Injury Prevention Program
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Agreement Between the Kansas Department of Health and
Environment and the Salina Fire Department
This agreement is made this October 15, 2008 by and between the Kansas Department of Health
and Environment, hereinafter referred to as "KDHE," and the Salina Fire Department;
WHEREAS, KDHE desires to engage the services of the Salina Fire Department to perform the
tasks hereinafter described:
WHEREAS, the Salina Fire Department is both capable and desirous of providing the services
desired by KDHE.
NOW, THEREFORE, the parties do mutually agree and covenant as follows:
Salina Fire Department agrees to:
Fund a local project coordinator for the Kansas Fire-related Injury Prevention Program
(KFIPP). The responsibilities for the local coordinator will be as follows:
1. Attend grantee training in Topeka, Kansas on December 1,2008.
2. Serve as the local point of contact and facilitate local coalition building in target areas
in Saline County.
3. Work with the local coalition and KDHE to provide project guidance and to develop
locally appropriate strategies for identifying target families, coordinating installation
of each smoke alarm by a trained professional, and delivering fire-related injury
prevention education including home fire escape plans.
4. Submit quarterly progress reports to KDHE following report guidelines, due January
31, April 30, July 31, and September 30, 2009 in order to be eligible for
reimbursement of expenditures.
5. Submit quarterly expense reports (due January 31, April 30, July 31, and September
30,2009) to KDHE for reimbursement of expenditures upon receipt and approval of
progress report for same period.
6. Participate in two (2) site visits and provide relevant information to the state
coordinator at such site visits.
7. Include the following language on all media and print materials (including reports,
programs, and so on) developed as a result of this project: "This (video, report,
research, brochure) was supported by Grant/Cooperative Agreement Number H28-
CE-000865 from the Centers for Disease Control and Prevention. The content is
solely the responsibility of the authors and does not necessarily represent the official
views of the Centers for Disease Control and Prevention."
8. Submit completed pre installation surveys to KDHE within 45 days of completion.
9. Provide immediate feedback to KDHE staff on challenges that will delay or alter
project goals or objectives as they relate to the local project.
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KDHE agrees to:
1. Provide consultation, facilitation, and guidance as appropriate.
2. Provide an advance payment of $100 on/after October 1,2008. .
3. Provide reimbursement upon receipt of and approval of affidavit of expenditures and
progress report for same period.
4. Provide technical assistance and programmatic supervision to the local coordinator
employed by Salina Fire Department via this contract, as well as to the local coalition.
5. Provide smoke alarms, fire-related injury prevention educational materials, and other
materials as necessary to complete goals and objectives.
It is Mutually Agreed and Covenanted:
1. The duration of this agreement is for the period beginning on October 1, 2008 and ending
September 30,2009.
2. The total cost shall not exceed the amount of $2,706 itemized in the budget, attached
hereto as Exhibit One and incorporated by reference.
3. Funds will be used for travel, printing, smoke alarm installation and educational supplies
4. Day to day supervision of the local personnel employed by Salina Fire Department will
be provided by Debbie Weaver, Public Education Specialist and direction will be
provided by KDHE staff.
5. That the provisions found in Contractual Provision Attachment (Form DA-146a), which
is attached hereto and executed by the parties of this agreement, are hereby incorporated
in this agreement.
6. This agreement is contingent upon the availability of federal funds and may be
terminated by either party upon providing written notice at least thirty (30) days in
advance of the effective date of termination.
7. Lack of significant progress and/or failure to submit reports will be considered grounds
for termination of this agreement.
8. If this agreement is terminated, Salina Fire Department will be paid for those fees earned
and hard costs incurred prior to the date of termination. KDHE shall receive all materials
and products produced prior to the date of termination.
9. This instrument supersedes all prior understandings or oral contracts between KDHE and
Salina Fire Department and may not be modified orally. No modification or waiver shall
be val' unless executed in writing by the parties hereto.
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Roderi L. Bremby, Se ary
Kansas Department of Health and Environment
Debbie Weaver, Public Ed. Specialist
Salina Fire Department
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Date '
II-~ -of'
Date
,
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Exhibit One
Budget Summary - Salina Fire Department
PROPOSED BUDGET FORM
Expenditure Classification Local Grant Amount Total Amount
Match
Amount
1. SALARIES $10,000 -0- $10,000
(Including Fringe Benefits)
84 hours @ $10.82 per hour
2. TRAVEL -0- $112 $172
Grantee Meeting $60
222 miles @ .505 per mile
per diem 2 people
3. SUPPLIES -0- $300 $300
Ladders
Drills
Screwdrivers
4. OTHER -0- $315 $2,234
(List each item & cost) $315
1 CD EDITH (English) $315 $315
1 CD EDITH (Spanish) $315 $315
1 CD Sparky Fire Safety Club (English)$315 $360
1 CD Sparky Fire Safety Club (Spanish) $315
500 Sparky Fire Safety Show Booklets $360
(250 English/250 Spanish) $104
500 Sparky Home Fire Inspection Booklet $150
500 Edith Exit Drill Booklet
Printing
5. AFFIDAVIT TOTAL $10,000 $2,706 $12,706
(Add lines 1-4)
State of Kansas
Department of Administration
Division of Account and Reports
DA-103(Rev 05-99)
Agency Purchase Order
Current Doc No.
V9009681
No/She
Name:
Street:
486017228/07
Salina Fire Depsartment
r;;"""lA Send InvoIce To:
Payment Indicator. ~
Due Date:
Purchasing Agency Name & Address
Office of Health Promotions-Helenl Ljungdahl-785-296-8919'
1000 SW Jackson Street
Suite 230
Document Date: 11/20/2008 Effective Date:
Vendor Information
222 West Elm
Topeka, KS 66612
City, State, Zip: Salina, KS 67401
Shipping Address if Different,
Description
Contract Payment
Fund
3071
BFY
2009
Amount
$100.00
Date & Invoice
Number
Quantity
Unit Descri tion of Material or Service
Each Contract payment to fund a local project coordinator for the Kanasas
Fire -related Injury Pregemtion Program.
Unit Price
$100.00
Amount
11/2012008
$100.00
Document Total
The enclosed warrant is a payment for the materials or services listed above. If you have questions
concerning this payment, please contact the paying agency at the address listed above.
THIS IS NOT AN ORDER
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