HomeMy WebLinkAbout2019-2921SFY 2019 ANNUAL PLAN AGREEMENT
STATE OF MINNESOTA, DEPARTMENT OF HUMAN SERVICES
Originator: Fill in all sections and fields. Obtain signatures in order listed.
FinDeptlD: H55EB 31414
Fill in the EBFD account number that identifies what account should be used for encumbering funds. Your
contract coordinator will encumber funds in SWIFT and write the encumbrance PO # in the box to the
right. You must reference this 10 digit PO # when submitting related invoices to Accounts Payable for
payments to this vendor for this service.
Vendor's Name: Columbia Heights Police Department
Vendor's Address: 825 41st Ave NE, Columbia. Heights, MN 55421
E -mail Address: mmarkham@columbiaheiizhtsmn.gov
Phone M 763 - 706 -8109
For Vendor Using:
individual name, supply the vendor's social security #:
a business name, supply the vendor's federal tax ID #: 41- 6005069
a business address located in MN, supply the MN. Tax ID # also:
2019 -2921
EIOR # _215279
SWIFT Encumbrance PO #:
3 0 0 0 0 U lSCt Z
(Coordinator will complete)
Cost of service must include descriptive rate:
16 checks @ $50 per compliance check for total of $800.00
Compensation: $ 800.00 Dates of Service: 2/18/19 to 6/30_/2019
Expenses: $ (SFY19 ends June 30, 2019)
Total to encumber: 800.00
*(See http://www.mmd.admin.state.mn.us/commissionersolan.htm for rates)
Provide a detailed description of expected duties on the following page. Please check the green highlighted box in section 7 if any
private data will be shared under this plan.
Originator's Name: Vicki Berg Division Name + Mail code: Behavioral Health Division - 0977
1). STATE Division Director — Ink Signature Please
Your signature gives approval to encumber funds Maisha Giles, Behavioral Health Director
and approval of the selected Information Privacy Print Name
Provision under Section 8 on this form. /14A % /Z �"/
Sign Name date
2). Contract Coordinator
SFY19 Master APK 141401- Verification of $5000 limit Is re l n
SWIFT Vendor #: 0000 1 01 _� lY) S NAME DATE
DO NOT HAVE VENDOR SIGN BELOW UNTIL DIVISION DIRECTOR HAS APPROVED BY SIGNING ABOVE AND FUNDS ARE
ENCUMBERED BY CONTRACT COORDINATOR.
3). Vendor's Signature (Vendor certifies it is not a State employee, and is an independent contractor; the individual signing must
have proof of authority to sign on behalf of company named)
7f��v7
-6-4/
Vendor's Signature Printed Name Title Date
APPROVED BY SIGNING ABOVE.
Annual Plan 2019 Page 1 of 7
STATE OF MINNESOTA
ANNUAL PLAN
This Annual Plan Agreement ( "Agreement ") is between the State of Minnesota, acting through its
Department of Human Services ( "STATE "), and Columbia Heights Police Department 825 41st Ave NE,
Columbia Heights, MN 55421, an independent contractor, not an employee of the State of Minnesota
( "VENDOR ").
By written acceptance, VENDOR agrees to perform the following work under the terms and conditions
listed below.
1. Vendor's Duties. VENDOR, who is not a state employee, agrees to perform the following
work /services under the terms and conditions listed below:
VENDOR's Duties:
The vendor who is the participating Sheriff, Police or Public Health Departments will conduct educational
tobacco compliance checks with the approved number of retailers. All compliance checks will be conducted in
compliance with N1N Statute 461.12 subd 5. Note this educational tobacco compliance check does NOT fulfill
the requirements of MN Statute 461.12 subd 5 that a licensing authority shall conduct unannounced compliance
checks at least once each calendar year because these checks are educational based and do NOT include a
penalty.
Vendor Will:
1. Complete sixteen 16 ), educational tobacco compliance checks by June 30, 2019. Checks will be
reimbursed at $50 per check.
2. Ensure that no penalty is levied on the clerk or the business owner from the county or city as a result of these
educational tobacco compliance checks.
3. Provide clerks who fail the educational tobacco compliance check an educational publication which
will be reviewed with them by the individual who conducted the compliance check.
4. Provide clerks who pass the educational tobacco compliance check a certificate of appreciation signed by the
organization conducting the checks.
5. Provide the owner of the establishment a publication including the date the check was conducted and the
results of the inspection (pass or fail).
6. Complete a short survey online and complete the vendor invoice form and email to vicki.ber a state.mn.us
for payment by July 15, 2019.
2. Scope of Agreement. This document is an agreement for professional /technical services, to be
interpreted pursuant to laws of the State of Minnesota. STATE, pursuant to Minnesota Statutes,
section 256.01, subdivision 2 is empowered to enter into professional /technical agreements.
STATE has identified the need for the services to be performed, as no State employee is available
or capable of performing these tasks. No work on this Agreement is to begin until STATE has
signed this document and STATE's Authorized Representative notifies VENDOR to begin work.
By signing this Agreement, VENDOR agrees to perform the scope of the services within the terms
and conditions of the Agreement and within the limits of the clauses specified in this Agreement.
VENDOR must sign in the designated signature block and return the original signed Agreement
and any attachments to STATE, prior to the commencement of services.
3. Conditions of Payment. All services provided by VENDOR pursuant to this Agreement must be
performed to the satisfaction of STATE, as determined in STATE's sole discretion, and not in
violation of any federal, state or local laws, ordinances, rules and regulations. VENDOR will not
receive payment for work found by STATE to be unsatisfactory, or performed in violation of
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federal, state or local law, ordinance, rule or regulation. Under Minnesota Statutes, section
16C.08, subdivision 2(10), no more than 90 percent (90 %) of the amount due under this
Agreement may be paid until the final product of this Agreement has been reviewed and
approved by STATE's agency head. The balance due will be paid when STATE's agency head
determines that VENDOR has satisfactorily fulfilled all the terms of this Agreement. Accordingly,
the STATE will withhold ten percent (10 %) of the total obligation amount in the manner checked
below.
x invoice amounts presented that equate to ninety percent (90 %) of the
total obligation amount will be paid, in full. Invoice amounts presented that
equate to the remaining ten percent (10 %) will be withheld and paid when the
STATE determines that the CONTRACTOR has satisfactorily fulfilled all the terms of
this contract.
4. Consideration and Terms of Payment. STATE will pay for all services performed by VENDOR
under this contract as follows:
A. Invoices. Payments shall be made by STATE promptly after VENDOR's presentation of
invoices for services performed if STATE's Authorized Representative accepts the invoices
and services as satisfactory.
B. Compensation. STATE will pay VENDOR for services actually performed according to the
rate and expense amount specified on the cover page of this Agreement.
C. Travel and Subsistence Expense. VENDOR will be reimbursed for travel and subsistence
expenses in the same manner and in no greater amount than is provided in the current
"Commissioner's Plan" promulgated by the Commissioner of Minnesota Management and
Budget, which is incorporated by reference. VENDOR will not be reimbursed for travel and
subsistence expense incurred outside the State of Minnesota unless it has received STATE'S
prior written approval for such out of state travel. Minnesota will be considered the home
state for determining whether travel is out of state.
D. Withholding. If applicable, for compensation payable under this Agreement, which is
subject to withholding under state or federal law, appropriate amounts will be deducted
and withheld by STATE as required.
E. Total Obligation. The total obligation of STATE for all compensation and reimbursements to
VENDOR shall not exceed eight hundred dollars ($800.00).
5. Cancellation. This Agreement may be canceled by STATE or the Commissioner of Administration
at any time, with or without cause, upon 30 days' written notice to VENDOR. In the event of such
a cancellation, VENDOR will be entitled to payment, determined on a pro rata basis, for the work
or services satisfactorily performed.
6. Authorized Representatives and Responsible Authority.
A. State. The STATE'S authorized representative is Vicki Berg, Behavioral Health Division,
vicki.berg @state.mn.us or her successor, who has the responsibility to monitor the
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VENDOR'S performance and the authority to accept the services provided under this
contract. If the services are satisfactory, the STATE'S Authorized Representative will
certify acceptance on each invoice submitted for payment.
B. Vendor. The VENDOR'S Authorized Representative is Captain Matthew Markham,
mmarkham @columbiaheightsmn.gov or his successor. If the VENDOR'S Authorized
Representative changes at any time during this contract, the CO VENDOR must
immediately notify STATE.
7. Indemnification. In the performance of this Agreement by VENDOR (which for the purposes of
this clause is defined to include VENDOR'S agents and /or employees), VENDOR must indemnify,
save, and hold harmless STATE, its agents, and employees, from any claims or causes of action,
including attorney's fees incurred by STATE, to the extent caused by VENDOR'S:
1) Intentional, willful, or negligent acts or omissions; or
2) Actions that give rise to strict liability; or
3) Actions that give rise to breach of contract or breach of warranty.
The indemnification obligations of this section do not apply in the event the claim or cause of
action is the result of STATE'S sole negligence. This clause will not be construed to bar any legal
remedies VENDOR may have for STATE'S failure to fulfill its obligation under this Agreement.
8. State Audit. Under Minnesota Statutes, 16C.05, subdivision 5, the books, records, documents, and
accounting procedures and practices of VENDOR and its employees, agents, subcontractors, or
representatives, relevant to this Agreement must be made available and subject to examination
by STATE, including the contracting Agency /Division, Legislative Auditor, and State Auditor, for a
minimum of six years from the agreement.
9. Information Privacy Protection.
A. It is expressly agreed that STATE will not be disclosing or providing information protected
under the Minnesota Government Data Practices Act, Minnesota Statutes Chapter 13, (the
"Data Practices Act") as "not public data" on individuals to VENDOR under this Agreement.
"Not public data" means any data that is classified as confidential, private, nonpublic or
protected nonpublic by statute, federal law, or temporary classification. Minn. Stat. § 13.02,
subd. 8a.
B. It is expressly agreed that VENDOR will not create, receive, maintain, or transmit "protected
health information ", as defined in the Health Insurance Portability Accountability Act
( "HIPAA "), 45 C.F.R. 160.103, on behalf of STATE for a function or activity regulated by 45
C.F.R. 160 or 164. Accordingly, VENDOR is not a "business associate" of STATE, as defined in
HIPAA, 45 C.F.R. §160.103 as a result of, or in connection with, this Agreement. Therefore,
VENDOR is not required to comply with the privacy provisions of HIPAA as a result of, or for
purposes of, performing under this Agreement. If VENDOR has responsibilities to comply
with the Data Practices Act or HIPAA for reasons other than this Agreement, VENDOR will be
responsible for its own compliance.
C. Notwithstanding paragraphs A and B, in its capacity as VENDOR under this Agreement,
VENDOR must comply with the provisions of the Data Practices Act as if it were a
governmental entity as defined by the Data Practices Act, to the extent that VENDOR will be
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performing functions of a government entity under Minn. Stat. § 13.05, subd. 11. Any data
created, collected, received, stored, used, maintained or disseminated by VENDOR in
performing its duties under this Agreement is subject to the protections of the Data
Practices Act. The civil remedies of Minnesota Statutes, section 13.08 apply to the release of
the data governed by the Data Practices Act, Minnesota Statutes, Chapter 13, by either
VENDOR or STATE.
D. If VENDOR receives a request to release data created, collected, received, stored, used,
maintained or disseminated by VENDOR in performing its duties under this Agreement,
VENDOR must immediately notify and consult with STATE's Authorized Representative as to
how VENDOR should respond to the request.
E. Under this Agreement, VENDOR will be performing the functions of a government entity
including, but not limited to, responding appropriately pursuant to Minn. Stat. § § 13.03 and
13.04 to requests for data created, collected, received, stored, used, maintained, or
disseminated by VENDOR in performing its duties under this Agreement.
10. Ownership of Works and Intellectual Property Rights. Except in the case of intellectual property
rights previously acquired by VENDOR, STATE owns all rights, title, and interest in all of the
intellectual property, including copyrights, patents, trade secrets, trademarks, and service marks
in the Works and Documents created and paid for under this Agreement. The Works and
Documents will be the exclusive property of STATE and all such Works and Documents must be
immediately returned to STATE by VENDOR upon completion or cancellation of this Agreement.
Works means all inventions, improvements, discoveries (whether or not patentable or
copyrightable), databases, computer programs, reports, notes, studies, photographs, negatives,
designs, drawings, specifications, materials, tapes, and disks conceived, reduced to practice,
created or originated by VENDOR, its employees, agents, and subcontractors, either individually or
jointly with others in the performance of this Agreement. Works includes "Documents."
Documents are the originals of any databases, computer programs, reports, notes, studies,
photographs, negatives, designs, drawings, specifications, materials, tapes, disks, or other
materials, whether in tangible or electronic forms, prepared by VENDOR, its employees, agents, or
subcontractors, in the performance of this Agreement.
11. Data Disclosure. Under Minn. Stat. § 270.66, and other applicable law, VENDOR consents to
disclosure of its social security number, federal employer tax identification number, and /or
Minnesota tax identification number, already provided to STATE, to federal and state agencies and
state personnel involved in the payment of state obligations. These identification numbers may
be used in the enforcement of federal and state laws which could result in action requiring
VENDOR to file state tax returns, pay delinquent state tax liabilities, if any, or pay other state
liabilities. This Agreement will not be approved unless these numbers are provided.
12. Governing Law, Jurisdiction and Venue. This Agreement is governed by the laws of the State of
Minnesota. Venue for all legal proceedings arising out of this Agreement, or breach thereof, will
be in the state or federal court with competent jurisdiction in Ramsey County, Minnesota.
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13. Survival of Terms. The following clauses survive cancellation of this Agreement: 7.
Indemnification; 8. State Audit; 9. Information Privacy Protection; 10. Ownership of Works and
Intellectual Property Rights; 12. Governing Law, Jurisdiction and Venue.
14. Prohibition on Weapons. VENDOR agrees to comply with all terms of the Department of Human
Services' policy, "Safety & Health: Prohibition of Weapons Policy," prohibiting carrying or
possessing weapons wherever and whenever VENDOR is performing services within the scope of
this Agreement. Any violations of this policy by VENDOR or VENDOR's employees may be grounds
for immediate suspension or termination of the agreement. Current Licensed Peace Officers are
exempt from clause 14. If Police or Sheriff Departments utilize officers who carry or possess
weapons, as defined in Minnesota Statutes, section 626.05, subdivision 2, for performing services
within the scope of this agreement, then these Departments shall utilize only its active and
currently licensed peace officers.
15. Criminal Background Check Required. VENDOR and employees of VENDOR working on site at
STATE's Central Office and accessing not public data or protected health information as
referenced in Section 8, Information Privacy Protection of this Agreement, or having direct contact
with STATE's program beneficiaries, must submit to or provide evidence of a computerized
criminal history system background check (hereinafter "CCH background check ") performed
within the last 12 months before work can begin under this Agreement. "CCH background check"
is defined as a background check including search of the computerized criminal history system of
the Minnesota Department of Public Safety's Bureau of Criminal Apprehension.
16. Assignment. VENDOR may neither assign nor transfer any rights or obligations under this
Agreement without the prior consent of STATE and a fully executed Assignment Agreement,
approved by the same parties who executed and approved this Agreement, including authorized
representatives.
17. Amendments. Any amendment to this Agreement must be written and will not be effective until
it has been executed and approved by the same parties who executed and approved the original
contract, including authorized representatives.
18. Waiver. If STATE fails to enforce any provision of this Agreement, that failure does not waive the
provision or STATE'S right to enforce it.
19. Severability. If any provision of this Agreement is held unenforceable, then such provision will be
modified to reflect the parties' intention. All remaining provisions of this Agreement shall remain
in full force and effect.
20. Entire Agreement. This Agreement contains all negotiations and agreements between STATE and
VENDOR. No other understanding regarding this Agreement, whether written or oral, may be
used to bind either party.
Annual Plan 2019 Page 6 of 7
21. Federal Audit Requirements and Vendor Debarment Information.
A. Compliance with Single Audit Act. All sub - recipients receiving $750,000 or more of federal
assistance in a fiscal year will obtain a financial and compliance audit made in accordance
with the Single Audit Act, Code of Federal Regulations, title 2, subtitle A, chapter II, part 200.
VENDOR certifies it will comply with the Single Audit Act, Code of Federal Regulations, title
2, subtitle A, chapter II, part 200, if applicable. Failure to comply with these requirements
could result in forfeiture of federal funds.
B. Vendor debarment, suspension and responsibility certification. Federal Regulation 45 CFR
§ 92.35 prohibits STATE from purchasing goods or services with federal money from vendors
who have been suspended or debarred by the federal government. Similarly, Minn. Stat. §
16C.03, subd. 2 provides the Commissioner of Administration with the authority to debar
and suspend vendors who seek to contract with STATE.
BY SIGNING THIS AGREEMENT, VENDOR CERTIFIES THAT IT AND ITS PRINCIPALS:
1) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from transacting business by or with any federal, state or local
governmental department or agency; and
2) Have not within a three -year period preceding this Agreement: a) been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain or performing a public
(federal, state or local) transaction or contract; b) violated any federal or state
antitrust statutes; or c) committed embezzlement, theft, forgery, bribery, falsification
or destruction of records, making false statements or receiving stolen property; and
3) Are not presently indicted or otherwise criminally or civilly charged by a governmental
entity for: a) commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain or performing a public (federal, state or local) transaction; b)
violating any federal or state antitrust statutes; or c) committing embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false statements or
receiving stolen property; and
4) Are not aware of any information and possess no knowledge that any subcontractor(s)
that will perform work pursuant to this Agreement are in violation of any of the
certifications set forth above; and
5) Will immediately give written notice to STATE should VENDOR come under
investigation for allegations of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing; a public (federal, state or local
government) transaction; violating any federal or state antitrust statutes; or
committing embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements or receiving stolen property.
END. REMAINDER OF PAGE INTENTIONALLY LEFT BLANK.
Annual Plan 2019 Page 7 of 7