Childhood Lead Posoining Prevention AgreementsMasterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
Dubuque
band
AI- America City
1
2007 • 2012 • 2013
SUBJECT: Iowa Department of Public Health Childhood Lead Poisoning and Healthy
Homes Funding and Agreement with the Visiting Nurse Association and
the Dubuque County Board of Health
DATE: August 26, 2013
Public Health Specialist Mary Rose Corrigan is recommending approval of a contract
with the Dubuque County Board of Health and the Iowa Department of Public Health for
continued funding of the Childhood Lead Poisoning Prevention Program and a renewed
agreement with the Visiting Nurse Association for services related to the Childhood
Lead Poisoning Prevention Program and Healthy Homes Program.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Mary Rose Corrigan, Public Health Specialist
THE CITY OF
Dui
Masterpiece on the Mississippi
TO: Mike Van Milligen, City Manager
FROM: Mary Rose Corrigan, Public Health Specialist
Dubuque
bard
All-America City
11111r
2007 • 2012 • 2013
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning and
Healthy Homes Funding and Agreement with the Visiting Nurse Association
(VNA) and the Dubuque County Board of Health
DATE: August 22, 2013
INTRODUCTION
This memorandum provides information regarding a contract with the Dubuque County
Board of Health and the Iowa Department of Public Health (IDPH) for continued funding of
the Childhood Lead Poisoning Prevention Program (CLPPP) and a renewed agreement
with the VNA for services related to the CLPPP and Healthy Homes Program.
BACKGROUND
In February 1994, the City Council approved a grant agreement authorizing the Health
and Housing Services Departments to contract with the Iowa Department of Public Health
for environmental follow -up and medical case management for children with lead
poisoning according to the Iowa Department of Public Health guidelines. The original
funding contract has been renewed annually. The latest contract ended June 30, 2013.
DISCUSSION
The Iowa Department of Public Health contracts with local Boards of Health for distribution
of their funds. This allows local Boards of Health to monitor public health funding, avoid
duplication of services and assure community health needs are addressed (see attached
contract.)
The subcontracted funds will allow the Health and Housing Services Departments to
provide additional follow -up of lead poisoned children through contracted nursing services
provided by the Dubuque Visiting Nurse Association, education for employees, and
monies to do outreach and education in targeted neighborhoods regarding lead poisoning
and healthy homes activities.
1
The contract also includes program performance standards, which we currently strive to
achieve through our existing protocols and outreach programs. The grant funds will be
reimbursed based on the specific activities outlined in the budget.
BUDGET IMPACT
The FY14 budget anticipated funding of $8,583. The contract is for $8,068, due to State
and Federal budget reductions. The sub - agreement with the VNA will be paid utilizing
funds from both the IDPH and HUD Lead and Healthy Homes grants.
RECOMMENDATION
It is recommended that the City Manager sign the attached subcontract with the Dubuque
County Board of Health and the agreement with the Dubuque Visiting Nurse Association
on behalf of the City of Dubuque.
MRC/cj
cc: Alvin Nash, Housing Services Manager
Nan Colin, VNA, Administrative Director
Kim Glaser, Healthy Homes Program Manager
Kevin Hirsch, Lead Program Manager
2
I.
Mariannette Miller- Meeks, B.S.N., M.Ed., M.D.
Director
hotwa
Prontuti
CONTRACT #: 5884LP03
Terry E. Branstad
Governor
PROJECT TITLE: Healthy Homes and Childhood
Lead Poisoning Prevention Program
FUNDING SOURCE OF IDPIF
FEDERAL: $0
STATE: $ 8,068
OTHER:$0
FEDERAL CATALOG #: NA
MATCH REQUIRED: YES❑ NON NA❑
FFATA REPORT REQUIRED YES❑ NON
IOWA CODE CHAPTER 8F DESIGNATION:
❑ This contract is covered by Iowa Code chapter 8F
® This contract is NOT covered by Iowa Code
chapter 8F
❑ At the time of execution, this contract is NOT
covered by Iowa Code chapter 8F, but if the Contractor
executes additional contracts with the Department, the
aggregate of which exceed $ 500,000, the contract may
be covered
It vans
Kim Reynolds
Lt. Governor
PROJECT PERIOD July 1, 2013 to June 30, 2014
CONTRACT PERIOD: July 1, 2013 to June 30, 2014
CONTRACT AMOUNT: $ 8,068
STATE OF IOWA DEPT. OF ADMINISTRATIVE
SERVICES VENDOR #: 00002128749
CONTRACTOR: Dubuque County Board of Health
CONTRACT ADMINISTRATOR
NAME: Mary Rose Corrigan, RN, MSN, Public Health
Specialist
AGENCY: City of Dubuque Health Services Department
CONTRACTOR ADDRESS:
720 Central Avenue
Dubuque, IA 52001 -4732
PHONE: 563 -589 -4181
FAX: 563 -589 -4299
The Contractor agrees to perform the work and to provide the services described in the Special conditions for the
consideration stated herein. The duties, rights and obligations of the parties to this contract shall be governed by the
Contract Documents, which include the Special Conditions, General Conditions, Request for Proposal and Application.
The Contractor has reviewed and agrees to the General Conditions effective January 1, 2013 Revised 1.10.13 as posted
on the Department's Web site under Funding Opportunities: www.idph.state.ia.tis or as available by contacting Kevin
Officer at (515) 242 -5902. The contractor specifies no changes have been made to the Special Conditions or General
Conditions.
The parties hereto have executed this contract on the day and year last specified below.
For and on behalf of the Department: For and on behalf of the Contractor:
Ken Sharp
D9uaty sired by Ken Slaty
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Ken Sharp, Director
Division of Environmental Health
Richard Fairley,
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Richard Fairley, MD, MPH
Board of Health Chair
Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319 -0075 U 515 - 281 -7689 Y
DEAF RELAY (Hearing or Speech Impaired) 711 or 1 -800- 735 -2942
AV. idph. state. ia. us
SPECIAL CONDITIONS FOR CONTRACT # 5884LP03
ARTICLE I — IDENTIFICATION OF PARTIES
Dubuque County Board of Health (CONTRACTOR) has demonstrated through application to the DEPARTMENT that
it is prepared to provide the activities and authority outlined per Iowa Administrative Code (IAC) 641 Chapter 72. The
CONTRACTOR has designated CITY OF DUBUQUE HEALTH SERVICES DEPARTMENT (hereinafter
referred to as the DESIGNATED AGENCY), to carry out the activities as required in IAC 641 72.2(3) and described
in this contract. The address of the DESIGNATED AGENCY is:
City Hall Annex
1300 Main Street
Dubuque, IA 52001 -4732
ARTICLE II — IDENTIFICATION OF AUTHORIZED STATE OFFICIAL:
Ken Sharp, Director, Division of Environmental Health, is the Authorized State Official for this contract. Any changes
in the terms, conditions, or amounts specified in this contract must be approved by the Authorized State Official.
Negotiations concerning this contract should be referred to Rita Gergely, Executive Officer 2, Surveillance Programs,
515/314 -3454
ARTICLE III — DESIGNATION OF AUTHORITY, CONTRACT ADMINISTRATOR, AND KEY
PERSONNEL
The CONTRACTOR, as listed on the contract face sheet, is responsible for fmancial and administrative matters of this
contract.
The CONTRACTOR has designated the Contract Administrator listed on the contract face sheet the authority to
manage the contract, to assure compliance with all conditions, and to negotiate matters concerning this project. The
Contract Administrator will receive key communications from the DEPARTMENT and will be responsible for keeping
the CONTRACTOR and all authorized agencies informed.
In addition to the CONTRACTOR and the Contract Administrator, additional individuals(s) as listed below shall be
considered key personnel and may sign claims.
Table A:
Name
Title
Michael C. Van Milligen, City Manager
Agency Director
Patrice Lambert, Health Administrator, Dubuque Co Health
Department; Mary Rose Corrigan RN, MSN, Public Health
Specialist
Program Administrator
Bonnie Brimeyer, Fiscal Officer, Dubuque Co. Health
Department; Ken TeKippe
Finance Manager
Laura Hankes
Data Entry Clerk
Michelle Zurcher RN
Nurse
Mary Rose Corrigan, Tim Link, Richard Miller, Bob Boge,
Kevin Hirsch, Richard Zeller
Certified Elevated Blood Lead (EBL)
Inspector /Risk Assessor
ARTICLE IV — STATEMENT OF CONTRACT PURPOSE
The purpose of this contract is to provide funds for the CONTRACTOR to ensure that childhood lead poisoning
prevention activities are conducted as specified in this contract and in compliance IAC 641 Chapter 72.
ARTICLE V - DEFINITIONS
DEFINITIONS
`Blood lead testing" means taking a capillary or venous sample of blood and sending it to a laboratory to determine
the level of lead in the blood.
"Capillary" means a blood sample taken from the finger or heel for lead analysis.
"Care coordination" means the process of linking the service system to the recipient and/or family, and coordination
of the various elements in order to achieve a successful outcome.
"CDC" means the Centers for Disease Control and Prevention.
"Certified elevated blood lead (EBL) inspection agency" means an agency that has met the requirements of 641
70.5035) and that has been certified by the department.
"Certified elevated blood lead (EBL) inspector /risk assessor" means a person who has met the requirements of 641
70.5035) for certification or interim certification and who has been certified by the department.
"Chelation "means the administration of medication that binds lead so that it can be removed from the body.
"Child health contractor" means an agency that has a contract with the Iowa Department of Public Health for the Title
V Child Health program.
"Community partnership" means a collaborative relationship between entities to address healthy homes and lead
poisoning prevention in the HHLPPP service area.
"Complete medical evaluation" means a history, physical examination, and testing for iron status as described in
Chapter 7 of Preventing Lead Poisoning in Young Children, CDC, October 1991.
"Data management" means all actions taken by the CONTRACTOR to manage blood lead data and case management
data. This includes, but is not limited to, entering blood lead test results for all individuals under the age of 16 years in
the HHLPPP service area who receive blood lead testing from the HHLPPP or any other provider in the STELLAR
database, documenting all case management actions such as contact with the family or provider, EBL inspection, lead
hazard remediation, home nursing or outreach visits, nutrition evaluations, and developmental assessments in the
STELLAR database, providing all STELLAR reports required by this contract, and providing monthly data uploads as
required by this contract.
"Developmental testing" means testing done by the local Early Access Program or Area Education Agency to
determine whether a child is developmentally delayed.
"Education and outreach " means seeking out and providing information regarding childhood lead poisoning and
healthy homes to members of populations who are at high risk for lead poisoning and those who work for agencies that
provide service to these high -risk populations; members of the general public, including homeowners, landlords,
Realtors, and members of community organizations, and health professionals and para - professionals, including
physicians, nurses, and laboratory technicians.
"Elevated blood lead (EBL) child" means any child who has had one venous blood lead level greater than or equal to
20 micrograms per deciliter (µg /dL) or at least two venous blood lead levels of 15 to 19 µg /dL.
"Elevated blood lead (EBL) inspection" means an inspection to determine the sources of lead exposure for an elevated
blood lead (EBL) child and the provision within ten working days of a written report explaining the results of the
investigation to the owner and occupant of the residential dwelling or child- occupied facility being inspected and to the
parents of the elevated blood lead (EBL) child.
"Elevated blood lead (EBL) inspection agency" means an agency that employs or contracts with individuals who
perform elevated blood lead (EBL) inspections. Elevated blood lead (EBL) inspection agencies may also employ or
contract with individuals who perform other lead -based paint activities.
"Environmental case management" means providing elevated blood lead (EBL) inspections in all dwellings associated
with an EBL child and assuring that lead hazards identified at these dwellings.
"Follow -up blood lead testing" means blood lead testing that is conducted after a child has had at least one capillary
or venous blood lead level greater than or equal to 10 µg /dL.
`Healthy Homes and Childhood Lead Poisoning Prevention Program (HHLPPP) service area means the geographic
area for which the HHLPPP has agreed to provide HHLPPP services.
"Healthy homes planning" means assessing housing issues other than lead in the community, developing a network of
service providers that could assist with housing issues other than lead, and participating in a state or local healthy
homes and lead poisoning prevention program advisory group or coalition.
"HHLPPP" means healthy homes and childhood lead poisoning prevention program.
"Home nursing or outreach visit" means a home visit conducted by a nurse or social worker to provide information to
the caregiver of a lead - poisoned child regarding the health effects of lead poisoning, the importance of good
housekeeping and nutrition, and the importance of follow -up blood lead testing and to assess the overall situation of
the child and family to determine whether the child and/or family should be referred for additional services.
"Laboratory " means a laboratory certified to perform either waived or non - waived blood lead analysis according to
the federal Clinical Laboratory Improvement Act of 1988 (CLIA).
"Lead -based paint hazard" means hazardous lead -based paint, a dust -lead hazard, or a soil -lead hazard as defined in
641 Chapter 70.
"Lead hazard remediation" means the control of lead hazards identified in the EBL inspection through interim
controls, renovation and remodeling, or lead abatement.
"Local board of health" means a county, district, or city board of health.
"Medical case management" means all services necessary to evaluate the health and development of a child with a
blood lead level greater than or equal to 10 µg /dL and to treat any conditions identified in the evaluation. Medical case
management includes, but it not limited to, follow -up blood lead testing, medical evaluation, home nursing or outreach
visits, chelation, nutrition evaluation, developmental assessment, and care coordination.
"Nutrition evaluation" means an evaluation conducted by a dietician to determine whether a child is receiving a well -
balanced and age- appropriate diet, with particular attention to the child intake of Vitamin C, iron, and calcium.
"Quarterly narrative report" means a report of the contractor's healthy homes and childhood lead poisoning
prevention activities for the quarter that is developed according to guidelines provided by the department and is
provided to the department by the deadlines given in Article VII.
"Referral" means to direct the family of a lead - poisoned to a service for the family or the child and to follow -up to
assure that the family actually received the service.
"STELLAR" means the Systematic Tracking of Elevated Lead Levels and Remediation database, which is provided
by CDC at no charge.
"STELLAR Lab Batch" means the procedure in STELLAR that processes blood lead tests and sets dates for follow -up
blood lead tests, opens medical cases, and opens environmental cases.
"STELLAR quarterly report" means the procedure in STELLAR that compiles the contractor's activities for the
quarter into a data file that is submitted to the department electronically by the deadlines given in Article VII.
"Venous" means a blood sample taken from a vein in the arm for lead analysis.
ARTICLE VI — DESCRIPTION OF WORK AND SERVICES
The CONTRACTOR shall ensure that healthy homes and childhood lead poisoning prevention services are conducted
as specified in this contract.
HHLPPP SERVICE AREA
The HHLPPP service area is Dubuque County.
REOUIRED SERVICES
The CONTRACTOR shall ensure that the DESIGNATED AGENCY implements all of the required reimbursable
services as described below within the HHLPPP service area. The required services are medical case management
(home nursing visits, referrals for nutrition counseling, and referrals for developmental testing), environmental case
management (inspections for lead - poisoned children, contacting property owners to determine if lead hazard
remediation is completed, conducting inspections to determine if lead hazard remediation is complete, and performing
clearance testing to assure that lead hazard remediation has been completed in a safe manner, and data management.
The CONTRACTOR shall ensure that the DESIGNATED AGENCY develops written protocols to describe how each
of these services will be provided. Templates provided by the DEPARTMENT may be used to develop these
protocols.
OPTIONAL SERVICES
The optional reimbursable services are blood lead testing, contacting families and health care providers, education and
outreach, community partnerships, healthy homes planning, x -ray fluorescence analyzer source replacement, initial
elevated blood lead (EBL) inspector /risk assessor certification, and refresher elevated blood lead (EBL) inspector /risk
assessor certification. The DESIGNATED AGENCY shall determine which optional services will be carried out in
the HHLPPP service area.
BLOOD LEAD TESTING
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Implements the State of Iowa Plan for Childhood Blood Lead Testing (January 2004) within the HHLPPP
service area.
• Conducts blood lead testing or ensures that medical providers conduct blood lead testing according to this
plan.
• Provides a written notice of the results of blood lead testing to the caregivers of all children tested by the
DESIGNATED AGENCY. The written notice shall include information regarding the meaning of the blood
lead test result and the date when the child should be tested again.
Provides a written notice of the results of blood lead testing to the caregivers of all children in the HHLPPP service
area who have blood lead levels greater than or equal to 10 µg /dL, regardless of who did the testing. The written
notice shall include information regarding the meaning of the blood lead test result, actions that the parents can take to
reduce the child's blood lead level, and the date when the child should be tested again. This may be waived if the
HHLPPP collaborates with health care providers that provide this information to the parents. The CONTRACTOR
shall ensure that the DESIGNATED AGENCY notifies the DEPARTMENT of such agreements in writing.
DATA MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Conducts data management as specified in this contract.
• Notifies the department within 10 working days of assigning STELLAR data entry duties to a new staff person
and ensures that new data entry staff has received appropriate training or works with the department to assure
that new data entry staff receives appropriate training.
• The CONTRACTOR shall ensure that the DESIGNATED AGENCY allows the DEPARTMENT and other
agencies providing medical and environmental case management of lead- poisoned children in the HHLPPP
service area to access the main STELLAR database via a web -based remote login program, Windows remote
desktop, or another software package approved in advance by the DEPARTMENT. This software shall be
installed on a computer that is available for the DEPARTMENT and other agencies for access. The
CONTRACTOR or DESIGNATED AGENCY may request that the DEPARTMENT waive the requirement
that STELLAR be installed on a network and that a computer be continuously available for the
DEPARTMENT and other agencies to access. The CONTRACTOR shall ensure that the DESIGNATED
AGENCY makes this request in writing. The DEPARTMENT will approve or deny these requests on a case -
by -case basis.
• Enters the results of blood lead testing for all individuals under the age of 16 years in the HHLPPP sery ice area
who receive blood lead testing from the HHLPPP or any other provider in the STELLAR database.
• Documents all case management actions taken by the DESIGNATED AGENCY such as contact with the
family or provider, EBL inspection, lead hazard remediation, home nursing or outreach visits, nutrition
evaluations, and developmental assessments in the STELLAR database and shall ensure that all HHLPPP
subcontractors also document all case management actions that they take in STELLAR.
• Enters blood lead test results and case management actions into STELLAR on at least a weekly basis.
• Runs STELLAR Lab Batch at least every two weeks and forwards case information to other agencies
providing medical and environmental case management in the HHLPPP service area at least every two weeks.
• Provides all STELLAR reports by the deadlines given in this contract. The DEPARTMENT will periodically
review the DESIGNATED AGENCY STELLAR database for errors and notify the DESIGNATED AGENCY
of errors that must be corrected.
• Provides monthly uploads of STELLAR data to an SFTP site by the close of business on the third
Monday of each month. If this day falls on a holiday during which the DESIGNATED AGENCY is
closed, the due date is moved to the third Tuesday of each month.
• Correct the errors by the date specified in the notification and shall implement quality control measures to
prevent data entry errors.
FILING SYSTEM AND RETENTION OF RECORDS
The DESIGNATED AGENCY shall file paper copies of all blood lead test results entered into STELLAR
alphabetically by the name of the child and shall retain them until one (1) year after the child attains the age of
majority. The DESIGNATED AGENCY will transfer paper copies of all blood lead test results to the
DEPARTMENT if the subcontract or contract is terminated. The DESIGNATED AGENCY may request that the
DEPARTMENT waive the requirement that the DESIGNATED AGENCY file all blood lead test results alphabetically
by the name of the child. The CONTRACTOR shall ensure that the DESIGNATED AGENCY makes this request in
writing. The DEPARTMENT will approve or deny these requests on a case -by -case basis.
ENVIRONMENTAL CASE MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Maintains certification of individual inspectors as elevated blood lead (EBL) inspector /risk assessors and
agency certification as an elevated blood lead level (EBL) inspection agency. The CONTRACTOR or
DESIGNATED AGENCY and the certified individuals shall comply with the provisions of Iowa
Administrative Code 641 70.6(3).
• Enrolls as a Medicaid provider for EBL inspection services, recovers reimbursement from Medicaid for EBL
inspections, and uses the reimbursement as program income.
• Conducts elevated blood lead (EBL) inspections for any child under the age of six years who has had one
venous blood lead level greater than or equal to 20 µg /dL or at least two venous blood lead levels of 15 to 19
µg /dL. EBL inspections shall be conducted for all addresses associated with the child and for all addresses
that the child moves to after the case is initially reported until the child has had one blood lead level less than
10 µg /dL or three blood lead levels less than 15 µg /dL. EBL inspections shall be conducted within the
following times:
Si, Two venous blood lead levels of 15 to 19 µg /dL — within 4 weeks after the report.
Si, Venous blood lead level of 20 to 44 µg /dL — within 2 weeks after the report
Si, Venous blood lead level of 45 to 69 µg /dL — within 1 week after the report
Si, Venous blood lead level greater than or equal to 70 µg /dL — within 2 days after the report.
• Documents in STELLAR the reason why the DESIGNATED AGENCY was unable to complete any
inspection required by this contract.
• Contacts the occupants and/or owners of dwellings where lead hazards have been identified within 30 days of
the initial inspection to check their progress towards making the dwelling lead -safe.
• Contacts the current owners of all dwellings where lead hazards were identified, but lead hazard remediation
has not been completed, at least once each year until lead hazard remediation is completed.
• Continues follow up on all of these dwellings until lead hazard remediation is completed, regardless of
whether the dwellings are owner - occupied or rental and regardless of changes in ownership.
• Does not close an address associated with a lead - poisoned child where lead hazards have been identified
unless the lead hazard remediation has been completed or written permission has been obtained in advance
from the DEPARTMENT to close the address even though lead hazard remediation has not been completed. .
• To the extent possible, assists families who have lead - poisoned children in locating resources for lead hazard
remediation and/or alternative housing.
• Conducts clearance testing according to Iowa Administrative Code Chapter 641 70, Lead Professional
Certification, before verifying that lead hazard remediation has been completed in a home associated with a
lead - poisoned child.
The CONTRACTOR must adopt and enforce a local code that requires hazards to be repaired in the homes of elevated
blood lead (EBL) children. A model code is available at Iowa Administrative Code 641 Chapter 68.
CONTRACTORS may adopt this model code by reference.
Local regulations must be as protective as Iowa Administrative Code 641 Chapter 68. Local regulations that were
previously adopted must be updated to reflect safe dust lead levels and other items that have changed since the local
regulations were adopted.
MEDICAL CASE MANAGEMENT
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Conducts medical case management as specified in this contract.
• Is enrolled as a Medicaid provider for services that can be reimbursed by Medicaid, recovers reimbursement
from Medicaid for medical case management services, and uses the reimbursement as program income.
Follow -up blood lead testing
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that providers in the IIIII,PPP service area that conduct blood lead testing provide follow -up blood
lead testing for children under the age of six years within the timelines listed below. The DESIGNATED
AGENCY may also provide this follow -up blood lead testing.
Confirmatory venous blood lead testing
➢ Capillary blood lead level of 15 to 19 pg /dL — within 4 weeks after the report.
➢ Capillary blood lead level of 20 to 44 pg /dL — within 1 week after the report.
➢ Capillary blood lead level of 45 to 69 pg /dL — within 48 hours after the report.
➢ Capillary blood lead level greater than or equal to 70 pg /dL — immediately.
Follow -up testing after an elevated blood lead level for a child who has not been chelated
➢ Capillary or venous blood lead level of 10 to 14 pg /dL — within 3 months. After two levels less than
10 pg /dL or three levels less than 15 pg /dL, testing should follow the routine testing schedule for
high -risk children.
Si, Venous blood lead level of 15 to 19 pg /dL — within 3 months.
Si- Venous blood lead level of 20 to 44 pg /dL — within 4 to 6 weeks.
Si- Venous blood lead level greater than or equal to 45 pg /dL — immediately.
Follow -up testing for a child who has been chelated
➢ At the end of chelation.
➢ Depending on the blood lead level, 7 to 21 days after the end of chelation. The results of this test will
determine the need for additional chelation and the schedule for additional blood lead testing.
Medical evaluations
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that providers in the HHLPPP conduct medical evaluations for children under the age of six years
within the following timelines:
Si, Venous blood lead level of 20 to 44 pg /dL — Refer within 48 hours after the report so that the service
is received within 5 days.
Si, Venous blood lead level of 45 to 69 pg /dL — Refer within 24 hours after the report so that the service
is received within 48 hours.
Si, Venous blood lead level greater than or equal to 70 pg /dL — Refer for emergency medical evaluation.
Home nursing or outreach visits
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides home nursing or outreach visits for
children under the age of six years according to the following timelines:
Si, Venous blood lead level of 15 to 19 pg /dL — within 4 weeks after the report.
Si, Venous blood lead level of 20 to 44 pg /dL — within 2 weeks after the report
Si, Venous blood lead level of 45 to 69 pg /dL — within 1 week after the report
Si, Venous blood lead level greater than or equal to 70 pg /dL — within 2 days after the report.
Chelation
The CONTRACTOR shall ensure that the DESIGNATED AGENCY
• Assures that children with two venous blood lead levels greater than or equal to 45 pg /dL receive chelation.
Nutrition Evaluation
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that children under the age of six years with a venous blood lead level greater than or equal to 15
pg /dL receive a nutrition evaluation according to the following timelines:
Si, Venous blood lead level of 15 to 19 pg /dL — Refer within 4 weeks after the report so that the service is
received within 6 weeks.
Si, Venous blood lead level of 20 to 44 pg /dL — Refer within 2 weeks after the report so that the service is
received within 4 weeks.
Si, Venous blood lead level of 45 to 69 pg /dL — Refer within 1 week after the report so that the service is
received within 2 weeks.
➢ Venous blood lead level greater than or equal to 70 µg /dL — Refer within 2 days after the report so that
the service is received with 1 week.
• Contacts the DEPARTMENT for assistance if access to a dietitian cannot be assured for children under the age
of six years with a venous blood lead level greater than or equal to 15 µg /dL.
Developmental Assessment
The CONTRACTOR shall ensure that the DESIGNATED AGENCY:
• Assures that children under the age of six years with a venous blood lead level greater than or equal to 20
µg /dL receive a developmental assessment according to the following timelines:
➢ Venous blood lead level of 20 to 44 µg /dL — Refer within 2 weeks after the report.
➢ Venous blood lead level of 45 to 69 µg /dL — Refer within 1 week after the report
➢ Venous blood lead level greater than or equal to 70 µg /dL — Refer within 2 days after the report.
Care Coordination
The CONTRACTOR shall ensure that the DESIGNATED AGENCY provides care coordination or refers the family to
the local child health contractor for this service.
Medical Case Closure Guidelines
Medical cases shall be closed only in the following circumstances:
1. A child has had two consecutive blood lead levels less than 10 µg /dL or three consecutive blood lead levels
less than 15 µg /dL after the initial elevated blood lead level.
2. A child has had a capillary false positive blood lead level; that is, a capillary or venous blood lead level less
than 10 µg /dL immediately after a single capillary blood lead level greater than or equal to 15 µg /dL.
3. A child has reached the age of six years and has a blood lead level less than 20 µg /dL.
4. A child has moved out of the HHLPPP service area. The CONTRACTOR shall ensure that the
DESIGNATED AGENCY immediately notifies the appropriate local HHLPPP agency in the area to which the
child has moved and provides copies of all environmental and medical case management records to the
appropriate local HHLPPP agency.
CHILDREN OVER THE AGE OF SIX YEARS
The CONTRACTOR shall ensure that the DESIGNATED AGENCY contacts the department for specific case
management guidelines for a child over the age of six years who has a venous blood lead level greater than or equal to
20 µg /dL.
ARTICLE VII — REPORTS
The CONTRACTOR shall ensure that the DESIGNATED AGENCY prepares and submits the following reports to the
DEPARTMENT on forms and /or in the format approved by the DEPARTMENT:
Report Number
Claim Voucher 1 electronic
Expenditure Report 1 electronic
STELLAR Documentation to 1 electronic
Support Expenditure Report
Date Due
Within 45 days of month of expenditure
Within 45 days of month of expenditure
Within 45 days of month of expenditure
Quarterly Narrative Report 1 Electronic 10 -25 -2013
1 -27 -2014
4 -25 -2014
7 -25 -2014
STELLAR Quarterly Report 1 Electronic 10 -25 -2013
1 -27 -2014
4 -25 -2014
7 -25 -2014
Claim vouchers and expenditure reports shall be filed via SharePoint.
STELLAR documentation to support the expenditure report shall be uploaded to SharePoint.
Quarterly STELLAR and narrative reports shall be emailed to:
Kevin Officer: kevin.officer@idph.iowa.gov
ARTICLE VIII -- BUDGET
1. The total approved budget for this contract period is detailed in Exhibit 1. All services except for initial EBL
inspector certification and EBL inspector refresher training will be reimbursed at a flat fee as specified on
Exhibit 1 up to the amount of the contract.
2. Initial EBL inspector certification and EBL inspector refresher training will be reimbursed at actual cost up to
the maximum amount shown on Exhibit 1. The Department will not reimburse travel amounts in excess of
limits established by Iowa Department of Administrative Services: Instate maximum allowable amounts for
food are $8.00/breakfast; $12.00 /lunch; and $23.00 /dinner; lodging maximum $83.00 plus taxes per night; and
mileage maximum of $0.39 per mile.
3. The CONTRACTOR or DESIGNATED AGENCY may change the number of any "required service"
deliverable that the DEPARTMENT will reimburse under this contract only after filing a written request for
the revision and receiving written approval for this change.
4. The CONTRACTOR or DESIGNATED AGENCY may change the total amount of funds that the
DEPARTMENT will reimburse under this contract for "optional services" or "required services" only after
filing a written request for the revision and receiving written approval for this change.
5. The CONTRACTOR or DESIGNATED AGENCY may change the number of any "optional services"
deliverable that the DEPARTMENT will reimburse under this contract without permission from the
DEPARTMENT, providing that the total amount expended for optional services does not exceed the amount
provided in the contract.
ARTICLE IX — PAYMENTS
1. Contractual funds issued by the DEPARTMENT (regardless of contractual program) will be delivered to the
CONTRACTOR only via Electronic Fund Transfer (EFT) or by mailing the warrant to the CONTRACTOR if
the EFT option has not been activated by the CONTRACTOR.
2. Payments shall be made to the CONTRACTOR based on the expenditure reports and claim vouchers
submitted to the DEPARTMENT by the DESIGNATED AGENCY.
3. Final payment may be withheld until all contractually required reports have been received and accepted by the
DEPARTMENT. At the end of the contract period, unobligated contract amount funds shall revert to the
DEPARTMENT.
ARTICLE X — ADDITIONAL CONDITIONS
1. Funds may not be spent for indirect costs, chelation or other medical treatment of lead poisoning, or lead
hazard remediation. Funds may not be spent for blood lead analyses that could be reimbursed by Medicaid.
2. On January 1, 2014, April 1, 2014, and June 1, 2014, the DEPARTMENT may amend the contract to revert
funds that are estimated to be unused to the DEPARTMENT and to reallocate the funds to contractors with
demonstrated special needs for healthy homes and childhood lead poisoning prevention services.
3. Payments may be withheld if the DESIGNATED AGENCY or personnel employed by the DESIGNATED
AGENCY are not in compliance with Iowa Administrative Code Chapter 641 70, Lead Professional
Certification.
4. The CONTRACTOR and/or DESIGNATED AGENCY must check Internet e-mail at least once each week for
lead poisoning prevention updates sent out by the DEPARTMENT.
5. XRF analyzers that were originally purchased, in part or in whole, with Iowa Department of Public Health
grant funds, are to be shared with other elevated blood lead (EBL) inspector /risk assessors that have a contract
with the Childhood Lead Poisoning Prevention program. This sharing is to be at no cost other than their travel
to pick up and deliver the machine. Programs are strongly encouraged to also share the XRF analyzers with
government and private, non - profit housing agencies that employ appropriately certified inspector /risk
assessors. Any fees received for sharing the machine with government and private, non - profit housing
agencies are considered program income that shall be returned to the lead program and used to enhance lead
program efforts.
6. The CONTRACTOR shall comply with Section 5 of the General Conditions for all subcontracts.
7. As a condition of the contract, the CONTRACTOR shall ensure that the DESIGNATED AGENCY provides
linkage with the local board of health in each county where services are provided. The DESIGNATED
AGENCY will ensure that the local board of health has been actively engaged in planning for and evaluation
of services. It will also maintain effective linkages with the local board of health, including timely and
effective communications and ongoing collaboration.
8. All work plan revisions must be approved by the DEPARTMENT prior to implementation.
9. Authorization - Each signatory to this contract or subsequent contract amendments represents and warrants to
the other parties that:
a. The signatory has the right, power, and authority to enter into this agreement and to bind the party
represented by the signatory to this agreement
b. The party has the right, power, and authority to perform its obligations under the agreement; and
c. The party has taken all requisite action (corporate, statutory, or otherwise) to approve execution, delivery,
and performance of this agreement and this agreement constitutes a legal, valid, and binding obligation
upon itself in accordance with its terms.
EXHIBIT 1 -- EXPENDITURE REPORT FOR THE MONTH OF
CONTRACTOR: Dubuque County Board of Health CONTRACT: 5884LP03 CONTRACT PERIOD: July 1, 2013 to June 30, 2014
Vendor Code: 00002128749
Required Services - Unit Cost Reimbursement
Line Description
Budgeted Rate (A) 1.1
+
Budgeted
Number
Budgeted Total (B)
Number Completed for
Month (C)
Reimbursement for
Month (A x C)
Number Completed
to Date
Reimbursement
to Date (D)
Balance
(B —D)
Non - Medicaid Home Nursing Visits
80
3
240
$
$
$
Referrals for Nutrition Counseling
10
3
30
$
$
$
Referrals for Developmental Testing
10
2
20
$
$
$
Non - Medicaid Initial Inspection Events
600
3
1800
$
$
$
EBL Investigation CONTC Events
10
55
550
$
$
$
Completed Lead Hazard Remediations
10
2
20
$
$
$
EBL Investigation INSAB, INSAI, INSAE
Events
80
560
$
$
$
EBL Investigation Properties Passing Clearance
Testing
300
1
300
$
$
$
STELLAR Error Correction Hours
50
4
200
$
$
$
Monthly STELLAR data upload
10
12
120
$
$
Running Lab Batch
5
24
120
$
$
$
STELLAR Quarterly Report Submitted on Time
25
4
100
$
$
$
Narrative Quarterly Report Submitted on Time
25
4
100
$
$
$
Total Required Services
$4160
Optional Services - Unit Cost Reimbursement
Line Description _
Budgeted Rate (E)
Budgeted
Number
Budgeted Total
Number Completed for
Month (F)
Reimbursement for
Month (E x F))
Number Completed
to Date
Reimbursement
to Date (G)
Balance
(B — G)
XRF Source Replacement
2000
$
$
$
Blood Lead Sample Collection (pay from 1351)
3
$
$
$
Children Tested for Lead Poisoning (under 6
years) -- pay from 1351
1
$
$
$
Child CONTC or ACTIO event
10
$
$
$
Education and Outreach, Community
Partnerships, and Healthy Homes Planning
Hours
50
$
$
$
Blood Lead Analysis
11
$
$
$
Optional Services - Cost Reimbursement Line
Description
Reimbursable
Expenses (H)
Reimbursement
to Date (H)
Balance
(B - H)
Initial EBL Inspector Certification
Not to exceed $3,000
per certification
EBL Inspector Refresher
Not to exceed $1,500
per certification
Total Optional Services
$3908
Total
$8068
IDPH NOTE:
DOCUMENTATION OF PROGRAM INCOME
SIGNATURE:
DATE:
Amount for Month
Amount to Date
Program Income Eamed
$
$
Program Income Received
$
$
Program Income Expended
$
$
SIGNATURE:
DATE:
SUBCONTRACT FOR HEALTHY HOMES AND CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE COUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE
WHEREAS, the Dubuque County Board of Health (County Board), as
Contractor, has entered into an Agreement (the Agreement) wit the Iowa Department of
Public Health to perform childhood lead poisoning prevention services as set forth in
the Agreement (Contract # 5883LP03), a copy of which is attached hereto; and
WHEREAS, County Board desires to enter into a subcontract with the City of
Dubuque (City) to perform the services required by the Agreement and City desires to
provide such services through its Health Services Department.
NOW, THERFORE, IT IS AGREED BY AND BETWEEN THE PARTIES AS
FOLLOWS:
1. City shall perform all of the services required of the Contractor in the
Agreement.
2. County Board shall pay City for its services in the same manner as County
Board as Contractor will be paid for its services under the Agreement.
Signed and dated the day of
cepiElvt
, 2013.
6/0
Richard Fairley, MD, Chair Micha I C. Van Milligen
City Manager
Dubuque County Board of Health
SUBCONTRACT
BETWEEN
THE CITY OF DUBUQUE, IOWA,
AND
THE DUBUQUE VISITING NURSE ASSOCIATION
FOR THE
HEALTHY HOMES AND CHILDHOOD LEAD POISONING PREVENTION PROGRAM
This Subcontract between the City of Dubuque, Iowa and The Visiting Nurse
Association is dated for reference purposes the 1st day of July, 2013.
Whereas, Dubuque County, Iowa (Contractor) has entered into Contract 5883LP03
with the Iowa Department of Public Health for Public Health (the Department) for the Healthy
Homes (HH) and Childhood Lead Poisoning Prevention Program (CLPPP) (the Contract), a
copy of which is attached hereto, pursuant to which Contractor will provide the work and
services described in the Contract in accordance with the Special Conditions therein, and the
General Conditions, a copy of which is attached hereto; and
Whereas, the Lead Hazard Control Program and Healthy Homes Production Program
funded by the Department of Housing and Urban Development will administer lead hazard
reduction and healthy homes remediation to improve the housing conditions for participating
clients.
Whereas, the City of Dubuque, Iowa (City) is the Contract Administrator of the
Contracts; and
Whereas, it is necessary for City to subcontract for certain work and services; and
Whereas, City now desires to enter into this Subcontract with the Visiting Nurse
Association (VNA) to provide the work and services described herein upon the terms and
conditions set forth herein.
NOW, THEREFORE, IT IS AGREED BY AND BETWEEN CITY AND VNA AS
FOLLOWS:
SECTION 1. WORK AND SERVICES. City and VNA agree to provide the following work
and services (the Work and Services):
1.1. City's Responsibilities. City agrees that it will provide the following services for the HH
& CLPPP:
(1) Submit reports /vouchers and other reporting requirements as required by the
Iowa Department of Public Health (IDPH), the Centers for Disease Control and
Prevention (CDC), and the Department of Housing and Urban Development (HUD).
(2) Provide for environmental investigations and environmental case management
for lead abatement \lead hazard reduction and healthy homes interventions in housing
units in the city of Dubuque, Iowa, and Dubuque County.
(3) Provide compensation to the VNA during the term of this Agreement not to
exceed $5,000.00 for the performances of VNA's responsibilities as set forth herein.
(4) Oversee and direct medical case management and educational /outreach
activities through verbal and written direction.
1.2. VNA's Responsibilities. VNA agrees to provide the following services for HH &
CLPPP during the term of this Agreement for the agreed compensation:
(1) Provide written quarterly reports on lead and healthy homes activities utilizing
the Iowa Quarterly Report Narrative Outline.
(2) Provide electronic documentation of medical case management and related
activities into City's lead and healthy homes database systems, STELLAR, and
of educational activities performed for each month by the 10th of the following
month.
(3)
Blood Lead Testing.
(a) VNA shall assure that the State oflowa Plan for Childhood Blood Lead
Testing (January 2004) is implemented within the CLPPP service area; that
medical providers conduct blood lead testing according to this plan; and may
also conduct blood lead testing.
(b) Shall provide a notification of the results of blood lead testing to the
caregivers of all children in the CLPPP service area who have blood lead levels
greater than or equal to 10 pg/dL, regardless of whether the VNA did the
testing. The written notice shall include information regarding the meaning of
the blood lead test result, actions that the parents can take to reduce the
child's blood lead level, and the date when the child should be tested again.
(c) Assure blood lead testing for child residents who are less than 6
years old or living in Healthy Homes Program housing units enrolled in the
project for HUD Grant lead hazard reduction utilizing venipuncture method
prior to the project beginning and six weeks after the project is completed.
(4) Medical Case Management:
(a) Be enrolled as a Medicaid provider for services that can be reimbursed
by Medicaid and shall recover reimbursement from Medicaid for medical case
management services and use the reimbursement as program income.
(b) Follow -up blood lead testing: Assure that providers in Dubuque County
that conduct blood lead testing provide follow -up blood lead testing for children
under the age of six years within the timelines listed below.
1. Confirmatory venous blood lead testing.
• Capillary blood lead level of 15 -19 pg/dL - within 4 weeks after
report
• Capillary blood lead level of 20 -44 pg/dL - within 1 week after
report
(5)
• Capillary blood lead level of 45 - 69 pg/dL - within 48 hours after
the report
• Capillary blood lead level greater than or equal to 70 pg/dL —
immediately
2. Follow -up testing after an elevated blood lead level for a child
who has not been chelated.
• Capillary or venous blood leads level of 10 - 14 pg/dL - within 3
months. After two levels less than 10 pg/dL or three levels less
than 15 pg/dL, testing should follow the routine testing schedule
for high -risk children
• Venous blood lead level of 15 - 19 pg/dL - within 3 months
• Venous blood lead level of 20 - 44 pg/dL - within 4 to 6 weeks
• Venous blood lead level greater than or equal to 45 pg/dL -
immediately.
3. Follow -up testing for a child who has been chelated.
• At the end of chelation
• Depending on the blood lead level, 7 - 21 days after the end of
chelation. The results of this test will determine the need for
additional chelation and the schedule for additional blood lead
testing.
Medical evaluations:
(a) Shall assure that providers in Dubuque County provide /conduct medical
evaluations for children under the age of six years within the following
timelines:
1. Venous blood lead level of 20 - 44 pg/dL - refer within 48 hours after
the report so that the service is received within 5 days.
2. Venous blood lead level of 45 - 69 pg/dL - refer within 24 hours after
the report so that the service is received within 48 hours
3. Venous blood lead level greater than or equal to 70 pg/dL - refer for
emergency medical evaluation
(6) Home nursing or outreach visits:
(a) Provide home nursing or outreach visits for children under the age of six
years according to the following timelines:
1. Venous blood lead level of 15 - 19 pg/dL - within 4 weeks after the
report.
2. Venous blood lead level of 20 - 44 pg/dL - within 2 weeks after the
report.
3. Venous blood lead level of 45 - 69 pg/dL - within 1 week after the
report.
4. Venous blood lead level greater than or equal to 70 pg/dL - within 2
days after the report
5. Conduct home visits as needed to families and residents in
order to provide medical case management, education and
prevention services in conjunction with HUD lead hazard
reduction and Healthy Homes activities.
(7) Chelation:
(a) Assure that children with two venous blood lead levels greater than or
equal to 45 pg/dL receive chelation.
(8) Nutrition evaluation:
(9)
(a) Assure that children under the age of six years with a venous blood lead
level greater than or equal to 15 pg/dL receive a nutrition evaluation
referral according to the following timelines:
1. Venous blood lead level of 15 -19 pg/dL - refer within 4 weeks afterthe
report so that the service is received within 6 weeks
2. Venous blood lead level of 20 - 44 pg/dL - refer within 2 weeks afterthe
report so that the service is received within 4 weeks
3. Venous blood lead level of 45 - 69 pg/dL - refer within 1 week after the
report so that the service is received within 2 weeks
4. Venous blood lead level greater than or equal to 70 pg/dL - refer within
2 days after the report so that the service is received with 1 week.
(b) Shall contact the IDPH for assistance if access to a dietician cannot be
assured for children under the age of six years with a venous blood lead
level greater than or equal to 15 pg/dL.
Developmental Assessment:
(a) Shall assure that children under the age of six years with a venous
blood lead level greater than or equal to 20 pg/dL receive a
developmental assessment by referral to the AEA Early ACCESS
program according to the following timelines:
1. Venous blood lead level of 20 - 44 pg/dL - refer within 2 weeks afterthe
report
2. Venous blood lead level of 45 - 69 pg/dL - refer within 1 week after the
report
3. Venous blood lead level greater than or equal to 70 pg/dL - refer within
2 days after the report.
(10) Care coordination. Shall provide medical care coordination as appropriate.
(11) Assist City with providing public education, lead /Healthy Homes coalition
development and activities, and outreach to the City of Dubuque residents
about childhood lead poisoning and Healthy Homes.
(12) Provide information about lead poisoning and available services to local
pediatric health care providers.
(13) Attend /participate in City- approved education and training opportunities to
further staff knowledge regarding lead and Healthy Homes.
(14) Participate with City in securing additional funding for childhood lead poisoning
prevention and healthy homes activities.
(15) Provide monthly work activity reports and invoices to the City Health Services
Department outlining services performed, by the 7th day of the month following
the previous month.
(16) Assist the City with linkage to the Dubuque County Board of Health for CLPPP
planning and evaluation activities.
SECTION 2. CONTRACT POLICIES AND REQUIREMENTS. In providing the Work and
Services, VNA agrees to comply with the requirements in the Contract, including the Special
Conditions, and the General Conditions, to the extent applicable to the Work and Services
described in Section 1.
SECTION 3. ACCESS TO BOOKS AND RECORDS. VNA to provide access, upon
reasonable notice, for the purpose of audit and examination, to its documents, papers, and
records, to the extent such documents, papers, and records are related to the Work and
Services, to the Department, Contractor, City, or any of their duly authorized representatives.
SECTION 4. COSTS TO BE REIMBURSED. Attached hereto is a line item CLLLP
Performance Measure budget of specific costs to be reimbursed under this Subcontract or
other cost basis for determining the amount of the Subcontract.The Healthy Homes activities
will be invoiced to the City for VNA staff time plus benefits at 32 %.
SECTION 5 INCORPORATION OF THE CONTRACT. VNA agrees that all of the
provisions of the Contract, including audit requirements, are incorporated herein by this
reference and VNA shall have all of the same requirements, obligations and conditions as
Contractor with respect to VNA's Work and Services.
SECTION 6. PERIOD OF PERFORMANCE. Unless terminated as provided herein, the
Period of Performance for the Work and Services shall be from the the 1st day of July 2012,
through the 30th day of June, 2013.
SECTION 7 TERMINATION. Either party may terminate this Subcontract for any reason,
with or without cause, upon ten (10) days written notice to the other party. In the event of
termination, City shall compensate VNA for its Work and Services rendered through the date
of termination.
SECTION 8 INDEMNIFICATION.
(1) VNA agrees to defend, indemnify, and hold Department, City and Contractor,
and their officers, and employees harmless from and against any and all claims of any
kind arising out of or related to VNA's negligence in the performance of the Work and
Services pursuant to this Subcontract.
(2) City agrees to defend, indemnify, and hold VNA and its officers, and
employees harmless from and against any and all claims of any kind arising out of or
related to City's negligence in the performance of the Work and Services pursuant to
this Subcontract.
SECTION 9. INSURANCE. VNA shall at its expense maintain insurance with the same
coverage which Contractor is required to maintain under Par. 13 of the General Conditions.
CITY OF DUBUQUE, IOWA
By:
Michael C. an Milligen
City Manager
VISITING NURSE ASSOCIATION
By: 39-1n)
Nan Colin
Administrative Director
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C
1. shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of work is
longer than 60 days. Providers presenting annual certificates shall present a Certificate at the end of each
project with the final billing. Each Certificate shall be prepared on the most current ACORD form approved
by the Iowa Department of Insurance or an equivalent. Each certificate shall include a statement under
Description of Operations as to why issued. Eg: Project # or Lease of premises at or
construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa
and all carriers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each Certificate shall be furnished to the contracting department of the City of Dubuque.
4. 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.
5. Subcontractors and sub subcontractor performing work or service shall provide a Certificate of
Insurance in accord with Exhibit I.
6. All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific I50 form is listed, an equivalent form may be substituted subject to the
provider identifying and listing in writing all deviations and exclusions that differ from the I50 form.
8. Provider shall be required to carry the minimum coverage /limits, or greater if required by law or
other legal agreement, in Exhibit I.
9. Whenever an I50 form is referenced the current edition of the form must be used.
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products - Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit (any one occurrence) $ 50,000
Medical Payments $ 5,000
a) Coverage shall be written on an occurrence, not claims made, form. All deviations from
the standard I50 commercial general liability form CG 0001, or Business owners form BP
0002, shall be clearly identified.
b) Include I50 endorsement form CG 25 04 "Designated Location(s) General Aggregate Limit"
or CG 25 03 "Designated Construction Project (s) General Aggregate Limit" as appropriate.
c) Include endorsement indicating that coverage is primary and non - contributory.
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) Include additional insured endorsement for:
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. Use I50 form CG 2026.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as prescribed by
Iowa Code Chapter 85 as amended.
Coverage A
Coverage B
Statutory —State of Iowa
Employers Liability
Each Accident $100,000
Each Employee- Disease $100,000
Policy Limit - Disease $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must be at least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $1,000,000
Page 2 of 3 Schedule C, Professional Services April, 2013.Doc
City of Dubuque Insurance Requirements for Professional Services
Preservation of 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 Coverage. 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 Coverage. 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 Change in Policy. The above preservation of governmental immunities shall not otherwise change or
alter the coverage available under the policy.
SPECIMEN
Preservation of 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 Coverage. 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 Coverage. 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 Change in Policy. The above preservation of governmental immunities shall not
otherwise change or alter the coverage available under the policy.
SPECIMEN