95-993 I�
N
�.� � I � � !`�� � �
Presented By
Referred To
;�����=���
�J��(�s
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Coimc;fl File #
Green Sheet #
9s= ��3
30587
�
WHEREAS, the City of Saint Paul seeks to improve the health and nutritional status
of women, infants and children; and
WHEREAS, the Minnesota Department of Health has approved an application grant
from Saint Paul Public Health to administer the W.I.C. (Women, Infants and Children)
Supplemental Food Program for Saint Paul and Suburban Ramsey County:
THEREFORE, BE IT RESOLVED, that the Saint Paul Board of Health supports the grant
application of Saint Paul Public Health and subsequent contract with the Minnesota
Department of Health for the W.I.C. Grant.
FINALLY BE IT RESOLVED, that the Saint
fied
by Saint Paul Public Health if the contract with the Minnesota Department of He.
for the WIC grant is reduced and appropriate action would be taken in regard to
staffing and reduction of the program at that time.
ea��
Gnmm
Guenn
Harris
Meeaz
Rettman
Thune
Adopted by Council:
Certified by Council
By: �
Approved by
Br• �
Navs Absent
— �
Committee: Date
Requested by Department of:
By: G (SEG� -L� ( °'{� °,��'--'
L�q,S Form A ov by ' tt� �
By: s
�!i
5 Appzov by Mayor for � b � ssi _ on to Council
B ��/L � ��C/��i
Public Health
Diane Aolmgren 292-7712
�UST BE ON COUNQL AGENDA BY (DATE)
Scheduled for 8/16/95
g� y�3
8/4/95 GREEN SHEET �° 3 0 5 8 7
INRIAL./OATE INITIAVDATE
� DEPAPTMENT DIRECTOR � CITV CqUNCIL
IGN CRYATTOflNEV �CITYCLERK
IBFA FOfl
RING UDGET DIRECTOR � PIN_ & MGT. SERVICES I�
iER �MAYOR(ORA$$ISTANiJ �
TOTAL # OF SIGNATURE PAGES ` (CLIP ALL LOCATIONS FOR SIGNATURE)
Signatures on a Resolution for Board of Health approval of the administration of the local
WIC (Women, Infants and Children) Supplemental Food Program for Saint Paul and Suburban
Ramsey County.
or
_ PLANNING COMMISSION _ (
_ CIB COMMITTEE _ _
_ STAFF _ .
_ DISTRICTCqURT _ _
SUPPORTS WHICH COUNCIL OBJECTIVE?
INITIATING
PERSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLLOWING �UESTIONS:
7. Has Mis persoNfirm ever worked untler a coniract for this departmeM?
YES NO
2. Has Cnis personHirm ever been a ciy employee?
YES NO
3. Does this persoNfirm possess a skill not normally possessed by any curreM city employee?
YES NO
Explain ali yes answers on separete sheet antl ettaeh to green aheet
Saint Paul Public Health will receive over $1,000,000 for each of two years between the dates
of October l, 1995 to September 30, 1997 to administer a local WIC Program in Saint Paul and
Suburban Ramsey County. �������'� �cCCI��D
G �-S
� �. ,.
� � t'
c •
' The City will receive funding to administer the WIC Program in Saint Paul and Suburban
Ramsey County.
' Pregnant and breastfeeding women, infants and children will receive continued high quality
and responsive WIC services.
NONE
�� � �
The City will not receive over $1,000,000 annually to administer the WIC Program and would
not be providing this service to residents in Saint Paul neighborhoods.
TOTAL AMOUNT OF TRANSAC710N E COS7/REVENUE BUDGE7ED (CIRCLE ONE) YES NO
Federal pass through from Minnesota
FUNDIIdGSOURCE Department of Aealth ACTIVITYNUMBER 33247
FINANCIAL INFORMATION: (E%PLAIN)
����� ����:� ��,����EC�9VfD
AEJG � 1995 Ai1� �7 ����
�F. .-w�{1�C � K � �
95-993
STATE OF MINNESOTA
• AGREEMENT FOR TF.3
ADMINISTRATION OF THE SPECIPS, SUPPLEN,ENTAL NUTRITION PROGRAM
FOR WOMEN, INFANTS, AND CAILDREN
(WZC PROGRAM)
This Agreement, which shall be interpreted pursuant to the laws of the State
of Hinnesota, between the State of Minnesota, acting through its Minnesota
Department of Health (hereinafter STATE AGENCY)
And St. Paul Division of Public Health (hereinafter LoCAL AGENCY), witnesaetka
that:
WHEREAS, the STATE AGENCY, pursuant to Minnesota Statutes and Rulea 4617.0030,
is authorized to enter into contractual agreemente for the adminietration of
the Minneaota Special Supplemental Nutrition Program for Women, Znfanta, and
Children (hereinafter WIC Program), and WE3EREA5 the U.S. Department of
Agriculture (hereinafter U.S.D.A.) has promulgated the code of Federal
Regulations, Title 7, Part 246, under Section 17 of the Child Nutrition Act of
1966 (42 U.S.C. 1786), to carry out the WIC Program,
AND WHEREAS, this Agreement is made in order to administer the WIC Program,
AND WHEREAS, the LOCAL AGENCY represents that it is duly qualified and willing
to perform the duties set forth herein, NOW TAEREFORE, it is agreed:
� I. THE LOCAL AGENCY AGREES TO:
A. Administer a WIC Program within its designated service area in an
efficient and effective manner and in compliance with applicable
State policies and procedures, Minne Rules chapter 4617, 7 CFR Part
246,.7 CFR Part 3015 and U.S.D.A. guidelines and instructions. The
LOCAL AGENCY's Application for the Administration ot a Local WIC
Project, October 1, 1995, to September 30, 1997, as may be amended
by agreement between the parties, is hereby made a part of this
Agreement.
Be Employ competent professional authority to perform WIC Program
certification procedures and nutrition education services in
accordance with State policies and proceduree, and Minnesota Rules
chapter 4617, including qualification, training, testing and
supervieion of ataff.
C, Have the facilities, equipment and materials necessary to perform
WIC Program certification proceduree and nutrition education
services.
D. Determine eligibility and certify persons eliqible for the WZC
Program according to established ceztification procedures, docume�s�
certification actions on the certification form provided by the
STATE AGENCY, provide WIC Program benefits on a timely basis to
• certified persons, and reassess eligibility at the preecribed
intervals,
Page 1 of g2
E. Hake available to WIC Program participants appropriate h�alt� ��
services (as set forth in Minnesota Rules chapter 4617 (A)), and
inform applicants and pzrticipants of the health services which are
available. •
F. Provide nutrition education and breaetfeeding promotion to WIC
Program participants in accordance with State policiea and
procedures, Minnesota Rules chapter 4617, 7 CFR Part 246.11,
U.S.D.A. guidelines and instructions, HN WIC Yrogram Operations and
Nutrition Education Manuals, and the LOCAL AGENCY's Nutrition
Education Plan.
G. Operate the Minneeota WIC Program Automated Food Delivery and
Management Znformation System in accordance with State Ru1es,
policies and procedures, including establiehing and maintaining
aecountability and inventory controls over WZC food vouchere.
" H. Reimburse the STATE AGENCY for paymenta previously paid to the
LOCAL AGENCY pursuant to Paragraph II of this Agreement for costs
found to be in excess of the LOCAL AGENCY's written grant letterap
eosta deemed to be improper, unallowable, or undoeumented ae the
result of an audit, review, or other examination; and for the '
cashed value of any WIC Program food vouchers which may be atolen
from or lost by the LOCAL AGENCY or isaued by the LOCAL AGENCY to
persons other than properly certified WIC Program participants or
their authorized proxies.
I. Maintain complete, accurate, documented and current program and
fiscal recorda and filea, in accordance with State financial
management requirements, Ru2es, policies and procedurea, 7 CFR Part •
246 and 7 CFR Part 3015, and II.S.D.A. quidelines and instzuctiona,
including source doeumentation to support WIC Program activities
and expenditurea made under the terma of this Agreement.
J. Submit financial reporta in a form prescribed by the STATE AGENCY.
1. The LOCAL AGENCY shall provide the STATE AGENCY by the
twentieth (20th) day of each month the Claim for.
Rei.mbursement/Report of Expenditures form, which ahall include:
a eummary of the funds actually expended during the report
pQriod by budqet line item, the amount of funda currently
obligated, the amount of funds expended year-to-date, the value
of in-kind services contributed, and the amount of WIC Program
caah on hand.
2e The LOCAL AGENCY shall submit a final Claim for
Reimburaement/Report of Expenditures form to the STATE AGENCY
by January 20th of the calendar year immediately following the
end of the fiscal year. Payments for said fiscal year will not
be made for clai.vts filed after this date.
•
Page 2 of 12
3. The LOCAL AGENCY sha11 provide the STATE AGENCY wit�an an� �-
expenditure plan prior to January first of the fiscal year „
• which indicates the LOCAL AGBNCY's fiscal year budget for
adminietration, nctrition education, and breast:eeding
promotion, including salary and fringe benefits, rent,
er suppliee, communication and travel, all other, and
inditect costs, and a11 other budqet data as the STATE AGENCY
may prescribe. .
K, Submit by the seventh (7th) day of each month the Monthly
Participation Report. , � -
L.- During normal working hours, provide accese to authorized
repreaentativea or agents of U.S.D.A., the U.S. General Accounting
Office, the STATE AGENCY, the Legislative Auditor, the S�ate
Auditor, and any independent auditor designated by the STATE
AGENCY, to the LOCAL AGENCY's recorde, documente, financial
atatementa, and accounting procedures and practicea related to this
Agreement for purposes of inepecting, auditing, or copying, and as
may be necessary for the State to comply with the Single Audit Act
of 1984 and OHB Cizcular A-128, or as applicable.
M. Maintain records sufficient to reflect all costa incurred by the
LOCAL AGENCY in its performance of th Agreement.
N. Maintain on file and have available for review, audit, and
evaluation, a11 criteria used for certification, including
information on the area served, income standards used, and epecific
� criteria used to deter•nine nutritional riak.
O. Comply with the following statutes and the regulationa adopted
under them: (1) Title VI of the Civil Righta Act of 1964, United
Statea Code, title 42, sections ZOOOd to 2000d-4a; (2) Title IX of
the Education Amendments of 1972 United States Code, title 20,
secbibna 1681 to 1688; (3) section 504 of the Rehabilitation Act of
1973, United States Codes, title 29, aection 794; (4) the Age
Diacrimination Act of 1975. United Statea Code, title 42, aections
6101 to 6107; and (5) the Americana with Disabilitiea Act of 1990,
United Statea Code, title 42, aections 12101 to 12213; to ensure
that no peraon is diacriminated againat in employment practices or
in the delivery of WIC Program benefits on the grounds of race,
color, national origin, age, sex, handicap, or disability.
P. R�quir� all new staff to undergo the training provided by the STATE
I,GEItCY pursuant to paraqraph XX(D) of this Agreement.
Q. Provide the services set forth in the LOCAL AcENCY's Application
for the Administration of a Local WIC Project, october 1, 1995 to
september 30, 1997. � ,
Re Promptly comply with all reasonable requesta by the STATE AGENCY
fos information.
Sa Obtain written consent from the STATE AGENCY prior to implementing
• any changes to the LOCAL AGENCY's WIC Program as described in the
LOCAL AGENCY's�Application for the Administration e£ a Local WIC
Project, October 1, 1995, to September 30, 1997a
Page 3 of 12
95
T. Develop a nutrition education plan which: (1) is consistent with
Code of Federal Regulations, title 7, section 246.11, paragraph
(d)(2); (2) includes the criteria used to aelect pazticipants for
high-risk nutrition ed�cation; (3) includes the criteria the local •
agency uses to determine which participants will receive an
- individual nutrition care p1an; {4} is consistent with Hinnesota
Rules, chapter 4617; and (5) is consistent with the WIC Program
Operations Manual in effeet as of October 1, 1995, and any
zevisions to this manual.
U. Have a plan, conaistent with Minnesota Rulee, chapter 4617, for
- continued efforts to make health services available to participants
at the clinic or through written agreements with health care
providers when health aervices are provided through referral.
II.� CONSZDERATZON AHD TERMS OF PAYMENT, __
The STATE AGENCY agrees to: �"'
A. Provide payment, in consideration for all services performed by the
LOCAL AGENCY purauant to this Agreement, not to exceed an amount
established in written grant lettera, which upon execution by the
commissioner of Health shall be a part of thia Aqreement. Such
payment for aervices shall be contincjent upon receipt of funds from
U.S.D.A., a properly submitted Claim for Rei.mbursement/Report of
Expenditurea form from the LOCAL AGENCY, and the acceptance of such
aervices by the STATE AGENCY's authorized agent purauant to
paragraph VI of this Agreement.
B. Upon the request of the LOCAL AGENCY, pay the LOCAL AGENCY one •
initial cash advance for each fiacal year, contingent upon the
STATE AGENCY's receipt of funds from U.S.D.A. Each such cash
advance ahall not exceed an amount equal to two months' of annval
expenditures (1/6th of pzevious fiscal year'e costa) authorized
under Paragraph ZI (A). All auch advance payments sha11 be
returned to the STATE AGENCY at the end of the Federal Fiscal Year,
or when the STATE AGENCY determinea that advance payments are no
lonqer needed, or that the aervices for which advance paymenta were
made were not satisfactorily rendered.
C. �Make paymenta from Federal funda obtained by the STATE AGENCY
through Title 7, Part 246 of the Child Nutrition Act of 1966 (42
II.S.C. 1786) and amendmenta thereto and from any State funds
appropriated to thQ WZC Proqram by the Legislature of the State of
ISinn�oota. If, at any time, such Federal and State funds become
unavailable, this Agreement shall be terminated immediately upon
c+rittaa notice of such fact by the STATE AGENCY to the LOCAL
- AGBNCY. In the event of such termination, the LOCAL AGENCY shall
be ent3t2ed to payment, determined on a pro rata basis, for
aervices eatiafactori2y performed.
• ,
Page 4 of 12
95�99� �
III. CONDZTZONS OF PAYMEHT. A11 services by the LOCAL AGENCY pursuant to
. this Agreeaent ehall be performed to the satisfaction of the STATE
AGENCY, as determined in the sole discretion of its authorized agent,
and in accord with a11 aoplicable Federal, State, and local laws,
ordinancee, rulee, and regulations. The LOCAL AGENCY shall not receive
payment for work found by the STATE AGENCY to be unsatisfactory or
performed in violation of Federal, State, or local law. ordinance,
rule, or regulation. -
ZV. TER![ OP GRANT CONTRACT. This Agreement shall be effective on Octobez
1, 1995, or upon euch date as it is executed as to encumbrance by the
Commissioner of Finance, whichever occura later, and shall remain in
effect, except for the requirements specified in this Agreement with
eompletion dates which extend beyond the tezmination date specified in
thia sentence, until September 30, 1997, or until a11 obligationa aet
forth in thia Agreement have been eatisfactorily fulfilled, whiehever
occura first. The expiration of this Agreement ie not aubject to
appeal.
A. The LOCAL AGENCY shall have ninety (90) days immediately following
the end of the Agreement period to liquidate all unpaid obligatione
related to the WIC Program incurred pr-ior to the end of the
Agreement period and to aubmit a detailed accounting of these
cumulative expenditurea to the STATE AGENCYe
B. The LOCAL AGENCY ehall return to the STATE AGENCY all funds
� provided by the STATE AGELICY which are not expended for allowa6le
WIC Program coata within ninety (90) days following the end of the
Agreement periode
V . CANCELIJiTION o
A. If the LOCAL AGENCY faila to comply with the proviaiona of this
Agreement, the STATE AGENCY may terminate thia Agreement without
prejudice to the right of the State to recover any money previously
paid. The termination ahall be effective three buainess daya after
the STATE AGENCY mails, by certified mail, return reeeipt
requeated, written notice of termination to the LOCAL AGEttCY at its
lnet known address.
H. Th� STATB AGENCY or LOCAL AGENCY may cancel thia Agreement at any
tia�, with or withovt cause, upon ninety (90) days' written notice
to th� ether pazty_ Zn the event of such cancellation, the LOCAL
11GiFCY shall be entitled to payment, determined on a pro rata
basis, for servicea satiafactorily performed. ,
C. Should this Agreement be terminated or cancelled effective before
' September 30, 1997, the LOCAL AGENCY ahall refund to the STATE
AGENCY all remaining unexpended WIC Program monies within fosty-
£ive {45) days of the date of effective termination.
. D. The STATE AGENCY ehall pay the LOCAL AGENCY for aervices
satisfactorily performed pursuant to this Agzeement before the
effective date termination or cancellation<
Page 5 0� g3
95
VI. STATB'3 AUTHORI2ED AG£NT. The STATE AGENCY's authorized agent for the
purposea of the administration of this Agreement is the WIC Program
Administrator, Minnesota Department of Aealth, or any other employee or •
employees of the Hinnesota Department of Health designated by the WIC
Program Administrator. Such agent sha11 have the final authority to
accept the LOCAL AG£NCY's services, and if eueh services are accepted
as satiafactory, sha11 so certify on each Claim for
Reimbursemeni/Report of Expendituras submitted parsaant to Paragraph II
(A)•
VIZ. A55IGHMEHT. The LOCAL AGENCY ehall neither assign nor transfer any
rights or obligations under this Agreement without the prior written
__. consent of_the STATE,AGENCY. - ; . ,-
VIII- AMEliD1�NT3. Any amendments to this Agreement shall be in writing, and
shall be executed by the same parties who executed the original
Agreement or their successors in office. .
SX. LZABILITY. The LOCAL AGENCY agreea to indemnify and save and hold the
State, STATE AGENCY, its agents and employees harmlesa from any and a11
claims or causes of action ariaing from the performance of this
Agreement by the LOCAL AGENCY or the LOCAL AGENCY's agents or
employeea. This clause ahall not be conaLrued to bar any legal
remedies the LOCAL.AGENCY may have for the STATE AGENCY's failure to
fulfill its obligations pursuant to this Agreement.
X. AVDIT REQUIREMEl7T5.
A. LOCAL AGENCY's Threahold for Audit Reguirementa
1. For Local Agencies that are Indian Tribes, or local
governmenta, and receive total direct and indirect federal
asaistance of: .
a. $100,000 or more per year, the LOCAL AGENCY agrees to
obtain a financinl and compliance audit made in accordance
with the Sinqle Audit Act of 1984 (P.L. 98-502) and £,ederal
Office of Hanagement and Hudqet (OHB) Circular A-128,
"Audits of State and Local Governmenta.^ The law and
circular provide that the audit shall cover the entire
operationa of the LOCAL AGENCY or, at the option of the
LOCAL AGENCY, it may cover departments, agencies or
establishments that received, expended, or otherwise
adminiatered Federal financial assistance during the year.
Hrnraver, if the LoCAL AGENCY receives $25,000 or more in
General Revenue Sharing £unds in a fiecai, year, it shall
have an audit of itn entire operations.
b: between 525,000 and 5100,000 per year, the LOCAL AGENCY
agrees to obtain either -
•
(1) a financial and compliance audit made in accordance
with the Single Audit Act of 1984 and OMB Circulnr
_ A-128, or - ' . -- - _
•
Page 6 of 12
•
95°993
(2) a financial and compliance audit of all Federal funds.
The audit must determine whether the LOCAL AGSNCY spent �
Federal assistance funds in accordance with apnlicable
laws and regulations, aad the audit nust be made in
accordance with any Fede-al laws and regulations
goverr.ing the Federal programs in which the LOCAL
AGENCY participatee. -
Audits shall be made annually unless the LOCAL AGENCY had, by
January 1, 1987, a constitutional or statutory requirement for
less frequent audits. For those LOCAL AGENCIES, the federal
cognizant agency ehall permit biennial audits, covering both
years, if the LOCAL AGENCY so requeste. It shall also honor
requesta for biennial avdits by LOCAL AGENCIES that have an
administrative policy calling for audits lesa frequent than
annual, but only for fiscal years beginning before January 1,
1987.
2. For Loeal Agencies that a=e institutions of higher education,
or non-profit organizatione, and receive total direct and
indirect Federal asaistance of: .
a. 5100,000 or more per year, the LOCAL AGENCY agrees to
obtain a financial and compliance audit made in accordance
with OMB Circular A-133 "Audita of Inatitutions of Higher
Education and Other Nonprofit Organizationa." The audit
must be an organization wide audit, unlesa it ia a
� eoordinated audit in accordance with OMB Circular A-133.
However, when the 5100,000 or more was received under only
one program, the LOCAL AGENCY may have an audit of that one
program.
b. between 525,000 and 5100,000 per year, the LOCAL AGENCY
agrees to obtain either:
(1) a financial and compliance audit made in accordance
with OHB Circular A-133, or '
(2) a financial and compliance audit of each Federal
program. The audit muat determine whether the LOCAL
AGENCY apent Federal asaistance funds in accosdance
with applicable lawa and regulations, and the audit
must be made in accordance with any Federal law and
zequlation qoverning the Federal programs in which the
LOCAL AGENCY participatea.
Audita shall usually be made annually, but not leas frequently
than every two yeara. �
�. The aud3t shall be made by an independent auditor. An independent
auditor is a State or local government auditor or a public
accountant who meeta the independence etandards apecified in th�
General Accounting Office's Standarda for Audit of tiooernmental
• Orcanizations Proarams Activitiea aad Funetions.
Ce The audit report sha11 atate that the audit was performed in
accordance with the provisiona of OMB Circular A-128 or A-133, aa
` applicable.
Page 7 of X.�
95
The reporting reguirements for audit reports on financial
statements shall be in accordance with the American Institute of
Certified Public Accountants' (AICPA) Statement on Auditing •
Standards (SAS) 58, "Reports on Audited Financia2 Statements" or
SAS 62, "Special Reports", ae applicable.
The�reporting requirements for audit reports on compliance and
internal controls ahall be in accordance with AICPA's SAS 63,
�.."Complianca Auditing Applicable to Government Entitiea and Other
Recipients of covernmental Financial Assiatance" and Statement of
- Position (SOP) 89-6,_"Auditors' Reports in Audits of State and
Local Governmental Units."
Zn addition to the audit report, the LOCAL AGENCY sha11 provide
commenta on the findinga and recommendationa in the report, ineluding a
plan for corrective action taken or planned, and comments on the etatua
of corrective action taken on prior findings. Zf corrective aetion is
not necessary, a statement describinq the reason it is not ahould
accompany the audit report.
D. The LOCAL AGENCY agrees that the State, the STATE AGENCY, the
Legislative Auditor, and any independent auditor designated by the
STATE AGENCY ahall have such access to the LOCAL AGENCY•s recorda
and finaneial etatements as may be necessary for the STATE AGENCY
to comply with the Single Audit Act of 1984 and OMB Circular A-129,
or A-133, as applicable.
E. Subcontractor Agencies of Federal aseistance for the LoCAi, AGENCIES
are aleo required to eomply with the Single Audit Act of 1984, OMB •
Circular A-128, or A-133, as applicable.
F. The LOCAL AGENCY agrees to use a standard statement format for the
achedule of Federal assiatance provided by the STATE AGENCY.
G. The LOCAL AGENCY agreea to retain documentation to support the
achedule of Federal assistance.
H. Required audit reporta must be filed with the Office of the State
Auditor, Single Audit Division, and Federal and 5tate agencies
providing FedQral assiatance within six months of the LOCAL
AGSNCY's fiscal year end. These reports must alao be filed within
this tims period with the Hinnesota D'epartment of Health, Financial
Manaqement Section.
Z. O!0 Circularea A-128 and A-133 require Local Agencies receiving
mor� than $100,000 in Federal funds to sabmit one copy of the avdit
report within 30 days after iasuance to the central clearinghouae
at the followinq address:
_ Bureau of the Censua -
Data Preparation Diviaion
- 1201 East lOth Street - .
Jefferaonville, Indiana 47132
Attn: Single Audit Clearinghouse _ • '
Page 8 0€ a�
95-993
XZ. OWNERSHIP OF DOCUMENTS AND EQUIPMENT� IHSURANCE ON AHD LIABILZTY FOR �
� EqUZPt2'22T• Any reports, studiee, photograohs, negatives, data,
aurveys, or other finished or unfinished documents prenared by the
� LOCAL AGENCY and any ewipment, medical supolies, computer equipment,
computer software, furniture, and furnishings purchased and/or utilized
by the LOCAL AGENCY in the performance of its WZC Program obligations
under thia Agreement and related to and funded in part or whole by the
STATE AGENCY, ahall be the exclusive property of the STATE AGENCY and
a11 euch materials sha11 be remitted to the STATE AGENCY by the LOCAL
AGENCY upon completion, termination, or cancellation of this Agreement.
The LOCAL AGENCY shall not use, willingly a11ow, or cause to have such
materials used for any pnrpose other than performance of the LOCAL
� AGENCY's obligations under this Agreement. without the prior written
consent of the STATE AGENCY.
� The LOCAL AGENCY shall maintain insurance on all equipment, medical
auppliea, computer eqvipment, computer software, furniture, and
furnishings purchaeed andJor utilized by the LOCAL AG£NCY in the
per£ormance of ita WIC Program obligations under this Agreement and
related to and funded in part or whole by the STATE AGENCY (hereinafter
collectively referred to as the "Equipment"). The LOCAL AGENCY shall
maintain inaurance on all of the Equipment at a11 timea unlese and
until the STATE AGENCY receives all of the Equipment upon completion,
termination, or cancellation of this Agreement. The insurance
maintained by the LOCAL AGENCY ahall cover all losa of or damage to the
Equipment cauaed by theft, vandalism, fire, or other casualty, and
shall be in an amount sufficient to cover replacement of a11 Equipment
� with substantially identical items. In the event of any lose of or
damage to any of the Equipment, including any loss or damage cauaed by
LOCAL AGENCY or ita agente or employeea and any loes or damage from
theft�, vandaliam, fire, or other casualty, the LOCAL AGENCY shall, at
the expenae of the LOCAL AGENCY, fu11y repair all damaged Equipment
and replace all lost Equipment with substantially identical itema. The
LOCAL AGENCY aha11 not usa any funds from STATE AGENCY to repair or
replace any loet or damaged Equipment.
XZI. 7.FFIRMATIVB ACTZON. The LOCAL AGENCY certifiea that it has received a
certificate of compliance from the Commissioner of Human Rights
pursuant to Hinneaota Statutes, Section 363.073e
XIIZo WORxERB' COI�ENSATION. In accordance with the proviaions of Hinnesota
Statut�s, Section 176.182, the LOCAL AGENCY has provided acceptable
evidsnc� of compliance with the workers' compensation insurance
cov�rage rrquirement ot Hinneaota Statutes, Section 176.181,
Subdivision 2.
XIV. aHTiTAIIBT. The LOCAL AGENCY hereby aseigna to the State df Minneeota
any and all claima for overchargea as to gooda andJor aervices providec�
in connection with this Agreement reaulting from antitruat violations
which ariae under the antitrust lawa of the United States and the
antitruat laws of the State of Minneaota. �_
XV. DATR PRZVACY. Yursuant to Minneaota Statutea, Section 13.05,
• Subdivision 6, the LOCAL AGENCY agrees to administer and maintain the
data on individuale�received or to which the LOCAL AGENCY has accesa
according to the atatutory provisiona applicable to the data. The
LOCRL AGENCY aqrees to indemnify and save and hold the State, the STATE
Page 9 of R2
95-993
AGENCY, ite agents and employees, harmless from any and a11 claims or
causea of action arising from the performance of thie Agreement by the
LOCAL AGENCY or the LOCAL AGENCY's agents or employees or in any manner �
attributable to any violation of any provieion of the Hinnesota
Government Data Practices Act, or other privacy laws, by the LOCAL
AGENCY or the LOCAL AGENCY's agents or employeea, including leqal fees
and disbuzsementa paid ar incurred to enforce this proviaion of'this
Agreement. _ _ -
: XVI._.VOTER RE6ZSTRATZON. The LOCAL AGENCY shall provide nonpartisan voter
-� - services and assistance, using forms provided by the
:_'__ State, to employees of the LOCAL AGENCY and the public, as required by
� �-� Minnesota Statutee, Section 201.162. ,. � .
XVII• VACAHT OR NEW POSZTIONS. The LOCAL AGENCY agreea to liat any vacant
--- or new positiona with the job services of the Commissioner of Economic
� Security or the local service units, as required by Minnesota Statutes,
' - Section 268.66. - . .
XVIII. RELZ6IOUS OR POLITICAL ACTSVITY. The LOCAL AGENCY certifies that no
�-�� funding provided under this Agreement will be uaed to support religious
counseling or partisan political activity.
XZX. LOBSYSN6. LOCAL AGENCY agrees to complyu with the proviaions of United
Statea Code title, eection 1352. LOCAL AGENCY must not uae any federal
funds from STATE AGENCY to pay any person for influending or attempting
to influence an officer or employee of a federal agency, a mecaber of
Congress in connection with a the awarding of any federal contrat, the
making of a federal grant, the making of a federal loan, the enterinq •
into of any cooperative agreement, and the extenaion, continuation,
renewal, amendment, or modification of any federal cont=act; grant,
loan or caoperative agzeement. If LOCAL AGENCY uses any funds other
than the federal funds from STATE AGENCY to conduct any of the
aforementioned activities, LOCAL AcENCY must complete and submit to
STATE AGENCY the discloaure form apecified by STATE AGENCY. Further,
LOCAL AGENCY muat include the language of this provision in all
contracts and eubcontracta and all contractors and aubcontractoza must
comply accordingly.
XX. TH8 STaTE ]16ENC7C AGRELS TOs
A. Provid� technical assistance and consultation to enable the LOCAL
11GZNCY to eatablish and adminiater a WIC Pzogram.
B. Provido appropriate forms and materials necessary to establish and
adniniater a WIC Program.
C. Yrovide copies of 7 CFR Part 246, the Minnesota WIC Program
Operations Hanual, Hinneaota Rules chapter 4617, State policiea and
procedurea, and other instructions and guidelines on a tisoely basie
neeeasary to eatabliah and administer a WIC Program.
D. Provide new staff training at times and places desiqnated by the
' �_ WIC Program Administrator. - __ •
Page 10 of ga
9�-993
XXI. OTHER PROVISIONS.
• A. The LOCAL AGENCY agrees to utilize competitive bidding and other
procedurea�reauired by Federal, State, and local laws, ordinances,
or regulations governing purchaeing and fiscal procedures.
B. If the LOCAL AGE*ICY decidee to fulfill any of its obligations and
duties under this Agreement through a aubcontractor to be paid for
by funds received under this Agreement, the LOCAL AGENCY ehall not
execute a contract with the Subcontract Agency or otherwise enter
into a binding agreement until it has first received written
approval from the STATE AGENCY. A LOCAL AGENCY eeeking to
aubcontract shall submit to the STATE AGENCY a written request for
authorization to eubcontract, along with a11 information and
documentation which the STATE AGENCY reaeonably requeats. Within
fifteen (15) buainess days after receivinq auch a written request
and all such information and doeumentation, the STATE AGENCY wi11
reepond to the requeat. The propoaed subcontract muet, among other
things, require the LOCAL AGENCY's payments to the Subcontract
Agency to be made in accordance with the time limits, interest
penalty paymente,�and a11 other provisions set forth in Minnesota
Statutes, Section 16A.1245. � �
Subcontract Agencies of Federal financial asaietance from LOCAL
AGENCIES ehall be held to the same atandarda as the LOCAL AGENCY
and are also required to comply with the Single Audit Act of 1984,
OMB Circular A-128, or A-133, as applicable.
� C. With reapect to facilitiea over which the LOCAI. AGENCY has control,
the LOCAL AGENCY shall prohibit smokinq in any area of a hospital,
health care clinic, doctor'a office or other health care-related
facility, except aa allowed by Minnesota Statutes, Section 144,414,
Subdivision 3.
De The LOCAL AGENCY hereby assures that no interest exista, directly
or indirectly, which could conflict in any manner or degree with
the LOCAL AGENCY's performance of aervieea required to be performed
under this Agreement. .
Ee Neither the STATE AGENCY nor the LOCAL AGENCY has an obligation �o
senew this Agreement. ,___
NpTiCE Tp ypC�y 71ciENCYo You are required by Hinnesota Statutes, section
270.66, to provido your eocial security number, federal taxpayer
identification number, or Minneaota tax identification number, if you do
business with the State of 2Sinneaota. This information may be uaed in the
enforcement of Federal and State tax 1aws. THIS AGREEMENT WILL NOT BE
APPROVED UNLE55 TH25 ZNFORMATION ZS PROVIDED. Supplying theae numbers could
sesult in action to require you to file State tax returns and pay delinquent
State tax liabilitiea. Theae numbera will be available to Federal and State
tax authoritiee and State peraonnel involved in the payment of State
obligations.
•
Page 11 Af 1�
Social aeeurity or federal taxpayer ID Number �� a^ ��
7
(if applicable): L��-'lpQ�,ss`�l
Hinnesota tax ID numbere ����� S�j
There are no further substantive provisions to this Agreement; the signaturea
of the authorized representatives of the parties to this Agreement who are
executing it on their behalf appear on this page. �
IN SiITNESS WBEREOF, the parties have caused this to be duly executed
intending to be bound thereby.
APPROVE:
1. LOCAL AGENCY: 2. STAT£ AGENCYa
(Zf a cor�oration two cor�orate
officers muet execute.l
BY: ��LC C�l�CJI�'�� BY:
qZTyge Director, Saint Paul Public HealthTITLE:-'
DATE: �I$I95
BY:
DATE:
3. As to fors and execution:
ATTORNEY GENERAL:
TITLE: 24ayor
DATE:
BY:
Director, Finance and
TZTLE: Management Services
DATE:
APPROVED AS TO FORM:
ASSISTANT CITY ATTORNEY
DATE:
BY:
DATE:
4. COMHISSZONER OF ADHINISTRATION:
HY:
DATE:
5. COMMISSIONER OF FZHANC£:
BY:
DATE:
s
C �
• �
Paqe 12 of 12
MtNNESOTA DEPARTMENT OF HEALT� 5
` 9 93 eSAeet
Grant Application For
• Special Supplementai Nuirition Progrem for Women, Infants and Children (WIC Program)
�
1. Appiicant Agency (with which contract is to be executed)
Legal Name Address Phone
555 Cedar Street
St. Pau1 Public Health St. Paul, MN 55101 (612) 292-7000
2. Director of Applicant Agency
Name/Title Address Phone
Neal Holtan, M.D. "
Actin Public Health Director (612) 292-7000
3. Fiscal Management O�cer of Applicant Agency
Name/Titie Address Phone
Diane Holmgren �� Ibl2 } 292-7�0�
Aealth Administzation Mana er
4. Operating Agency tif different from number 1)
Name/Titie Address Phone
( )
5. Contact Person for Operating Agency (if different from number 2)
Name/Titie Address Phone
Mary Peick 1954 University Ave., Room 12
WIC Coordinator St. Paul, MN 55104 (612)292-7000
6. Contact Person for Further {nformation on AppNcation Gf ditferent from number 5)
Name/Tiile Address Phone
( )
7. Copies of tfiis application have been seni to the foliowing Community Health Boards for Review:
Community Health Ageney Namels) �ece ser,t
BOard(S)-- N/A ifthe David Thune, President, St. Paul Communit Health Boa 5-24-95
Board is the Applicant
310 B City Hall, Courthouse, St. Paul, MN 55102
Hal Norgard, Ramsey County Communit Health Board 5-24-
15 W. Kellogg Blvd., Room 220, St. Paul, I�IN 55102
8. I cerYify that the information contained herein is true and accurate to the besi of my knowledge
and that I submit this appiication on behaif of the appiicant agency
Signature of DirecYOr of Applicant Aqency 7itle Date
� YI��P_ ,�P,�.,- - - f� �`,.� 1�� � !�l� �r r. 5-23-95
HE�09a74�03 16/931
Page t
MINNESOTA DEPARTMENT OF HEALTH
Project tnformation For 7� 9 9�
Special Suppiementai Nutrition Program for Women, Infants and Children (WIC Program) •
'1. Project )nformation
APPLICANT AGENCY
St. Paul Public Health
BEGiNNING DATE END DATE PROJECT FUNDS REQUESTED
October 1, 1995 September 30, 1997 Year 1 Year 2
SERVICE AREA (City, County, or Counties LOCAL MATCH PROVtDED
Year 1 Year 2
N/A N/A N/A
MN TAX I.D.�i
N/A N/A
FED. I.D.# (if applicable)
N/A N/A
2. Non-Profit Status:
501.C3 Copy Attached: Yes _ Not Applicable _X_
3. Evidence of Workers' Compensation insurance: '
Attached: Yes _ No _ Not Applicable x
4. A�rmative Action:
The agency has a certificate from the Commissioner of Human Rights, pursuant to M.S. 363.073:
Attached:
Yes No X Not Applicable Because: `
' ` (a) Total Contract is 550,000 or Less �
_(b) Agency Has 20 or Fewer Futl-Time Employees
X (c) Units of Local Government •
(d)lndian Reservation
Page 2
EVIDENCE OF COMPUANCE g 5- 99 3
• State Iaw forbids the Commissianer of Heaith from entering into any contract untii the
Commissioner receives acceptable evidence of compiiance with workers' compensations
insurance coverage requirements from the contractor. The exception to this requirement is
a self-empioyed contractor who has no empioyees. An employee, as defined by
Minnesota Stat. 176.011, subd. 9, is any person who performs services for another for
hire, including minors and tamily members.
If you do not fail within the exCeption and you wish to enter into a contract with the
Commissioner of Health, you can furnish acceptable evidence of compliance with workers`
compensation coverage in any one of the following four ways:
I. Attach a certificate of insurance (supplied by your workers' compensation carrier to
this Exhibit; or
Ii. If you are self-insured, attached a written order from the Minnesota Commissioner
of Commerce allowing you to self-insure to the Exhibit; or _
ill. If you are self-insured and you are a state agency or a municipal subdivision of the
state, pursuant to Minnesota Stat. 176.181, subd. 2, and are not required to obtain
a written order from the Commissioner of Commerce, circle this entire item and sign
and date the form below in the space provided; or —
IV. Fiil the information for each item below and sign in the space provided:
CJ
A. Name of Contractor's insurance carrier:
B. Address of Contractor's insurance carrier:
C. Contractor's insurance policy number:
De I affirm that all the employees of
IContractor's Namel
are covered by the workers' compensation
�
insurance policy listed above.
Signed by: /�� � o �
Title: /�G��`^�ti ���r�C ��4 ��c �t/'���
Date:— � Z 3 ��5
Page 3
EV[DENCE OF INSURANCE COVERAGE 9�_��� �
i. Attach a certificate of insurance for all equipment and furniture used by agency
� �
Ii. Fill the information for each item below and sign in the space provided:
A. Name of Contractor's insurance carrier:
B. Address of Contractors insurance carrier:
C. Contractor's insurance policy number:
D. I affirm that WIC equipment and furniture at
are covered by the insurance policy listed above.
Signed by:
Title:
Date:
(Convectcr's Namel
�
C�
•
Page 4
EVIDENCE OF INSURAiv'CE COVERAGE C� � 99 3
CJ
C
I, AiicCil Z CEliiiiCciB Of in_<urance �Of c'II EQL'�F('ifEtli c'�ld iL'IfalLfe USEd .�+Y �gency
� �
11. Fill the in`ormz;ion `er each item befow �nd sicn in the <_pace psovided:
q, h'a���e cf Conitacior's insurznce carrier. Commerce and Industry Ins. Co.
B. Address of Convactors insur�nca carrier. 70 Pine St.
'�Y, NY 10270
C. Contractor's insurance policy number: 6058435
' City of St. P2u1
D, I aftirm that VJIC eqUipment snd turniture 2t
' - , lConcec7a!'s NemeJ
are covered by the insurance policy listed zbeve.
Signed by:
7itle: —
D'ci8:
• . :. . � � ...
. >.�Page4
�
�'
�
INSURANCE SUMMARY
SJ �� 95-�93 '
�_�-
�NSURED:
T�i'SURANCE
COMPAIVY:
POLICY NU11�ER:
pOLICY PER14D:
COVEI2AGE:
SCHED[JI,E OF
LOCATIONS:
City of St. Paul
Real Estate Division
140 City Hall
St. Paul, MN 55102
Commerce and Industry Insurance Co.
6058435
7-22-94 to 7-22-95
PROPER"I`Y
As Per Schedule of Locaiions Submitted With Request for
Proposal
POLICY LIlYIITS: $288,o31,585 Blanket Rea1 and Personal Property IncIuding
Licensed Vehicles, Non-Licensed Vehicles, and
Flectronic Data Processing Equipment
$ 2,144,372 Blanket Vacant Buildings
�: 1U�
$ 5,000,000 Business Income (Inciuding Extra Expense & Rents)
$
$
$
$
$
�
$
$
$
15,989,480
13,00�,000
9,963,477
7,000,0�6
5,000,000
S,OOO,OQO
r,oao,000
500,000
SOO,OdO
$ 250,000
$ 250,000
$ 250,000
$ 250,000
$ l0,OQ0
$ Greater of
25% of L.oss
or $1,000,000
Licensed Velucles oa Premises
Electranic Data Processing F,quipment
Noa-Licensed Vehicles on Premises
Demolition Cost and Increased Cost of Construction
Flood (Occurrence/Annual AQgregate)
Earthquake (Occurrence/Annual Aggregate)
EDP Extra Fxpense
Vehicles at Undesignated Location
Froperties Acquired by the HRA through Mortgage
DefauIt
Newly Aquired Property (120 Days)
MisceIIaneous UnnamedLocations (Per Occurrence)
Mobile Equipment on Prem.ises
Properiy in Transit
Pollution Ciean Up
bebris Removal
� s:160\t[pauil9dsum
This scheduie is mere!y descriptive and should be used for reference purposes
only. Specific quesiians on ail policyterms and conditians should be referred to
youc Alexander & Alexsnder contact and the policy itself should be reviewed.
� - . �
�T• . •
lNSURANCE SUMMARY
95-993
•
CAUSES OF LOSS:
Special, °AlI Risk" Pen7s, iacluding Theft, Flood, Earthguake,
EDP Perils and Cdass Breakage
BASLS FOR
ADJtiST'ING LOSS/
VALUATIQ\T:
COINSURANCE
DEDUCI'IBLE All losses, damages, ar expense arising out of any loss shall be
adjusted as one loss, and from the amount of each such adjusted
Ioss shall. be deducted the sum of $25,000. If a loss exceeds
$25,OOQ, tUe $25,000 retained by the City of Sainx Paul will count
toward the aggregate.
There will be 2$100,000 annuai aggregate with a�2,500 per
occunence deductible once the aggregate has been met.
❑
�
CANCELLATION
PROVISION
ADDI7'IONAL
INTERESTS
Repair or RepIacement Cosi, Fxcept Actual Cash Value on Vacant
Buildings, and HeriCage Freservation Sites will be restozed ta theu
onQinai histaric condition as far as it is possible
Waived - Agreed Amount
The iocai retention of the City of Saint Paul shaIl not be in excess
of the $lOQ,000 in any one policy year (not counting the $2,500
maintenance deductible once the aggregate has been reached). All
amounts over $100,006 will be paid by the Company less the
appropriate maintenance deduciible if applicahie.
120 Days Written Norice of CancelIatioa except 10 days for Non-
Payment of Premium.
Housing and Redevelopment Authoriry
1400 City Ha1I Annex
Saint PauI, MN 55101
ATTN: James Zdon
As their incerest may appear on HRA Properties
Board of Water Commissioners
400 City Hall Annex
Saint Paul, MN 55102
As their interest may appear oa any Water Utility i'ropercies
s:t601xpuuR94.aum
This scheduie is merely descriptive and should be used tor reference purposes
only. Spscific ques[ions an all policy terms and conditions should be raferred to
your Alexander & Alexander contact and the policy itself should be reviewed.
� exander
exander
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TOTRL �.04
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What geographic area do you propose to serve? If your proposed project is not bound
by county borders, please describe the boundaries or attach a map of the service area.
All of Ramsey County
•
PART I
AGENCY iDENTIFiCAT10N
Type of Applicant Agency:
2.
95
Public. X
Privaie, non-profit. _ Tax exempt number:
indian Heaith Service (IHS) service unit.
Indian tribe, band or group which operates a heaith ciinic is provided health services
by an IHS service unit.
intertribal council or group that is an authorized representative of tribes, bands, or
groups, which operates a health clinic or is provided health services by an IHS service
unit.
Ciassification of Applicant Agency:
a. Exciuding WIC, approximate percentage of applicant agency's budget spent on:
Heaith services 1 �� °�
Non-health human services %
Oihef °�
b. Exciuding WIC, approximate percentage of applicant agency employee work
hours related to:
Health services 100 ° h
Non-health human services °�
Other °h
3. If the operating agency is not the same as the applicant agency, explain the
relationship between the two agencies.
(Not applicabie X )
------------------
SCOPE OF OPERATIONS
2o if your proposed project wiil service "members of populations" within the area
described above, describe the population to be served and how membership in that
population is determined. (See Instructions fior the defiinition of "members or
populations.")
(Not appiicable X 1
Page 5
95-993
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Page 3
2. For health services provided directly by your applicant agency, describe any eligibility
criteria for participation, such as age, income or residency. -
(Not applicabie , `"� � 9 5 9 9 3
•. The Family Plannino Program at St. Paul Public Health has no specific eligibility require-
ments. Cost is based on family size and income but no one is denied services due to
inability to pay. Services are available to all at both city and suburban sites under
a Title X grant which prohibits discrimination.
B. The immunization program at St. Paul Public Health asks for $5.00 per vaccine except for
Hep B vaccine which may be more expensive. 230 one is turned away due to inability to pay.
Services are available to all. - Continued below -
3. A participant who is not receiving ongoing, routine pediatric and obstetric care through
his/her own provider is identified through the certification process and must be provided
with the recommended care schedule.
a. if your agency provides health care directly, how witl such a part+c+pant be referred
into your health care system?
(Not applicable _)
The participant is referred in one of the following ways:
a) He or she may be "walked over" to the service.
b) A call may be made directly to the health care service fxom the WIC clinic so that an
appointment can be made immediately.
c) He or she may be given a"Who to Call" flyer (sample attached) with the needed service
circled or written in.
b. if your agency provfdes heaith care through written agreements with another agency
� or private physicians, or through referrals to private physicians, how will such a
participant be given a�vritten referral to an agency or a physician with whom you
have an agreement or letter of understanding?
(Not applicable _)
Given a list of the agenCies or physicians who have signed an agreement or letter of
understanding X �
Given a referral form addressed to an agency or a physician who signed an
agreement or letter of understanding X
Othar (specify).
�k2 continued:
C. Pediatric services are available at no cost to refugee infants and children who have
lived in the U.S. 12 months or less. This is the only criteria for participation.
D. Pediatric services are also available via the Preventive Medicine Clinic to all infant
and child WIC participants who are residents of the City of Saint Paul. A sliding fee
scale with a minimum $10. donation is used to determine payment. No one is turned awa�
based on inability to pay,
E. Prenatal and postpartum services are available to women who are on M.Ae and U-Care an�
whose clinic assignment is St. Paul Public Health.
` I
Page 9
c. How and when will you foflow-up on the referral? ������
i. Contacting the participant X
Contacting the agency or physician
Other (specify).
ii. At next pickup appointment X
At next certification appointment
Other (specify).
iii. Written follow-up
Verbal follow-up X
d. How will you document ihe referrai and foilow-up in the participanYs chartl
Health history form '
Nursing notes
SOAP chart
Referral follow-up sheet X
Other (specify).
4. How will your applica�t agency provide integrated referral services with the Iocal Public
Health Nursing/Maternai and Chiid Health Program7 (check one)
Not appiicable, because ap participants receive health services through IHS andlor
Public Health Agency _
Agency is part or a subgrantee of the local Public Health Nursing/ Community Health
Services structure x
Agency subco�tracts with local Pubiic Health Nursing to provide some WIC services
Agency has a letter of understanding with local Public Health Nursing/ Community
Heaith Services
•
��
•
Page 10
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PART IV
•
/ 1
�J
STAFFING
1. Activities to be performed by competent professional authorities.
ti�
�
�
�.,
95-�93
a. Indicate all position(s) which will periorm the activiiies below, whether employed by your
appficant or operating agency, or obteined from another source.
Competent Assess Prescribe Food Prepare Nutri. Provide
Professional Nutritional Package; Ed. Plan; One-to-One
Authority Risk; assign change Approve Nutri. Nutrition
Type Priority Package Ed. Materials Education
Pnysician
Nuvitionist with
Nutrition or
Dietetics �egree
Homa Economist
with �Emphasis in
Nutn
Registered
D
Repistered Nurse
Physician's
Assistant
Licensed Practical
Nurse
Dietetic
Technician
Othar Individual
CurrenUy
ADP�oved es e
Competent
Protessional
Authority
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Develop
Individual Care
Plans for High
Risk
Participants
X X
X X
X X
X X
X
X
b. Does your applicant agency hire CPA staff with qualifications as outlined in the instruetions
for this grant applicationl Yes X No `
c. Does your applicant agency require aIl CPA staff employed after January 1, 1994, to
attend new staff tre+�ing conducted by the State WIC Office? Yes � No _
d. Does your applicant agency have alf CPA staff employed after Jartuary t, 1994, take the
Minnesota WIC Pro9ram Nutrition Test within six months of employment and pass the test
with a score of 80% or better within one year of empioyment? Yes X No _
• e. If your agency employs Licensed Practicai Nurses, Dietetic Technicians or Certifiers with
prior approval, does your appiicant agency perform supervision, chart audits, chart reviews
and observations of CPA staff as outlined in the instructions for this flrant apptication?
Yes X No �
Pape g 1
f. Tell us the source of any non-WIC positions indicated above:
(Not applicable _)
Another program within your appiicant or operating agency X
Another agency under 5ubcontract to your agency _ Attach a copy of your
agreement(s) with such agency(ies). Specify agency nameis):
Other fspecify).
g. Do you have a p7an for providing a qualitied reptacemeni or posiponing the cfinic in the
absence ot the competent professional authority as indicated above.
X Yes _ No, explain
Substitution of quali£ied staff
2. Other activities.
a. List ail positionfjob title(s) which wili perform the activities befow, whether empioyed by
your appticant agency or o6tained from another source.
�
•
i. Initial determination of eli9ibility (category, residence and income).
Clerical Trainees Nutritionists and Nutrition Assistants
Clerk Typists Urban Corps Students
Office Manager Med aAssistaa�son Assistants
ii: Collection of certification data fdietary intake, medica� an�iropometric and
� hemacologic datal.
Nutritionists and Nutrition Assistants Nurses •
Urban Corps Students L.P.N.s
Health and Education Assistants Lab Technicians
Medical Assistants
Note: We also use certification data less than 60 days old from M.D.s, clinics and
iii. Voucherissuance.agencies including HMOs, community clincs, Health Start.
Clerical Trainees People employed in a variety of job titles
Clerk Typists probably collect this information (for example
Nutritionists Mds, Rns, LPNs, Lab Technicians).
Nutrition Assistants
Urban Corps Students
b. Does your WIC Pro9�am have a contract with another agency to colleM certification data?
If so, attach a copy of ;he contract.
�7.7
95g993
•
Pa9e 12
�
�
PART V
PROGRAM OPERATIONS
95-993
1. indicate the agency which wili provide the administrative services listed below.
Provided 6y the
applicant or the
o�eratina aaencv
a. Supervision and management
b. Financial management
c. Procurement
d. Propesty management
e. Program reporting
f. Records Maintence
X
x
x
x
x
x
Provided through a
written agreement
with another aaencv'
2. Provide the following information regarding your agency's financiai management
system:
a. Do your agency's accounting record keeping systsms meet federai tinancial
management standards as established under relevant parts of Office of Management
and Budget Circulares (i.e., A-21, A-87, A-102, A-110, A-122 and A-133) as
applicable?
Yes x No Specify:
b. What type of accounting system does your agency use?
Accrual x Cash _ Other ____ Specify:
.
c. How wiil WIC funds be accounted for7
Separate WIC bank account
Ledger Account with in a general fund �
Other Specify:
�Attach a copy of the agreement.
Page 93
.�e
95�993
i c 'Y g
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y . �
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-+ N r'1 J u1 �o t� c0 O� O
Page 14 '"
PART VI q 5- 9 9�3
CIVIL RIGHTS COMPLIANCE
�J
1. a. is your applicant agency a current or recent (within three years) recipient of
State or Federal funds? Yes X No
b. If yes, has your appiicant agency had any civii rights complaints filed against it
or experienced any other civii rights problems within the last three years?
Yes _ No �
If yes, describe and note any corrective action taken:
2. Are aii of your proposed procedures, related to delivery of program benefits, {i.e.,
clinic sites, and hours of operation, etc.) designed in such a manner so as not to
discriminate against any person based on race, color, national origin, age, sex or
disability? Yes X No _
if no, describe the problem(5) and indicate your corrective action plan:
u
3. if the applicant agency must contrect for WIC services (for example, ongoing, routine
pediatric and obstetr+c care, ctinic space or certification staff), do the contractual
agreements contain the proper nondiscrimination assurances7 Yes X No �
NA
If no, indicate your corrective action plan:
4. Based on Census data, what is the statisticai racial/ethnic composition of your
proposed service areal
iNot appiicable because proposed project wiil service "members of populations"
)
County: Caunty: County:
RAMSEY
White 88.0 °h °�6 %
Black 4.7 °h °h °�
• Hispanic 2.9 % °i6 %
Asian/Pacific Islander 5. i ° h °,6 °�
American Indian • 9 °r6 °k °k
Other 1.3 ° h °� °�
These percentages are from 1990 census data. (See attached page.)
*Hispanics are already counted in oLher groups (primarily white). Therefo��>98 �5
the percentages will add up to 102.97.
95���� �
5. is there a non-English speaking population in your proposed service area?
Yes X No i `
if yes, what languages are spoken?
Hmong
Spanish
Describe the staff, volunteers or other translation resources available to serve this
population:
We have 6 Hmong/English bilinguals on staff.
Several staff inembers are fluent in Spanish.
City of St. Paul employees who speak various languages are "on call"
to serve as interpreters.
Zf necessary, we seek out other translation resources.
6. D o you have appropriate staff, volunteers or other transtation resources available to
serve any hearing impaired participantsl Yes X No
If no, indicate your correcfive action plan:
•
7. Who will be responsible for training new WIC staff on civii rightsl
Name: Kathy Duffy
Title' Nutritionist I
Agency Name• St. Paul Public Health
•
Page 16
95-993
�:
POPULA3ION OF RAMSEY G�UNTY BY RAC� AND ETHNIC GROUP
Ac�arding to the 7990 U.S. Census
RACB and
E i NNIC Gr^�OUP
All rc�s, totat
NUMBE� CF PEASaNS
Rartts2y
County
City of
5L Faui
485.76�
272.235
White .............e......_..__......_e.. 42: ,5i7 " 22?.°47
ol2Ck ................................... 22.014 20.�E3
lndian .................................. 4,�09 3.697
• Asiane.--•-••......_ ................... 2d.732 i 9. ; 97
Other ................................... 6,113 5,371
All e:hnic grouos, totai.._......
QES. i o�
2 i 2.2�5
Nis�anic .......:............._.......
No n-�ils ranic ...................._
13,9�0
471,57�
11,4;6
2�O.i�9
P�r�CE3JT OF P�RSONS
Ramsay
Ccunfy
City of
St. Pauf
t OO.C°!o
E8.0%
�.i'.a
0.9°;
�.]°o
1.3°0
10Q.0°o
2.9' o
47.1
9 00.0° �
E2.3°;
7.4° o
1.4°6
7.1°a
2.0°0
100.0° o
�.� o
C� $°o
NO i C: �+isaanic persons ara persans who recor,ed hiscanic �rgin or descent from such Soanish-soeaking
cauntries as Scain, Mexica, Puerto Rtra, Caba, and c;her c�unvies ct Scuth antl Cantral America
H/sranic Coes not Cenote a rca. Hiscanics rnay be cf any raca, and in the U.S. Cansus, inCiviCual
sait•t'enUfication ct rca desamined the rcial categcry of aach Hispanic.
�
•
lOSP.]v� r
� �_.
�U <<��C��_ C�'✓l,7YG( G(�� C�1��'J
�i �� ��,�i'� 'r'��=flL ���"
�,ti'¢����4e 1�c��r-4;t'1 ���: �c���
AGREEMENT FOR HEALTH SERV(CES ',.(�;�(',�� �-f-1�'�
� THIS AGREEMENT is entered into by and between Face To Face Health and ��_ Z
99�
Counseling Service, 1165 Arcade Street; Saint Paui, MN 55106 hereinafter
referred to as the "Care Provider" and the Saint Paul Public Health Department
, (Local WIC Agency), hereinafter referred to as "The Department",
WHEREAS, The Department is Approved to administer a local project of the Special
Suppfementa4 Food Program for Women, lnfants, and Children (WIC�; and
WHEREAS, State and Federal requirements for the WIC program require local W1C
Programs such as The Department to either provide health services to W1C
participants or to refer such participants to qualiffed health professionals for such
heafth services; and
� WHEREAS, State and Federai requirements require a formalized written Agreement
between local WIC projects and private physicians for the purposes of referrals of
pasticipants in need of health seevices who do not have a private physician of their
own.
NOW THEREFORE, to compiy with the aforementioned requirements it is
understood and agreed by the parties hereto that:
1. The Care Provider agrees to see, its usuai and normal clientele of 11-23 year
olds for purposes of providing appropriate health services, any WIC participant
referred by The Department who is without a private physician at the time of
the referral.
2. The care provider agrees to provide on-going routine pediatric and
. obstetric care as foliows:
95-993
a. Ongoing, routine obstetric care from antepartum care through postpartum
. review and examination. The care includes an initial evaluation,
subsequent visits and a postpartum review. See Attachment A for
delineation of care components.
3. A11 billings for heaith services provided to WIC participants referred by The
Department shall be seni to the individual participant, it being understood that
The Department shall in no way be responsible for the payment of the health
services provided by the Care Provider. The Care Provider is likewise under no
obligation to accept a person referred to it by The Department if the person is
financialiy unable to pay for services to be rendered.
4. The Care Provider further agrees to hold harmiess The Department from any
claims, demands, actions or causes of action which may arise out of any act
� or omission on the part of the Care Provider and its agents or employees in the
performance of or with relation to any of the health services provided by the
physician under the terms of this Agreement. In order to glve the foregoing
indemnification full force and effect, the Care Provider agrees to purchase.at
its own expense with The Department named as an additional insured thereon,
a policy of professional liability (malpractice) insurance with a minimum limit of
51,000,000 covering any ciaim or action for wrongfu! injury or death.
5. Both The Department and the Care Provider wili exchange lnformation as
requested by each other, if proper releases are obtained from the participant,
so that health services may be fully coordinated with WIC benefits.
• 2
g5-993
6. The Care Provider agrees not to discriminate against any WIC participant on
�
grounds of race, color, national origin, age, sex or handicap.
7. This Agreement shail be effective from October 1, 1995 through September
30, 1997, unless terminated by either party, without cause, upon thirty t30)
days written notice.
l�I
n
U
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly
executed.
Face to Face Health and Counseling
Service, Inc.
B "��
ITS: �X-e�ufi✓��i/ec�l
City of Saint Paul
Activity Code 33247
Y�.�cr,l �-(.�---
Disector, Saint Paul Public Hezlth
DATE:
DATE: �5�3���17
n
J .P .FZ� l.�
Dire tor, Finance and Management
Services
DATE: 1.��/( S
APPROVED AS TO FORM
�
Assistant City Attorney
DATE � /J = y �
s
ATTACHMENT A
FACE TO FACE HEALTH AND COUNSELING SERVICE
�
COMPONENTS OF ON-GO1NG.
ROUTINE OBSTEiRIC CARE
A. Women
f. tnitial prena2al evafuation
- Comprehensive health
history
- Current pregnancy history
- Past medical famiiy and
sociai history
- Physical examination
- Laboratory procedures
Hemoglobin or hematocrit
Urinalysis
Blood group and Rh type
Irregular antibody screen
Rubelia antibody titer,
when indicated
Cervical cytology
- Obstetric risk assessment
II. Subsequent prenatal visits
- Opportunity for patient
� to ask questions about her
pregnancy
- Physicaf examination
B(ood pressure
Weight
Measured fundal height
Fetai heart rate
Urinalysis
Hemoglobin or hematocrit
- Review of hospitai
admission and labor and
delivery procedures
- Nutritional status evaluation
- Health and childbirth
education
� Psychosocial services
- Counseling and detection of
genetic and other birth
defects
111. Postpartum evaluation
- Physical examination
� Blood pressure
- Weight
- Opportunity for patient to
ask questions
� - Family planning
95
4
Council File # � S — `� °� '��-,"
Green S6eet # 27060
-�...
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Committee Date
WHEREAS, Eleanor Weber served the citizens of Saint Paul with great distinction on the School Board
for twenty yeazs; and
WHEREAS, Alvin Weber has served his community through his work with the St. Anthony Park
Association, American Field Service, Cub Scouts, and Minnesota Zoological Society; and
5 WHEREAS, the Webers have acted as role models for others in their hue partnership and their civic
6 participation; and
7 WHEREAS, it is appropriate for the community to celebrate an anniversary along with the family because
8 strong families build strong communities; and
9 WHEREAS, the commitment Alvin and Eleanor Weber made to their community and each other has lasted
10 over 50 yeazs;
11 NOW, THEREFORE, BE IT RESOLVED, that the City Council of Saint Paul thanks Alvin and Eleanor
12 Weber for their conhibutions to Saint Paul, congratulates them on their Golden Amuversary and wishes
13 them many more years of happiness.
Requested by Department of
�
�
� ���
�
Form Approved by City Attomey
�
Approved by Mayor for Submission to Council
�
Adopied by Council: Date
Adoption Certified by Council Secretary