91-2254 Council File � ��L:�5�{
���C�il�i�. 5 l) I �}^�
, Green Sheet � (Q�`I L�
RESOLUTION
CtTY OF SAINT PAUL, MINNESOTA
Presented By '� �`
Referred T Committee: Date
Saint Paul Board of Health
RESOLVED, that the proper Citv Officials are herebv authorized and
directed to execute an agreement with the Minnesota Department of
Health,
WHEREBY the City will administer the Refugee Health Programs for
Ramse,y County, a cop,y of which is to be kept on record and on file
in the Department of Finance and Management Services .
Yeas Navs Absent Requested by Department of:
imon s-
acca ee �
(� �/iv�� i/{P�?�S
ettman �
un e i
By:
v �'��2 e�� �?,Z1's
Adopted by Council: Date ( � �� �—� ( FO� Ap oved by C'ty ttorney
Adoption Certified by Counc' S cretary �
� By
By: � �
�-' Approved by Mayor for Submission to
Approved b Ma�io : e � �' Council �
DEC 12 1 91 �����'
By: By�
PUell�ll�fl !'�'�' �1'91
�
c�' ai -z��
DEPARTM[NT/OFFICE/COUNqL DATE INITIATED
�.s. Public Health 11/.15/91 GREEN SHEET No. 6���a A�
TACT PERSON 8 PNONE PARTMENT DIRECTOR �CITY C01JNdl
Di ane Holm ren 292-7712 ���� 1T�RNEY �CItY CLERK
MUBT BE ON OOUNqL AOENDA 8Y(DI1TE� IIOU7IN(i DpET pIRECTOR �FIN.d MOT.BERVICE8 DIR.
ovember 26 1991 tiu►v ca+�esisrMm ��,
TOTAL#►OF SKiNATURE PAGIES � (CLIP ALL L ATION8 FOR SIGNATUR�
ACTION REGUESTEO:
Signatures on a contract between the City of St. Paul Division of Public Health and the
Minnesota Department of Health to administrer a refugee health program for �amsey County,
and signatures on a Board of Health resolution.
r�c�N�►�s:�vwa•cN«�c� couNa�c�MRTEE/�ARCH REPORT OPTIONAL
_PLANNINO COAAAAIS810N _GVIL SERVIC�COMMIS810N ��YBT PNONE NO.
_pB WMMITTEE _
_STAFF _ COMMENT8:
_DISTRICT OOURT _
SUPPORTS WHK�H COUNqL OBJEC17VE9
INITIATiNG PROBLEM.186UE.OPPORTUNITY(Wlp.Wh�f.Wf�n�WMro�Wh»:
The Division of Public Health will receive $17,350 from 10/31/91 to 9/30/92„and approximate y
$17,350 from 10/1/92 to 9/30/93 to administer a refugee health program to ensure health
screening referrals for newly arrived refugees to Ramsey County.
ADVMITAOE8 IF APPROVED: �C� ' �� /�/�
c �
The Ci ty wi 11 recei ve fundi ng to admi ni��r�ar� r,��gee heal th progr�/I•� '�� Q
nv�►
�� '��,
MAYOR'3 OFFICE Q�A,
�N��''
DISADVANTAOES IF APPFlOVED:
NONE RECEIVED RECEIVED
oEC 041991 Nov 20 �9a1 �
- CiTY CLERK ���� �E���'�
DIBADVANTAOEB IF NOT APPROVED:
The City will not receive approzimately $17,350 for each of two years to conduct this
activity and to ensure the health of St. Paul & Ramsey County residents.
� �j��ri k4,�i#1 �f,:•n.,�ce:r��:��'v, 9„tL��a�t
�,;:�� 0� 199t
TOTAL AMOUNT OF TRANSACTION = 17,3 50 f o r e a c h o f two ,�r�����p��� y� �
�N���State of Mi nnesota Department of He�N� 33244
Fiwwc�iu.iNwR�noH:�ocPUUM .
�W
� ��� - � � �
„_ r :
NOTE: COMPLETE�RECTIONS ARE IN�LUDED IN THE(iRE�!SHEET INSTRUCTIONAL
MANUAL AVAtLABLE IN THE PURCHASINt�I OFFICE(PHONE NO.298�:
ROl1TIN�i ORDER:
Below are proferred routings for the five most irequent types of documeMs:
OONTRACTS (awmes suthorizsd COUNGL RESOLUTION (Amend� 8dptsJ
budget exists) Acc�.(irants)
1. Outsfds A�snCy 1. Department DlrectM
2. InitiaHng D�nent 2. Budget Diroctor
3. City Attorney 3. Cdry Attornsy
4. Mayor 4. MayodAssistaM
5. Flnar�cs d-Mpmt Svcs. Director b. City Cour�cil
8. Flnence AccouMing 8. Chisf Accounhnt. Fln 8�Mgmt Svcs.
ADMIWISTRATIVE ORDER (Budget COUNCIL RE30LUTION (all othsrs)
Revision) aru!ORDINANCE
1. In�iaUnp Depe�tmeM Director
2. De�p ntmeM AocouMaM 2. �Y��Y
3. DspeRrnent Director 3. AAayorMesistsrn
4. Budgst Director 4. aty CoUncil
5. City CIe�1c
6. Chief Accountant.Fn 8�Mpmt Svca.
ADMINISTFiATIVE ORDERS (ail oths�
1. InfitiadMnp D�pertmeM
2. Gty Attorr►sy
3. AAaya/AseMtent -
4. qty Ckrk
TOTAL NUMBER OF SKiNATURE PA(3ES
Indkx�te the M of pepes on which si�natures are requirod snd peperc�ip
esch of thses� .
ACTION RE�UESTED
DacMbs whst ths project/roquest ss�ks to exomp8sh fn eittwr chrorwlo�i-
csl order or ords�of impo�tancs.whichsver la nrost approp►fate tor ths
iaw. Do rat write complste s�Msnc�e. Bspin�ch hem in your liet with
a vsrb.
RECOMMENDATION3
Complete if the issus in questbn has been preeented before arry body, public
or private.
SUPPORTS WHICH OOUN(�l OBJECTIVE?
I�icaM which Cour�cil objsctive(s)you�ProlscUre4ue�supporta bY�isti�9
the ksy word(a)(HOUSINO, RC-CREA110N;NEIQHBORHOODS, ECONOMIC�EVELOPMENT,
BUDC33ET,3EWER 3EPARATION).(SEE tbMPLETE LIST IN INSTRUCTIONAL MANUAL.)
COUNqL OOMMIITEFJRESEARCH REPORT-OPTIONAL A3 RE�UESTED BY OOUNGL
INITIATIN(3 PROBLEM, ISSUE,OPPORTUNII'Y
Explein ths eituation w condidons that created a need for your project
or request.
ADVANTACiES IF APPROVED
Ir�dk�te whstl�er thb is Nmply an ennwl budpet procedure requfred by law/
chM�r or whMMr thsro�n sp�dflc in whfch ths qry of 3aint Paul
and its citizens wiN bsnNit irom thit pro�lution.
DISADVANTA(3ES IF APPROVED
What nepativs effscts or major cha�qss to exiatin�or past processes might
this ProlecUreQusst prod�e if it is passsd(e.g.,treiNc dslays� noisa,
tax I�creaNS or asssssments)?To Whan?When7 For ho�r long?
DISADVANTA(iES IF NOT APPF�VED
1Alhat will bs the nepatiw cor�ssqwnces if the promiaed action is not
epp►oved4 Inebility to dsliver service? Continued high treTfic, noise, •
aocfdent rete�Loss of rovsnue?
FlNANGAL IMPACT
ARhough you must taflor the infonnation you provide here to the issue you
ars�ddre�in�, in�al you must answer two questions: How much is it
going to oo�t?Who is poiny to pay?
, g1-225�1
Grant Contract No. 12500-83533-01 between the Minnesota Department of
Health and St. Paul Division of Public Health.
II. CONSIDERATION AND TERMS OF PAYMENT.
A. CONSIDERATION for all services performed and goods or materials supplied
by GRANTEE pursuant to this grant contract shall be paid for by the
STATE as follows:
1. The total obligation of the STATE for all compensation and
reimbursements to GRANTEE shall not exceed thirty-four thousand seven
hundred dollars (a34,700) .
2. Compensation shall be consistent with the Program Line Item Budget
below. GRANTEE shall not seek, nor shall the STATE pay, compensation
to GRANTEE for any indirect, overhead or administrative costs not
otherwise included as an expense within the Program Line Item Budget.
Program Line Item Budget
The GRANTEE shall adhere to the following program budget in
performing the activities listed in Section 1, GRANTEE'S DUTIES:
Category of Expenditure Estimated Allocation
Salaries and Fringe Benefits 34 700
TOTAL 534,700
Modi�fications within each category of the above line item budget of
less than 10 percent of any line item are permitted without prior
approval by the STATE, so long as notification of such modifications
is made through the submitted quarterly expenditure reports.
Provided, however, that the total obligation of the STATE for all �
, compensation and reimbursements to �GRANTEE shall not exceed thirty-
four thousand seven hundred dollars ($34,700) .
B. TERMS OF PAYMENT:
1. Payments shall be made by the STATE promptly after GRANTEE'S
submission of quarterly expenditure reports for the quarters ending
December 31, 1991, March 31, June 30, and September 30, 1992.
2. Payments are to be made from funds obtained by the STATE through
� Title 8 U.S.C. 1522(b) (5) of the Immigration and Nationality Act as
amended by Public law 97-363 and 99-190 and amendments thereto. If
at any time such funds become unavailable, this grant contract shall
be terminated immediately upon written notice of such fact by the
STATE to GRANTEE. In the event of such termination, GRANTEE shall be
entitled to payment, determined on a pro rata basis, for services
satisfactorily performed. �
Page 3 of 12 _
. `�� l�f
Grant Contract No. 12500-83533-01 between the Minnesota Department of
Health and St. Paul Division of Public Health. �
VIII. AMENDMENTS. Any amendments to this grant contract shall be in writing,
and shall be executed by the same parties who executed the original grant
contract or their successors in office.
IX. LIABILITY. GRANTEE agrees to indemnify and save and hold the STATE, its
agents and employees harmless from any and all claims or causes of action
arising from the performance of this grant contract by GRANTEE or GRANTEE'S
agents or employees. This clause shall not be construed to bar any legal
remedies GRANTEE may have for the STATE'S failure to fulfill its obligations
pursuant to this grant contract.
X. AUDIT REQUIREMENTS. The books, records, documents, and accounting
procedures, and practices of the GRANTEE relevant to this grant contract shall
be subject to examination by the STATE, the legislative auditor, and the state
auditor. Records shall be sufficient to reflect all costs incurred in
performance of this grant contract. GRANTEE also agrees to make all its
financial records to the grant contract available to the STATE upon request
, during normal working hours and to provide a copy of any report, completed by an
independent auditor, to the STATE.
A. GRANTEE'S ORGANIZATION - Threshold for Audit .Requirements
1. For GRANTEES who are state (includes Indian tribes) or local �
governments and receive total direct and indirect federal assistance
of: _�
a. 5100,000 or� more per year, the GRANTEE agrees to obtain a
financial and compliance audit made in accordance with the
Single Audit Act of 1984 (P.L. 98-502) and federal Office of
Management and Budget (OMB) Circular A-128 "Audits of State
and Local Governments." The law and circular provide that the
audit shall cover the entire operations of the GRANTEE
government or, at the option of the GRANTEE government, it may
cover departments, agencies, or establishments that received,
expended, or otherwise _ administered federal financial
assistance during the year. However, if the GRANTEE
� government receives $25,000 or more in General Revenue Sharing
Funds in a fiscal year, it shall have an audit of its entire
operations.
_ b. between �25,000 and $100,000 per year, the GRANTEE agrees to
obtain either .-
(1) a financial and compliance audit made in accordance with
the Single Audit Act of 1984 and OMB Circular A-128, or
Page 5 of 12
.- � �1 I- 226�(
Grant Contract No. 12500-83533-01 between the Minnesota Department of
Health and St. Paul Division of Public Health.
B. The audit shall be made by an independent auditor. An
independent auditor is a state or local government auditor or
a public accountant who meets the independence standards specified in
the General Accounting Office's Standards for Audit of Governmental .
Orqanizations. Pro4rams, Activities, and Functions.
C. The audit report shall state that the audit was performed in
accordance with the provisions of OMB Circular A-128 or A-133
as appli�cable.
The reporting requirements 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 Financial �Statements" or SAS 62, "Special
Reports", as applicable.
The reporting requirements for audit reports on compliance and
internal controls shall be in accordance with AICPA's SAS 63,
"Compliance Auditing Applicable to Governmental Entities and Other
Recipients of Governmental Financial Assistance" and Statement of
Position (SOP) 89-6, "Auditors' Reports in Audits of State and Local
Governmental Units.
In addition to the audit report, the GRANTEE shall provide comments
on the findings and recommendations in the report, including a plan
- _. for corrective action taken or planned and comments on the status of
corrective action taken on prior findings. If corrective action is
. not necessary, a statement describing the reason it is not should
accompany the audit report.
D. GRANTEE agrees that the STATE, the Legislative Auditor, the
State Auditor and any independent auditor designated by the
STATE shall have such access to GRANTEE'S records and
financial statements as may be necessary for the STATE to
comply with the Single Audit Act and OMB Circular A-128, or A-133,
as applicable.
E. SUBGRANTEES of federal financial assistance from GRANTEES a.re also
required to comply with the Single Audit Act, OMB Circular A-128, or
A-133, as applicable.
� F. GRANTEES agree to use a standard statement format for the schedule of
federal assistance provided by the STATE.
G. The GRANTEE agrees to retain documentation to support the schedule of
federal assistance.
Page 7 of 12 '
� q i- zZ�{
Grant Contract No. 12500-83533-01 between the Minnesota Department of
Health and St. Paul Division of Public Health.
or cause to have such materials used for any purpose other than performance of
GRANTEE'S obligations under this grant contract without the prior written
consent of the STATE.
XII. AFFIRMATIVE ACTION. (When applicable) GRANTEE certifies that it has
received a certificate of compliance from the Commissioner of Human Rights
pursuant to Minnesota Statutes, Section 363.073.
XIII. WORKER'S COMPENSATION. In accordance with the provisions of Minnesota
Statutes, Section 176.182, the GRANTEE has provided acceptable evidence of
compliance with the workers' compensation insurance coverage requirement of
Minnesota Statutes, Section 176.181, Subdivision 2.
XIV. ANTITRUST. GRANTEE hereby assigns to the State of Minnesota any and all
claims for overcharges as to goods and/or services provided in connection with
this grant contract resulting from antitrust violations which arise under the
antitrust laws of the United States and the antitrust laws of the State of
Minnesota.
XV. DATA PRIVACY. Pursuant to Minnesota Statutes 13.05, subdivision 6,
GRANTEE agrees to maintain the data on individuals received or to which GRANTEE
has access according to the statutory provisions applicable to" the data. The
GRANTEE agrees to indemnify and save and hold the STATE, its agents and
employees, harmless from any and all claims or causes of action arising from a
violation of any provision of the Minnesota Government Data Practices Act,
�including legal fees and disbursements paid or incurred to enforce this
provision of this grant contract.
XVI. VOTER REGISTRATION. GRANTEE shall provide nonpartisan voter registration
services and assistance, using forms provided by the State, to employees of
GRANTEE and the public as required by Minnesota Statutes, Section 201.162.
XVII. VACANT OR NEW POSITIONS. (When applicable) GRANTEE agrees to list any
vacant or new positions with the job services of the Commissioner of Jobs and
Training or the local service units as required by Minnesota Statutes, �
Section 268.66.
XVIII. GRANTEE certifies that no funding provided under this grant contract will
be used to support religious counseling or partisan political activity.
- XIX. LOBBYING. In accordance with the provisions of Public Law 101-121, Section
319, the GRANTEE has provided acceptable evidence of compliance with the
lobbying restrictions provisions of this legislation.
XX. OTHER PROVISIONS
A. For purposes of administration of this contract, the term "Refugee" has �
Page 9 of 12
q1�1Z5�f
Grant Contract No. 12500-83533-01 between the Minnesota Department of
Health and St. Paul Division of Public Health.
IN WITNESS WHEREOF, the parties have caused this grant contract to be duly
executed intending to be bound thereby.
� (1) GRANTEE � (3) ATTORNEY GENERAL
(If a corporation, two corporate officers By: �
must exe e.)
_ Date:
By:
�� /, ��x�S'
Title: � (4) COMMISSIONER OF ADMINISTRATION
Dir. , ept. f Comm. Svcs.
Date• _J/��'/��,� BY'
� Date:
By:
Title: � (5) COMMISSIONER OF FINANCE
' Budget D'rect r �
Date: '� / BY:
Date•
(2) STATE AGENCY OR DEPARTMENT:
�
By:
Title:
Date:
(1) GRANTEE - continued
BY� `�"'j�'���'�`�� Approv to f o
�
TITLE: BY: �
; Mayor .
DATE: _ TITLE:
Assistant City Attorney
DATE: /I— Z C � �j�
BY:
TITLE:
Directar, Finance Dept. ,
DATE:
Page 11 of 12
� � �� � � ��-� Z��f .
Minnesota Department of Health
Refugee Health Unit U.S. Arrival Date:
717 Delaware Street SE � �
P.O. Box 9441 Month Day vear
Minneapolis, MN 55440 Forms Received at MDH:
(612) 623-5237 � �
Month Day Year
REFUGEE HEALTH SCREENING AND FOLLQW-UP INFORMATION
NAME(tast,first,middle) DATE OF BIRTH(month,day,year)
Alien or Visa Registration # (from ACVA form)
1. Date of Care (for services indicated below): I I
Month Day Year
2. Immunization Record:
DTP1Td I I ! I �
Mo. Yr. Mo. Yr. Mo. Yr. Mo. Yr. Mo. Yr. •
Polio I I I I
Mo. Yr. Mo. Yr. Mo. Yr. Mo. Yr.
Measles 1 Mumps 1 Rubella � � �
t Mo. Yr. Mo. Yr. Mo. Yr.
3. Tuberculosis Screening: Chest X•Ray: Chemotherapy and Chemoprophylaxis
Tuberculin Skin Test (taken in U.S.) 1. � Infected without disease- prophylaxis prescribed
1. � PPD 0-4 mm 1. C Normal 2. ^u Infected without disease - no prophylaxis
2. � PPD 5-9mm 2 ❑ Abnormal prescribed; explain
3. � PPO 10-14mm 3. � Suspected tuberculosis disease - chemotherapy
. 4. ` PPD�- 15mm prescribed
-- 4. ^ Tuberculosis disease - chemotherapy prescribed
4. Hepatitis B Screening HBIGlHBV Vaccine Record
1. ` HBsAg negative
a. � Anti-HBs negative HBIG I .
b. ❑ Anti-HBs positive Mo. vr.
2. �• HBsAg positive HBV Vaccine I 1 �
Mo. Yr. Mo. Yr. Mo. Yr.
5. Screened for parasites: � Yes u No
If POSITIVE, check parasite(s) found:
u Ascaris � Trichuris G� Clonorchis � Strongyloides ❑ Schistosomiasis
` Hookworm �.: Giardia - L� Aragonimus ❑ Amoebic Dysentery ❑ Other:
6. Currently Pregnant: :� Yes ❑ No 7. ECG Administered: � Yes � No
8. HEIGHT(inches) WEIGHT(fb5.1 HEMOGLOBIN HEMATOCRIT
- ^/o
AGENCY.CLINIC or PHYSICIAN PROVIDING SERVICE COMMENTS
STREET ADDRESS .
�ITY,STATE.ZIP
► Please retum completed�orm within 30 tlays.Thank you. Disfnbuhon: Whrte— MDH Relugee Health Umt
Canary— Local Health Agency
HE-o���-c2 Page 12 of 12