85-1348 WMITE - CITV CLERK
PINK - FINANC�E G I TY OF SA I NT PALT i, Council n�_ 13 ��
CANARV - DEPARTMENT File NO• �+
BLUE -MAVOR
� � C cil Resolution
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Presented By
�Referred To rl 11�✓'�(.l C.(� Commi ttee: Date � f�� 6 �
Out of Committee By Date
RESOLUID, that the proper City c�ticials are hereby auzthorized
aixl directed to ex,ecut�e an agreement with Ramsey Caunty Puhlic
Health Nursing whereby the City o� Saint Paul through its
Divisiai of Puhlic Iiealth will receive the services o� a n�se
practitioner far the Haneless Clinics according t�o the ten�n.s
of said agreement, a copy of whid7 is to be kept on file and
on record in the Dep�artinent � Finance and Mangenent Services.
COU[VCILMEN Requested by Department of:
Yeas p�eW Nays �
Community Services
Masanz _,r [n Favor
Nicosia � C-�� �
Scheibel ,
Sonnen � ' _ Against BY —T �/
Tedesed
W i Ison
Adopted by Council: Date �C'T � � Form pproved b Ci tt ne
Certified Y s e y Council , re BY •
gy,
Approved by M or: Da �— ���,T � �. � SAppr y Mayor for Submissio o �
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�ipr��• �VT,.� C ��VJ
PU8L9���.��,�
Community Services . '� • DE PARTMENT �`S �3��NO 3�g 5
.
COHTACT ' '
� PHONE
DATE �Q��� Qr
ASSIGN NUMBER FOR ROUTING ORDER li All Locations for Si nature :
�Y Department Director � Director of Management/Mayor
Finance and Management Servic s Director 4 City Clerk
Budget Director 5 �,�u �kU��
� City Attorney
WHAT WILL BE ACHIEVED BY TAKING A TION ON THE ATTACHED MATERIALS? (Purpose/
Rationale) :
Resolution on a contract between Ramsey County Public Health Nursing and the City of Saint
Paul through its Division of Pub ic Health to provide nurse practitioner services and
consultation at Homeless Clinics in Saint Paul. rj� �
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COST/BENEFIT BUDGETARY AND PERSO NEL IMPACTS ANTICIPATEO: . �� �'����'E
Ramsey County Public Health Nurs ng shall provide up to 400 hours of. nurse practioner services
and consultation at Homeless Cli ics at $18.75 per hour. Payment for all services performed
will be 90� of all the receipts eceived on or about September l, 1985 with the balance of the
funds (10%) being dispersed._on o about October 31, 1985. •
I
FINANCING SOURCE AND BUDGET ACTIVITY NUMBER CHARGED OR CREDITED: (Mayor's signa-
ture not re-
Total Amount of Transaction: $7,600.00 quired if under
$10,000)
Funding Source:
Activity Number: 33230
.
ATTACHMENTS List and Number All ttachments : � , �
1. Copy of Agreement � a �
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2. Certificate of Insurance v
3. Resolution
DEPARTMENT REVIEW CITY ATTORNEY REVIEW
Yes No Council Resolution quired? Resolution Required? Y s No
Yes No Insurance Required? Insurance Sufficient? Yes No
Yes No Insurance Attached:
(SEE REV RSE SIDE FOR INSTRUCTIONS)
Revised 12/84
HOW TO USE THE GREEN SHEET • � •
The GREEN SHEET has several PURPOSES: • ' .
1. to assist in routing documents and in securing required signatures
2. to brief the reviewers of documents on the impacts of approval f
3. to help ensure that necessary supporting materials are prepared, and, if
required, attached.
Providing complete information under the listed headings enables reviewers to make
decisions on the documents and eliminates follow-up contacts that may delay execution.
The COST/BENEFIT, BUDGETARY AND PERSONNEL IMPACTS heading provides space to explain
the cost/benefit aspects of the decision. Costs and benefits related both to City
budget (General Fund and/or Special Funds) and to broader financial impacts (cost
to users, homeowners or other groups affected by the action) . The personnel impact
is a description of change or shift of Full-Time Equivalent (FTE) positions.
If a CONTRACT amount is less than $10,000, the Mayor's signature is not required,
if the department director signs. A contract must always be first signed by the
outside agency before routing through City offices.
Below is the preferred ROUTING for the five most frequent types of documents:
CONTRACTS (assumes authorized budget exists)
1. Outside Agency 4. Mayor
2. Initiating Department 5. Finance Director
3. City Attorney 6. Finance Accounting
ADMINISTRATIVE ORDER (Budget Revision) ADMINISTRATIVE ORDERS (all others)
1. Activity Manager 1. Initiating Department
2. Department Accountant 2. City Attorney
3. Department Director 3. Director of Management/Mayor
4. Budget Director 4. City Clerk
5. City Clerk
6. Chief Accountant, F&MS
COUNCIL RESOLUTION (Amend. Bdgts./Accept. Grants) COUNCIL RESOLUTION (all others)
1. Department Director l. Initiating Department
2. Budget Director 2. City Attorney
3. City Attorney 3. Director of Management/Mayor
4. Director of Management/Mayor 4. City Clerk
5. Chair, Finance, Mngmt. & Personnel Com. 5. City Council
6. City Clerk
7. City Council
8. Chief Accountant, F&MS
SUPPORTING MATERIALS. In the ATTACHMENTS section, identify all attachments. If the
Green Sheet is well done, no letter of transmittal need be included (unless signing
such a letter is one of the requested actions) .
Note: If an agreement requires evidence of insurance/co-insurance, a Certificate of
Insurance should be one of the attachments at ti.me of routing.
Note: Actions which require City Council Resolutions include:
1. Contractual relationship with another governmental unit.
2. Collective bargaining contracts.
3. Purchase, sale or lease of land.
4. Issuance of bonds by City.
5. Eminent domain.
6. Assumption of liability by City, or granting by City of indemnification.
7. Agreements with State or Federal Government under which they are providing
funding.
y .
8. Budget amendments.
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CRANT P�REII�iENr
This Agreanent, made and �cecuted this clay of ,
198 , by and between the City c� Saint Paul acting thrcugh its
Division c�f Public Health hereinafter referred to as "Grantor"
and Ramsey County Public Health Nursing referred to as
°Gr3ritE'e n.
,�
Grantar agrees to m�ke the following grant and Grantee agrees to
accept such gzant, in accardance with the terms and conditions
hereinafter set forth.
1• AMQJNT P,ND TEE�MS Cg' Zi� GRANT. The amQUnt of the grant,
tenns of p3yment and tasks to be perfoaned, as stated in the
S[INIMARY CF' GRANT AGREFMII�Tr attached hereto and hereby n�de a
part hexeof. . .. --._ _
2. SPDCIFIC AJRPOSES CF TF� GRANT. The grant shall be used
solely for and Pxpended in the manner and over the period
of time, described in the grant application chted May 31,
1985. Grantee agrees to notify Grantor of and d�tain its
consent to, any substantial deviations fran said grant.
3. REOORDI�ING. Grantee agrees to naintain its b�oks and �
records to shaw and separately accaunt for, the funds
received under this Grant. Expenditures ma�e b� the Grantee
in furtherance of the purposes specified in the Grant
Agreanent mist L�e charged against the grant. Grantee will
maintain records of c�penditures adequate to identify the
purposes for which and manner in which, grant funds have k�een
expended.
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Page 2
4. REPORTS 7.0 GRANI'OR. With respect to each grant, Grantee
shall supply Grantor with a report or reports showing:
a) The use of funds granted ka sed upon the recards of the
Grantee, detailing all expenditures made fran such
grant, (including salaries, travel and supplies) ,
b) ca�liance with the tenns of �the grant, and
c) the progres's made b� the Grantee tvward achieving the
purposes for which the grant v�ss made, including the
sucvesses and problens �cauntered c�iring the reportin
g
iod. Such r /
peY' �orts shall be furnished as pravided for
in the SUNIl�SARX CE' GRANT P�R�MENT.
5. AVAILABII�ITY CF' GRAN'I'EE'S REC`.pRDS. Grantee will �intain its
records of �cpenditures fran the grant, as well as copies of
the reports sukmitted b� the Grantor with respect to such
grant, for at least faur years after canpletion c�
tennination of the project.
6. REPAYNIEI�7r CF THE �T. Grantee will repay to Grantor any
portion of the amount granted which is not used L� Grantee
for the purposes specif ied in Grant Agrec�nent t.� Septanber
30, 1985.
7. ACZZONS P�AINST GRANTEE. Grantee agrees that it will '
im�ed.iately notify Grantor of any lawsuit, or any preceding
before any federal, state ar local administratiue agency,
which m�y be initiated against it.
8. PUffi,ICATICRJS C�t OOPYRIGHTS. �he Grantee may publish results
of its functions and participation in the approved catminity
action program withcut priar review by the Grantar, provided
such publications indicate that the p�ogram is supported Y�
funds granted b� the Office of Econanic Opportunity.
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Fag e 3
If the Grant results in a book ar aopyrightable material, the
author is free to copyright the �rk, bnt the Office af
F.�onc�nic Opportuni.ty reserves a royalty free, non-�xclusive
and irrevocable license to regroduce, publish or otherwise
use.
9. TEFd�IIIv�1TI0N. This Agreement may be t�nniriated without cause
by either'parEq upon ten t10) days written notice. In the
event of termination, all property and finished or unfinished
doc�nnents, data,. studies and reports purchased or �epared b�
the Grantee under this Agreanent shall at the option of the
GYantor, becane its property and the Grantee shall be
entitled to oompensation for any unreimburs� expenses
necessarily incurred in satisfactory perfonnance af the
Agreenent. - _
10. MLNNESaI'A IAW. This Agreement shall be gaverned b,� the la�
of the State af Minnesota and Minnesota Goverrment Data
Ptactices Act. -
11. �e Grantee shall �wide professional liability insurance
accept�ble to the City Attorney. A certificate evidencing
such insurance shall be attached to this Grant Agreanent.
IN WI'I'NE'SS WHEREOF, the �rties have �ecuted this Agreanent in
duplicate as of the c�y and year first above c�itten. �
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CITY CE' S�,INT PAUL GRANI�E:
Activity Cale: 33230
SY:
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ITS: �
Director, Department af , �
Finance/Managanent Services ,�
Director, Degartment of
Go�ernuzity Services : . _ _ ...�.
APPROVID AS 'IC) �ORNI:
Assistant City Attorney
OGC:jr
7/9/85
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SUMN�RY CF GRANT AGREIIKEI�Tr
GII�RP,.L II�'ORMATION
Grant aa�tho�ized b� the Minnesota Department of Econanic Security 1985 Ca�runity
Ccnmunity Services Block C7ant (CSBG) IInergency �serve Program (ERP> , C�ant
ntIInber 82513.
An Agreement has been made between the City o�E Saint Paul thraugh its Division
of Public Hr�alth and Ramsey Action Programs, Inc. , (RAP) far the distributicn of
funds for Health Screening, Fdeferral and Treatrnent for the Hameless.
PROC'�RF,SS REPORTS
Nbnthly program reports will be sulznitted to the Grantor as requi.red to ireet
terns of the c�rant, b� the seventh wnrkir�g chy of eadz month. The month�y
report fonn to be used is shown as Attachment A. The final report shazld be
suYmitted to the Grantor no later than October 15, 1985.
FINANCIAL REPpRTS
All available fiscal records shall be �3e available to RAP and to the City of
Saint Paul. Al1 receipts should be su�mitted t�o the Division of Puhlic Health
for services extended through this grant. All recipients of services thraugh
this grant must meet the incorre eligibility requirements as listed in Attachment
(4) faur.
PROGRAM OBJ�C.`I'IVFS AND EVAI�JATION
1. Provide up to 400 haurs of nurse practitioner services and oan�ultation at
Haneless Clinics at $18.75 per hair. (See Attachment A for reporting sheet).
2. Provide 000rdi.nation to the clinical team providing services at Haneless
Clinics.
3. Provide required doc�unentation af clinic and consultation training services
pra�ided b� the team to Saint Paul. (See Attachments A and B)
4. Camplete reports as requi.red for fulfillment of grant a�reenent.
(Attacru�nts A and B}
5. Payment for all services will be 90� of all the receipts received, on c�
about Septanber 1, 1985; with the kalanoe of the funds (10$) beirx� d.isbursed
on c� about Octaber 31, 1985, upon ca�letion and suhnission of the final
report.
SLIt�fARY REPORT
All available summary program information will be made available in �liance
with the State of Minnesota Goverrment Data Practices Act.
PERSC[J RESPCyNSIBLE �3R TEFd�fS C�' GRANT PGREIIKE'[�Tr IS:
Barbara O'Grady, Director
�msey County Public Health Nursing �
7/18/1 jb
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NAA1E: T90NTH: �,1���5 —/'�yO
1. Please specify the training/educational sessions 'you provided.
HOURS
TOPIC LOCATION � PREP PRESENT
�:
2. Please specify the type of consultation you provijd.
CONSULTED TO N0� OF HOURS
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3. hfiat hours did you work on the Health Care for the Homeless Project?
DATE _ HOURS ACTIVITY
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Return this form to Pat Bullick by the first Friday of the month.
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b-85
, s� Attachment B _ ,
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NAME: . . _ . . AATE: .� ��J� STAFF SEEiNC CLIENT: , _
� D08: RACE: � ( ) Dorothy Day ( ) Doctor
( ) YWCA ( ) Nurse Practitioner
I.�IST PERM. ADDRESS: O Women's Advoc. O Nurse
(only on initial) (city) (state) ( ) Casa ( ) Nutritionist
• ( ) Housing Info ( ) Lab Technician
INCOME: per month �(estimate) ( ) Union Gospel ( ) Outreach Worker
� ( ) ( ) Volunteer
OFFICE OiARGES . '
PAY SOURCES VISIT TYPE
NEM PATIENT ESTAHLISHED PATIENT
2 () Brief Visit i1 () Minimal Visit (Nurse Only) �
t () Limited Visit 12 () Bsief Visit � ( ) No Charge ( ) New
4O Inte�ediate Visit 13 O Limiced Visit ; O Welfare-MA O Follow-up
5 () Excended visic 1a () Intermediate visit ► � ( ) Referral com plete
6 () C o m p r e h e n s i v e V i s i t 1 5 () E x t e n d e d V i s i t � (complete shiAgle)
16 () Comprehensive Visit � �umber
• • • • • D I A G N 0 S I 5 • • • • •
SERVICE M/0 DIAGNOSIS GASTR02NfE5tINAL MUSNLOSKELETAL
3O Contraceptive AanaYemeni� 71 O Abdominal p;in
4 () Dietary counselinII 7Z () Coneti ation � 162 () Backache
i () History of infectious dis. p 163 () Bursitis, synovitis, etc:
73 () Diarrhea 164 () Low back pain
BO History of parasites 74 O Gastritis
10 () I�mouni:atioos 75 () Gastroenteritis. infectious 306 �� Osceoarthrosis
23 O Nutrition assessment 7g O Hemorrhoids J O Sciatica
166 () Traumatie arthritis
8 () Nutrition deficiency 79 () HepatomeQaly
30 (� Other special exam 240 () Jaundice GE�ITOURINARY
12 () Pelvic exam 80 () Liver disorder, tmspec. 171 () AbnormsI pap smear
18 O Physical exam 84 O Peptic acid disease 17y
() Albuaiinuria (protein)
14 () .Refill prescriptlon 82 () Splenomegaly 373 () Amenorrhea
I () �efugee screening 184 smenorrhea
2 () Onspecified follor-ug exam NEUROPSYQI 185 () Dysuria '
20 () Yell child health check 301 () Alcoholism "
IfYCOBACTERIAL DISEASES 102 () Anxiet state 174 () Fibrocystic (breast)
103 () Depressive disorder 175 () Hematuria -
() Mycobacterium 176 () Mastitis
3: f` TB e osure 104 O Headache, tension I77 O Menorrhagia
�) 7B e�rapulmonarv 107 O Psychomotor retardation 178 O PID '
O Mentally I11 1�9 O Pregnancy
34 O TB infection - no isea—d'— se
3- O 7B puimonary, unspecified EYE 5 EAR lA2 O UTI _
31 O TB screening 111 O Blepharitis, unspecified 183 O Vaginitis"
35 () TB suspected 112 () Cataract. unspecified SKI!�
- IhFECTI0U5 d PARI�SITIC DIS. 113 () Conjunctivitis 2Q1 () Abscess or cellulitis
Q1 O Aa�ebiasis 114 O Corneal abrasion 202 O Acne
48 O Ascarissis 121 O Disorder of eardrum 2Q5 O Dermatitis - contact
245 (� Chicken ox 115 Q Hordeolum (stye) 203 O Dermatitis. non-specific
P 122 () Impacted ce nanen - 204
() Diaper rash
SS f; Culd sore
42 () Giardiasis l2d t) Otitis externa 207 () Eczema
52 () Gonorrhes 123 () Otitis media 212 () ImpetiQo
S' () Herpes (Yenital) 117 () Refsactive error 209 () Tinea pedis
�54 O Hepatitis vi:al A RESPIAATORY SYS7EM 210 O Tinea vezsicolor
211 () Urticaria
•3 () Hepatitis viral B 148 () Abnozmal chest x-ray
47 () Hookrorm 131 () Asthma ENDOCFIt�fE, NIffRIT.. METABOLIC .
68 () NSU (non-spee.urethritis) 332 () Bronchitis, acute 227 () pevelopmental delay �
62 () Para�onimiasis 1S3 () Bronchitis, ehronic 221 (� Oiabetes eellitus, adult oaset
58 O Pediculosis 13� O Chest pain 228 O Diabetes mellitus. jw. onset
142 () Pharyn�itis. strep 136 () Couyh 223 () Failure to thrive
64 () Salmonella 1;7 () I?yspnes 222 () Gout
SI O Suhies 138 O Hayfever
65 O SAi�ella 224 O Nutritional deficieney
56 O Influenxa 225 O ODesity
a9 (j StroaQyloides 140 () Laryngitis 25I () Short sssture
66 O Syphilis 141 O Pharyngitis 226 O Thyromt�aly (Qoiter)
id () Tapevona !43 () Pleurisy
60 O Thrush �CS O Pneumonia MISCELL�INEOUS
67 () Trichomoniasis (uroQenital) 146 () Sinusitis
46 () Trichuris 83 () Stomatitis �dg () Abrasion
1' O tlnspec.fnfec.6 psra.dia. �49 O Tonsillitis 231 O Allergy, unspecified
117 () URTI 232 �) Anorexia
69 () Viral exanthem 233 () Burns
70 () Viral infection.�u►spec. �ARDIOYASNUR SYSTEM 234 () Contusion (bruises)
HEHATOLOGIC 235 O DruQ reaction
355 () ASND 236 () Effects of to1Q
95 () Abnormsl Dlood chemistry 351 () Con�estive heart failuze 237 () Fever
91 (� Anemia. �ron deficient 152 () Heart disease, unspecified 2S� () Frnstbiie
92 O Memis. unspecified 153 O Heart aurmuz 239 O Head�che
93 O Eosinophill� 151 O Hypertension .
250 () Insoemi•
�7 () Le�d poieonin�. ot��r source� 249 () Laceration
96 O Lead polsoninp, paint
9� O LyspMdenopathy 2,1 O Malaise, fati�ue
2a2 () Sprain. strsin
UT1fER: (vrite in) 2�7 () Superficial injurr. fntetted
2�15 O Superficial injury, noL infscted
216 () Y�rti�o (dissin�iaj
SPDPH 197 2t♦ O kei`ht Ioss
6-85 .1,
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LAB0RAT0RY AN-D � X -- RAY` CHAR �GES �.���5"��?�.
HEMATOLOGY CHEMISTRY X-R.'1YS ��
1:�1 O CBC 1201 O Albumin� Serum 3016 O Chest Apical Lordotic
:S��Z O CBC 6 Differential 1202 O Amylase, Serum 3001 O Chest PA
1_03 O Nematocrit 1002 O Automated 12 Channel 3002 (} Chest PA f Lsteral
::�3 O Hemoglobin 1203 O Bilirubin. Total O Other X-Ray
;S1i O Hgb Electrophoresis 1401 O BUN , Body Part
.:�6 O Platelets 1204 O Calcium. Serum 1'ie►:!s
.:'7 O RBC 1205 O Creatinine� Serum _
?�^B () Reticulocytes 3006 () Electrolyte Profile
'��9 () Sedimentation Rate 1402 () Ferritin .
_>10 O 1tiBC 122Q O GGT MISCELLAI`EOUS
1206 () Glucose, Serum
IhL�NtiOLOGY 6_SEROLOGY 1207 43 O Dressing Change
O Gravindex PG Test qy O Ear Irrigation
'*_,:?1 O Hepaiitis - HBSAG 1301 O Iron Binding Capacity
;602 O Malaria 1302 O Iron Total 33 O EKG
?c,�3 ;) Monospot 1306 O Lead Blood (Macro) 44 O Qn-site Meds (supervisrd}
16Qo O Rubelia Antibody Titer 1305 {) Lead Blood �Micro) 32 O Screening: Hearing •
1604 () VDRL 1304 () Lead Screening (ZEP) _ 41 {) Screening: Visual Acuity
'� 1004 O Liver Profile 45 O Spirometry
MICROBIQLOGY 37 O TB Skin Test
1208 () Occult Biood (Guaiac)
i'O1 O AFB Culture X 1307 O Paint Chip Sample O �her: (writt in)
:includes smear - 1702 14I5 O Potassiwn -
!'63 () Culture, Routine Aerobic 1404 () Protein, t�rine Quant. - ( )D7p
i'�4 O GC Culture 12Q9 O RRA f, RIA�PG Test OT�
:'13 () Gram Stain 1405 () SGOT ( )TOPV •
:'05 O KOH Prep. Fungus 1453 O SGPT � OhAiR
1'06 O Malaria Smear 1416 O Sodium
:'07 () Ova $ Parasites 1406 () T-5 Uptake
:'10 () Paragonomiasis, Serology 1411 () T-4
:"09 () Par-agonomiasis. Sputum 1407 () ?-4 Free � Total (RIA)
:'il () Sensitivity. Mlibiotic 1408 () TSH (Thyroid)
1%13 () Throat Culture 1409 () Uric Acid, Serum
i'18 () llrine Culture 1430 () Uric Acid, Urine
;�01 O Pap Smear 1102 O Urinalysis. wo/micro
1101 () Urinalysis with micro -
P H A R M A C Y C H A R G E 5 . REFEfu�q1.SM,wE _
.
aG3 O Ethamhutol 100mg 202 O Amoxieillin Tabs 250mg ( j Mentai xea2th xo3rker
O Ethambutol 400mg O Amoxicillin Susp 125/5 C ) M.D. in cliaic
O Ethionamide 250mg (ETH) O Amoxicillin Susp 250/5 O �b in clinic
O INH 100mg 212 O Aspirin O Nutzitionist in clinic
O ItiH 300m , AVC Su ositor O Dentai
$ �) pP y ( ) Family Plann�ng
(} Pyridoxine SOmg � 216 O Baby Aspirin O St. Paul Ramsey Medieal Cent�
:!5 O Pyra:inamide SOOmg (PZA) 217 O Bactrim Susp O privatet�
a14 O Rifamate 222 O Bactrim Tabs O �ildren�s Haspital
. ( ) M�c
O Rifami+in 300mg- _ 224 O Benadryl 25mg O R.C. Public Health Nursin�
a16 () Seromycin (Cycloserine� 213 () Benadryl Eli�• � �
36 () Streptomycin inj. () Benzoyl Peroxide
() Capreomycin () Benzagel 5$ � �
298 O Clotrimazole Cream 317 O ^Bicillin 2.4 mu O
266 O Gantrisin Qphthalmic 321 O Clotrimozol Cream
:68 O Hydrocortisone Cream l� 2ZB O Cortisporin Otic Susp
O Kvell Shampoo 230 O Debrox Drops lSml
() KMell Lotion ' 232 () Desquan 43mg
�80 () Maalox 234 () Dimetapp Elix •
315 O Mintezol Tabs 236 O Dimetapp Extentabs
O Mol-Iron (Liq) . ' 238 O E-mycin 250mg�
() Motrin (Tab) 240 () Erythromycin Susp 250/5
324 O Niclocide 319 O Eurax 60gm .
�36 O Pen VK Susp 125/5 244 O Fer-In-Sol Drops
2B8 () Pen VK Susp 250/5 246 () Fenous SuIfate
i90 () Penicillia VK 250mg () Flagyl
{) Sudafed O Furoxone 100mg
296 O Tetracycline 250mg
32S O Trinsicon
3Q0 O Tylenol Elix
302 O Tylenol Drops '
211 O 7ylenol Tabs
SD8 O Vermox
310 O Vi-Daylin Drops "
312 O Vi-Daylin + Iron
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. Attac m f�-�5`/3�d" .
. , h ent # 4 �
• POVERTY GUIDELINES .
Household Size-� Poyerty Guideline
1 � E 5,250
Z 7,050
. 3 8,850
4 ' 10,650
5 � 12,450
- - 6 14,250
� 16,050
s 17,850
For family units with more than eiqht (8) m�bers, add al ,800 for
each additional member.
Source: U. S. Oepartner�t of Health and Hwnan Services
� Effective Date: March 8, 1985 �
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Fede_ral R ister, Vol . 50, No. 48, Page 9517 .
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; �� � 3inder No.
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�'�:��'•aME pti�ADDRESS OF AGcNCV COMPANY � �J —/�.C/�
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:�` � Alexander � Alexander, Inc. St. Paul Fire � Marine Insurance Com an
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900 Norwest Center Effective12•01 am 5-1 .i985
r 55 East Sth Street Expires ❑ i2:oi am ❑ NoonUNTIL PpBICY ISSUE
�. St. Paul, Minnesota 55101 ❑This tiinder is issued to extend coverage in the above named
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company per expiring policy q
Ie.ceDt as note0 befowl
,�. •.eMe 4ND MAiUNG ADDRESS OF INSURED OBSCfIPt�Ofl Of Op@►B�IOnIV8f11C195IPfOpBl�y
Ramsey County Nursing Service � . �/ ����
r Ramsey County Public Health �0 J '�
150 East Kellogg
Room 910 � Room 610
� P Mi e o 55101
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Type and Locetion af Property � CoveragelPerilslForms � Amt ol Irtsura�ce Ded. co��s
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Type ottnsurance Coverage/Forms
Limits ot Liabilitr
� Each Occurrence A9g�egate
1 ❑ Scheduled Form Bodily Injury g
� Comprehensive Form $ �
A ❑ Premisesl0perations
B
� ❑ Products/Completed Operations Property Damage. $ g
L � �
� ❑ Contractual � Bodily Injury 8
T � Other (specify below) prOfessiondl Lidb].11ty Property Damage 5 600,400, �1,800,000
Y
❑ Med. Pay. S ve� $ ve� Combined
Pe�son Acc�dem I; (� PersOnal In ur $
❑ Personal Injury U A ,_, B �C � y
• Limits of Liabilify
A U Liability ❑ Non-owned ❑ Hired � Bodily Injury(Each Person) $
U s
T ❑ Comprehensive�Deductible $ . Bodiiy Injury(Each Accident)
� ❑ Collision•Deductible 3
M �1
� lJ Medical Payments $ Property Damage S
B
� ❑ Uninsured Motorist S
� ❑ No Fault (specify): Bodily Injury 8 Property Damage
E
❑ Other (specify): Combined $
u WORKERS' COMPENSATION — Statutory Limits (specify states below) u EMPLGYERS' LIABILITY — L�mit S
SPECIAL CONDiTIONSfOTHER COVERAGES
tisME AhD ADDRESS OF D MORTGAGEE ❑ lOSS PAYEE LX� noo��r,suaeo JPTJRDW/dtn • ' '�
1) School•D�strict 621 ���'��. ..�'� -�
LOAN NUMBER �
2) M.F. R�ard ';'`�'' -- • ' ..'\ * ��.
3� Ramsey County Officials, Employ�, � Volunteers ?� �,+: •� • :`;�'�;, ~__�I,•.�;,� �;�
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� `"'�— '��L�Y.���T
S�Qrr3iure ot'Atr.rd�zed Representat�ye Oate
aCOFiD 75(�tl77c)
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• ���r- 'y�,� �i:r�� CITY OF SA.INT �.t�.UL
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f;=: ,-t;. �' OI'TICT: OF THLr CITY COIINCIL �
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'._y�g3�:.:CC'.•;�� ��`.
�� � �=a"��-='` D o t e ; Sept. 26, 1985
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COi1/iM (TTEE F� EPORT
TO = SQ �n�t PQU I City Counci !
FR � � = COi`J1C1ni�tQ° Oh FINANCE, MANAGEMENT � PERSONNEL
. C F� A I R James Sche i bel .
1. ResoluCion amending the. l°85 budgec and �;ansrerring $1,C00,000 from Community Ceve!opmenc
Block Granc Fund-Program inccme-.!and Sales to CommuniLy DevelopmenC Block Grant fund-
World Trade Cencer. (pED) {�P��,fl . •
� 2. Resolution amending the 1985 budget and adding $58,434 to the Financi�g and Spending
' : Plan for £quipment Services rire-Police. (Fire Oept.) rCI���QV'4'..10
� j, Resolution amending the 1985 budget and adding $15,364 to the Financing and Spending
- � Pla� for fire FighCing Equipmen�: (Fir.e Oept.) qpPi�OVQp ,
. ; 4. Resoiucion amendin the 1985 bud et and addin •
9 g , g $28,310 to the Financing and Spending
, � Plan for Infrastructure Invencory. (Public Worics},�Oti/� . -
5, Resolution amending [he 1985 budge[ and adding $Z0,000 to the Einanci�ng and Spendina
' Plan for 6eneral Govt. Accpunts-City Attorney'S Office. (City Attorney`s Office)����
. 6. Resolution authorizing an agreement with Hinnesota Sta[e Agricuitural Society (Hinnesota
• State Fair Board) whereby the City will provide animal control services. (Comn. Services)���i'�Q'���
� 7. Ordi�ance amending Chapters 369, 374, �and 310 of the Legislative Code pertaining to
building trades busin�ss licenses and cerLificaces ot' compecency. (Comn_�'i'ervices)I.I�t1 Q. (jV'� � ,
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, 8. ftesolucion auchorizing a supplemencal �agreement With the Commissioner o 4 Transoorta[ion
to allow additional funding for comoletion of communication cabie systerd�fer. comoucerized
� � signal system. (Public uorks) �PPRbV� .
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. 9. Resolucion authorizin9 an agreemenc with Ramsey Eouncy Public Heaith Nursing where6y the ',��y
C:ty with receive se�vices cr a nurse praccitioner for the Homeless CTinics. (Cemm. Serv.}a'°Sf''� �-��d��
ld. Resolu[ion au[horizing a 1985 �Perating AgreemenC with I.S:�. „625 Whereby thg�rity
furnishes various services to tfie Oistrict. (Finance E Mgmt. Services) �i"'�W��
11. Resolution•�authorizing an agre�menc with MN. State Agriculturai Societ;�±herehv $he City
� provided various police services during che 1985 State Fair. (Police pepc.) ��?�'� �
� 12. Resalution auchorizing-an amendment to a Lease Agreement with the Pmrt Autho sty for
additional -land [o be used for Che City's Imnound Lot. (Police Depc.) ���
, 13. Resolu�ion auchorizi�g and accepcing ;3a,�00 Urban Parks b Recreation Recovery Proaram ^�
gran[ Lo conduct a citywide needs assessmenc for the Parks E Rec. System. (�emm. Services)/'St ��`�'��
14. Resolucion approving 1°,85 Memo. of AgreemenL be[ween ISD .z625 and Operative Plasterers
. E• Cemenc Masons, Locals ,�20 $ 5b0, Twin City. G.iaziers E 6 ass WoGrk�rs, Local 1324 and . '
Twin City Carpeneters OistricL Council. (Personnel} ���U�+ .
' _ • 15. ResoluLion approving 1985 Maintenance Labor Agreement between ISD Tb25 and [he U i
Union of Roorers, uacerproofers and Allied 'dorkers, Local n96. (Personnel) ����
� 16. Resolucion relating to the West-Hidway So. SC. Anthony Par!c Redevelopment area, aoproving
amendment oT the reaevelopmen[ plan and approving adootion ar a tax inctemenc plan creaced
within and for said area (4Jaldor� Corp-� (PEJ) 'Q���� � ' , • •
•"'17. Discus ion or allocating additio�al 1°85 funds for the has�cet�reave p�ogram. .
�ESOLLIT1oN p� �t�Gl. OF Q-�6-�5 P�gROU�.
CITY HALL SEVENTH FLOOR SAINT PAUL, �4INNESOTA 55i0�
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