBRECIPIENT plans activities which are flexible and responsive to change in:
(1) Individual participant needs and interests.
(2) Characteristics of the service area's older population.
(3) Other programs in the relevant service area.
Objective 5: To inform the community about the meal site program.
Elements:
i. SUBRECIPIENT publicizes programs in local newspapers, flyers, brochures, posters,
fraternal organizational meetings, etc.
ii. SUBRECIPIENT ensures Center is identified by an easily visible sign at its entrance.
iii. SUBRECIPIENT posts monthly menus in an obvious position in the Center and delivers
them to home-bound clients each month.
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iv. SUBRECIPIENT mails or delivers calendar of upcoming Center activities to current and
potential participants.
Objective 6: To plan for provision of services in cooperation with site Advisory Committee and
Area Agency on Aging ("AAA")Adult Center Liaison Committee.
Elements:
i. SUBRECIPIENT identifies needs and concerns specific to the Center and service area
participants.
ii. SUBRECIPIENT incorporates information from other service providers, community
agencies, and governmental organizations in providing services.
iii. SUBRECIPIENT conducts program participant satisfaction survey at least once per year.
iv. SUBRECIPIENT food service manager meets quarterly with COUNTY nutrition
consultant to go over status of meal program files, plans, goals, accountings, etc.
Objective 7: To collect, account for and report program income (participant donations).
Elements:
i. SUBRECIPIENT provides each participant (congregate and home delivered)with an
opportunity to voluntarily contribute to the cost of the service.
ii. SUBRECIPIENT sets up container for donations at meal site which ensures and protects
the privacy of the participants.
iii. SUBRECIPIENT has system set up at site to collect full meal price from persons not
eligible for services.
iv. SUBRECIPIENT posts:
(1) full cost of the meal, and
(2) a notice describing the donation and payment policies.
v. SUBRECIPIENT may post suggested donation information if it is clear that:
(1) every donation from an eligible participant is on a "pay what you can afford"
basis, and
(2) no means test is used in the collection of contributions or provision of the meal.
i. OAA HDM Assessment
Objective:
Elements:
Determine eligibility of homebound older adults and target services to individuals who are in
the greatest economic or social need, with particular attention to low-income minority
individuals.
i. Conduct an in-person assessment of homebound older adult's nutritional needs.
ii. Evaluates the recipient's strengths and limitations with regards to meeting their
nutritional needs and activities of daily living.
iii. Review other means of realistically obtaining consistent and adequate meals such as
shopping assistance, assistance from friends/family, attending congregate meals
should be explored.
j. Evidence-based Health &Wellness Program
Objective: To provide contracted units of service throughout the contract period.
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Elements:
i. SUBRECIPIENT regularly schedules classes that meet the evidenced-based
requirements and either include a focus on strength, balance, and flexibility to promote
physical activity and/or prevent falls or on disease self-management/stress
management.
ii. SUBRECIPIENT registers participants for activities, obtaining a waiver to injury for each
participant if necessary.
iii. SUBRECIPIENT has physical condition of clients assessed before setting up plan for
workouts with equipment.
j. Caregiver Respite—
Objective: To provide contracted units of service for family members of eligible under the Family
Caregiver Support Program.
Elements:
Agency respite program coordinator(RPC) interviews care providers to determine
appropriateness of clients to program.
ii. Agency RPC registers clients in program.
iii. Agency staff, led by an RN, provide weekly activity program for respite clients.
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EXHIBIT A-2
Transportation Provider Standards
A. Vehicle Standards
1. SUBRECIPIENT shall maintain its vehicles to provide comfortable and safe rides to clients.
SUBRECIPIENT's vehicles shall meet the following requirements:
a. The interior of the vehicle shall be clean;
b. SUBRECIPIENT shall not smoke or permit smoking in the vehicle;
c. SUBRECIPIENT shall maintain appropriate safety equipment in the vehicle, including but
not limited to:
i. First Aid Kit;
ii. Fire Extinguisher;
iii. Roadside reflective or warning devices;
iv. Flashlight;
v. Chains or other traction devices (when appropriate); and,
vi. Disposable gloves.
d. SUBRECIPIENT shall maintain the vehicle in good operating condition, by providing the
following:
i. Seatbelts;
ii. Side and rear view mirrors;
iii. Horn; and,
iv. Working turn signals, headlights, taillights, and windshield wipers.
2. SUBRECIPIENT shall maintain a preventative maintenance schedule, which incorporates, at a
minimum, all maintenance recommended by the vehicle manufacturer. SUBRECIPIENT shall
comply with appropriate local, state, and federal transportation safety standards regarding
passenger safety and comfort. SUBRECIPIENT shall provide all equipment necessary to transport
Clients using wheelchairs.
B. Drivers
1. SUBRECIPIENT shall inform drivers of their job duties and responsibilities and provide training
related to their job duties. SUBRECIPIENT shall also:
a. Brief drivers about the Non-Medical Transportation Services, reporting forms, vehicle
operation, and the geographic area in which drivers will be providing service;
b. Ensure that drivers are capable of safely operating vehicles;
c. Require drivers to complete the National Safety Council Defensive Driving course, or an
equivalent course, within six months of date of hire;
d. Require drivers to complete Red Cross approved First Aid, Cardiopulmonary
Resuscitation and blood spill procedures within six months of date of hire prior to
providing Medicaid Non-medical transportation services to Clients;
e. Require drivers to complete passenger assistance training, as required by the
Americans with Disabilities Act; and,
f. Establish procedures for drivers to deal with situations in which emergency care is
needed for Clients that they have been assigned to transport.
2. SUBRECIPIENT's selection of its drivers shall include:
a. Verification that the driver has an appropriate and valid, unrestricted State of
Oregon driver's license as defined in ORS Chapter 807 and OAR Chapter 735, Division
062; and,
b. Verification that the driver has not been convicted of any crimes against people or any
drug or alcohol related offenses. If a Provider desires an exception to this requirement,
such exception shall be made only with the approval of COUNTY and shall be dependent
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upon when the crime occurred, nature of the offense, and other circumstances to assure
Clients is not placed at risk of harm from the driver.
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EXHIBIT B
SUBRECIPIENT Program Budget
PROGRAM NAME: AGREEMENT No. 24-006
Older Americans Act
SUBRECIPIENT: City of Lake Oswego - Lake Oswego Adult Community Center
LAKE OSWEGO ADULT COMMUNITY CENTER
Fiscal Year 2023-24
Estimated
Funding Category AL Max.Total Required program Services No.of Reimb.
_Funding Type Number Award Match* Income Units Rate
Case Management 90 $ 40.00
Reassurance 100 $ 20.00
Client Services OAA IIIB 93.044 $ 9,750 $ 1,083 NA
Info&Assistance 200 $ 20.00
Outreach 3 $ 50.00
OAA Meal Site Management 20,000 $ 1.55
OAA C1&C2 93.045 $ 79,800 $ 8,867 Food Service 20,000 $ 2.35
Nutrition
Services $ 6,600 HDM Assessment 90 $ 20.00
NSIP 93.053 $ 14,000 NA Food Service 20,000 $ 0.70
Health Evidence-Based Health&
OAA IIID 93.043 $ 1,000 NA NA NA NA
Promotion Wellness Programs
Family Caregiver Support
Respite OAA IIIE 93.052 $ 11,600 $ 3,867 NA 290 $ 40.00
Program Respite
Transp. TriMet GF NA $ 16,020 NA $ 178 Rides within the TriMet Service 1,780 $ 9.00
Services Area
Total Maximum Award $ 132,170 Federal Award Total: $ 116,150
'"Source of OAA Match-Staff time
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EXHIBIT C — LOBBYING CERTIFICATE
CERTIFICATION REGARtDING LOBBYING
Certification for Contracts, Grants,Loans, and Cooperative Agreements
The undersigned certifies,to the best of his or her knowledge and belief,that:
1. No Federal appropriated funds have been paid or will be paid by or on the behalf of the
undersigned,to any person for influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal contract,the making of any
Federal grant,the making of any Federal loan,the entering into of any cooperative agreement, and
the extension, contribution,renewal, amendment, or modification of any Federal contract, grant,
loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of
Congress,an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal 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 sub-awards at all tiers(including subcontracts, sub-grants, and contracts under
grants,loans, and cooperative agreements) and that all sub-recipients 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 Title 31 U.S.C. §1352. Any person who fails to file the required certification shall
be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure.
Please do not alter this form; any questions regarding the form should be directed to EFSP staff.
City of Lake Oswego
Representative Name
Representative Signature Date(month/day/year)
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EXHIBIT D
REQUIRED REPORTING AND PAYMENT REQUEST
1. INVOICES
SUBRECIPIENT shall submit invoices in a format designated or approved by COUNTY. Invoices are
due by the 10th calendar day of the subsequent month. COUNTY shall make payment to
SUBRECIPIENT within 21 days of receipt of each invoice submitted.
Invoices and reports on units of service provided shall bear SUBRECIPIENT's name and address and
be signed by an authorized representative of SUBRECIPIENT. The authorized signer of the invoice
shall verify that the services billed have been performed.
SUBRECIPIENT shall submit the following invoices and reports:
a. Financial summary including match and program income.
b. Vehicle Maintenance Invoices for vehicle maintenance will be entered into Ride Connection
database as outline in Exhibit A-1 Section 3 and noted on monthly transportation reports
submitted to COUNTY.
c. Additional financial reports for the administration of this contract, as required by COUNTY.
Withholding of Contract Payments: Notwithstanding any other payment provision of this agreement,
should SUBRECIPIENT fail to submit reports when due, or submit reports which appear patently
inaccurate or inadequate on their face, or fail to perform or document the performance of contracted
services, COUNTY shall immediately withhold payments hereunder. Such withholding of payment for
cause may continue until SUBRECIPIENT submits required reports, performs required services, or
establishes to COUNTY's satisfaction that such failure arose out of causes beyond the control, and
without the fault or negligence of SUBRECIPIENT.
SUBRECIPIENT shall return to COUNTY all funds which were expended in violation of this contract.
2. PROGRAM ACTIVITY REPORTS
SUBRECIPIENT shall submit monthly program activity reports presenting data comparing actual levels
of service to the planned levels specified in Exhibit 6 Budget& Units of Service. These reports are due
with the invoices. The format of these reports shall be designated or approved by COUNTY, and
contain the following:
a. SUBRECIPIENT shall submit nutrition reports monthly. These reports shall have:
i. the over and under aged 60 meal program participation numbers broken out by:
Congregate, HDM, Medicaid, volunteers, guests and staff.
ii. the amount of participant donations by Congregate and HDM.
b. SUBRECIPIENT may bill Food Services for OAA funded HDM if they have been ordered by
recipients then cancelled after 2:00 PM the day before delivery. SUBRECIPIENT may not bill
for Meal Site Management for these meals.
c. Monthly NAPIS/GetCare information for client registration and program service data including
client identifiers for all new clients. Programs service data must be equal to or greater than
units of service billed.
d. Master Transportation Report form.
e. List of Medicaid waivered services clients who were provided non-medical transportation
during the billing period, with number of rides provided for each client by ride type.
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f. SUBRECIPIENT shall submit copies of the SPD Medicaid Home Delivered Meals vouchers
on current State approved form.
3.AUDIT/MONITORING
SUBRECIPIENT shall permit authorized representatives of COUNTY and other applicable audit
agencies of the state or federal government,to review the records of SUBRECIPIENT in order to satisfy
program audit and evaluation purposes deemed necessary by COUNTY and permitted under law.
SUBRECIPIENT agrees to participate with COUNTY in any evaluation project or performance report,
as designated by COUNTY or applicable state or federal SUBRECIPIENT, and to make available all
information required by any such evaluation process.
COUNTY agrees to notify SUBRECIPIENT in writing of intent to conduct onsite evaluation of reported
performance management data and SUBRECIPIENT agrees to provide COUNTY access to its facility
and staff, all related programs and fiscal documents, SUBRECIPIENT'S reports and any other related
documentation to substantiate performance management data reports.
4.ADMINISTRATION
COUNTY Project Manager shall be the ADS Contract Specialist or any other person as shall be
designated in writing by the Director of the Social Services Division. The Project Manager is authorized
to approve invoices, make site inspections, and be COUNTY representative in matters related to this
contract. SUBRECIPIENT shall designate one or more representatives in writing who shall be
authorized to sign the invoices and accompanying activity reports.
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EXHIBIT E
General Administrative and Federal Terms & Conditions
1. Federal Funds
a) This Agreement is funded in part by federal funds. By signing this Agreement, SUBRECIPIENT
certifies neither it nor its employees, contractors, subcontractors, or subrecipients who will
perform the Program activities described herein are currently employed by an agency or
department of the federal government.
b) COUNTY has determined:
❑x Entity is a subrecipient ❑ Entity is a contractor ❑ Not applicable
c) Assistance Listing Number(s) of federal funds paid through this Agreement: 93.044; 93.045;
93.053; 93.043; 20.513, 93.778.
2. Administrative Requirements. SUBRECIPIENT agrees to its status as a subrecipient, and
accepts among its duties and responsibilities the following:
a) Financial Management. SUBRECIPIENT shall comply with 2 CFR Part 200, Subpart D—Post
Federal Award Requirements, and agrees to adhere to the accounting principles and procedures
required therein, use adequate internal controls, and maintain necessary sources documentation
for all costs incurred.
b) Revenue Accounting. Grant revenue and expenses generated under this Agreement should be
recorded in compliance with generally accepted accounting principles and/or governmental
accounting standards. This requires that the revenues are treated as unearned income or
"deferred" until the compliance requirements and objectives of the grant have been
met. Revenue may be recognized throughout the life cycle of the grant as the funds are
"earned." All grant revenues not fully earned and expended in compliance with the requirements
and objectives at the end of the period of performance must be returned to COUNTY within 15
days.
c) Change in Key Personnel. SUBRECIPIENT is required to notify COUNTY, in writing, whenever
there is a change in SUBRECIPIENT key administrative or programmatic personnel and the
reason for the change. Key personnel include but are not limited to: Executive Director, Finance
Director, Program Manager, Bookkeeper, or any equivalent to these positions within the
organization.
d) Cost Principles. SUBRECIPIENT shall administer the award in conformity with 2 CFR 200,
Subpart E. These cost principles must be applied for all costs incurred whether charged on a
direct or indirect basis. Costs disallowed by the Federal government shall be the liability of the
SUBRECIPIENT.
e) Period of Availability. SUBRECIPIENT may charge to the award only allowable costs resulting
from obligations incurred during the funding period.
f) Match. SUBRECIPIENT is required to provide match in the amounts specified in Exhibit B:
Budget.
g) Budget. SUBRECIPIENT use of funds may not exceed the amounts specified in the Exhibit B:
Subrecipient Program Budget. At no time may budget modification change the scope of the
original grant application or Agreement.
h) Indirect Cost Recovery. Indirect cost recovery is statutorily unavailable for this award.
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i) Payment. SUBRECIPIENT must submit a final request for payment no later than fifteen (15)
days after the end date of this Agreement. Routine requests for reimbursement should be
submitted as specified in Exhibit D: Reimbursement Request.
j) Performance Reporting. SUBRECIPIENT shall comply with reporting requirements as
specified in Exhibit A.
k) Financial Reporting. Methods and procedures for payment shall minimize the time elapsing
between the transfer of funds and disbursement by the grantee or SUBRECIPIENT, in
accordance with Treasurer regulations at 31 CFR Part 205. Therefore, upon execution of this
Agreement, SUBRECIPIENT will submit completed Exhibit D: Reimbursement Request on a
monthly basis.
I) Closeout. COUNTY will closeout this award when COUNTY determines that all applicable
administrative actions and all required work have been completed by SUBRECIPIENT, pursuant
to 2 CFR 200.344—Closeout. SUBRECIPIENT must liquidate all obligations incurred under this
award and must submit all financial, performance, and other reports as required by the terms
and conditions of the Federal award and/or COUNTY, no later than 90 calendar days after the
end date of this Agreement.
m) Unique Entity Identifier and Contractor Status. SUBRECIPIENT shall register and maintain
an active registration in the Central Contractor Registration database using its Unique Entity
Identifier("UEI"), located at http://www.sam.gov.
n) Suspension and Debarment. SUBRECIPIENT shall comply with 2 CFR Part 180. These rules
restrict subawards and contracts with certain parties that are debarred, suspended or otherwise
excluded from or ineligible for participation in Federal assistance programs or activities.
SUBRECIPIENT is responsible for further requiring the inclusion of a similar term or condition in
any subsequent lower tier covered transactions. SUBRECIPIENT may access the Excluded
Parties List System at http://www.sam.gov. The Excluded Parties List System contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Orders 12549 and
12689. Awards that exceed the simplified acquisition threshold shall provide the required
certification regarding their exclusion status and that of their principals prior to award.
o) Lobbying. SUBRECIPIENT certifies (Exhibit C: Lobbying)that no portion of the Federal grant
funds will be used to engage in lobbying of the Federal Government or in litigation against the
United States unless authorized under existing law and shall abide by 2 CFR 200.450 and the
Byrd Anti-Lobbying Amendment 31 U.S.C. 1352. In addition, the SUBRECIPIENT certifies that it
is a nonprofit organization described in Section 501(c) (3) of the Code, but does not and will not
engage in lobbying activities as defined in Section 3 of the Lobbying Disclosure Act.
p) Audit. SUBRECIPIENT shall comply with the audit requirements prescribed in the Single Audit
Act Amendments and the new Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards, located in 2 CFR 200.501. SUBRECIPIENT expenditures of
$750,000 or more in Federal funds require an annual Single Audit. SUBRECIPIENT is required
to hire an independent auditor qualified to perform a Single Audit. Subrecipients of Federal
awards are required under the Uniform Guidance to submit their audits to the Federal Audit
Clearinghouse ("FAC")within 9 months from SUBRECIPIENT's fiscal year end or 30 days after
issuance of the reports, whichever is sooner. The website for submissions to the FAC is
https://harvester.census.gov/facweb/. At the time of submission to the FAC, SUBRECIPIENT will
also submit a copy of the audit to COUNTY. If requested and if SUBRECIPIENT does not meet
the threshold for the Single Audit requirement, SUBRECIPIENT shall submit to COUNTY a
financial audit or independent review of financial statements within 9 months from
SUBRECIPIENT's fiscal year end or 30 days after issuance of the reports, whichever is sooner.
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q) Monitoring. SUBRECIPIENT agrees to allow COUNTY access to conduct site visits and
inspections of financial records for the purpose of monitoring in accordance with 2 CFR 200.332.
COUNTY, the Federal government, and their duly authorized representatives shall have access
to such financial records and other books, documents, papers, plans, records of shipments and
payments and writings of SUBRECIPIENT that are pertinent to this Agreement, whether in
paper, electronic or other form, to perform examinations and audits and make excerpts and
transcripts. Monitoring may be performed onsite or offsite, at COUNTY's discretion. Depending
on the outcomes of the financial monitoring processes, this Agreement shall either a)continue
pursuant to the original terms, b) continue pursuant to the original terms and any additional
conditions or remediation deemed appropriate by COUNTY, or c) be de-obligated and
terminated.
r) Record Retention. SUBRECIPIENT will retain and keep accessible all such financial records,
books, documents, papers, plans, records of shipments and payments and writings for a
minimum of six (6)years from the end of program date, or such longer period as may be
required by the Federal agency or applicable state law, following final payment and termination
of this Agreement, or until the conclusion of any audit, controversy or litigation arising out of or
related to this Agreement, whichever date is later, according to 2 CFR 200.334-338.
s) Certification of Compliance with Grant Documents. SUBRECIPIENT acknowledges that it
has read the award conditions and certifications for[Federal program name], that it understands
and accepts those conditions and certifications, and that it agrees to comply with all the
obligations, and be bound by any limitations applicable to the Clackamas County, as COUNTY,
under those grant documents.
t) Failure to Comply. SUBRECIPIENT acknowledges and agrees that this Agreement and the
terms and conditions therein are essential terms in allowing the relationship between COUNTY
and SUBRECIPIENT to continue, and that failure to comply with such terms and conditions
represents a material breach of the original grant and this Agreement. Such material breach
shall give rise to COUNTY's right, but not obligation, to withhold SUBRECIPIENT grant funds
until compliance is met, reclaim grant funds in the case of omissions or misrepresentations in
financial or programmatic reporting, require repayment of any funds used by SUBRECIPIENT in
violation of this Agreement, to terminate this Agreement, and to pursue any right or remedy
available to COUNTY at law, in equity, or under this Agreement.
u) HIPAA Compliance. SUBRECIPIENT shall comply with the Health Insurance Portability and
Accountability Act of 1996 and its implementing regulations ("HIPAA"), which include the
Standards for the Privacy of Individually Identifiable Health Information (the"Privacy Rule"), the
Standards for Electronic Transactions, and the Security Rule (45 C.F.R. Parts 160-64), and the
Privacy provisions (Subtitle D) of the Health Information Technology for Economic and Clinical
Health Act and its implementing regulations (the "HITECH Act") (collectively, and as amended
from time to time, the "HIPAA Rules"), together with the regulations governing disclosure of
substance use disorder information under 42 C.F.R. Part 2. SUBRECIPIENT shall further
execute the Business Associate Agreement [or Qualified Service Organization Business
Associate Agreement] attached hereto as Exhibit L and incorporated by this reference herein.
3. Compliance with Applicable Laws
a) Public Policy. SUBRECIPIENT expressly agrees to comply with all public policy requirements,
laws, regulations, and executive orders issued by the Federal government, to the extent they are
applicable to the Agreement: (i)Titles VI and VII of the Civil Rights Act of 1964, as amended; (ii)
Sections 503 and 504 of the Rehabilitation Act of 1973, as amended; (iii)the Americans with
Disabilities Act of 1990, as amended; (iv) Executive Order 11246, "Equal Employment
Opportunity" as amended; (v)the Health Insurance Portability and Accountability Act of 1996; (vi)
the Age Discrimination in Employment Act of 1967, as amended, and the Age Discrimination Act
of 1975, as amended; (vii)the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as
amended; (viii) all regulations and administrative rules established pursuant to the foregoing laws;
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and (ix) all other applicable requirements of federal and state civil rights and rehabilitation
statutes, rules and regulations; and 2 CFR Part 200 as applicable to SUBRECIPIENT.
b) Rights to Inventions Made Under a Contract or Agreement. SUBRECIPIENT agrees that
contracts or agreements for the performance of experimental, developmental, or research work
shall provide for the rights of the Federal Government and the recipient in any resulting invention
in accordance with 37 CFR part 401, "Rights to Inventions Made by Nonprofit Organizations and
Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and
any further implementing regulations issued by the U.S. Treasury Department.
c) Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act as
amended (33 U.S.C. 1251 et seq.). SUBRECIPIENT agrees that if this Agreement is in excess
of$150,000, the recipient agrees to comply with all applicable standards, orders or regulations
issued pursuant to the Clean Air Act, 42 U.S.C. 7401 et seq., and the Federal Water Pollution
Control Act, as amended 33 U.S.C. 1251 et seq. Violations shall be reported to the awarding
Federal Department and the appropriate Regional Office of the Environmental Protection Agency.
d) State Statutes. SUBRECIPIENT expressly agrees to comply with all statutory requirements,
laws, rules, and regulations issued by the State of Oregon, to the extent they are applicable to
this Agreement.
e) Conflict Resolution. If potential, actual or perceived conflicts are discovered among federal,
state and local statutes, regulations, administrative rules, executive orders, ordinances or other
laws applicable to the Services under the Agreement, SUBRECIPIENT may in writing request
COUNTY to resolve the conflict. SUBRECIPIENT shall specify if the conflict(s) create a problem
for the design or other Services required under the Agreement. COUNTY shall undertake
reasonable efforts to resolve the issue but is not required to deliver any specific answer or
product. SUBRECIPIENT shall remain obligated to independently comply with all applicable laws
and no action by COUNTY shall be deemed a guarantee, waiver, or indemnity for non-
compliance with any law.
f) Disclosure of Information.Any confidential or personally identifiable information (2 CFR 200.1)
acquired by SUBRECIPIENT during the execution of the project should not be disclosed during or
upon termination or expiration of this Agreement for any reason or purpose without the prior
written consent of COUNTY. SUBRECIPIENT further agrees to take reasonable measures to
safeguard such information (including those set forth in 2 CFR 200.303(e)) and to follow all
applicable federal, state and local regulations regarding privacy and obligations of confidentiality.
g) Mileage reimbursement. If mileage reimbursement is authorized in SUBRECIPIENT budget or
by the written approval of COUNTY, mileage must be paid at the rate established by
SUBRECIPIENT's written policies covering all organizational mileage reimbursement or at the
IRS mileage rate at the time of travel, whichever is lowest.
h) Human Trafficking. In accordance with 2 CFR Part 175, SUBRECIPIENT, its employees,
contractors and subrecipients under this Agreement and their respective employees may not:
• Engage in severe forms of trafficking in persons during the period of the time the award is in
effect;
• Procure a commercial sex act during the period of time the award is in effect; or
• Used forced labor in the performance of the Agreement or subaward under this Agreement.
SUBRECIPIENT must inform COUNTY immediately of any information SUBRECIPIENT receives
from any source alleging a violation of any of the above prohibitions in the terms of this
Agreement. COUNTY may terminate this Agreement, without penalty, for violation of these
provisions. COUNTY's right to terminate this Agreement unilaterally, without penalty, is in addition
to all other remedies under this Agreement. SUBRECIPIENT must include these requirements in
any subaward made to public or private entities under this Agreement.
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EXHIBIT F
SUBRECIPIENT INSURANCE REQUIREMENTS
During the term of this Agreement, SUBRECIPIENT shall maintain in force, at its own expense, each
insurance noted below:
1) Workers' Compensation. Insurance in compliance with ORS 656.017, which requires all employers
that employ subject workers, as defined in ORS 656.027, to provide workers' compensation coverage
for those workers, unless they meet the requirement for an exemption under ORS 656.126(2). If
contractor is a subject employer, as defined in ORS 656.023, contractor shall obtain employers'
liability insurance coverage limits of not less than $1,000,000.
2) Commercial General Liability.
❑x Required by COUNTY ❑ NOT Required by COUNTY
SUBRECIPIENT shall obtain, at SUBRECIPIENT's expense, and keep in effect during the term of this
Agreement, Commercial General Liability Insurance covering bodily injury and property damage on
an "occurrence"form in the amount of not less than $4,000,000 per occurrence/$4,000,000 general
aggregate for the protection of COUNTY, its officers, elected officials, and employees. This coverage
shall include Contractual Liability insurance for the indemnity provided under this Agreement. This
policy(s) shall be primary insurance as respects to the COUNTY. Any insurance or self-insurance
maintained by COUNTY shall be excess and shall not contribute to it.
3) Commercial Automobile Liability.
Z Required by COUNTY ❑ NOT Required by COUNTY
Automobile Liability Insurance covering SUBRECIPIENT's business use including coverage for all
owned, non-owned, or hired vehicles with a combined single limit of not less than $4,000,000.00 for
bodily injury and property damage. This coverage may be written in combination with the Commercial
General Liability Insurance (with separate limits for Commercial General Liability and Automobile
Liability). Use of personal automobile liability insurance coverage may be acceptable if evidence that
the policy includes a business use endorsement is provided to COUNTY.
4) Professional Liability.
❑ Required by COUNTY NOT Required by COUNTY
SUBRECIPIENT shall obtain and furnish COUNTY evidence of Professional Liability Insurance in the
amount of not less than $1,000,000 combined single limit per occurrence/$2,000,000 general annual
aggregate for malpractice or errors and omissions coverage for the protection of COUNTY, its
officers, elected officials and employees against liability for damages because of personal injury,
bodily injury, death, or damage to property, including loss of use thereof, and damages because of
negligent acts, errors and omissions in any way related to this Agreement. COUNTY, at its option,
may require a complete copy of the above policy.
5) Abuse and Molestation Clause.
❑ Required by COUNTY ❑x NOT Required by COUNTY
As part of the Commercial General Liability policy, SUBRECIPIENT shall obtain Abuse and
Molestation coverage in a form and with coverage satisfactory to COUNTY covering damages arising
out of actual or threatened physical abuse, mental injury, sexual molestation, negligent hiring,
employment, supervision, investigation, reporting to proper authorities, and retention of any person
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for whom SUBRECIPIENT is responsible including but not limited to SUBRECIPIENT and
SUBRECIPIENT's employees and volunteers. Policy endorsement's definition of an insured shall
include SUBRECIPIENT, and SUBRECIPENT's employees and volunteer. Coverage shall be written
on an occurrence basis in an amount of not less than $1,000,000 per occurrence. Any annual
aggregate limit shall not be less than $3,000,000.
6) Additional Insured Provisions. All required insurance, other than Professional Liability, Workers'
Compensation, and Personal Automobile Liability and Pollution Liability Insurance, shall include
"Clackamas County, its agents, elected officials, officers, and employees" as an additional insured.
(a) Required by State of Oregon for OAA funded services and non-medical rides for Medicaid
clients— Insurance must provide that the State of Oregon, Department of Human Services, and
its divisions, officers and employees are Additional Insured but only with respect to the
transportation services funded under Agreement between the State of Oregon and Clackamas
County Social Services.
(b) Required for Ride Connection/Tri-Met Transportation Funding—the insurance shall:
(i) include Ride Connection and Tri-Met and its directors, officers, representatives,
agents, and employees as additional insured with respect to work or operations
connected with providing transportation;
(ii)give Ride Connection and Tri-Met not less than thirty (30) days-notice prior to
termination or cancellation of coverage; and
(iii) include an endorsement providing that the insurance is primary insurance and that no
insurance that may be provided by Ride Connection or Tri-Met may be called in to
contribute to payment for a loss.
7) Notice of Cancellation. There shall be no cancellation, material change, exhaustion of aggregate
limits or intent not to renew insurance coverage without 60 days written notice to COUNTY. Any
failure to comply with this provision will not affect the insurance coverage provided to COUNTY. The
60 days' notice of cancellation provision shall be physically endorsed on to the policy.
8) Insurance Carrier Rating. Coverage provided by SUBRECIPIENT must be underwritten by an
insurance company deemed acceptable by COUNTY. Insurance coverage shall be provided by
companies admitted to do business in Oregon or, in the alternative, rated A- or better by Best's
Insurance Rating. COUNTY reserves the right to reject all or any insurance carrier(s)with an
unacceptable financial rating.
9) Certificates of Insurance. As evidence of the insurance coverage required by this Agreement,
SUBRECIPIENT shall furnish a Certificate of Insurance to COUNTY. The COUNTY and its, elected
officials, employees and officers must be named as an additional insured on the Certificate of
Insurance. No Agreement shall be in effect until the required certificates have been received,
approved, and accepted by COUNTY. A renewal certificate will be sent to COUNTY 10 days prior to
coverage expiration.
10) Primary Coverage Clarification. SUBRECIPIENT coverage will be primary in the event of a loss
and will not seek contribution from any insurance or self-insurance maintained by, or provided to, the
additional insureds listed above.
11) Cross-Liability Clause. A cross-liability clause or separation of insured's condition will be included in
all general liability, professional liability, and errors and omissions policies required by the Agreement.
12) Waiver of Subrogation. SUBRECIPIENT agrees to waive their rights of subrogation arising from the
work performed under this Agreement.
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Program Name: Older Americans Act Agreement#: 24-006
Federal Award#: # Date of Submission:XX/XX/XX
Subrecipient: City of Lake Oswego—Lake Oswego Adult Community Center
Has Subrecipient submitted all requests for reimbursement? Y/N
Has Subrecipient met all programmatic closeout requirements? Y/N
Exhibit G: Final Financial Report
Report of Funds received, expended, and reported as match (if applicable) under this Agreement
Total Federal Funds authorized on this agreement:
Total Federal Funds requested for reimbursement on this
agreement:
Total Federal Funds received on this agreement:
Total non-Federal Funds authorized on this agreement:
Agreement-to-Date non-Federal Funds requested for
reimbursement on this agreement:
Total non-Federal Funds received on this agreement:
Total match reported on this agreement(if required):
Balance of unexpended Federal Funds
(Line 1 minus Line 3):
Balance of unexpended non-Federal Funds
(Line 4 minus Line 6):
By signing this report, I certify to the best of my knowledge and belief that the report is true,complete,and accurate,and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the
Federal award. lam aware that any false, fictitious, or fraudulent information, or the omission of any material fact,may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Sections 3729-3730 and 3801-3812).
Subrecipient's Certifying Official (printed):
Subrecipient's Certifying Official (signature):
Subrecipient's Certifying Official's title:
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EXHIBIT H - 1
2 CFR 200.332(a) REQUIRED INFORMATION
Federal award identification
City of Lake Oswego — Lake Oswego Adult
SUBRECIPIENT Name:
Community Center
SUBRECIPIENT Unique Entity Identifier: YJJFCP3HM9L6
Federal Award Identification Number(FAIN): Unavailable
Federal award date: Unavailable
Period of Performance (This Agreement): 7/1/2023—6/30/2027
Budget Period (This Agreement): 7/1/2023—6/30/2024
Total amount of all federal funds from this ALN
$9,750
obligated by this action:
Total amount of all federal funds obligated to
$116,150
SUBRECIPIENT during the current fiscal year:
Amount of federal funds from this FAIN
[x]
committed to SUBRECIPIENT:
Pass-through entity identifying number: NVWKAVB8JND6
Name of pass-through entity: Clackamas County
Contact information for awarding official of the Tonia Hunt
pass-through entity: THunt@clackamas.us
Federal awarding agency: Administration for Community Living
Federal award program name: Older Americans Act
Is Award for Research and Development? No
Assistance Listing Number(ALN) &Title: 93.044 Title III, Part B
SUBRECIPIENT indirect cost rate on this
N/A
Agreement:
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EXHIBIT H - 2
2 CFR 200.332(a) REQUIRED INFORMATION
Federal award identification
City of Lake Oswego — Lake Oswego Adult
SUBRECIPIENT Name:
Community Center
SUBRECIPIENT Unique Entity Identifier: YJJFCP3HM9L6
Federal Award Identification Number(FAIN): Unavailable
Federal award date: Unavailable
Period of Performance (This Agreement): 7/1/2023—6/30/2027
Budget Period (This Agreement): 7/1/2023—6/30/2024
Total amount of all federal funds from this ALN
$116,150
obligated by this action:
Total amount of all federal funds obligated to
$79,800
SUBRECIPIENT during the current fiscal year:
Amount of federal funds from this FAIN
[x]
committed to SUBRECIPIENT:
Pass-through entity identifying number: NVWKAVB8JND6
Name of pass-through entity: Clackamas County
Contact information for awarding official of the Tonia Hunt
pass-through entity: THunt@clackamas.us
Federal awarding agency: Administration for Community Living
Federal award program name: Older Americans Act
Is Award for Research and Development? No
Assistance Listing Number(ALN) &Title: 93.045 Title III, Part C
SUBRECIPIENT indirect cost rate on this
N/A
Agreement:
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EXHIBIT H - 3
2 CFR 200.332(a) REQUIRED INFORMATION
Federal award identification
City of Lake Oswego — Lake Oswego Adult
SUBRECIPIENT Name:
Community Center
SUBRECIPIENT Unique Entity Identifier: YJJFCP3HM9L6
Federal Award Identification Number(FAIN): Unavailable
Federal award date: Unavailable
Period of Performance (This Agreement): 7/1/2023—6/30/2027
Budget Period (This Agreement): 7/1/2023—6/30/2024
Total amount of all federal funds from this ALN
$14,000
obligated by this action:
Total amount of all federal funds obligated to
$116,150
SUBRECIPIENT during the current fiscal year:
Amount of federal funds from this FAIN
[x]
committed to SUBRECIPIENT:
Pass-through entity identifying number: NVWKAVB8JND6
Name of pass-through entity: Clackamas County
Contact information for awarding official of the Tonia Hunt
pass-through entity: THunt@clackamas.us
Federal awarding agency: Administration for Community Living
Federal award program name: Older Americans Act
Is Award for Research and Development? No
Assistance Listing Number(ALN) &Title: 93.053 NSIP
SUBRECIPIENT indirect cost rate on this
N/A
Agreement:
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EXHIBIT H - 4
2 CFR 200.332(a) REQUIRED INFORMATION
Federal award identification
City of Lake Oswego — Lake Oswego Adult
SUBRECIPIENT Name:
Community Center
SUBRECIPIENT Unique Entity Identifier: YJJFCP3HM9L6
Federal Award Identification Number(FAIN): Unavailable
Federal award date: Unavailable
Period of Performance (This Agreement): 7/1/2023—6/30/2027
Budget Period (This Agreement): 7/1/2023—6/30/2024
Total amount of all federal funds from this ALN
$1,000
obligated by this action:
Total amount of all federal funds obligated to
$116,150
SUBRECIPIENT during the current fiscal year:
Amount of federal funds from this FAIN
[x]
committed to SUBRECIPIENT:
Pass-through entity identifying number: NVWKAVB8JND6
Name of pass-through entity: Clackamas County
Contact information for awarding official of the Tonia Hunt
pass-through entity: THunt@clackamas.us
Federal awarding agency: Administration for Community Living
Federal award program name: Older Americans Act
Is Award for Research and Development? No
Assistance Listing Number(ALN) &Title: 93.045 Title III, Part D
SUBRECIPIENT indirect cost rate on this
N/A
Agreement:
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EXHIBIT H - 5
2 CFR 200.332(a) REQUIRED INFORMATION
Federal award identification
City of Lake Oswego — Lake Oswego Adult
SUBRECIPIENT Name:
Community Center
SUBRECIPIENT Unique Entity Identifier: YJJFCP3HM9L6
Federal Award Identification Number(FAIN): Unavailable
Federal award date: Unavailable
Period of Performance (This Agreement): 7/1/2023—6/30/2027
Budget Period (This Agreement): 7/1/2023—6/30/2024
Total amount of all federal funds from this ALN
$8,000
obligated by this action:
Total amount of all federal funds obligated to
$116,150
SUBRECIPIENT during the current fiscal year:
Amount of federal funds from this FAIN
[x]
committed to SUBRECIPIENT:
Pass-through entity identifying number: NVWKAVB8JND6
Name of pass-through entity: Clackamas County
Contact information for awarding official of the Tonia Hunt
pass-through entity: THunt@clackamas.us
Federal awarding agency: Administration for Community Living
Federal award program name: Older Americans Act
Is Award for Research and Development? No
Assistance Listing Number(ALN) &Title: 93.052 Title III, Part E
SUBRECIPIENT indirect cost rate on this
N/A
Agreement:
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EXHIBIT I: BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement is entered into as of 7/1/2023 ("Effective Date") by and between
Clackamas County, on behalf of its Department of Health, Housing and Human Services, Social
Services Division ("Covered Entity") and City of Lake Oswego — Lake Oswego Adult Community
Center("Business Associate") in conformance with the Health Insurance Portability and Accountability Act
of 1996, and its regulations ("HIPAA").
RECITALS
Whereas, the Covered Entity has engaged the services of the Business Associate, as defined under 45
CFR§160.103, for or on behalf of the Covered Entity;
Whereas, the Covered Entity may wish to disclose Individually Identifiable Health Information to the
Business Associate in the performance of services for or on behalf of the Covered Entity as described in a
Services Agreement ("Agreement");
Whereas, such information may be Protected Health Information ("PHI") as defined by the HIPAA Rules
promulgated in accordance with the Administrative Simplification provisions of HIPAA;
Whereas, the Parties agree to establish safeguards for the protection of such information;
Whereas, the Covered Entity and Business Associate desire to enter into this Business Associate
Agreement to address certain requirements under the HIPAA Rules;
Now, Therefore, the parties hereby agree as follows:
SECTION I— DEFINITIONS
1.1 "Breach" is defined as any unauthorized acquisition, access, use or disclosure of Unsecured PHI,
unless the Covered Entity demonstrates that there is a low probability that the PHI has been
compromised. The definition of Breach excludes the following uses and disclosures:
1.1.1 Unintentional access by a Covered Entity or Business Associate in good faith and within
an Workforce member's course and scope of employment or placement;
1.1.2 Inadvertent one time disclosure between Covered Entity or Business Associate Work force
members; and
1.1.3 The Covered Entity or Business Associate has a good faith belief that an unauthorized
person to whom the disclosure was made would not reasonably have been able to retain
the information.
1.2 "Covered Entity"shall have the meaning given to such term under the HIPAA Rules, including, but
not limited to, 45 CFR§160.103.
1.3 "Designated Record Set" shall have the meaning given to such term under the HIPAA Rules,
including, but not limited to 45 CFR§164.501.
1.4 "Effective Date" shall be the Effective Date of this Business Associate Agreement.
1.5 "Electronic Protected Health Information" or"Electronic PHI" shall have the meaning given to such
term at 45 CFR§160.103, limited to information of the Covered Entity that the Business Associate
creates, receives, accesses, maintains or transmits in electronic media on behalf of the Covered
Entity under the terms and conditions of this Business Associate Agreement.
1.6 "Health Care Operations" shall have the meaning given to such term under the HIPAA Rules,
including, but not limited to, 45 CFR §164.501.
1.7 "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules
codified at 45 CFR Part 160 and Part 164.
1.8 "Individual" shall have the meaning given to such term in 45 CFR §160.103 and shall include a
person who qualifies as a personal representative in accordance with 45 CFR §164.502(g).
1.9 "Individually Identifiable Health Information" shall have the meaning given to such term under the
HIPAA Rules, including, but not limited to 45 CFR §160.103.
1.10 "Protected Health Information" or "PHI" means any information, whether oral or recorded in any
form or medium: (i) that relates to the past, present or future physical or mental condition of an
Individual; the provision of health care to an Individual; or the past, present or future payment for
the provision of health care to an Individual; and (ii) that identifies the Individual or with respect to
which there is a reasonable basis to believe the information can be used to identify the Individual,
and shall have the meaning given to such term under the HIPAA Rules, 45 CFR §160.103 and
§164.501.
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1.11 "Protected Information" shall mean PHI provided by the Covered Entity to Business Associate or
created, maintained, transmitted or received by Business Associate on Covered Entity's behalf.
1.12 "Required by Law" shall have the meaning given to such phrase in 45 CFR §164.103.
1.13 "Secretary" shall mean the Secretary of the Department of Health and Human Services or his or
her designee.
1.14 "Security Incident" shall have the meaning given to such phrase in 45 CFR §164.304.
1.15 "Unsecured Protected Health Information" shall mean protected health information that is not
rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a
technology or methodology specified by the Secretary in accordance with 45 CFR§164.402.
1.16 Workforce means employees, volunteers, trainees, and other persons whose conduct, in the
performance of work for a Covered Entity or Business Associate, is under the direct control of such
Covered Entity or Business Associate, whether or not they are paid by the Covered Entity or
Business Associate.
SECTION II—OBLIGATIONS AND ACTIVITIES OF THE BUSINESS ASSOCIATE
The Business Associate agrees to the following:
2.1 Not to use or further disclose PHI other than as permitted or required by this Business Associate
Agreement or as Required by Law;
2.2 To use appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 with respect to
Electronic PHI, to prevent use or disclosure of PHI other than as provided for by this Business
Associate Agreement;
2.3 To mitigate, to the extent practicable, any harmful effect that is known to the Business Associate of
a use or disclosure of PHI by the Business Associate in violation of the requirements of this
Business Associate Agreement;
2.4 To immediately report to the Covered Entity any use or disclosure of PHI not provided for by this
Business Associate Agreement of which it becomes aware, including any Security Incident of which
it becomes aware;
2.5 In accordance with 45 CFR §§164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any
agent, including a subcontractor, that creates, receives, maintains, or transmits PHI on behalf of
the Business Associate agrees in writing to the same restrictions, conditions and requirements that
apply to the Business Associate with respect to such PHI;
2.6 To provide access, at the request of the Covered Entity, and in the time and manner designated by
the Covered Entity, to PHI in a Designated Record Set, to the Covered Entity or, as directed by the
Covered Entity, to the Individual or the Individual's designee as necessary to meet the Covered
Entity's obligations under 45 CFR §164.524; provided, however, that this Section 2.6 is applicable
only to the extent the Designated Record Set is maintained by the Business Associate for the
Covered Entity;
2.7 To make any amendment(s)to PHI in a Designated Record Set that the Covered Entity directs or
agrees to pursuant to 45 CFR §164.526 at the request of the Covered Entity or an Individual, and
in the time and manner designated by the Covered Entity; provided, however, that this Section 2.7
is applicable only to the extent the Designated Record Set is maintained by the Business Associate
for the Covered Entity;
2.8 To make internal practices, books and records, including policies and procedures on PHI, relating
to the use and disclosure of PHI received from, or created or received by the Business Associate
on behalf of, the Covered Entity available to the Covered Entity, or at the request of the Covered
Entity to the Secretary, in a time and manner designated by the Covered Entity or the Secretary,
for purposes of the Secretary's determining the Covered Entity's and the Business Associate's
compliance with the HIPAA Rules;
2.9 To document such disclosures of PHI and information related to such disclosures as would be
required for the Covered Entity to respond to a request by an Individual for an accounting of
disclosures of PHI in accordance with 45 CFR§164.528;
2.10 To provide to the Covered Entity or an Individual, in a time and manner designated by the Covered
Entity, information collected in accordance with Section 2.9 of this Business Associate Agreement,
to permit the Covered Entity to respond to a request by an accounting of disclosures of PHI in
accordance with 45 CFR§164.528;
2.11 That if it creates, receives, maintains, or transmits any Electronic PHI on behalf of the Covered
Entity, it will implement administrative, physical, and technical safeguards that reasonably and
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appropriately protect the confidentiality, integrity, and availability of the Electronic PHI, and it will
ensure that any agents (including subcontractors)to whom it provides such Electronic PHI agrees
to implement reasonable and appropriate security measures to protect the information. The
Business Associate will report to the Covered Entity any Security Incident of which it becomes
aware;
2.12 To retain records related to the PHI hereunder for a period of six (6) years unless the Business
Associate Agreement is terminated prior thereto. In the event of termination of this Business
Associate Agreement, the provisions of Section V of this Business Associate Agreement shall
govern record retention, return or destruction;
2.13 To promptly notify the Covered Entity of a Breach of Unsecured PHI as soon as practicable, but in
no case later than 10 calendar days, after the discovery of such Breach in accordance with 45 CFR
§164.410. A Breach shall be treated as discovered as of the first day on which such Breach is
known, or by exercising reasonable diligence would have been known, to any person, other than
the person committing the Breach, who is an employee, officer, or agent of Business Associate.
The notification shall include, to the extent possible, the identification of each Individual whose
Unsecured PHI has been, or is reasonably believed by Business Associate to have been,
accessed, acquired, used, or disclosed during the Breach in addition to the information required in
Section V. In addition, Business Associate shall provide the Covered Entity with any other available
information that the Covered Entity is required to include in the notification to the individual under
45 CFR§164.404(c); and
2.14 To the extent Business Associate is to carry out one or more of the Covered Entity's obligations
under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the
Covered Entity in the performance of such obligations.
SECTION III -THE PARTIES AGREE TO THE FOLLOWING PERMITTED USES AND
DISCLOSURES BY THE BUSINESS ASSOCIATE:
3.1 Business Associate agrees to make uses and disclosures and requests for PHI consistent with the
Covered Entity's minimum necessary policies and procedures.
3.2 Except as otherwise limited in this Business Associate Agreement, the Business Associate may
use or disclose PHI to perform functions, activities or services for, or on behalf of, the Covered
Entity as specified in the Services Agreement, provided that such use or disclosure would not
violate the HIPAA Rules if done by the Covered Entity; and,
3.3 Except as otherwise limited in this Business Associate Agreement, the Business Associate may:
a. Use for management and administration. Use PHI for the proper management and
administration of the Business Associate or to carry out the legal responsibilities of the
Business Associate; and,
b. Disclose for management and administration. Disclose PHI for the proper management
and administration of the Business Associate or to carry out the legal responsibilities of the
Business Associate, provided that disclosures are Required by Law, or the Business Associate
obtains reasonable assurances from the person to whom the information is disclosed that it will
remain confidential and will be used or further disclosed only as Required by Law or for the
purposes for which it was disclosed to the person, and the person notifies the Business
Associate of any instances of which it is aware in which the confidentiality of the information
has been breached.
SECTION IV— NOTICE OF PRIVACY PRACTICES
4.1 If requested, the Covered Entity shall provide the Business Associate with the notice of privacy
practices that the Covered Entity produces in accordance with 45 CFR §164.520, as well as any
changes to such notice. Covered Entity shall (a) provide the Business Associate with any changes
in, or revocation of, permission by an Individual to use or disclose PHI, if such changes affect the
Business Associate's permitted or required uses and disclosures; (b) notify the Business Associate
of any restriction to the use or disclosure of PHI that the Covered Entity has agreed to in accordance
with 45 CFR§164.522, to the extent that such restrictions may affect the Business Associate's use
or disclosure of PHI; and (c) not request the Business Associate to use or disclose PHI in any
manner that would not be permissible under the Privacy Standards if done by the Covered Entity,
except as set forth in Section 3.2 above.
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SECTION V—BREACH NOTIFICATION REQUIREMENTS
5.1 With respect to any Breach, the Covered Entity shall notify each individual whose Unsecured PHI
has been, or is reasonably believed by the Covered Entity to have been, accessed, acquired, used,
or disclosed as a result of such Breach, except when law enforcement requires a delay pursuant
to 45 CFR§164.412. This notice shall be:
a. Without unreasonable delay and in no case later than 60 calendar days after discovery of a
Breach.
b. In plain language including and to the extent possible:
1) A brief description of what happened, including the date of the Breach and the date of
the discovery of the Breach, if known;
2) A description of the types of Unsecured PHI that were involved in the Breach (such as
whether full name, social security number, date of birth, home address, account
number, diagnosis, disability code, or other types of information were involved);
3) Any steps Individuals should take to protect themselves from potential harm resulting
from the Breach;
4) A brief description of what the Covered Entity and/or Business Associate is doing to
investigate the Breach, to mitigate harm to Individuals, and to protect against any
further Breaches; and,
5) Contact procedures for Individuals to ask questions or learn additional information,
which shall include a toll-free telephone number, an e-mail address,web site, or postal
address.
c. By a method of notification that meets the requirements of 45 CFR§164.404(d).
d. Provided to the media when required under 45 CFR §164.406 and to the Secretary pursuant
to 45 CFR§164.408.
5.2. Business Associate shall promptly provide any information requested by Covered Entity to
provide the information described in Section 5.1.
5.3 Covered Entity may, in its sole discretion, require Business Associate to provide the notice of
Breach to any individual or entity required by applicable law to receive such notice.
SECTION VI—TERM AND TERMINATION
6.1 Term. The term of this Business Associate Agreement shall be effective as of the date set forth
above in the first paragraph and shall terminate when all of the PHI created, maintained,transmitted
or received by the Business Associate on behalf of the Covered Entity, is destroyed or returned to
the Covered Entity, or, if it is infeasible to return or destroy PHI, protections are extended to such
information, in accordance with the termination provisions in this Section.
6.2 Termination for Cause. Upon the Covered Entity's knowledge of a material breach of this
Business Associate Agreement by the Business Associate, the Covered Entity shall provide an
opportunity for the Business Associate to cure the breach or end the violation. The Covered Entity
shall terminate this Business Associate Agreement and the Services Agreement if the Business
Associate does not cure the breach or end the violation within the time specified by the Covered
Entity, or immediately terminate this Business Associate Agreement if cure is not reasonably
possible.
If the Business Associate fails to cure a breach for which cure is reasonably possible, the Covered
Entity may take action to cure the breach, including but not limited to obtaining an injunction that
will prevent further improper use or disclosure of PHI. Should such action be taken, the Business
Associate agrees to indemnify the Covered Entity for any costs, including court costs and attorneys'
fees, associated with curing the breach.
Upon the Business Associate's knowledge of a material breach of this Business Associate
Agreement by the Covered Entity, the Business Associate shall provide an opportunity for the
Covered Entity to cure the breach or end the violation. The Business Associate shall terminate this
Business Associate Agreement and the Services Agreement if the Covered Entity does not cure
the breach or end the violation within the time specified by the Business Associate, or immediately
terminate this Business Associate Agreement if the Covered Entity has breached a material term
of this Business Associate Agreement if cure is not reasonably possible.
6.3 Effect of Termination.
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a. Return or Destruction of PHI. Except as provided in Section 6.3(b), upon termination of this
Business Associate Agreement, for any reason, the Business Associate shall return, or if
agreed to by the Covered Entity, destroy all PHI received from the Covered Entity, or created,
maintained or received by the Business Associate on behalf of the Covered Entity and retain
no copies. This provision shall apply to PHI that is in the possession of subcontractors or
agents of the Business Associate.
b. Return or Destruction of PHI Infeasible. In the event that the Business Associate determines
that returning or destroying PHI is infeasible, the Business Associate shall provide to the
Covered Entity notification of the conditions that make return or destruction infeasible. Upon
mutual agreement of the parties that return or destruction of the PHI is infeasible, the Business
Associate shall extend the protections of this Business Associate Agreement to such PHI and
limit further uses and disclosures of such PHI to those purposes that make the return or
destruction infeasible, for so long as the Business Associate maintains such PHI. In addition,
the Business Associate shall continue to use appropriate safeguards and comply with Subpart
C of 45 CFR Part 164 with respect to Electronic PHI to prevent use or disclosure of the PHI,
for as long as the Business Associate retains the PHI.
SECTION VII —GENERAL PROVISIONS
7.1 Regulatory references. A reference in this Business Associate Agreement to the HIPAA Rules
or a section in the HIPAA Rules means that Rule or Section as in effect or as amended from time
to time.
7.2 Compliance with law. In connection with its performance under this Business Associate
Agreement, Business Associate shall comply with all applicable laws, including but not limited to
laws protecting the privacy of personal information about Individuals.
7.3 Amendment. The Parties agree to take such action as is necessary to amend this Business
Associate Agreement from time to time. All amendments must be in writing and signed by both
Parties.
7.4 Indemnification by Business Associate. Business Associate agrees to indemnify, defend and
hold harmless the Covered Entity and its commissioners, employees, directors, officers,
subcontractors,agents or other members of its workforce,each of the foregoing hereinafter referred
to as"Indemnified Party,"against all actual and direct losses suffered by the Indemnified Party and
all liability to third parties arising from or in connection with Business Associate's breach of Sections
II and III of this Business Associate Agreement.Accordingly, on demand, Business Associate shall
reimburse any Indemnified Party for any and all actual and direct losses, liabilities, fines, penalties,
costs or expenses (including reasonable attorneys' fees) which may for any reason be imposed
upon any Indemnified Party by reason of any suit, claim, action, proceeding or demand by any third
party which results for Business Associate's breach hereunder. The obligation to indemnify any
Indemnified Party shall survive the expiration or termination of this Agreement for any reason.
7.5 Survival. The respective rights and obligations of Business Associate under Section II of this
Business Associate Agreement shall survive the termination of the Services Agreement and this
Business Associate Agreement.
7.6 Interpretation. Any ambiguity in this Business Associate Agreement shall be resolved to permit
Covered Entity to comply with the HIPAA Rules.
[Signature Page Follows]
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The Parties hereto have duly executed this Agreement as of the Effective Date as defined here above.
Covered Entity Business Associate
CLACKAMAS COUNTY City of Lake Oswego
By: By:
Its: Its:
Dated: Dated:
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Subrecipient Grant Agreement—24-006 [Older Americans Act Services]
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Exhibit J: Provider Application Recertification
OAA Focal Point Service Provider Application Recertification
The below requested information provides an update to material originally submitted in prior Request for
Proposals for Older American Act Focal Point Service Providers.
Name of Service Provider: Lake Oswego Adult Community Center
Date Completed: 5/5/2023
Organizational Policies/Procedures:
1. How does your organization handle client and staff grievances? Please describe your policies and
procedures for handling complaints, including how/if Clackamas County Social Services fits into the
process. Clackamas county would not be involved in our complaint processes unless the complaint
was regarding a procedure guided by the county contract.
a. How do you handle client complaints?
Administrative Procedure:
PURPOSE:
The purpose of the attached Inquiry/Complaint Routing list is to identify the appropriate
departments for the initial response to an inquiry or complaint from the public. The routing list
should also assist City staff in identifying areas of responsibility in order to quickly address service
issues and provide a high level of customer service. The list identifies the initial department or
division contact, with responsibility for the inquiry or complaint. The responsible department or
division shall involve other departments or divisions as necessary. If a department receives a call
for assistance that it is unable to remedy,the name and number of the individual should be taken
and the individual told that they will be contacted by the appropriate department or person.The
caller information is then forwarded by the initial contact to the Citizen Information Coordinator.
It is then the responsibility of the Citizen Information Coordinator to find the appropriate
department and follow-up to ensure that the citizen was contacted. It is preferable that citizens
are not transferred from department to department in order to get their question answered or
complaint heard.
REFERRAL:
If staff determines that the complaint may require conflict resolution services, the caller should
be either transferred to the Citizen Information Coordinator (Ext. 0257) or given the phone
number to contact the Citizen Information Coordinator(503-635-0257).
REVISIONS:
It is the responsibility of each department or division to make note of any inaccuracies on the
attached Inquiry/Complaint Routing list,and to inform the Deputy City Recorder of these changes.
For example, over a period of time, it may become evident to a department that although they
are listed as the initial contact, another department should be
b. How do you handle staff complaints?
HR Policy:
POLICY STATEMENT: The City recognizes the importance of providing timely procedures for
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Page 43 of 46
the resolution of complaints and grievances arising from the employment relationship.
Accordingly, employees are encouraged to use the Complaint Resolution Process.
GUIDELINES 1. Complaints A'complaint' is an employee's formal,written expression of
disagreement with aspects of employment such as working conditions, hours of work,
environment, relationships with supervisor and other employees, or policies or
decisions of the department considered by the employee to be inappropriate. The
complaint should state the action(s) to be reviewed, the date(s) of each act, and the
resolution requested. 2. Eligibility All regular non-represented employees who have
completed their initial probationary period are encouraged to use this procedure to file
a complaint. Represented employees should use the grievance procedure outlined in
their respective collective bargaining agreement. On-call and temporary employees,
including probationary employees, alleging violation of the City's equal employment
opportunity, anti-harassment/non-discrimination, ethics or other policies may take
their complaints to the Human Resources Department. 3. Four-Step Process The
employee must initiate his or her own complaint resolution process as set forth below.
On occasion and by mutual agreement, the specified time-lines may be altered to suit
the circumstances. Employees who have questions about how to proceed may seek
guidance from Human Resources at any Personnel Policy 1-7 City of Lake Oswego - 2 -
Complaint Resolution Process time in the process. (Note: The following process is the
primary process for all regular non-represented employees. Represented employees
should consult their collective bargaining agreement for filing a grievance.) Step 1:
Informal Discussions Employees, supervisors, and managers are encouraged to identify
and resolve workplace problems and disputes as early as possible by using informal
problem-solving methods, such as: direct discussions with the individual(s) involved;
involvement of the supervisor, manager or department director; and assistance from
the Human Resources Office. If the problem remains unresolved after these efforts,the
employee may submit a formal, written complaint to the Department Director. Step 2:
Department Review Upon receiving a written complaint or statement of grievance,the
Department Director shall review the situation, investigate as appropriate, and issue a
written determination, generally within 10 workdays of receiving the complaint or
grievance. Step 3: Human Resources Review If the employee is not satisfied with the
response, the employee may forward the written complaint and any supplemental
materials to the Human Resources Director within 10 workdays of the Department
Director's response.The written complaint and the supplemental materials should fully
define the problem, explain reasons for dissatisfaction with the Department Director's
reply, and specify the remedy sought. The Human Resources Director will review the
situation, investigate as appropriate, and issue a determination, generally within 10
workdays of receiving the complaint. Personnel Policy 1-7 City of Lake Oswego - 3 -
Complaint Resolution Process Step 4: City Manager Review If the employee is not
satisfied with the response of the Human Resources Director, the employee may file a
written appeal to the City Manager within 10 workdays. The City Manager's decision is
final and will be issued within 30 days of receiving the written appeal. 4. Complaints
Against Charter Officers Any employee who believes that he or she has been subjected
to any type of unlawful employment practice by one of the City's Charter Officers (i.e.,
the City Attorney, the City Manager, or the Municipal Court Judge) should take their
concerns to the Human Resources Director or either of the other Charter Officers. In
the event that the issue is unresolved, either the City Manager or the City Attorney will
then report directly to the City Council regarding the complaint and will provide a copy
of the written complaint to the City Council. S. Related Information > Personnel Policy
City of Lake Oswego - Lake Oswego Adult Community Center
Subrecipient Grant Agreement—24-006 [Older Americans Act Services]
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No. 1-3: Anti-Harassment and Non-Discrimination > Personnel Policy No. 1-6:
Appropriate Workplace Conduct> Personnel Policy No. 2-5: Corrective Action
2. How does your organization handle donations and ensure that they are being collected and used
appropriately for acceptable program purposes? Please describe your policies and procedures for
accepting and tracking donations, including any specialized software or tools used, communication
with donors, and regular review and analysis of donation data to ensure compliance with program
requirements. We collect donations and put them into bank bags that correspond with the
program for which the donation is intended.And then at the time of deposit the donations are
processed through our finance software called Incode, and the donation is deposited using the
corresponding general leger account. Some donations are recognized by a letter, stating our tax ID
number and we do offer a fillable receipt for in-kind donations.
NAPIS Enrollments/Service Records:
3. How does your organization ensure required NAPIS enrollments are collected and reported within
the first month of service delivery for eligible participants? Please describe your process for
determining eligibility and collecting required assessments, demographic information and other
required enrollment information. Before we submit our reimbursement request form we use an
Excel spreadsheet to verify all clients that received services (a report exported from My Senior
Center) have a NAPIS form in the NAPIS file. We determine eligibility based on the answers of the
NAPIS questions and other conversation.
4. How does your organization document provided service units for Case Management, Reassurance,
Information &Assistance and Nutrition programs? Describe your record keeping system for each
service type among OAA eligible and non-OAA eligible individuals. When people call into the client
services coordinator(CSC),the CSC will determine what category the needs falls under.The CSC
then fills out a NAPIS and fills out a client profile in the software program, My Senior Center. Below
is a sample of the menus the CSC will click through to determine the category.
InIFradion
Fr+ Manage List
Categpry
Type or click Interaction
Mee f How did you Ielp this person?
Assistance Fomple:Phone mrrsult iron,Hone Cbnsultztion
Refer Fro,. By Phone
In Person
Refer To Other
Via Email
service thins 0.25 Via Outreach
Rott
City of Lake Oswego - Lake Oswego Adult Community Center
Subrecipient Grant Agreement—24-006 [Older Americans Act Services]
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Interaction By Phone %Ai Add - Seigle Add
Category I R+Manage List
Assislance Type or dick Category
What ategory would this Outreach action fall under?
Example Are You OK?.Ad ocagc erg C
Refe`From APS Report
Refer To Case Management
HDM Assessments
Service Units 0.25 Information and Assistance
Non-Reimbursable
Reassurance
Wellness Check
notes
Late radio]] By Phone Multi Add - Sngle Add
Category Case Management cm
R+Manage list
" noe Type or click Assistance
Mar type of assisiance urea given to the person?
Refer Flom Example heanvg aid check,road information,...
ACC Program
Refer To Behavior/Conduct at ACC
Caregiver Information f Assista nce
service units 0.25 _ Congregate Meals
Consultation
Financial
not4m Food Basket
Food Pantry
Foot Care
g[ Kim? Age:83
Phone:971-335-7514 Datels,'e;mz3
Lake Oswego,OR Disability: Time AM
i
L.i.raction By Phone 1
�+Manage List
Case Management
Type or dick Referral To
Who chi you refertho person to?
Ass/tance ACC Program Eoniplet WestTo"o senor Center,Eldoly Service Agency,Fred
ACC Medical Equip_Loan Program
Refer From Family Member ACC Program
ACC Respite Program
Refer To County Agency
service units 0 25 HDM f MOW
Housing Resources
In home care
Medical Ride Program
notes Other
Other Senior Center
Placement and Referral Agency
City of Lake Oswego - Lake Oswego Adult Community Center
Subrecipient Grant Agreement—24-006 [Older Americans Act Services]
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• Kim? Ph e3 p�He,'zox3 I lo[
Phone:
9?1-33rr?514
Lake Csi4ego.OR Disability: rme 11:53 RM I
5. one
lam Case r a-ia3e111e-it (Optional)Type Notes
E anylm GU loinr payment info,grunyinos
AG O F'rogi sill lbw dick doe ABC Burton
Refer Flom Family Member
iil7dvTu Inhonle care
u•IN 0.25
My Senior Center can produce a report that give the client's age so we can track and report the
OAA eligibility.The CSC uses a calendar and a notepad to track any follow-up needed.
Transportation:
5. How do you ensure adequate documentation for rides provided each month as a service provider
for riders who are 60+or experiencing a disability? Please describe your process and the steps you
take to track and document rides, including any specialized software or tools used, paper records
maintained, communication with riders, and regular review and analysis of ride data.
The participant calls us to schedule a ride,they are entered into My Senior Center and then a
reminder call is made as the transportation coordinator is on his way to pick up the participant. We
use My Senior Center, a software program where we register a participant for transportation. My
Senior Center allows us to create "events"for each time we offer a ride to or from the Center.The
transportation coordinator also lists all rides on the master transportation tracking spreadsheet.
And at the end of each month the report from My Senior Center must match the spreadsheet.The
information is reviewed monthly prior to being sent to Clackamas County for reimbursement.
6. How do you ensure that drivers report mileage,time, rider issues,vehicle maintenance needs, and
other issues that may arise while delivering rides to riders who are 60+or experiencing a disability?
Please describe your process for tracking and documenting this information, including any
specialized software or tools used, communication with drivers, and the steps taken to address any
reported issues. Each vehicle is equipped with a clipboard and a form for the driver to track mileage
and time, i.e.: ff
ricIe ty
Date Start Time 1st Pf U Trip Start Time Last D/O Time 1st P/U Miles Last D/O Miles
Miles
2,1 i i st C.—I 5 3 gi q i q 31. 0110 -37 p
Z l I0`i5 iD 55 it.L2. 3cLoCi r _% 0 t 37. OI
We then use the clipboard information to complete the master transportation tracking spreadsheet
that lists, mileage and time.The transportation coordinator will bring to management any rider
issues to discuss and resolve.Along with alerting management, if we have a customer incident the
transportation coordinator fills out the "Citizen and Volunteer Incident Report Form"; a copy goes
to human resources. We have a maintenance department that tracks our vehicle maintenance
schedule and the transportation coordinator will alert the maintenance department of any issues
that arise.
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Outreach:
7. How does your organization provide information about its services to the community? Please
describe your outreach efforts to the targeted population of frail, low-income, minority, and rural
residents aged 60 and older. Our programs and services are promoted in our Parks & Recreation
Activities Guide that is published three times a year and mailed to every resident.We also promote
our services in the Hello LO,the City's monthly newsletter that is also mailed to every resident.
Lake Oswego is home to two low income senior apartment building and we have posted flyers in
the elevators.
8. How does your organization prioritize services for the target population of frail, low-income,
minority, and rural residents aged 60 and older? Please describe your procedure for prioritizing
services. At this time, we are able to meet the demand for our services and have not needed to
prioritize for a special target population.
Organization Operations:
9. What are your hours of operation and official closures? Please provide details about your
organization's operating hours and any scheduled closures.
We are open Monday-Friday 8a-4:30p expect for the following holidays:
• Monday,January 2, 2023 New Year's Day observed
• Monday,January 16, 2023 Martin Luther King,Jr.
• Monday, February 20, 2023 Presidents' Day
• Monday, May 29, 2023 Memorial Day
• Monday,June 19, 2023 Juneteenth
• Tuesday,July 4, 2023 Independence Day
• Monday, September 4, 2023 Labor Day
• Friday, November 10, 2023 Veterans Day observed
• Thursday, November 23, 2023 Thanksgiving Day
• Friday, November 24, 2023 Day after Thanksgiving
• Monday, December 25, 2023 Christmas Day
• Monday,January 1, 2024 New Year's Day
10. What are the geographic boundaries of your organization's service area? Please describe the
specific areas your organization serves.
BOUNDARIES:
Lake Oswego area, including Lake Grove.
North — Clackamas County/Multnomah County line, except part of LO that is in Multnomah
County;
West — Clackamas County/Washington County line except small area of LO that is in
Washington County;
South —Tualatin River to Stafford Rd., North on Stafford to SE Bergis Rd., S. to Crestline Dr.,
through Skylands to West Linn city limits;
East—Willamette River.
11. Community-based, nonprofit organizations only: Provide a current list of Board officers and
members and the frequency of Board meetings. N/A