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IDPH Childhood Lead Poisoning FundingTHE CITY OF DUB E Masterpiece on the Mississippi MEMORANDUM October 2, 2007 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning Funding and Agreement with the Visiting Nurse Association (VNA) and the Dubuque County Board of Health Public Health Specialist Mary Rose Corrigan recommends City Council approval of a subcontract with the Dubuque County Board of Health and an agreement with the Dubuque Visiting Nurse Association for services to lead poisoned children, training for employees, and monies to do outreach and education in targeted neighborhoods. I concur with the recommendation and respectfully request Mayor and City Council approval. Z iti C ~ Michael C. Van Milligen MCVM/jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Mary Rose Corrigan, RN, Public Health Specialist THE CITY OF DUB E Masterpiece on the Mississippi Dubuque rwwab 1'II~'r z~~ MEMORANDUM September 18, 2007 TO: Michael C. Van Millige Manager FROM: Mary Rose Corriga ,Pub Health Specialist SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning Funding and Agreement with the Visiting Nurse Association (VNA) and the Dubuque County Board of Health INTRODUCTION This memorandum provides information regarding a contract with the Dubuque County Board of Health for continued funding of the Childhood Lead Poisoning Prevention Program (CLPPP) and a renewed agreement with the VNA for services related to the CLPPP. 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, 2007. DISCUSSION Since that time, the Iowa Department of Public Health has applied for ongoing funds with the Centers for Disease Control and Prevention (CDC) to distribute to local childhood lead poisoning prevention programs. The funds are distributed to local Boards of Health in the State based on numbers of children in a community and the incidence of lead poisoning. 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, training for employees, and monies to do outreach and education in targeted neighborhoods. 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 FY 08 budget anticipated funding of $16,500. This year's contract is for $16,362, the same as FY 07. 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. CITY COUNCIL ACTION Approve the attached contracts and authorize the City Manager to execute on behalf of the City of Dubuque. M RC/cj cc: David Harris, Housing Services Manager Kathaleen Lamb, Senior Housing Inspector Nan Colin, VNA, Administrative Director SUBCONTRACT AGREEMENT FOR CHILDHOOD LEAD POISONING PREVENTION SERVICES BETWEEN DUBUQUE COUNTY BOARD OF HEALTH AND THE CITY OF DUBUQUE, IOWA WHEREAS, the Dubuque County Board of Health (County Board), as Contractor, has entered into an Agreement (the Agreement) with the Iowa Department of Public Health to perform childhood lead poisoning prevention services as set forth in the Agreement, 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, THEREFORE, 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 , 2007. ., ~. Nick Good an, Acting Chair Dubuque County Board of Health Michael C. Van Milligen City Manager AGREEMENT BETWEEN THE CITY OF DUBUQUE, IOWA, AND THE VISITING NURSE ASSOCIATION FOR THE CHILDHOOD LEAD POISONING PREVENTION PROGRAM (CLPPP) Now on this 1st day of July 2007, it is agreed by and between the City of Dubuque, Iowa, (City) and the Dubuque Visiting Nurse Association (VNA) as follow: A. TERM. The term of this Agreement shall be from the 1 st day of July 2007, through the 30th day of June 2008. B. CITY'S RESPONSIBILITIES. City agrees that it will provide the following services for the CLPPP: Submit quarterly reports and other reporting requirements as requested to the Iowa Department of Public Health (IDPH) and the Centers for Disease Control and Prevention. (CDC). 2. Provide for environmental investigations and environmental case management for lead abatement\lead hazard reduction 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 $9,000.00 for the performances of VNA's responsibilities as set forth herein. 4. Oversee and direct medical case management and educational activities through verbal and written direction. 5. Shall provide a written notice 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 Ng/d L, 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. VNA'S RESPONSIBILITIES. VNA agrees to provide the following services for CLPPP during the term of this Agreement for the agreed compensation: 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. Blood Lead Testing. a. VNA shall assure, within the ability and scope of practice for the VNA nurse, that the State of Iowa Plan for Childhood Blood Lead Testing (January 2004) is implemented within the CLPPP service area; that 1 medical providers conduct blood lead testing according to this plan; and may also conduct blood lead testing. b. Provide a written notice of the results of blood lead testing to the caregivers of all children tested by the VNA. 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. 4a. Medical Case Management: 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. 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. Confirmatory venous blood lead testing ^ Capillary blood lead level of 15 - 19 Ng/dL -within 4 weeks after report ^ Capillary blood lead level of 20-44 Ng/dL -within 1 week after report ^ Capillary blood lead level of 45 - 69 Ng/dL -within 48 hours after the report ^ Capillary blood lead level greater than or equal to 70 Ng/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 - 14 Ng/dL -within 3 months. After two levels less than 10 Ng/dL or three levels less than 15 Ng/d L, 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 Ng/dL - immediately. 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. 4b. Medical evaluations: Within the ability and scope of practice for the VNA nurse, shall assure that providers in Dubuque County provide/conduct medical evaluations for children under the age of six years within the following timelines: ^ Venous blood lead level of 20 - 44 Ng/dL -refer within 48 hours after the report so that the service is received within 5 days. ^ Venous blood lead level of 45 - 69 Ng/dL -refer within 24 hours after the report so that the service is received within 48 hours ^ Venous blood lead level greater than or equal to 70 ug/dL -refer for emergency medical evaluation 4c. Home nursing or outreach visits: Provide home nursing or outreach visits for children under the age of six years according to the following timelines: 2 ^ Venous blood lead level of 15 - 19 Ng/dL -within 4 weeks after the report ^ Venous blood lead level of 20 - 44 pg/dL -within 2 weeks after the report ^ Venous blood lead level of 45 - 69 pg/dL -within 1 week after the report ^ Venous blood lead level greater than or equal to 70 pg/dL -within 2 days after the report 4d. Chelation: Within the ability and scope of practice for the VNA nurse, assure that children with two venous blood lead levels greater than or equal to 45 pg/dL receive chelation. 4e. Nutrition evaluation: Assure that children under the age of six years with a venous blood lead level greater than or equal to 15 Ng/dL receive a nutrition evaluation according to the following timelines: ^ Venous blood lead level of 15 - 19 Ng/dL -refer within 4 weeks after the report so that the service is received within 6 weeks ^ Venous blood lead level of 20 - 44 pg/dL -refer within 2 weeks after the report so that the service is received within 4 weeks ^ 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 ^ Venous blood lead level greater than or equal to 70 Ng/dL -refer within 2 days after the report so that the service is received with 1 week. 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 Ng/dL. 4f. Shall assure that children under the age of six years with a venous blood lead level greater than or equal to 20 Ng/dL receive a developmental assessment according to the following timelines: ^ Venous blood lead level of 20 - 44 pg/dL -refer within 2 weeks after the report ^ Venous blood lead level of 45 - 69 Ng/dL -refer within 1 week after the report ^ Venous blood lead level greater than or equal to 70 pg/dL -refer within 2 days after the report. 4g. Care coordination: Shall provide care coordination. 5. Assist City with providing public education, lead coalition development and activities, and outreach to the City of Dubuque residents about childhood lead poisoning. 6. Provide information about lead poisoning and available services to local pediatric health care providers. 3 7. Participate with City in securing additional funding for childhood lead poisoning prevention activities. 8. 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. 9. Assist the City with linkage to the Dubuque County Board of Health for CLPPP planning and evaluation activities. 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 sole 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 sole 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 BY: Michael C. Van Milligen City Manager VISITING NURSE ASSOCIATION BY: 7 %~~~ Nan Colin Administrative Director 4 INSURANCE SCHEDULE C INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF DUBUQUE 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 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, except for 10 day notice for non-payment, if cancellation is prior to the expiration date. This endorsement supersedes the standard cancellation statement on the Certificate of Insurance. 3. ~~~ shall furnish a signed 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) Commercial General Liability policy is primary and non-contributing. b) Commercial General Liability additional insured endorsement. c) Governmental Immunities Endorsement. '` p~¢ ~~~ 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 r b ~ this contract. Said certificates shall meet the same insurance requirements as required of N ~~ 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 $2,000,000 Products-Completed Operations Aggregate Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 Fire Damage limit (any one occurrence) $ 50,000 Medical Payments $ 5,000 5 INSURANCE SCHEDULE C (Continued) INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF DUBUQUE This coverage shall be written on an occurrence form, not claims made form. All deviations or exclusions from the standard ISO commercial general liability form CG 0001 or Business owners BP 0002 shall be clearly identified. Form CG 25 04 03 97 'Designated Location (s) General Aggregate Limit' shall be included. Governmental Immunity endorsement identical or equivalent to form attached. Additional Insured Requirement: 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 shall be named as an additional insured on General Liability including "ongoing operations" coverage equivalent to ISO CG 20 10 07 04. b) Automobile $1,000,000 combined single limit. c) WORKERS COMPENSATION 8 EMPLOYERS LIABILITY Statutory for Coverage A Employers Liability: Each Accident $ 100,000 Each Employee Disease $ 100,000 Policy Limit Disease $ 500,000 d) PROFESSIONAL LIABILITY $1,000,000 e) UMBRELLA/EXCESS LIABILITY "Coverage and/or limit of liability to be determined on a case-by-case basis by Finance Director. Completion Checklist ^ Certificate of Liability Insurance (2 pages) ^ Designated Location(s) General Aggregate Limit CG 25 04 03 97 ^ Additional Insured CG 20 10 07 04 ^ Governmental Immunities Endorsement 6 of 7 June 2005 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 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 Chanae in Policy. The above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy. SPECIMEN 7 of 7 June 2005 INSURANCE SCHEDULE C INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF DUBUQUE 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 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, except for 10 day notice for non-payment, if cancellation is prior to the expiration date. This endorsement supersedes the standard cancellation statement on the Certificate of Insurance. 3. ~~~ shall furnish a signed 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) Commercial General Liability policy is primary and non-contributing. b) Commercial General Liability additional insured endorsement. c) Governmental Immunities Endorse nt. /~/~ ' ~ ~~~ s all a so be requ'~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 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 (any one occurrence) Medical Payments $2,000,000 $1,000,000 $1,000,000 $1,000,000 $ 50,000 $ 5,000 5 INSURANCE SCHEDULE C (Continued) INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE CITY OF DUBUQUE This coverage shall be written on an occurrence form, not claims made form. All deviations or exclusions from the standard ISO commercial general liability form CG 0001 or Business owners BP 0002 shall be clearly identified. Form CG 25 04 03 97 `Designated Location (s) General Aggregate Limit' shall be included. Governmental Immunity endorsement identical or equivalent to form attached. Additional Insured Requirement: 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 shall be named as an additional insured on General Liability including "ongoing operations" coverage equivalent to ISO CG 20 10 07 04. b) Automobile $1,000,000 combined sins~le limit. c) WORKERS COMPENSATION ~ EMPLOYERS LIABILITY Statutory for Coverage A Employers Liability: Each Accident $ 100,000 Each Employee Disease $ 100,000 Policy Limit Disease $ 500,000 d) PROFESSIONAL LIABILITY $1,000,000 e) UMBRELLAIEXCESS LIABILITY *Coverage and/or limit of liability to be determined on a case-by-case basis by Finance Director. Completion Checklist ^ Certificate of Liability Insurance (2 pages) ^ Designated Location(s) General Aggregate Limit CG 25 04 03 97 ^ Additional Insured CG 20 10 07 04 ^ Governmental Immunities Endorsement 6 of 7 June 2005 CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT 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 7 of 7 June 2005 THE POLICIES OF INSURANCE LISTED BE LGvv n.~v~ actrv iaautu i U I Rt INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T O ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM/DDM' E PDATE MM/DD/Yl N LIMITS GENERAL LIABILITY A EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY 132508 04/01/07 04/01/08 PREMISES (Eaoccurence) $ CLAIMS MADE ~ OCCUR iE rv O EXF (iiny one person] $ X Professional Liab PERSONALS D A VINJURY $ See BelOW GENERAL AGGREG T ' A E $ GEN L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS -COMP/OP AGG $ POLICY JECT LOC AU TOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY _ ~ EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND _ EMPLOYERS' LIABILITY TORY LIMITS ER "NY FRUP^~ETOiY/PA?TNE:v~;;i?CUTI'vE OFFICER/MEMBER EXCLUDED? E.=.. EACH ACCIDENT . 5 If yes, describe under E.L. DISEASE - EA EMPLOYEE $ SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Primary Coverage IA-$3000000/$5000000, Primary Coverage IL -$2000000/$4000000 Excess Liability IA & IL - $10000000/$10000000 See Attached List of Providers CERTIFICATE HOLDER CANCELLATION DUBVISI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN Dubuque Visiting Nurse NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Association P . O . BOX 35 9 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Dubuque IA 52004-0359 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ' David H. Fritz CIC CPCU ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ACORD CERTIFICATE OF LIABILITY INSURANCE CSR DH DATE (MM/DD/YYYY) „ MEDIC-3 04 02/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE TRICOR, Inc . - Dubuque HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 1810, 500 Iowa Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dubuque IA 52004-1810 Phone: 563-556-5441 Fax: 608-723-6440 INSURERS AFFORDING COVERAGE NAIC # INSURED Medical Associates ~'11n1C PC Mercy Family Care Network LLC INSURER A: physicians ins co of WI, inc , Preferred Health Choices, LLC T i-St t O i INSURERS r a e ccupat onal Health Services, LLC INSURER C: 1500 Associates Dr Dubuque IA 52002 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLI EFFECTIVE DATE MM/DD/YY POLI Y EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ A COMMERCIAL GENERAL LIABILITY 132508 04/01/07 04/01/08 PREMISES (Eaoccurence) $ CLAIMS MADE U OCCUR ' NICD EXr (rviy one persanj $ X Professional L1ab PERSONAL 8 ADV INJURY $ See BelOW GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ POLICY PRO LOC JECT AU TOMOBILE LIABILITY ) INGLE LIMIT B D $ ANY AUTO (Ea a cide t ALL OWNED AUTOS BOD ILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS ~ (Per accident) $ PROPERTY DA E MAG $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY FRG!'^iETOR/PA?,T:L'Ei'v~XECUTI'vE E.'.. EACH ACCIDENT $ - OFFICER/MEMBER EXCLUDED? - If es describe under E.L. DISEASE - EA EMPLOYEE $ y , SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS !LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Primary Coverage IA-$3000000/$5000000, Primary Coverage IL -$2000000/$4000000 Excess Liability IA & IL - $10000000/$10000000 See Attached List of Providers ctrl I IrICA I t rl~LUtR CANCELLATION DUBVISI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN Dubuque Visiting Nurse NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Association P . O . BOX 35 9 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Dubuque IA 52004-0359 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE David H, Fritz, CIC, CPCU AcoRU z5 (zw~ios) ©ACORD CORPORATION 1988 OP ID C DATE (MMlDOlYYYYS ,~CORU® INSURANCE BINDER 03/29/2007 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FO 2 6.8 _' COMPANY ~ BINDER# AGENCY Travelers - '~ PIRATE Kunkel, Sounds & Assoc., Inc 203 High Street Mineral Point WI 53565 _.__ Hr~e~erick S-. Bounds __._ - FAX- ----- (AIC,NO,Ext): 608-.987-1155 ___(Arc,No):,___608=987-2310 CODE: SUB CODE :RID: FINFTOSI Finley Hospital Dennis Benda 350 23. Grandview Avenue Dubuque IA 52001 EFFECTIVE X DATE TIME DATE TIME _. -----__---T ~AM I ~ 1201 AM 04/04/07 12:01 ~ PM 04/04/08 NOON ---- -~---- .- .L_ _~_ 1_ _. - _ .. ~_ .. THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY #: DESCRIPTION OF OPERATIONSNEHICLESIPROPERTY (Including Location} COVERAGES TYPE OF INSURANCE COVERAGEfFORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS _-~ BASIC _~ BROAD ` . J SPEC GENERAI. LIABILITY EACH OCCURRENCE S ~_ "AAE70 ~ COMMERCIAL GENERAL LIABILITY RENTED PREMISES _„___ $ __-__. _ ___ ~ OCCUR ~ MED EXP {Any one person) CLAIMS MADE r - S _- _ __ _ PERSONAL & ADV INJURY ~ J $ _ GENERAL AGGREGATE S _ j RETRO OATS FOR CLAIMS MADE: PRODUCTS - COMProP AGG j S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $lOOOOOO X, ANY AUTO BODILY INJURY (Per person) $ __ ALL OWNED AUTOS BODILY INJURY (Peracddenq i S .' SCHEDULED AUTOS PROPERTY DAMAGE S - _ HIRED AUTOS MEDICAL PAYMENTS $ S O OO _ ~_ _ NON-OWNED AUTOS PERSONAL INJURYPROT $ UNINSUREDMOTORIST ~ $IOOOOOO tTaa.rinsu=.a xce S 10 0 0 0 0 0 AUTp PHYSICAL DAMAGE DEDUCTIBLE X ALL VEHICLES SCHEDULED VEHICLES X _ ACTUAL CASH VALUE X .COLLISION: IOOO - STATED AMOUNT $ X OTHER THAN COL. ZOOO OTHER GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY:- . ...----- -- EACHACCIDENT S _ -_ _. _ AGGREGATE $ EXCESS LIABILITY ~ EACH OCCURRENCE S _ __ UMBRELLA FORM __ ,AGGREGATE ~ S . OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION S ~~ WC STATUTORY LIMITS WORKER'S COMPENSATION E.L. EACH ACCIDENT $ AND EA EMPLOYEE ; S DISEASE L ~ ~ E ' _ -__ _ . S LIABILITY EMPLOYER ~ E.L. DISEASE - POLICv LIMIT S FEES S __ _ ___-._--„_ SPECIAL CONDITIONS? OTHER TAXES _ __ $ _ __ I COVERAGES S ESTIMATED TOTAL PREMIUM NAME 8 ADDRESS MORTGAGEE ~ ADDITIONAL INSURED LOSS PAVES tel.- _ - .. _..... LOAN # AUTHORIZED REPRESENTATIVE Frederick S. Bounds ACORD 75 (2004/09) NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE ©ACORD CORPORATION 1993-2004 CONDITIONS This Company binds the kind{s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of the form is changed from "Insurance Binder" to "Cover Note". Applicable in Colorado With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home owners, the insurer has thirty (30) business days, commencing from the effective date of coverage, to evaluate the issuance of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien an real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except far Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company. Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. ACORD 75 t20U4/09) OP ID C D03/29/2007 ,4` o INSURANCE BINDER THIS BINDER 15 A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. _ __ AGENCY "--~-------~-~----.-.~------'---- COMPANY ..,-..----~ ~~~BINDERiF 267 Travelers Kunkel, Bounds & Assoc. , Inc EFFECTIVE ~-r ~ ~~RTITI~Y DATE TIME DATE TIME 203 High Street ~ g AM ~---~XIt2:01AM Mineral Point WI 53565 -.. _ .~.. Frederick_S_. Bounds _,_,_ 04/04/07 12:01 PM -~- 04/04/O8~ , NooN (AlC No, Ext): fi 0-89 8 78 7 -115 5 ~ _-~c, Nol: 6 0 8 - 9 87 - 2 310 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY PER EXPIRING POLICY # CODE: SUB CODE: AZ'ERCY ~ FINHOSI , DESCR1P710NOFOPERATIONSNEHICLES!PROPERTY{IncludingLocation) CUSTOMER ID: INSURED Finley Hospital Dennis Benda 350 N. Grandview Avenue Dubuque IA 52001 l: V V t1<AbCJ TYPE OF INSURANCE COVERAGElFORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS Blanket Bldg & C'OntentS 25000 133197 ~ Baslc ~ BROaD ~ sPEC Blanket BI/EE 48 HOU 64262000 __ Replacement Cost Quake 50000 25000000 Agreed Amount Flood (excluding C or X zones 50000 25000000 GENERAL LIABILITY EACH OCCURRENCE ! S _ -_ _ l~ COMMERCIAL GENERAL LIABIUTV RENTED. PREMISES _ A ~T0 S ~ - - t -~ J CLAIMS MADE L ,~ OCCUR ~ MED EXP {Any one person) - I PERSONAL 8 ADV INJURY S I - - . ._ GENERAL AGGREGATE S ~ RETRO DATE FOR CLAIMS MADE: PRODUCTS - COMPlOP AGG $ AUTOMOBILE LIABILITY ,COMBINED SINGLE LIMIT _ 5 _ ANY AUTO BODILY INJURY (Per person) $ ___ ALL OWNED AUTOS BODILY INJURY (Per accident) $ - SCHEDULEDAUTOS I PROPERTY DAMAGE _ S -_ - 'HIRED AUTOS MEDICAL PAYMENTS 5 ___ ~ NON-OWNED AUTOS PERSONAL INJURY PROT $ -_ ! UNINSURED MOTORIST $ AUTO PHYSICAL DAMAGE pEDUCTIBLE ALL VEHICLES - 'SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION: _ _ STATED AMOUNT S OTHER THAN CO L: ;OTHER GARAGE LIABILITY AUTOONLV - EAACCIDENT $ - ANY AUTO OTHER THAN AUTO ONLY: _ ~ EACH ACCIDENT S ~--• - _.._- -. ._.-.... - --- AGGREGATE $ EXCESS LfABILRY EACH OCCURRENCE $ UMBRELLA FORM ' AGGREGATE ! S _ _ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION S WC STATUTORY LIMITS _ - WORKER'S COMPENSATION _ _ - E.L. EACH ACCIDENT -, $ -_ AND EMPLOYER'S LU\BiLITV E: L. DISEASE - EA EMPLOYEE S _ - E.L. DISEASE -POLICY LIMIT S SPECIAL FEES _ .-----_ $ -°-__-- CONDRIONS! OTHER COVERAGES TAXES 5 ___ _ __- ~.- ' ESTIMATED TOTAL PREMIUM $ NAME 8r ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE ~.... LOAN # AUTHORIZED REPRESENTATNE Frederick S. Bounds ACORD 75 (2004!09) NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE ©ACORD CORPORATION 1993-2004 CONDITIONS This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the poficy(ies} in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of the form is changed from "Insurance Binder" to "Cover Note". Applicable in Colorado With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobi{e home owners, the insurer has thirty (30} business days, commencing from the effective date of coverage, to evaluate the issuance of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company. Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and {B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. ACORD 75 ~zounrua~ OP ID S D041/03/2007 ~~ fNSURANCE BINDER THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE B NDERIiI 24353 COMPANY AGENCY Safety National Casualty Corp Cottingham & Butler, Inc. EFFECTIVE --i x DATE T1ME DATE TIME 300 SECURITY BUILDING PO BX 28 `-JI-~~AM I ~x 12:01 AM DUBUQUE IA 52001 04/04/07 12:01 pM 04/04/08 NOON Bradle J. Plummer ~~-._. AfC,No E:t-• 563-587-5000 ~ ~~ ~-: 563-583-7339 THIS BINDER ISISSUEOTOEXTENDCOVERAGEINTHEABOVEriAMEDCAMPANY CODE- 'i SUB CODE: PER EXPIRING POLICY #: FINHOSl DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY (including Location) CUSTOMER ID: INSURED Finley Hospital Dennis Benda 350 North Grandview Avenue Dubuque IA 52001 unnlTs cvveriAVta COVERAGEIFORMS DEDUCTIBLE COINS °b AMOUNT TYPE OF INSURANCE ' PROPERTY CAUSES OF LOSS BASIC ~~ BROAD ~ SPEC GENERAL LIABILTfY EACH OCCURRENCE $ L GENERAL LIABILITY ~RENTEO PREMISES E COMMERCIA CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ ~RSONAL 8 AOV INJURY $ GENERAL AGGREGATE $ RETRO DATE FOR CLAIMS MADE: PRODUCTS - COMPIOP AGG S AUTO MOBRE LIABILITY COMBINED SINGLE LIMIT E ANY AUTO BODILY INJURY (Per person) ~ E ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS I PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS ~ $ NON-0W NED AUTOS PERSONAL }W URY PROT S UNINSURED MOTORIST $ $ ALL VEHICLES SCHEDULED VEHICLES AUTO PHYSICAL DAMAGE DEDUCTIBLE ~ ACTUAL CASH VALUE ~ STATED AMOUNT $ COLLISION: OTHER THAN COL: OTHER GARAGE LABILITY AUTO ONLY - EA ACCIDENT $ NY AUTO OTHER THAN AUTO ONLY: A EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ U OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION $ X WC STATUTORY UMITS WORKER'S COMPENSATK)N E.L. EACH ACCIDENT $ pND EMPLOYER'S LIABILITY E.L. DISEASE - £J1 EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ THIS INSURANCE BI NDER IS SUBJECT TO ALL TERMS ANS CONDITIONS AS OOTLINID FEES $ CONCDITKTNSI IbT TBE PROPOSAL. MaX Ind bilit Li l TAXES S -~ . y a oyers OTHER ExceaS WOrkerS' CompeasatiOn: $1,000,000 Emp COVERAGES - M S325,000 3e1£ Incur Ret: 52,000,000 Aggregate Excess Limit. $ ESTIMATED TOTAL PREMIU IYAMC Ot AIdu RCO~7 MORTGAGEE ADD4TIONAL INSURED LOSS PAYEE ~_ LOAN # SENTATIVE REPRE AUTHORIIED ~ ~ ~c7s~~ ~ ^'~'~ 1~j ~,~~ ....~~_ .u....et w.,T cTwTC ,u enou ATIAN AN REVERSE S(6E ®ACORD CORPORATION 1993-2004 A~.VK1J ro (w~wva~ C~NDITIDNS This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of the form is changed from "Insurance Binder" to "Cover Note". Applicable In Colorado With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home owners, the insurer has thirty (30) business days, commencing from the effective date of coverage, to evaluate the issuance of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agenk if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company. Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. T5 ,, .. -- ~ a~ INSURANCE BINDER oplo s °oa(io3/ 0'7 DE ~ TEMPORARY INSURANCE CONTRACT, SUBJECT 70 THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. - COMPANY BINDER# 24423 National Qnion Fire lgrli • $ntlar , InC . GATE EFFECTIVE T®„~ DATE TIME ,CLJF~ BIIILDING PO BX 28 X AM X 12:01 AM JE IA !001 J- 1 :uJ>~er 04/04/07 12:01 PM 04/04/08 NoDN nl; 563-? 67-5000 1A/C,No-: 563-583-7339 THlSB1NDERISISSUEDTOEXTENDCOVERAGEINTHEA80VENAtvtEDCOMPANY SU8 CODE: PER EXPIRING POLICY #: I m• FINHOSl DESCRIPTION OF OPERATIONSNEHICLESIPROPERTY (Including Location) 'inlay Hospital )enr-i s Benda 350 2lorth Grandviei+ Avenue )tabuque IA 52001 ~i_rc LIMITS TYPE OF INSURANCE COVERAGE7FORM5 DEDUCTIBLE COINS X AMOUNT ~ CAUSES OF LOSS lC ~ BROAD ^ SPEC LIABILITY FJ1CH OCCURRENCE $ AMERGAL GENERAL LIABILITY RENTED PREMISES 3 CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE S RETRO DATE FOR CLAIMS MADE: PRODUCTS - COMPlOP AGG $ iLLE LIABILITY COMBINED SINGLE LIMfT S 'AUTO BODILY INJURY (Per person) $ O WNED AUTOS BODILY INJURY (Per accident) $ ~EDULED AUTOS PROPERTY DAMAGE S ED AUTOS MEDICAL PAYMENTS $ N-0WNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST $ S YSICAL DAMAGE DEDUCTIBLE ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE LLISION: STATED AMOUNT $ HER THAN COL: OTHER LU1BILlTY AUTO ONLY - EA ACCIDENT $ Y AUTO OTHER THAN AUTO ONLY: I( EACH ACCIDENT $ AGGREGATE $ LU181uTY EACH OCCURRENCE $ tBRELLAFORM ~ AGGREGATE $ 'HER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION S WC STATUTORY LIMBS WORKER'S COMPENSATION E.L. EACH ACCIDENT S ANO EMPLOYER'S LABILITY E.L. DISEASE - EA EMPLOYEE S E.L DISEASE -POLICY LIMIT $ THIS INSURANCE BINDER IS SUBJECT TO ALT. TEAMS AND CONDITIONS AS OUTLINED FEES $ DNS! pgOpOSAL. Directors S Officer' Liability/Employment Practices Liability: 000 retention/IIiA and $75,000 retention/&PL/Third P 000 limit; $35 000 $5 TAXES $ , , ~$ , Continuity Dates:DiO 4/4/88; Organization 4/4/94; VNA 10/1/96. ESTIMATED rOTAI. PREMIUM S B~ADDRESS MORTGAGEE ~ ADDITIONAL INSURED LOSS PAYEE LOAN p T<e a D 75 t2004109J NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE ®ACORD CORPORATION 1 k-~Dept. ~, Pvtyx: hk~r'~+I 1~ .yF,.,45n. Iowa Department of Public Health Advancing Health Through the Generations Chester J. Culver Patty Judge Governor Lt. Governor CONTRACT #: 5888LP05 PROJECT TITLE: Childhood Lead Poisoning Prevention Program FUNDING SOURCE OF IDPH: FEDERAL: $13,142 -- 80.32% STATE: $3,220 -- 19.68% OTHER: $0 -- 0.00 FEDERAL CATALOG #: 93.197 Thomas Newton Director PROJECT PERIOD: July 1, 2007 to June 30, 2008 CONTRACT PERIOD: July 1 2007 to June 30 2008 CONTRACT AMOUNT: $16,362 FEDERAL TAX ID#: 426004597 CONTRACTOR: Dubuque County Board of Health MATCH REQUIRED: YES^ NO® NA^ c%o City of Dubuque Health Services Department IOWA CODE CHAPTER 8F DESIGNATION: City Hall Annex ^ This contract is covered by Iowa Code Chapter 8F. 1300 Main Street ® This contract is NOT covered by Iowa Code Chapter 8F. Dubuque IA 52001 ^ At the time of execution, this contract is NOT covered by CONTRACT ADMINISTRATOR INFORMATION Iowa Code Chapter 8F, but if the Contractor executes NAME: Mary Rose Corrigan additional contracts with the Department, the aggregate of PHONE: 563-589-4181 FAX: 563-589-4299 which exceed $500,000, the contract may be covered. E-MAIL: health@cityofdubuque.org 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 February 1, 2007, as posted on the Department's web site under Grants, Bids, and Proposals: www.idph.state.ia.us or as available by contacting Rita Gergely at 515/242-6340. 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 b ow. .. -~ For and on behalf of the Department: For an on beha ~ ~t a Contractor: By --z--:~.~ BY Nick Goodma Acting Ken Sharp, Director, Division of Environmental Health ,Chair, Board of Health Date Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319-0076 ~ 515-281-7689 ~ www.idph.state.ia.us DEAF RELAY (Hearing or Speech Impaired) 711 or 1-800-735-2942 SPECIAL CONDITIONS FOR CONTRACT #5888LP05 ARTICLE I -IDENTIFICATION OF PARTIES. This contract is entered into by and between the Iowa Department of Public Health (hereinafter referred to as the DEPARTMENT) and the CONTRACTOR, as identified on the contract face sheet. 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, Chief, Bureau of Lead Poisoning Prevention, 515/242-6340 ARTICLE III -DESIGNATION OF CONTRACT ADMINISTRATOR AND KEY PERSONNEL Mary Rose Corrigan has been designated by the CONTRACTOR to act as the Contract Administrator. This individual is responsible for financial and administrative matters of this contract. Negotiations concerning this contract should be referred to Mary Rose Corrigan; telephone 563-589-4181. The primary agency subcontracted to carry out the responsibilities of the contract is: City of Dubuque Health Services Department. The following individual(s) shall be considered key personnel: Name Title M Rose Corri an A enc Director M Rose Corri an Contract Administrator Mary Rose Corri an RN Fro am Administrator Ken TeKi e Finance Mana er Chris Johnson Data En Clerk Michelle Zurcher RN (Finley Tri- States Health Grou VNS Nurse M Rose Coiri an and Ro er Benz Certified Elevated Blood Lead EBL Ins ector/Risk Assessor ARTICLE IV -STATEMENT OF CONTRACT PURPOSE The purpose of this contract is to provide funds for the CONTRACTOR to conduct childhood lead poisoning prevention activities as specified in Article V, Description of Work and Services. ARTICLE V -DESCRIPTION OF WORK AND SERVICES: The CONTRACTOR shall conduct childhood lead poisoning prevention services as specified in this article. 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 641-70.5(135) and that has been certified by the department. "Certified elevated blood lead /EBL) inspector'risk assessor" mear_s a person who has met the requirements of 641-70.5(135) 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 Deparhnent of Public Health for the Title V Child Health program. "Childhood Lead Poisoning Prevention Program (CLPPP) service area "means the geographic area for which the CLPPP has agreed to provide CLPPP services. "CLPPP" means childhood lead poisoning prevention program. "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 CLPPP service area who receive blood lead testing from the CLPPP 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, and providing all STELLAR reports required by this contract. "Developmental testing" means testing done by the local Area Education Agency to determine whether a child is developmentally delayed. "Education and outreach "means seeking out and providing information regarding childhood lead poisoning 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. "Home nursing or outreach visit" means a home visit conducted by a nurse or social worker to provide information to the caregiver of alead-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. "Lead-based paint hazard "means hazardous lead-based paint, adust-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. "Local coalition " means a group convened by the CONTRACTOR to address the issue of childhood lead poisoning in the CLPPP service area. The local coalition should be composed of physicians, nurses, housing officials, parents, contractors, and representatives of neighborhoods where homes are being renovated. `iLledical 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 aYry 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 awell-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 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 alead-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 CLPPP SERVICE AREA The CLPPP service area is Dubuque County. REQUIItED SERVICES The CONTRACTOR is responsible for blood lead testing, data management, environmental case management, medical case management, education and outreach, and the local coalition within its service area. The CONTRACTOR shall develop written protocols to describe how each of these services will be provided. The CONTRACTOR may use templates provided by the department to develop these protocols. BLOOD LEAD TESTING The CONTRACTOR shall assure that the State of~Iowa Plan for Childhood Blood Lead Testing (January 2004) is implemented within the CLPPP service area. The CONTRACTOR shall assure that medical providers conduct blood lead testing according to this plan. The CONTRACTOR may also conduct blood lead testing. The CONTRACTOR shall provide a written notice of the results of blood lead testing to the caregivers of all children tested by the CONTRACTOR. 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. The CONTRACTOR shall provide a written notice 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 µg/dL, regardless of whether the CONTRACTOR 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. DATA MANAGEMENT The CONTRACTOR shall conduct data management as specified in this contract. The CONTRACTOR shall notify the department within 10 working days of assigning STELLAR data entry duties to a new staff person. The CONTRACTOR shall assure the department that new data entry staff has received appropriate training or work with the department to assure that new data entry staff receives appropriate training. The CONTRACTOR shall install STELLAR on a computer network consisting of at least two computers that are linked to the same server. The CONTRACTOR shall allow the DEPARTMENT and other agencies providing medical and environmental case management oflead-poisoned children in the CLPPP service area to access the main STELLAR database via the software, PC Anywhere, or another software package approved in advance by the DEPARTMENT. This software shall be installed on a computer that is continuously available for the DEPARTMENT and other agencies for access. The CONTRACTOR 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 make this request in writing. The DEPARTMENT will approve or deny these requests on a case-by-case basis. The CONTRACTOR shall enter the results of blood lead testing for all individuals under the age of 16 years in the CLPPP service area who receive blood lead testing from the CLPPP or any other provider in the STELLAR database. The CONTRACTOR shall document all case management actions taken by the CONTRACTOR 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 assure that all CLPPP subcontractors also document all case management actions that they taken in STELLAR. The CONTRACTOR shall enter blood lead test results and case management actions into STELLAR on at least a weekly basis. The CONTRACTOR shall run STELLAR Lab Batch at least every two weeks and shall forward case information to other agencies providing medical and environmental case management in the CLPPP service area at least every two weeks. The CONTRACTOR shall provide all STELLAR reports by the deadlines given in this contract. The DEPARTMENT will periodically review the CONTRACTOR STELLAR database for errors and notify the CONTRACTOR of errors that must be corrected. The CONTRACTOR shall 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 Paper copies of all blood lead test results entered into STELLAR shall be filed alphabetically by the name of the child and shall be retained by the CONTRACTOR until one (1) year after the child attains the age of majority. Paper copies of blood lead test results shall be maintained by the primary agency subcontracted to carry out the responsibilities of the contract. Paper copies of blood lead test results will be transferred to the DEPARTMENT if the contract is terminated. The CONTRACTOR may request that the DEPARTMENT waive the requirement that the CONTRACTOR file all blood lead test results alphabetically by the name of the child. The CONTRACTOR shall make this request in writing. The DEPARTMENT will approve or deny these requests on a case-by-case basis. ENVIRONMENTAL CASE MANAGEMENT The CONTRACTOR shall maintain 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 and the certified individuals shall comply with the provisions of Iowa Administrative Code 641-70.6(3). The CONTRACTOR shall be enrolled as a Medicaid provider for EBL inspection services and shall recover reimbursement from Medicaid for EBL inspections and use the reimbursement as program income. The CONTRACTOR shall conduct 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: • Two venous blood lead levels of 15 to 19 µg/dL -within 4 weeks after the report. • Venous blood lead level of 20 to 44 µg/dL -within 2 weeks after the report • Venous blood lead level of 45 to 69 µg/dL -within 1 week after the report • Venous blood lead level greater than or equal to 70 µg/dL -within 2 days after the report. The CONTRACTOR shall document in STELLAR the reason why the CONTRACTOR was unable to complete any inspection required by this contract. The CONTRACTOR shall contact 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. The CONTRACTOR shall contact the current owners of all dwellings where lead hazards were identified, but Lead hazard remediation has not been completed, at least once every six months until lead hazard remediation is completed. The CONTRACTOR shall continue to 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. The CONTRACTOR shall not close an address associated with a lead-poisoned child where lead hazards have been identified unless the lead hazard remediation has been completed unless permission is obtained in advance from the DEPARTMENT. The CONTRACTOR shall, to the extent possible, assist families who have lead-poisoned children in locating resources for lead hazard remediation and/or alternative housing. The CONTRACTOR must conduct 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 alead-poisoned child. To be eligible for continued funding beginning July 1, 2008, each county in the service area must have adopted a local board of health regulation or a local board of supervisors ordinance that is at least as protective as Iowa Administrative Code Chapter 641-68, Control of Lead-Based Paint Hazards. MEDICAL CASE MANAGEMENT The CONTRACTOR shall conduct medical case management as specified in this contract. The CONTRACTOR shall 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. Follow-up blood lead testing The CONTRACTOR shall assure that providers in the CLPPP service 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 CONTRACTOR may provide this follow-up blood lead testing. Confinnatorv venous blood lead testing • Capillary blood lead level of 15 to 19 µg/dL -within 4 weeks after the report. • Capillary blood lead level of 20 to 44 µg/dL -within 1 week after the report Capillary blood lead level of 45 to 69 µg/dL -within 48 hours after the report Capillary blood lead level greater than or equal to 70 µg/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 µg/dL -within 3 months. After two levels less than 10 µg/dL or three levels less than 15 µg/dL, testing should follow the routine testing schedule for high-risk children. • Venous blood lead level of 15 to 19 µg/dL -within 3 months. • Venous blood lead level of 20 to 44 µg/dL -within 4 to 6 weeks. • Venous blood lead level greater than or equal to 45 µg/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 assure that providers in the CLPPP provide conduct medical evaluations for children under the age of six years within the following timelines: Venous blood lead level of 20 to 44 µg/dL -Refer within 48 hours after the report so that the service is received within 5 days. Venous blood lead level of 45 to 69 µg/dL -Refer within 24 hours after the report so that the service is received within 48 hours. Venous blood lead level greater than or equal to 70 µg/dL -Refer for emergency medical evaluation. Home nursing or outreach visits The CONTRACTOR shall provide home nursing or outreach visits for children under the age of six years according to the following timelines: • Venous blood lead level of 15 to 19 µg/dL -within 4 weeks after the report. • Venous blood lead level of 20 to 44 µg/dL -within 2 weeks after the report • Venous blood lead level of 45 to 69 µg/dL -within 1 week after the report • Venous blood lead level greater than or equal to 70 µg/dL -within 2 days after the report. chelation The CONTRACTOR shall assure that children with two venous blood lead levels greater than or equal to 45 µg/dL receive chelation. Nutrition evaluation The CONTRACTOR shall assure that children under the age of six years with a venous blood lead level greater than or equal to 15 µg/dL receive a nutrition evaluation according to the following timelines: Venous blood lead level of 15 to 19 µg/dL -Refer within 4 weeks after the report so that the service is received within 6 weeks. Venous blood lead level of 20 to 44 µg/dL -Refer within 2 weeks after the report so that the service is received within 4 weeks. • Venous blood lead level of 45 to 69 µg/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. The CONTRACTOR shall contact the DEPARTMENT 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 µg/dL. Developmental assessment The CONTRACTOR shall assure 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 provide care coordination or refer 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: 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. 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. A child has moved out of the CLPPP service area. The CONTRACTOR shall immediately notify the appropriate local CLPPP agency in the area to which the child has moved and provide copies of all environmental and medical case management records to the appropriate local CLPPP agency. CHILDREN OVER THE AGE OF SIX YEARS The CONTRACTOR shall contact 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. EDUCATION AND OUTREACH The CONTRACTOR shall provide education and outreach regarding childhood poisoning in the CLPPP service area. LOCAL COALITION The CONTRACTOR shall establish a local coalition for the CLPPP service area. The coalition may be a subgroup/work group of a larger umbrella coalition. However, participation in an umbrella coalition does not meet this requirement unless a specific subgroup has been formed to deal with lead poisoning prevention in the community. The coalition shall include citizens who are not part of agency (Health, Housing, Human Services, etc.) staff that participate in the CLPPP. The CONTRACTOR shall devote at least 8 hours of staff time to the establishment and maintenance of the coalition. ARTICLE VI -PERFORMANCE MEASURE Not applicable. ARTICLE VII -REPORTS The CONTRACTOR shall prepare and submit the following reports to the DEPARTMENT on forms and/or in the format approved by the DEPARTMENT: Report Number Date Due Claim Voucher 1 original Within 45 days of month of expenditure Expenditure Report 1 original Within 45 days of month of expenditure Quarterly Narrative Report 1 Electronic 10-25-2007 1-25-2008 4-25-2008 7-25-2008 STELLAR Quarterly Report 1 Electronic 10-25-2007 1-25-2008 4-25-2008 7-25-2008 Claim vouchers and expenditure reports shall be mailed to: Rita Gergely, Chief Bureau of Lead Poisoning Prevention Division of Environmental Health Iowa Department of Public Health 321 East 12'h Street Lucas State Office Building Des Moines, IA 50319-0075 Quarterly narrative reports shall be emailed to: Mindy Uhle muhle@idph. state. ia.us Quarterly STELLAR reports shall be emailed to: Pilar Logsdon plogsdon@idph. state. ia.us ARTICLE VIII-- BUDGET: The total approved budget for this contract period is detailed in Exhibit 1. Services will be reimbursed at a flat fee as specified on Exhibit 1 up to the amount of the contract. The CONTRACTOR may change the number of any 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. ARTICLE IX: PAYMENTS 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 -LOCAL BOARD OF HEALTH LINKAGE: As a condition of the contract, the CONTRACTOR shall assure linkage with the local board of health in each county where services are provided. The CONTRACTOR will assure 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. 2. All work plan revisions must be approved by the DEPARTMENT prior to implementation. ARTICLE XI -ADDITIONAL CONDITIONS Funds must be made available to reimburse subcontractor expenses no later than October 1, 2007. 2. 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 analysis unless this service is listed as a line item on the expenditure report. On January 1, 2008, April 1, 2008, and June 1, 2008, 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 childhood lead poisoning prevention services. Final payments may be withheld if the agency or personnel employed by the agency are not in compliance with Iowa Administrative Code Chapter 641-70, Lead Professional Certification. The CONTRACTOR must check Internet a-mail at least once each week for lead poisoning prevention updates sent out by the DEPARTMENT. 6. 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. EXHIBIT I -- EXPENDITURE REPORT FOR THE MONTH OF CONTRACTOR: Dubuoue County Board of Health rn~.r~ru err NcQVQr nnc ...,,..~.,, . ,,.,, .,~ - - -- --- -- Reimbursable B d • • •~-~> ~ ~~~~~ ~-~ wiv rrcr~~ r r l/tc(VU: Jw 1 LUII ! to Jwle 3U 2 (108 u geted Number Budgeted Rate (A) Budgeted Total (B) Number Completed for Month (C) Reimbursement for Month (A s C) Number Completed to Date Reimbursement to Date (D) Balance (B - D) Ctuldren Tested for Lead Poisoiung (wider 6 years) --pay from 1351 2,850 $1 $2,850 - $ $ $ Child CONTC or ACTIO event 403 $10 $4,030 $ $ $ N M di id on- e ca Home Nursing Visits 6 $80 $480 $ $ $ R f l f erra e s or Nutrition Counseling G $10 $GO $ $ $ R f l f D erra e s or evelopmental Testing 3 $10 $30 $ $ $ N M di id I i on- e ca n tial Inspection Events 5 $600 $3,000 $ $ $ EBL I i i nvest gat on CONTC Events 74 S10 $740 $ $ $ C l d L omp ete ead Hazard Remediations -pay from 1351 10 $10 $ I00 $ $ $ EBL I i nvest gation INSAB, INSAI, INSAE Events 19 $50 $950 $ $ $ EBL I i nvest gation Properties Passing Clearance Testing -- pay from 1351 5 $300 $1,500 $ $ $ liti C M i oa on eet ng Hours 8.000 $50 $400.00 $ $ $ Ed i ucat on and Outreach Hours (pay from 1351) 27.64 $50 $1,382.00 $ $ $ R i L b B unn ng a atch 24 $10 $240 $ $ $ STELLA R Quarterly Report Submitted on Time 4 $75 $300 $ $ $ N i arrat ve Quarterly Report Submitted on Time 4 $7j $300 $ $ $ TOTAL IDPH NOTE: Pay Children Tested for Lead Poisonin NA (and 6 NA EBL I $16,362 NA NA g er years), nvestlgahon Properties Passing Clearance Testing, Completed Lead Hazard Remediations, Education and Outreach Hours, and other line items from 1351 to total of $3,220. Pay all other items from 1352 to total of $13,142. DOCUMENTATION OF PROGRAM rNrnMF Amount for Month Amount to Date Program Income Eamed $ $ Program Income Received $ $ Program Income Expended $ $ r cernry that no lands have been spent on chelation or other medical treatment of lead poisoning; lead hazard remediation, or blood lead analysis. .' SIGNATURE: DATE: