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Home My WebLink AboutAgreement A-21-399 with CDPH.pdfAgreement No. 21-399 TOMAS J . ARAG6N , M.D., Dr.PH Director and State Public He alth Officer State of Cal ifornia-Health and Human Serv ices Agency California Department of Public Health ACCEPTANCE OF AWARD County of Fresno, Department of Public Health Base Award: $342,571 Base Award Number: 2110BASE00 Food, Shelter, Incentives and Enablers Allotment: $20 ,546 Food, Shelter, Incentives and Enablers Allotment Number: 211 0FSIE00 Data Universal Numbering System (DUNS) Number: 556197655 Funding Period: July 1, 2021 through June 30, 2022 Go vernor I hereby accept this award. By accepting th is award, I agree to the requiremen ts as described in the FY 2021-2022 Tube rculosis Control Local Assis tance Funds St andards and Procedures Manual and any othe r cond it ions stipula ted by t he Ca l ifornia Department of Public H a l,, Tuberculos is Contro l Branch . n bU . s l~-2,, ---'----r-''----'---- Authorized Signature Steve Brandau Pri nt Name ATTEST: BERNICE E. SEIDEL Clerk of the Board of Supervisors Coun of Fresrio , tate of California Date Chairman of the Board of Supervisors of the County of Fresno Ti tl e * Federal funds fiscal information: Project Gra nts and Cooperative Agreements for Tube rculos is Contro l Programs ; CFDA number: 93 .116; FAIN number: NU52PS910219 Californ ia Department of Public Hea lth • Tuberculosis Control Bran c h 850 Marina Bay Pa rkway • Building P , 2nd Floor • Richmond, CA 94804-6403 {5 10) 620-3000 • (5 10) 620-3034 FAX Internet Address : ht1os ://cdoh .ca.gov/tbcb California Department of Public Health Tuberculos is Control Branch Exhibit F Federal Terms and Conditions STATE OF CALIFORNIA CALIFORNIA DEPARTMENT OF PUBLIC HEALTH CERTIFICATION REGARDING LOBBYING T he undersigned certifies , to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been pa id or w ill be pa id, by or on behalf of the undersigned , to any person for infl uenc ing or attempting to influence an officer or employee of an age ncy, a Me mber of Co ngress , a n officer or emp loyee of Co ngress , or an employee of a Member of Cong ress in connection w it h the mak ing , award ing or entering into of this Federa l contract , Federal grant , or cooperative agreement , and the extension , cont inuation , renewal, amendment, or modification of th is Federa l cont ract, grant , or cooperative ag reement. (2) If any funds other than Federa l appropriated funds have been paid or w ill be paid to any person fo r infl uencing or attempting to influence an officer or employee of any agency of the United Sta tes Government , a Member of Congress , an officer or emp loyee of Congress , or an employee of a Member of Congress in con nect ion w ith this Federal contract, grant , or cooperative agreement, the undersigned shall complete and subm it Standard Form LLL , "Disclosu re of Lobby ing Activities " in accordance with its inst ructions . (3) The undersig ned shall require that the language of th is certificat ion be included in the awa rd documents for all subawards at all tiers (including subcontractor's , subcontracts , and co ntracts under cooperati ve agreements) of $100 ,000 or more, and that all subrecipients sha ll cert ify and disclose accord ing ly. Th is certification is a mater ial rep resentation of fact upon which reliance was placed when th is transact ion was made or entered into . Submission of th is certification is a prerequisite for mak ing or enteri ng into this transact ion imposed by Sect ion 1352 , T itle 31 , U .S.C ., any person who fails to file the requ ired certification sha ll be subject to a civ il penalty of not less than $10 ,000 and not more than $100 ,000 for each such fa ilure . County of Fresno Steve Brandau Name of Conl ract or Conl ra ct Number Chairman of the Board of Supervisors of the County of Fresno ato 11 e ATTEST: After execution by or on behalf of Contractor, please return to: BERNICE E . SEIDEL Clerk of the Board of Supervisors California Department of Public Health Cou of f res o , State of California B~1-1-1'-""-'...._-"-'""""~I-¥'---- CDPH reseNes the right to notifiy the Contractor i n writing of an alternate submission address. Adapted from CDPH Exhibit F (Rev 04/16) Page 10 of 12 Jun e 202 1 California Department of Public Health Contractor Certification Clauses CERTIFICATION Tuberculosis Control Branch I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bihd 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) Federal ID Number County of Fresno ATTEST: BERNICE E. SEIDEL Clerk of the Board of Supervisors By (Aduthori hd Signature) ---,,_.......,,..~---------------Cou of Fresno State o California Printed Name and Title of Person Signing Steve Brandau, Chairman of the Board of Supervisors of the County of Fresno Date Executed Execu t ed in the County of Fresno I CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT 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 arid will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees tha t 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: 1) the dangers of drug abuse in the workplace; 2) the person's o r organization's policy of maintaining a drug-free workplace; 3) any available counsel1ng, 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 : 1) receive a copy of the company's drug-free workplace policy statement; and, Adapted from CCC 04/2017 1 of 4 February 2021 Ca lifornia Department of Public Health Tuberculosis Control Branch Darfur Contracting Act Pursuant to Public Contract Code (PCC) sections 104 75~10481, the Darfur Contracting Act's intent is to preclude State agencies from contracting with scrutinized companies that do business in the African nation of Sudan. A scrutinized company is a company doing specified t ypes of business in Sudan as defined in PCC section 10416. Scrutinized companies are inelig ible to, and cannot, contract with a State agency for goods or services ( PCC section 104 77 (a)) unless a.btaining permission from the Department of General Services according to the criteria set forth in PCC section 104 77(b). Therefore, to be eligible to contract with the California Department of Public Health , please initial one of the following three paragraphs and complete the certification below: 1 . We do not currently·have , or we have not had within the previous SB Initials three years , business activities or other qperations outside of the United States . OR 2. We are a scrutinized company as defined in Public Contract Code Initials section 104 76, but we have received written permiss ion from the Department of General Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section 104 77(b) or submifa contract/purchase order . A copy of thewritten permission from DGS rs included with our bid, proposal or contract/p.urchase order. 3. Initials CERTIFICATION OR We currently have , or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a scrutinized company as defined in Public Contract Code section 10476. I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this company to the clause listed above . This certification is made under the laws of the State of California . J! Company Name (Printed) lj County_ of Fresno ! By (Authorized s;g i , ~===~========-===-=-=-=-=-=-==-=================== Printed Name and Title of Person Signing : Steve Brandau, Chairman of the Board of Supervisors of the County of Fresno 1 Date Executed ll· ------ ~ ---~~<51~----=- ,~xecuted in the County and State of j __ -e-t=\'~(\0 ~\. ~O(~ Adapted from CDPH 9067 (7/17) February 2021 California Department of Public Health Tubercu los is Contro l Bra nch Certification of Established Electronic Directly Observed Therapy (eDOT) Policy and Procedures Ju ri sdiction: County of Fresno Loca l Assistance Subvention Award The Contactor named above hereby certifies that a policy and procedures document has been established for the use of electronic directly observed therapy (eDOT) that includes the minimum requirements listed in the California Department of Pub l ic Health-California Tuberculosis Controllers Assoc iation joint gu idelines, "Guidelines for Electronic Directly Observed Therapy (eDOT) Program Pro t ocols in California 2016." Please sign and return this form with your funding request for equipment and services for use with eDOT. Local assistance award funds cannot be used to purchase cell phones or computers for use by patients. Authori le'd Signature Date ATTEST: BERNICE E. SEIDEL S_t_e_ve_B_r_a_nd_a_u ___________ Clerk of the Board of Supervisors Print Name Count of Fr esno , State of Californ ia By--="-~~~~~::?--- Deputy Chairman of the Board of Supervisors of the County of Fresno Title Guidelines for eDOT Program Protocols in California 2016 can be found on the CTCA website at: https://ctca.org/wp-content/uploads/2018/11/CDPH_CTCA-eDOT- Guidel ines-Cleared-081116 .pdf Page 1 of 1 February 202 1 California Department of Public Health Name/No.: Tuberculosis Control Branch Base Award and Food, Shelter, Incentives and Enablers (FSIE) Allotment (No. 2110BASE00; No. 2110FSIE00) Fund/Subclass: 0001/10000 Organization #: 56201658 Revenue Account #: 3525 & 4380