HomeMy WebLinkAboutAgreement A-19-325 with CDPH.pdfAgreement No . 19-325
STATE OF CALIFORNIA -DEPARTMENT OF GENERAL SERVICES ~-----------~-------------~
STANDARD AGREEMENT AGREEMENT NUMBER
18-10932
PURCHASING AUTHORITY NUMBER (If Applicable)
STD 213 (Rev. 10/2018)
1. This Agreement is entered into between the Contracting Agency and the Contractor named below:
CONTRACTING AGENCY NAME
California Department of Public Health
CONTRACTOR NAME
County of Fresno
2. The term of this Agreement is :
START DATE
April 1, 2019
THROUGH END DATE
June 29, 2020
3 . The maximum amount of this Agreement is :
43,000.00
4 . The parties agree to comply with the terms and conditions of the following exhibits, which are by this reference made a part of the Agreement.
EXHIBITS TITLE
Exhibit A Scope of Work
Exhibit B Budget Detail and Payment Provisions
Exhibit B Attachment I and Attachment II -Budget
Exhibit C * General Terms and Conditions (GTC 04/2017)
Exhibit D Special Terms and Conditions
Exh ibit E Additional Provisions
Exhibit F Federal Terms and Conditions (only if applicable, use for federal funded agreements)
Exhibit G HIPAA/lnformation Confidentiality
Exhibit H Contractor's Release Form
Items shown with an asterisk(*), are hereby incorporated by reference and made part of this agreement as if attached hereto .
These documents can be viewed at www.dgs .ca .gov/olslresourceslstandardcontractlanguage.aspx
IN WITNESS WHEREOF, THIS AGREEMENT HAS BEEN EXECUTED BY THE PARTIES HERETO.
CONTRACTOR
CONTRA CTOR NAME (if other than an individual, state whether a corporation, partnership, etc.)
County of Fresno
CONTRACTOR BUSINESS ADDRESS
1221 Fulton Street, DPH Ad min, 6th Floor -Contracts
PRINTED NAME OF PERSON SIGNING
Nathan Magsig
ATTEST:
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
County of Fresno, State of California
By 3,.1~ ~Sb~
Deputy
CITY
Fresno
TITLE
Chairman, Board of Supervisors
DATE SIGNED
STATE
CA
PAGES
10
3
2
GTC
16
3
12
15
1
ZIP
93721
Page 1 of 2
Exhibit F
Federal Terms and Conditions
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF PUBLIC HEAL TH
CERTIFICATION REGARDING LOBBYING
The unders igned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid , by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of an agency , a Member of Congress ,
an officer or employee of Congress, or an employee of a Member of Congress in connection with the making ,
awarding or entering into of this Federal contract, Federal grant , or cooperative agreement, and the extension ,
continuation, renewal , amendment , or modification of this Federal contract , grant, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency of the United States Government , a
Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with this Federal contract , grant, or cooperative agreement, the undersigned shall complete and submit Standard
Form LLL , "Disclosure of Lobbying Activities" in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontractor's , subcont racts , and contracts under cooperative agreements)
of $100,000 or more, and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for mak ing or entering into this transaction
imposed by Section 1352, Title 31 , U.S .C., any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure .
County of Fresno
Name of Con tracto r
18-10932
Contract Number
Date
After execution by or on behalf of Contractor , please return to :
Cal ifornia Department of Pub lic Health
Nathan Magsig
Printed Name of Person Signing for Contractor
Chairman of the Board of Supervisors of the County
of Fresno
Title
ATTEST :
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
County of Fresno , State of Californ ia
By &so.«-~s1f:'fl
Deputy
CDPH reserves the right to notifiy the Contractor in writing of an alternate submission address .
(Rev 04/16) Page 10 of 12
CCC 04/2017
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PER.JURY that I am duly
authorized to legally bind the prospective Contractor to the clause(s) listed below. This
certification is made under the laws of the State of California.
Contractor/Bidder Firm Name (Printed) I Federal JD Number
County of Fresno 94-6000512
i
By (Autharized Signatu ~Q
=~~ Print ed Name and Title of Person Signing
J
Nathan Magsig, Chairman of the Board of Supervisors of the County of Fresno
E'e Executed '7-9-\9 Jrecuted in the Caunty af
Fresno
CONTRACTOR CERTIFICATION CLAUSES
I. ST A TEMENT OF COMPLIANCE: Contractor has , unless exempted, complied with
the nondiscrimination program requirements. (Gov. Code § 12990 (a-f) and CCR , Title 2,
Section 11102) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture , distribution ,
dispensation, possession or use of a controlled substance is prohibited and specifying
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
I) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will:
I) receive a copy of the company's drug-free workplace policy statement; and ,
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the