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VNA & United Clinical Memo Unde D~ ~Yk-~ MEMORANDUM March 26, 2004 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Memorandums of Understanding with VNA and United Clinical Laboratories Public Health Specialist Mary Rose Corrigan is recommending City Council approval of an agreement with the Visiting Nurse Association (VNA) to provide case management and education services related to children enrolled in the HUD lead paint reduction program and approval of an agreement with United Clinical Laboratories for blood lead testing of children living in dwellings where lead hazard reduction work is taking place. I concur with the recommendation and respectfully request Mayor and City Council approval. J!JJj ~ f1I ~ Michael C. Van Milligen MCVM/jh Attachment cc: Barry Lindahl, Corporation Counsel Cindy Steinhauser, Assistant City Manager Mary Rose Corrigan, RN, Public Health Specialist CITY OF DUBUQUE, IOWA MEMORANDUM FROM: M;ohael C. Va" Mm~.~" Mary Rose Corrigan~N, Public Health Specialist March 15, 2004 TO: SUBJECT: Memorandums of Understanding with VNA and United Clinical Laboratories INTRODUCTION This memorandum provides agreement~ between the City and Visiting Nurse Association (VNA) and the City and United Clinical Laboratories (UCL) for activities related to the HUD Lead Hazard Reduction Program. BACKGROUND During implementation of the first HUD for lead hazard reduction, the City signed an agreement with the Dubuque VNA for providing case management and education services related to children enrolled in the HUD lead paint reduction program. The City also signed an agreement with UCL for blood lead testing of children living in dwelling where lead hazard reduction work took place. DISCUSSION Since being refunded by HUD, we are once again utilizing the services ofVNA and UCL to carry out activities related to the HUDlead grant program. These services were planned for in the HUD grant application budget. The attached agreement with the VNA states that they assure blood lead testing of children living in HUD lead hazard reduction projects and assist with case management and community education. The agreement with UCL provides a fee for blood lead testing, its methodology, and reporting mechanisms. RECOMMENDATION It is recommended that the City Council approve the attached agreements and authorize the City Manager to sign the agreements between the City of Dubuque and the VNA, and between the City of Dubuque and UCL for HUD lead grant-related services. CITY COUNCIL ACTION Authorize the City Manager to sign the attached agreements on behalf of the City. MRC/cj cc: David Harris, Housing & Community Development Department Manager Kathaleen Lamb, Senior Housing Inspector A. AGREEMENT BETWEEN THE CITY OF DUBUQUE, IOWA, AND THE VISITING NURSE ASSOCIATION FOR THE CHILDHOOD LEAD POISpNING PREVENTION PROGRAM (CLPPP)/ HUD LEAD HAZARD REDUCTION PROGRAM Now on this 1 st day of March 2004, it is agreed by and between the City of Dubuque, Iowa, (City) and the Dubuque Visiting Nurse Association (VNA) as follows: B. TERM. The term of this Agreement shall be from the 1 st day of March, 2004, through the 28th day of February, 2007. CITY'S RESPONSIBILITIES. City agrees that it will provide the following services for the CLPPP: 1. Submit quarterly reports required by the Department of Housing and Urban Development (HUD). 2. Provide for environmental investigations and environmental case management for lead abatement\lead hazard reduction in housing units in the city of Dubuque, Iowa. 3. Provide compensation to the VNA at an established rate of $ 28.87 per hour for lead screening assurance and medical case management of children enrolled in the City HUD Round 11 Lead Hazard Reduction Program. This hourly rate may be adjusted annually by City, based on a written request from VNA. 4. Oversee and direct medical case management activities through verbal and written direction. C. VNA'S RESPONSIBILITIES. VNA agrees to provide the following services for CLPPP: 1. Provide written quarterly reports on lead-related activities utilizing the Iowa Quarterly Report Narrative Outline. 2. Provide computer documentation of medical case management and related activities into City's lead database system, STELLAR. 3. Assure blood lead testing for child residents who are less than 6 years old living in housing units enrolled in the project for lead hazard reduction utilizing venipuncture method. 4. Assist City with providing public education, lead coalition development and activities, and outreach to city of Dubuque residents about childhood lead poisoning. 5. Conduct home visits as needed to families and residents in order to provide medical case management and prevention services in conjunction with HUD lead hazard reduction activities. 6. Conduct medical case management primary prevention services which includes: . Assuring that children are being screened and retested for lead according to Iowa Department of Public Health protocols; . Assuring that children and parents receive nutritional counseling and educational materials; . Educating parents and families about major sources of lead and how to prevent poisoning; . Assisting in interpreting blood lead levels; . Refering all children with confirmed blood lead levels greater to or equal to 20 I-Ig\dL to Keystone Area Education Agency for appropriate developmental testing, evaluation and assessment; and . Providing information about lead testing and follow-up, available services, and resources for lead- poisoned children. . Assuring blood lead testing of children living in HUD lead hazard reduction projects prior to start of the project and 6 weeks after project is completed. . Educating residents on primary prevention activities such as cleaning techniques and other Healthy Homes initiatives. 7. Participate with City in securing additional funding for childhood lead poisoning prevention activities. 0 D. INSURANCE. VNA agrees to provide insurance as set forth in the attached Insurance Schedule. E. INDEMNIFICATION. City agrees to save, defend, indemnify and hold harmless VNA from and against any and all claims which may be made against VNA arising out of this Agreement which are the result of the negligence of City, its officers, agents or employees. VNA agrees to defend, hold harmless and indemnify City from and against any and all claims which may be made against City arising out of this Agreement which are the result of the negligence of VNA, its officers, employees or agents. F. TERMINATION. Either party may terminate this Agreement by giving sixty (60) days written notice to the other party. CITY OF DUBUQUE, IOWA VISITING NURSE ASSOCIATION BY: BY: THIS LOOKS LIKE AN OUTDATED SCHEDULE. CHECK WITH KEN. NEED TO INCLUDE ADDITIONAL INSURED ENDORSEMENT AND GOVERNMENTAL IMMUNITIES ENDORSEMENT INSURANCE SCHEDULE SCHEDULE C INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES 1. All policies of insurance required hereunder shall be with an insurer authorized to do business in Iowa. All insurers shall have a rating of A of better in the current A.M. Best Rating Guide. 2. All policies of insurance shall be endorsed to provide a thirty (30) day advance notice of cancellation to the City of Dubuque if cancellation is prior to the expiration date. This endorsement supersedes the standard cancellation statement on the Certificate of Insurance. 3. VNA shall furnish a Certificate of Insurance to the City of Dubuque, Iowa for the coverage required in Paragraph 6 below. Such Certificates shall include copies of the following endorsements: a) Thirty day notice of cancellation to the City of Dubuque. b) Commercial General Liability policy is primary and non-contributing. c) Commercial General Liability additional insured endorsement. d) Governmental Immunities Endorsement. e) Waiver of Recovery under workers compensation. VNA shall also be required to provide Certificates of Insurance of all subcontractors and all sub-sub contractors who perform work or services pursuant to the provisions of this contract. Said certificates shall meet the same insurance requirements as required of VNA. 4. Each certificate shall be submitted to the contracting department of the City of Dubuque. 5. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of this agreement. 6. Contractor shall be required to carry the following minimum coverage/limits or greater if required by law or other legal agreement: a) COMMERCIAL GENERAL LIABILITY General Aggregate Limit Products-Completed Operations Aggregate Limit Personal and Advertising Injury Limit Each Occurrence Limit $2,000,000 $1,000,000 $1,000,000 $1,000,000 Fire Damage Limit (anyone occurrence) Medical Payments $ $ 50,000 5,000 This coverage shall be written on an occurrence, not claims made, form per project. All deviations or exclusions from the standard ISO commercial general liability form CG 0001 or Businessowners BP 0002 shall be clearly identified. Governmental Immunity endorsement identical or equivalent to form attached. An additional insured endorsement identical or equivalent to ISO Form CG 2029 and include as additional insureds: "The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees, and volunteers." b) WORKERS COMPENSATION & EMPLOYERS LIABILITY Statutory for Coverage A Employers Liability: $100,000 each accident $100,000 each employee-disease $500,000 policy limit-disease Policy shall include an endorsement waiving right of recovery against City of Dubuque. c) PROFESSIONAL LIABILITY: d) UMBRELLAlEXCESS LIABILITY $1,000,000 Coverage to be determined on a case-by-case basis by Finance Director. POLICY NUMBER COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGE'" THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. . SCHEDULE Name of Person Or Organization: The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees, and volunteers. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. Coovriohllnsurance Services Office. Inc. 1994 CG20261185 CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT 1. Nonwaiver of Govemmentallmmunitv. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any of the defenses of govemmental immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time. 2. Claims Coveraoe. The insurance carrier further agrees that this policy of insurance shàll cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time. Those claims not subject to Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy. 3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. 4. Non-Denial of Coveraoe. The insurance carrier shall. not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to .the City of Dubuque, Iowa under this policy for reasons of govemmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa. No Other ChanQe in Policy. The above preservation of govemmental immunities shall not otherwise change or alter the coverage available under the policy. BLOOD LEAD TESTING AGREEMENT BETWEEN THE CITY OF DUBUQUE, IOWA, AND UNITED CLINICAL LABORATORIES It is agreed by and between United Clinical Laboratories, Inc. (UCL) and the City of Dubuque, Iowa (City), as follows: 1. TERM. The term of this Agreement shall be from the 1st day of March, 2004, through and including the 28th day of February, 2007. 2. BLOOD LEAD TESTING. UCL agrees to provide blood lead testing to City through City's Departments of Health and Housing Services to satisfy the analytical element of City's lead based paint hazard reduction project, a component of the Dubuque Childhood Lead Poisoning Prevention Program (CLPPP) as funded by the Federal Housing & Urban Development Office (HUD). The specific analytical method shall be anodic stripping voltammetry. The system shall be run in batch mode and shall be sensitive and specific to 5.0 ug/dllead consuming -100 ul of EDT A whole blood per trial. In providing blood testing, UCL shall comply with the following: (a). Specimen. UCL understands and communicates the fact that compromised sample integrity is often the largest obstacle to reliable results. Lead is virtually ubiquitous in the environment and is a constant source of contamination and interference to its assessment in the clinical setting. Scrupulous collection technique and sample handling are critical to the quality of the outcome. In an effort to manage down considerable preanalytical variables the following details are specified by UCL: (i) The routinely acceptable specimen shall be EDT A whole blood obtained by venipuncture rather than finger stick. Collection tubes shall be filled completely. If a microvette is used, the minimum volume shall be 500 ul. Clotted and hemolyzed specimens shall be rejected. (ii) Materials necessary for proper specimen collection, including vacutainers, microvettes, needles, syringes, alcohol wipes, and etc. shall be supplied by UCL. The cost of phlebotomy supplies for this program as well as any additional expenses to a.c. shall be included in the charge per reportable result; i.e., $13.33. This price is fixed until July of 2004 and shall be subjèct to small market basket index adjustments of not more than 4% annually thereafter. (iii) Specimens may be collected at two different UCL locations: the Finley Hospital laboratory and the Mercy St. Joseph's Medical Center laboratory site. Laboratory personnel at these locations are proficient in the requisite collection technique. If UCL personnel perform the phl~botomy, a charge of $2.35 will be itemized in the monthly statement. . (iv) UCL offers to formally train and certify two people from the Visiting Nurse Association (VNA) in the proper technique for the acquisition and handling of whole blood specimens destined for lead analysis. (v) Specimens collected on weekdays between the hours of 0800 and 1500 shall be forwarded directly to Special Testing at the Mercy Medical Center laboratory site. Specimens collected outside of those hours shall be refrigerated at 2 - 8 DC and sent to Special Testing as soon as possible the next day. Once the whole blood specimen arrives at Special Testing it shall be aliquoted into the Metexchange reagent where it is stàble for 30+ days. (b) Reporting Results. (i) Blood lead results shall be transcribed from the instrument printout to the established Whole Blood Lead report form. (See enclosure.) This form shall be tagged to indicate that the specimen was a sample out of the Dubuque CLPPP program. (ii) The original form along with one copy shall be forwarded directly to Dubuque's Health Services Department, care of Mary Rose Corrigan, Public Health Specialist. Disposition of results from that point will be the responsibility of the Public Health Specialist. (c) Archiving Results: (i) Blood lead results from the CLPPP program shall be stored in the LIS (Laboratory Information System) for both short and long-term recovery. (ii) These laboratory results shall be tagged so that they can be sorted and retrieved differentially from other blood lead results archived in the system. This may become important at some future date if ad hoc reports are desired; e.g., comparison of blood lead toxicity incidence pre and post CLPPP program. (d) Billing. UCL shall issue an itemized statement once per month directly to the Health Services Department of Dubuque. The statement shall be easily reconcilable with the individual blood lead results that have been reported in hard copy that month. 3. INSURANCE. UCL shall provide insurance as set forth iri the attached Insurance Schedule. 4. INDEMNIFICATION. City agrees to defend, indemnify and hold harmless UCL, its officers, agents and employees from and against any and all claims, which may be made against UCL, its officers, agents or employees arising out of this Agreement that are the result of the negligence of City, its officers, agents or employees. UCL agrees to defend, indemnify and hold harmless. the City of Dubuque, its officers, agents and employees from and against any and all claims that may be made against City, its officers, agents or employees arising out of this Agreement that are the result of the negligence of UCL, its officers, employees or agents. 5. TERMINATION. Either party may terminate this Agreement by giving sixty (60) days written notice to the other party. CITY OF DUBUQUE, IOWA By: UNITED CLINICAL LABORATORIES,INC. By: SCHEDULE C INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES 1. All policies of insurance required hereunder shall be with an insurer authorized to do business in Iowa. All insurers shall have a rating of A of better in the current A.M. Best Rating Guide. 2. All policies of insurance shall be endorsed to provide a thirty (30) day advance notice of cancellation to the City of Dubuque if cancellation is prior to the expiration date. This endorsement supersedes the standard cancellation statement on the Certificate of Insurance. 3. UCL shall furnish a Certificate of Insurance to the City of Dubuque, Iowa for the coverage required in Paragraph 6 below. Such Certificates shall include copies of the following endorsements: a) Thirty day notice of cancellation to the City of Dubuque. b) Commercial General Liability policy is primary and non-contributing. c) Commercial General Liability additional insured endorsement. d) Governmental Immunities Endorsement. e) Waiver of Recovery under workers compensation. UCL shall also be required to provide Certificates of Insurance of all subcontractors and all sub-sub contractors who perform work or services pursuant to the provisions of this contract. Said certificates shall meet the same insurance requirements as required of UCL. 4. Each certificate shall be submitted to the contracting department of the City of Dubuque. 5. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of this agreement. 6. Contractor shall be required to carry the following minimum coverage/limits or greater if required by law or other legal agreement: a) COMMERCIAL GENERAL LIABILITY General Aggregate Limit Products-Completed Operations Aggregate Limit Personal and Advertising Injury Limit Each Occurrence Limit Fire Damage Limit (anyone occurrence) Medical Payments $2,000,000 $1,000,000 $1,000,000 $1,000,000 $ 50,000 $ 5,000 Thisfuverage shall be written on an occurrence, not claims made, form per project. All deviations or exclusions from the standard ISO commercial general liability form CG 0001 or Businessowners BP 0002 shall be clearly identified. Governmental Immunity êndorsement identical or equivalent to form attached. An additional insured endorsement identical or equivalent to ISO Form CG 2026 and include as additional insureds: "The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees, and volunteers." b) WORKERS COMPENSATION & EMPLOYERS LIABILITY Statutory for Coverage A Employers Liability: $100,000 each accident $100,000 each employee-disease $500,000 policy limit-disease Policy shall include an endorsement waiving right of recovery against City of Dubuque. c) PROFESSIONAL LIABILITY: d) UMBRELLA/EXCESS LIABILITY $1,000,000 Coverage to be determined on a case-by-case basis by Finance Director. POLICY NUMBER COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person Or Organization: The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees, and volunteers. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or rented to you. CoDvriohl.lnsurance Services Office. Inc. 1994 CG20261185 CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT 1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time. 2. Claims Coveraqe. The insurance carrier further agrees that this policy of insurance shall cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time. Those claims not subject to Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy. 3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. 4. Non-Denial of Coveraqe. The insurance carrier shall not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa. No Other Chanqe in Policy. The above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy.