HomeMy WebLinkAboutAgreement A-21-066 with CSU Fresno Foundation.pdf1
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AGREEMENT
This Agreement is made and entered into this ______ day of ___________ 2021, by and between
the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter referred to as
“COUNTY”, and California State University, Fresno Foundation, a California non-profit corporation, whose
address is 4910 N. Chestnut Ave., Fresno, CA 93726, hereinafter referred to as "CONTRACTOR,"
(collectively the “parties”).
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), recognizes the need
for a qualified agency to provide evaluation on short-term lodging driven by peer support services to
individuals who have a severe mental illness (SMI), are currently homeless, or at-risk of homelessness,
are eligible for DBH Services, and have not previously engaged in ongoing outpatient behavioral health
services; and
WHEREAS, COUNTY, through its DBH, Mental Health Services Act (MHSA) Innovation (INN)
component, has a need for evaluation services for any Innovation Plan; and
WHEREAS, CONTRACTOR, is uniquely qualified, willing and able to provide services required by
the COUNTY, pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties hereto
agree as follows:
1.SERVICES
A.CONTRACTOR shall perform all services and fulfill all responsibilities set for in
Exhibit A “Summary of Services”, which is attached hereto and by this reference incorporated herein and
made part of this Agreement.
B.CONTRACTOR shall align evaluations, services, and practices with the vision,
mission, and guiding principles of the DBH, as further described in Exhibit B, "Fresno County Department
of Behavioral Health Guiding Principles of Care Delivery", attached hereto and by this reference
incorporated herein and made part of this Agreement.
C.CONTRACTOR shall participate in meetings consisting of staff from COUNTY's
DBH to discuss evaluation requirements, data reporting, outcomes measurement, training, policies and
9th March
Agreement No. 21-066
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procedures, overall program operations, and any problems or foreseeable problems that may arise.
D. CONTRACTOR shall comply with all contract monitoring and compliance protocols,
procedures, data collection methods, and reporting requirements conducted by the COUNTY.
2.T ERM
The Agreement shall become effective upon execution and shall terminate on the 30th of
June, 2023. This Agreement may be extended for one (1) additional consecutive six (6) month period
upon written approval of both parties no later than thirty (30) days prior to the first day of the next
extension period. The DBH Director, or designee, is authorized to execute such written approval on
behalf of COUNTY based on CONTRACTOR’s satisfactory performance.
3.T ERMINATION
A.Non Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving CONTRACTOR thirty (30) days advance written notice.
B.Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1)An illegal or improper use of funds;
2)A failure to comply with any term of this Agreement;
3)A substantially incorrect or incomplete report submitted to COUNTY;
4)Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of any
breach of this Agreement or any default which may then exist on the part of CONTRACTOR. Neither
shall such payment impair or prejudice any remedy available to COUNTY with respect to the breach or
default. COUNTY shall have the right to demand of CONTRACTOR the repayment to COUNTY of any
funds disbursed to CONTRACTOR under this Agreement, which in the judgment of COUNTY were not
expended in accordance with the terms of this Agreement. CONTRACTOR shall promptly refund any
such funds upon demand or, at COUNTY’s option, such repayment shall be deducted from future
payments owing to CONTRACTOR under this Agreement.
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C.Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY upon thirty (30) days advance written
notice of an intention to terminate the Agreement. COUNTY’s DBH Director, or designee, is authorized to
execute such written notice on behalf of COUNTY.
4.COMPENSATION
For actual services provided as identified in the terms and conditions of this Agreement,
including Exhibit A, COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation in accordance with Exhibit C, “Budget Summary,” attached hereto and by this reference
incorporated herein. Mandated travel shall be reimbursed based on actual expenditures and mileage
reimbursement shall be at CONTRACTOR’s adopted rate per mile, not to exceed the IRS published rate.
Payment shall be made upon certification or other proof satisfactory to COUNTY’s DBH that services
have actually been performed by CONTRACTOR as specified in this Agreement.
The maximum amount payable to CONTRACTOR for the period effective upon execution
through June 30, 2021 shall not exceed Twenty-One Thousand, Four Hundred Forty-Seven and No/100
Dollars ($21,447.00).
For the period July 1, 2021 through June 30, 2022, in no event shall actual services
performed be in excess of Fifty Thousand, Five Hundred Fifty-Seven and No/100 Dollars ($50,557.00).
For the period July 1, 2022 through June 30, 2023, in no event shall actual services
performed be in excess of Forty-Six Thousand, Five Hundred Sixteen and No/100 Dollars ($46,516.00).
For the period July 1, 2023 through December 31, 2023, in no event shall actual services
performed be in excess of Thirty-One Thousand, Four Hundred Eighty and No/100 Dollars ($31,480.00).
In no event shall services performed under this Agreement be in excess of One Hundred
Fifty Thousand, and No/100 Dollars ($150,000.00). It is understood that all expenses incidental to
CONTRACTOR’s performance of services under this Agreement shall be borne by CONTRACTOR.
Except as provided below regarding State payment delays, payments shall be made by
COUNTY to CONTRACTOR in arrears, for services provided during the preceding month, within forty-five
(45)days after the date of receipt, verification, and approval of CONTRACTOR’s invoices by COUNTY’s
DBH.
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If CONTRACTOR should fail to comply with any provision of this Agreement, COUNTY
shall be relieved of its obligation for further compensation. All final invoices shall be submitted by
CONTRACTOR within sixty (60) days following the final month of service for which payment is claimed.
No action shall be taken by COUNTY on claims submitted beyond the sixty (60) day closeout period. Any
compensation which is not expended by CONTRACTOR pursuant to the terms and conditions of this
Agreement shall automatically revert to COUNTY.
The services provided by CONTRACTOR under this Agreement are funded in whole or in
part by the State of California. In the event that funding for these services is delayed by the State
Controller, COUNTY may defer payment to CONTRACTOR. The amount of the deferred payment shall
not exceed the amount of funding delayed by the State Controller to COUNTY. The period of time of the
deferral by COUNTY shall not exceed the period of time of the State Controller’s delay of payment to
COUNTY plus forty-five (45) days.
5.INVOICING
CONTRACTOR shall invoice COUNTY in arrears by the twentieth (20th) day of each month
for actual expenses incurred and services rendered in the previous month electronically to
dbh-invoices@fresnocountyca.gov, with a carbon copy email to the assigned COUNTY’s DBH Staff
Analyst.
CONTRACTOR shall submit to the COUNTY by the twentieth (20th) of each month a
detailed general ledger (GL), itemizing costs incurred in the previous month. Failure to submit GL reports
and supporting documentation shall be deemed sufficient cause for COUNTY to withhold payments until
there is compliance, as further described in Section Five (5) herein. Supporting documentation shall
include but is not limited to receipts, invoices received, and documented administrative / overhead costs.
No reimbursement for services shall be made until invoices, reports and outcomes are received, reviewed
and approved by COUNTY’s DBH. Support documents will be made available upon request.
At the discretion of COUNTY’s DBH Director or designee, if an invoice is incorrect or is
otherwise not in proper form or substance, COUNTY’s DBH Director or designee shall have the right to
withhold payment as to only that portion of the invoice that is incorrect or improper after five (5) days prior
notice to CONTRACTOR. CONTRACTOR agrees to continue to provide services for a period of ninety
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(90)days after notification of an incorrect or improper invoice. If after the ninety (90) day period, the
invoice(s) is still not corrected to COUNTY’s DBH satisfaction, COUNTY’s DBH Director or designee may
elect to terminate this Agreement, pursuant to the termination provisions stated in Paragraph Three (3) of
this Agreement. In addition, for invoices received ninety (90) days after the expiration of each term of this
Agreement or termination of this Agreement, at the discretion of COUNTY’s DBH Director or designee,
COUNTY’s DBH shall have the right to deny payment of any additional invoices received.
CONTRACTOR must maintain such financial records for a period of three (3) years or until
any dispute, audit or inspection is resolved, whichever is later. CONTRACTOR will be responsible for
any disallowances related to inadequate documentation.
6.INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR’s officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venturer, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right to
control or supervise or direct the manner or method by which CONTRACTOR shall perform its work and
function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
CONTRACTOR is performing its obligations in accordance with the terms and conditions thereof.
CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules and
regulations, if any, of governmental authorities having jurisdiction over matters which are directly or
indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally required employee
benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
matters relating to payment of CONTRACTOR's employees, including compliance with Social Security,
withholding, and all other regulations governing such matters. It is acknowledged that during the term of
this Agreement, CONTRACTOR may be providing services to others unrelated to COUNTY or to this
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Agreement.
7.MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent of
all the parties without, in any way, affecting the remainder.
Changes to expense category (i.e., Salary & Benefits, Client Support, Facilities/Equipment,
Operating Expenses, Administrative Expenses, Special Expenses, Fixed Assets, etc.) subtotals in the
budgets, and changes to the volume of units of services/types of service units to be provided as set forth
in Exhibit C, that do not exceed 10% of the maximum compensation payable to the CONTRACTOR may
be made with the written approval of COUNTY’s DBH Director, or designee. Said modifications shall not
result in any change to the annual maximum compensation amount payable to CONTRACTOR, as stated
in this Agreement.
8.NON-ASSIGNMENT
Neither party shall assign, transfer or subcontract this Agreement nor their rights or duties
under this Agreement without the prior written consent of the other party.
9.HOLD HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY’s request,
defend COUNTY, its officers, agents and employees from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to COUNTY in
connection with the performance, or failure to perform, by CONTRACTOR, its officers, agents or
employees of covenants and duties under this Agreement, and from any and all costs and expenses,
including attorney fees and court costs damages, liabilities, claims and losses occurring or resulting to
any person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, their officers, agents or employees of covenants and duties under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal and/or State of California audit
exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
10.INSURANCE
Without limiting COUNTY's right to obtain indemnification from CONTRACTOR or any third
parties, CONTRACTOR, at its sole expense, shall maintain in full force and effect the following insurance
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policies throughout the term of this Agreement:
A.Commercial General Liability
Commercial General Liability Insurance with limits of not less than Two Million
Dollars ($2,000,000) per occurrence and an annual aggregate of Four Million
Dollars ($4,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverages including completed operations, product
liability, contractual liability, Explosion-Collapse-Underground, fire legal liability or
any other liability insurance deemed necessary because of the nature of this
contract.
B.Automobile Liability
Comprehensive Automobile Liability Insurance with limits no less than One Million
Dollars ($1,000,000) per accident for bodily injury and property damage. Coverage
should include any automobile used in connection with this Agreement.
C.Professional Liability
If CONTRACTOR employs licensed professional staff (e.g. Ph.D., R.N., L.C.S.W.,
L.M.F.T., etc.) in providing services, Professional Liability Insurance with limits of
not less than One Million Dollars ($1,000,000) per occurrence, Three Million Dollars
($3,000,000) annual aggregate. CONTRACTOR agrees that it shall maintain, at its
sole expense, in full force and effect for a period of three (3) years following the
termination of this Agreement, one or more policies of professional liability
insurance with limits of coverage as specified herein.
D.Worker’s Compensation
A policy of Worker's Compensation Insurance as may be required by the California
Labor Code.
E.Molestation
CONTRACTOR shall have either separate policy or an umbrella policy with
endorsements covering sexual abuse/molestation coverage or have a specific
endorsement on their General Commercial liability policy covering sexual
abuse/molestation. The policy limits for this policy shall be One Million Dollars
($1,000,000) per occurrence with a Two Million Dollars ($2,000,000) annual
aggregate. The policy shall be on a per occurrence basis.
CONTRACTOR shall obtain endorsements to the Commercial General Liability insurance
naming the County of Fresno, its officers, agents, and employees, individually and collectively, as
additional insured, but only insofar as the operations under this Agreement are concerned. Such
coverage for additional insured shall apply as primary insurance and any other insurance, or self-
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insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not
contributing with insurance provided under CONTRACTOR’s policies herein. This insurance shall not be
cancelled or changed without a minimum of thirty (30) days advance written notice given to COUNTY.
CONTRACTOR hereby waives its right to recover from COUNTY, its officers, agents, and
employees any amounts paid by the policy of worker’s compensation insurance required by this
Agreement. CONTRACTOR is solely responsible to obtain any endorsement to such policy that may be
necessary to accomplish such waiver of subrogation, but CONTRACTOR’s waiver of subrogation under
this paragraph is effective whether or not CONTRACTOR obtains such an endorsement.
Within thirty (30) days from the date each CONTRACTOR signs this Agreement, said
CONTRACTOR shall provide certificates of insurance and endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health, 1925 E.
Dakota Ave, Fresno, California, 93726, Attention: Public Behavioral Health Division, stating that such
insurance coverages have been obtained and are in full force; that the County of Fresno, its officers,
agents and employees will not be responsible for any premiums on the policies; that for such worker’s
compensation insurance the CONTRACTOR has waived its right to recover from the COUNTY, its
officers, agents, and employees any amounts paid under the insurance policy and that waiver does not
invalidate the insurance policy; that such Commercial General Liability insurance names the County of
Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned; that such coverage for additional insured
shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
officers, agents and employees, shall be excess only and not contributing with insurance provided under
CONTRACTOR policies herein; and that this insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as herein
provided, COUNTY may, in addition to other remedies it may have, suspend or terminate this Agreement
upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of California.
Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating of A FSC VII or
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better.
11.RECORDS
Financial, statistical and demographic data shall be kept and reports made as required by
the County’s Department of Behavioral Health Director and State. COUNTY shall be allowed to review all
records of services provided, including the goals and objectives of services, and how the services
provided is achieving the goals and objectives. All such records shall be available for inspection by the
designated Auditors of COUNTY or State at reasonable times during normal business hours. All such
records shall be maintained through the end of this Agreement. All records shall be considered property
of COUNTY and shall be retained by COUNTY at the termination or expiration of this Agreement.
12.REPORTS
CONTRACTOR shall submit to COUNTY's DBH by the twentieth (20th) of each
month all program and budget reports for the preceding month. CONTRACTOR shall also furnish
to COUNTY such statements, records, reports, data, and other information as COUNTY’s DBH may
reasonably request pertaining to matters covered by this Agreement. In the event that CONTRACTOR
fails to provide such reports or other information required hereunder, it shall be deemed sufficient cause
for COUNTY to withhold monthly payments until there is compliance. In addition, CONTRACTOR shall
provide written notification and explanation to COUNTY within five (5) days of any funds received from
another source to conduct the same services covered by this Agreement.
13.REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during
the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
14.COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates its mental health programs under an
agreement with the State Department of Health Care Services, and that under said agreement the State
imposes certain requirements on COUNTY and its subcontractors. CONTRACTOR shall adhere to all
State requirements, including those identified in Exhibit D, “State Mental Health Requirements”, attached
hereto and by this reference incorporated herein and made part of this Agreement.
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15.CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating to
confidentiality.
16.HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
A.The parties to this Agreement shall be in strict conformance with all applicable
Federal and State of California laws and regulations, including but not limited to Sections 5328, 10850,
and 14100.2 et seq. of the Welfare and Institutions Code, Sections 2.1 and 431.300 et seq. of Title 42,
Code of Federal Regulations (CFR), Section 56 et seq. of the California Civil Code and the Health
Insurance Portability and Accountability Act (HIPAA), including but not limited to Section 1320 D et seq. of
Title 42, United States Code (USC) and its implementing regulations, including, but not limited to Title 45,
CFR, Sections 142, 160, 162, and 164, The Health Information Technology for Economic and Clinical
Health Act (HITECH) regarding the confidentiality and security of patient information, and the Genetic
Information Nondiscrimination Act (GINA) of 2008 regarding the confidentiality of genetic information.
Except as otherwise provided in this Agreement, CONTRACTOR, as a Business
Associate of COUNTY, may use or disclose Protected Health Information (PHI) to perform functions,
activities or services for or on behalf of COUNTY, as specified in this Agreement, provided that such use
or disclosure shall not violate the Health Insurance Portability and Accountability Act (HIPAA), USC 1320d
et seq. The uses and disclosures of PHI may not be more expansive than those applicable to COUNTY,
as the “Covered Entity” under the HIPAA Privacy Rule (45 CFR 164.500 et seq.), except as authorized for
management, administrative or legal responsibilities of the Business Associate.
B.CONTRACTOR, including its subcontractors and employees, shall protect, from
unauthorized access, use, or disclosure of names and other identifying information, including genetic
information, concerning persons receiving services pursuant to this Agreement, except where permitted in
order to carry out data aggregation purposes for health care operations [45 CFR Sections 164.504
(e)(2)(i), 164.504 (3)(2)(ii)(A), and 164.504 (e)(4)(i)] This pertains to any and all persons receiving
services pursuant to a COUNTY funded program. This requirement applies to electronic PHI.
CONTRACTOR shall not use such identifying information or genetic information for any purpose other
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than carrying out CONTRACTOR’s obligations under this Agreement.
C.CONTRACTOR, including its subcontractors and employees, shall not disclose any
such identifying information or genetic information to any person or entity, except as otherwise specifically
permitted by this Agreement, authorized by Subpart E of 45 CFR Part 164 or other law, required by the
Secretary, or authorized by the client/patient in writing. In using or disclosing PHI that is permitted by this
Agreement or authorized by law, CONTRACTOR shall make reasonable efforts to limit PHI to the
minimum necessary to accomplish intended purpose of use, disclosure or request.
D.For purposes of the above Sections, identifying information shall include, but not be
limited to name, identifying number, symbol, or other identifying particular assigned to the individual, such
as finger or voice print, or photograph.
E.For purposes of the above Sections, genetic information shall include genetic tests
of family members of an individual or individual, manifestation of disease or disorder of family members of
an individual, or any request for or receipt of, genetic services by individual or family members. Family
member means a dependent or any person who is first, second, third, or fourth degree relative.
F.CONTRACTOR shall provide access, at the request of COUNTY, and in the time
and manner designated by COUNTY, to PHI in a designated record set (as defined in 45 CFR Section
164.501), to an individual or to COUNTY in order to meet the requirements of 45 CFR Section 164.524
regarding access by individuals to their PHI. With respect to individual requests, access shall be provided
within thirty (30) days from request. Access may be extended if CONTRACTOR cannot provide access
and provides individual with the reasons for the delay and the date when access may be granted. PHI
shall be provided in the form and format requested by the individual or COUNTY.
CONTRACTOR shall make any amendment(s) to PHI in a designated record set at
the request of COUNTY or individual, and in the time and manner designated by COUNTY in accordance
with 45 CFR Section 164.526.
CONTRACTOR shall provide to COUNTY or to an individual, in a time and manner
designated by COUNTY, information collected in accordance with 45 CFR Section 164.528, to permit
COUNTY to respond to a request by the individual for an accounting of disclosures of PHI in accordance
with 45 CFR Section 164.528.
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G.CONTRACTOR shall report to COUNTY, in writing, any knowledge or reasonable
belief that there has been unauthorized access, viewing, use, disclosure, security incident, or breach of
unsecured PHI not permitted by this Agreement of which it becomes aware, immediately and without
reasonable delay and in no case later than two (2) business days of discovery. Immediate notification
shall be made to COUNTY’s Information Security Officer and Privacy Officer and COUNTY’s DPH HIPAA
Representative, within two (2) business days of discovery. The notification shall include, to the extent
possible, the identification of each individual whose unsecured PHI has been, or is reasonably believed to
have been, accessed, acquired, used, disclosed, or breached. CONTRACTOR shall take prompt
corrective action to cure any deficiencies and any action pertaining to such unauthorized disclosure
required by applicable Federal and State Laws and regulations. CONTRACTOR shall investigate such
breach and is responsible for all notifications required by law and regulation or deemed necessary by
COUNTY and shall provide a written report of the investigation and reporting required to COUNTY’s
Information Security Officer and Privacy Officer and COUNTY’s DPH HIPAA Representative. This written
investigation and description of any reporting necessary shall be postmarked within the thirty (30) working
days of the discovery of the breach to the addresses below:
County of Fresno County of Fresno County of Fresno
Dept. of Behavioral Health Dept. of Public Health Information Technology Services
HIPAA Representative Privacy Officer Information Security Officer
(559)600-4645 (559)600-6439 (559)600-5800
1925 E. Dakota Ave. P.O. Box 11867 2048 N. Fine Street
Fresno, CA 93726 Fresno, CA 93775 Fresno, CA 93727
H.CONTRACTOR shall make its internal practices, books, and records relating to the
use and disclosure of PHI received from COUNTY, or created or received by the CONTRACTOR on
behalf of COUNTY, in compliance with HIPAA’s Privacy Rule, including, but not limited to the requirements
set forth in Title 45, CFR, Sections 160 and 164. CONTRACTOR shall make its internal practices, books,
and records relating to the use and disclosure of PHI received from COUNTY, or created or received by
the CONTRACTOR on behalf of COUNTY, available to the United States Department of Health and
Human Services (Secretary) upon demand.
CONTRACTOR shall cooperate with the compliance and investigation reviews
conducted by the Secretary. PHI access to the Secretary must be provided during the CONTRACTOR’s
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normal business hours, however, upon exigent circumstances access at any time must be granted. Upon
the Secretary’s compliance or investigation review, if PHI is unavailable to CONTRACTOR and in
possession of a Subcontractor, it must certify efforts to obtain the information to the Secretary.
I.Safeguards
CONTRACTOR shall implement administrative, physical, and technical safeguards
as required by the HIPAA Security Rule, Subpart C of 45 CFR 164, that reasonably and appropriately
protect the confidentiality, integrity, and availability of PHI, including electronic PHI, that it creates,
receives, maintains or transmits on behalf of COUNTY and to prevent unauthorized access, viewing, use,
disclosure, or breach of PHI other than as provided for by this Agreement. CONTRACTOR shall conduct
an accurate and thorough assessment of the potential risks and vulnerabilities to the confidential, integrity
and availability of electronic PHI. CONTRACTOR shall develop and maintain a written information
privacy and security program that includes administrative, technical and physical safeguards appropriate
to the size and complexity of CONTRACTOR’s operations and the nature and scope of its activities.
Upon COUNTY’s request, CONTRACTOR shall provide COUNTY with information concerning such
safeguards.
CONTRACTOR shall implement strong access controls and other security
safeguards and precautions in order to restrict logical and physical access to confidential, personal (e.g.,
PHI) or sensitive data to authorized users only. Said safeguards and precautions shall include the
following administrative and technical password controls for all systems used to process or store
confidential, personal, or sensitive data:
1.Passwords must not be:
a.Shared or written down where they are accessible or recognizable
by anyone else; such as taped to computer screens, stored under keyboards, or visible in a work area;
b.A dictionary word; or
c.Stored in clear text
2.Passwords must be:
a.Eight (8) characters or more in length;
b.Changed every ninety (90) days;
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c.Changed immediately if revealed or compromised; and
d.Composed of characters from at least three (3) of the following four
(4)groups from the standard keyboard:
1)Upper case letters (A-Z);
2)Lowercase letters (a-z);
3)Arabic numerals (0 through 9); and
4)Non-alphanumeric characters (punctuation symbols).
CONTRACTOR shall implement the following security controls on each workstation
or portable computing device (e.g., laptop computer) containing confidential, personal, or sensitive data:
1.Network-based firewall and/or personal firewall;
2.Continuously updated anti-virus software; and
3.Patch management process including installation of all operating
system/software vendor security patches.
CONTRACTOR shall utilize a commercial encryption solution that has received
FIPS 140-2 validation to encrypt all confidential, personal, or sensitive data stored on portable electronic
media (including, but not limited to, compact disks and thumb drives) and on portable computing devices
(including, but not limited to, laptop and notebook computers).
CONTRACTOR shall not transmit confidential, personal, or sensitive data via e-mail
or other internet transport protocol unless the data is encrypted by a solution that has been validated by
the National Institute of Standards and Technology (NIST) as conforming to the Advanced Encryption
Standard (AES) Algorithm. CONTRACTOR must apply appropriate sanctions against its employees who
fail to comply with these safeguards. CONTRACTOR must adopt procedures for terminating access to
PHI when employment of employee ends.
J.Mitigation of Harmful Effects
CONTRACTOR shall mitigate, to the extent practicable, any harmful effect that is
suspected or known to CONTRACTOR of an unauthorized access, viewing, use, disclosure, or breach of
PHI by CONTRACTOR or its subcontractors in violation of the requirements of these provisions.
CONTRACTOR must document suspected or known harmful effects and the outcome.
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K.CONTRACTOR’s Subcontractors
CONTRACTOR shall ensure that any of its contractors, including subcontractors, if
applicable, to whom CONTRACTOR provides PHI received from or created or received by
CONTRACTOR on behalf of COUNTY, agree to the same restrictions, safeguards, and conditions that
apply to CONTRACTOR with respect to such PHI and to incorporate, when applicable, the relevant
provisions of these provisions into each subcontract or sub-award to such agents or subcontractors.
L.Employee Training and Discipline
CONTRACTOR shall train and use reasonable measures to ensure compliance
with the requirements of these provisions by employees who assist in the performance of functions or
activities on behalf of COUNTY under this Agreement and use or disclose PHI and discipline such
employees who intentionally violate any provisions of these provisions, including termination of
employment.
M.Termination for Cause
Upon COUNTY’s knowledge of a material breach of these provisions by
CONTRACTOR, COUNTY shall either:
1.Provide an opportunity for CONTRACTOR to cure the breach or end the
violation and terminate this Agreement if CONTRACTOR does not cure the breach or end the violation
within the time specified by COUNTY; or
2.Immediately terminate this Agreement if CONTRACTOR has breached a
material term of these provisions and cure is not possible.
3.If neither cure nor termination is feasible, the COUNTY’s Privacy Officer
shall report the violation to the Secretary of the U.S. Department of Health and Human Services.
N.Judicial or Administrative Proceedings
COUNTY may terminate this Agreement in accordance with the terms and
conditions of this Agreement as written hereinabove, if: (1) CONTRACTOR is found guilty in a criminal
proceeding for a violation of the HIPAA Privacy or Security Laws or the HITECH Act; or (2) a finding or
stipulation that the CONTRACTOR has violated a privacy or security standard or requirement of the
HITECH Act, HIPAA or other security or privacy laws in an administrative or civil proceeding in which the
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CONTRACTOR is a party.
O.Effect of Termination
Upon termination or expiration of this Agreement for any reason, CONTRACTOR
shall return or destroy all PHI received from COUNTY (or created or received by CONTRACTOR on
behalf of COUNTY) that CONTRACTOR still maintains in any form, and shall retain no copies of such
PHI. If return or destruction of PHI is not feasible, it shall continue to extend the protections of these
provisions to such information, and limit further use of such PHI to those purposes that make the return or
destruction of such PHI infeasible. This provision shall apply to PHI that is in the possession of
subcontractors or agents, if applicable, of CONTRACTOR. If CONTRACTOR destroys the PHI data, a
certification of date and time of destruction shall be provided to the COUNTY by CONTRACTOR.
P.Disclaimer
COUNTY makes no warranty or representation that compliance by CONTRACTOR
with these provisions, the HITECH Act, HIPAA or the HIPAA regulations will be adequate or satisfactory
for CONTRACTOR’s own purposes or that any information in CONTRACTOR’s possession or control, or
transmitted or received by CONTRACTOR, is or will be secure from unauthorized access, viewing, use,
disclosure, or breach. CONTRACTOR is solely responsible for all decisions made by CONTRACTOR
regarding the safeguarding of PHI.
Q.Amendment
The parties acknowledge that Federal and State laws relating to electronic data
security and privacy are rapidly evolving and that amendment of these provisions may be required to
provide for procedures to ensure compliance with such developments. The parties specifically agree to
take such action as is necessary to amend this agreement in order to implement the standards and
requirements of HIPAA, the HIPAA regulations, the HITECH Act and other applicable laws relating to the
security or privacy of PHI. COUNTY may terminate this Agreement upon thirty (30) days written notice in
the event that CONTRACTOR does not enter into an amendment providing assurances regarding the
safeguarding of PHI that COUNTY in its sole discretion, deems sufficient to satisfy the standards and
requirements of HIPAA, the HIPAA regulations and the HITECH Act.
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R.No Third-Party Beneficiaries
Nothing express or implied in the terms and conditions of these provisions is
intended to confer, nor shall anything herein confer, upon any person other than COUNTY or
CONTRACTOR and their respective successors or assignees, any rights, remedies, obligations or
liabilities whatsoever.
S.Interpretation
The terms and conditions in these provisions shall be interpreted as broadly as
necessary to implement and comply with HIPAA, the HIPAA regulations and applicable State laws. The
parties agree that any ambiguity in the terms and conditions of these provisions shall be resolved in favor
of a meaning that complies and is consistent with HlPAA and the HIPAA regulations.
T.Regulatory References
A reference in the terms and conditions of these provisions to a section in the
HIPAA regulations means the section as in effect or as amended.
U.Survival
The respective rights and obligations of CONTRACTOR as stated in this Section
shall survive the termination or expiration of this Agreement.
V.No Waiver of Obligations
No change, waiver or discharge of any liability or obligation hereunder on any one
or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall
prohibit enforcement of any obligation on any other occasion.
17.DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into
a contractual relationship with the COUNTY for the purpose of providing services under this Agreement
must employ adequate data security measures to protect the confidential information provided to
CONTRACTOR by the COUNTY, including but not limited to the following:
A.CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
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CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1)CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2)Current virus protection software is in place;
3)Mobile device has the remote wipe feature enabled; and
4)A secure connection is used.
B.CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use without prior authorization from the COUNTY’s Chief Information
Officer, and/or his or her designee(s), including but not limited to mobile storage devices. If data is
approved to be transferred, data must be stored on a secure server approved by the COUNTY and
transferred by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on non-
COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer, and/or his or
her designee(s).
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data on
any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E.CONTRACTOR shall be responsible to employ strict controls to ensure the integrity
and security of COUNTY’s confidential information and to prevent unauthorized access, viewing, use or
disclosure of data maintained in computer files, program documentation, data processing systems, data
files and data processing equipment which stores or processes COUNTY data internally and externally.
F.Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
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G.CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, data maintained
in computer files, program documentation, data processing systems, data files and data processing
equipment which stores or processes COUNTY data internally or externally.
H.COUNTY shall provide oversight to CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information provided to
CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals as
required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
responsible for all costs incurred as a result of providing the required notification.
18.NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR and its subcontractors shall not
deny the contract’s benefits to any person on the basis of race, religious creed, color, national origin,
ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex,
gender, gender identity, gender expression, age, sexual orientation, or military and veteran status, nor
shall they discriminate unlawfully against any employee or applicant for employment because of race,
religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition,
genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual
orientation, or military or veteran status. CONTRACTOR shall insure that the evaluation and treatment of
employees and applicants for employment are free of such discrimination.
CONTRACTOR and subcontractors shall comply with the provisions of the Fair
Employment and Housing Act (Gov. Code §12800 et seq.), the regulations promulgated thereunder (Cal.
Code Regs., tit. 2, §11000 et seq.), the provisions of Article 9.5, Chapter 1, Part 1, Division 3, Title 2 of
the Government Code (Gov. Code §11135-11139.5), and the regulations or standards adopted by the
awarding state agency to implement such article. CONTRACTOR shall permit access by representatives
of the Department of Fair Employment and Housing and the awarding state agency upon reasonable
notice at any time during the normal business hours, but in no case less than twenty-four (24) hours
notice, to such of its books, records, accounts, and all other sources of information and its facilities as
said Department or Agency shall require to ascertain compliance with this clause. CONTRACTOR and
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its subcontractors shall give written notice of their obligations under this clause to labor organizations with
which they have a collective bargaining or other agreement. (See Cal. Code Regs., tit. 2, §11105)
CONTRACTOR shall include the Non-Discrimination and compliance provisions of this clause in all
subcontracts to perform work under this Agreement.
19.CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or responsibility for
planning and carrying out the services provided under this Agreement shall have any direct or indirect
personal financial interest in this Agreement. In addition, no employee of COUNTY shall be employed by
CONTRACTOR to fulfill any contractual obligations with COUNTY.
CONTRACTOR shall also comply with all Federal, State of California, and local conflict of
interest laws, statutes, and regulations, which shall be applicable to all parties and beneficiaries under this
Agreement and any officer, agent, or employee of COUNTY.
20.SINGLE AUDIT CLAUSE
A.If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars and No/100
Dollars ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to
conduct an annual audit in accordance with the requirements of the Single Audit Standards as set forth in
Office of Management and Budget (OMB) 2 CFR 200. CONTRACTOR shall submit said audit and
management letter to COUNTY. The audit must include a statement of findings or a statement that there
were no findings. If there were negative findings, CONTRACTOR must include a corrective action plan
signed by an authorized individual. CONTRACTOR agrees to take action to correct any material non-
compliance or weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s
DBH Business Office for review within nine (9) months of the end of any fiscal year in which funds were
expended and/or received for the program. Failure to perform the requisite audit functions as required by
this Agreement may result in COUNTY performing the necessary audit tasks, or at COUNTY’s option,
contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to
enter into future agreements with CONTRACTOR. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR.
B.A single audit report is not applicable if CONTRACTOR’s Federal contracts do not
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exceed the Seven Hundred Fifty Thousand and No/100 Dollars ($750,000.00) requirement or
CONTRACTOR’s only funding is through Drug-related Medi-Cal. If a single audit is not applicable, a
program audit must be performed and a program audit report with management letter shall be submitted
by CONTRACTOR to COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said
audit report shall be delivered to COUNTY’s DBH Business Office for review, no later than nine (9)
months after the close of the fiscal year in which the funds supplied through this Agreement are
expended. Failure to comply with this Act may result in COUNTY performing the necessary audit tasks or
contracting with a qualified accountant to perform said audit. All audit costs related to this Agreement are
the sole responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under
this Section shall be billed to the CONTRACTOR at COUNTY’s cost, as determined by COUNTY’s
Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the Federal
Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a period of at
least three (3) years following final payment under this Agreement or the closure of all other pending
matters, whichever is later.
21.ASSURANCES
In entering into this Agreement, CONTRACTOR certifies that it is not currently excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs: that it
has not been convicted of a criminal offense related to the provision of health care items or services; nor
has it been reinstated to participation in the Federal Health Care Programs after a period of exclusion,
suspension, debarment, or ineligibility. If COUNTY learns, subsequent to entering into a contract, that
CONTRACTOR is ineligible on these grounds, COUNTY will remove CONTRACTOR from responsibility
for, or involvement with, COUNTY’s business operations related to the Federal Health Care Programs
and shall remove such CONTRACTOR from any position in which CONTRACTOR’s compensation, or
the items or services rendered, ordered or prescribed by CONTRACTOR may be paid in whole or part,
directly or indirectly, by Federal Health Care Programs or otherwise with Federal Funds at least until such
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time as CONTRACTOR is reinstated into participation in the Federal Health Care Programs.
A.If COUNTY has notice that CONTRACTOR has been charged with a criminal
offense related to any Federal Health Care Program, or is proposed for exclusion during the term of any
contract, CONTRACTOR and COUNTY shall take all appropriate actions to ensure the accuracy of any
claims submitted to any Federal Health Care Program. At its discretion given such circumstances,
COUNTY may request that CONTRACTOR cease providing services until resolution of the charges or the
proposed exclusion.
B.CONTRACTOR agrees that all potential new employees of CONTRACTOR or
subcontractors of CONTRACTOR who, in each case, are expected to perform professional services
under this Agreement, will be queried as to whether: (1) they are now or ever have been excluded,
suspended, debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) they
have been convicted of a criminal offense related to the provision of health care items or services; and or
(3)they have been reinstated to participation in the Federal Health Care Programs after a period of
exclusion, suspension, debarment, or ineligibility.
1)In the event the potential employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible, or has been
convicted of a criminal offense relating to the provision of health care services, and CONTRACTOR hires
or engages such potential employee or subcontractor, CONTRACTOR will ensure that said employee or
subcontractor does no work, either directly or indirectly relating to services provided to COUNTY.
2)Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Two (2) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a timeframe to be determined by COUNTY
to protect the interests of COUNTY consumers.
C. CONTRACTOR shall verify (by asking the applicable employees and
subcontractors) that all current employees and existing subcontractors who, in each case, are expected
to perform professional services under this Agreement (1) are not currently excluded, suspended,
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debarred, or otherwise ineligible to participate in the Federal Health Care Programs; (2) have not been
convicted of a criminal offense related to the provision of health care items or services; and (3) have not
been reinstated to participation in the Federal Health Care Program after a period of exclusion,
suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs
CONTRACTOR that he or she is excluded, suspended, debarred or otherwise ineligible to participate in
the Federal Health Care Programs, or has been convicted of a criminal offense relating to the provision of
health care services, CONTRACTOR will ensure that said employee or subcontractor does no work,
either direct or indirect, relating to services provided to COUNTY.
1)CONTRACTOR agrees to notify COUNTY immediately during the term of
this Agreement whenever CONTRACTOR learns that an employee or subcontractor who, in each case,
is providing professional services under this Agreement is excluded, suspended, debarred or otherwise
ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal offense relating
to the provision of health care services.
2)Notwithstanding the above, COUNTY at its discretion may terminate this
Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
CONTRACTOR will perform work, either directly or indirectly, relating to services provided to COUNTY.
Such demand for adequate assurance shall be effective upon a timeframe to be determined by COUNTY
to protect the interests of COUNTY clients.
D. CONTRACTOR agrees to cooperate fully with any reasonable requests for
information from COUNTY, which may be necessary to complete any internal or external audits relating to
CONTRACTOR’s compliance with the provisions of this Section.
E.CONTRACTOR agrees to reimburse COUNTY for the entire cost of any penalty
imposed upon COUNTY by the Federal Government as a result of CONTRACTOR’s violation of
CONTRACTOR’s obligations as described in this Section.
22.PUBLIC PROHIBITION
None of the funds, materials, property or services provided directly or indirectly under this
Agreement shall be used for CONTRACTOR’s advertising, fundraising, or publicity (i.e., purchasing of
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tickets/tables, silent auction donations, etc.) for the purpose of self-promotion. Notwithstanding the
above, publicity of the services described in Section One (1) of this Agreement shall be allowed as
necessary to raise public awareness about the availability of such specific services when approved in
advance by COUNTY’s DBH Director, or his or her designee, and at a cost to be provided in Exhibit C for
such items as written/printed materials, the use of media (i.e., radio, television, newspapers) and any
other related expense(s).
23. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104, and
455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit E, “Disclosure of
Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein
and made part of this Agreement. CONTRACTOR shall submit this form to COUNTY’s DBH within thirty
(30) days of the effective date of this Agreement. Additionally, CONTRACTOR shall report any changes
to this information within thirty-five (35) days of occurrence by completing Exhibit E. CONTRACTOR is
required to submit a set of fingerprints for any person with a five (5) percent or greater direct or indirect
ownership interest in CONTRACTOR. COUNTY may terminate this Agreement where any person with a
five (5) percent or greater direct or indirect ownership interest in the CONTRACTOR did not submit timely
and accurate information and cooperate with any screening method required in CFR, Title 42, Section
455.416. Submissions shall be scanned portable document format (pdf) copies and are to be sent via
email to DBHAdministration@fresnocountyca.gov, Attention: Contracts Administration. COUNTY may
deny enrollment or terminate this Agreement where any person with a five (5) percent or greater direct or
indirect ownership interest in CONTRACTOR has been convicted of a criminal offense related to that
person’s involvement with the Medicare, Medicaid, or Title XXI program in the last ten (10) years.
24. DISCLOSURE – CRIMINAL HISTORY AND CIVIL ACTIONS
CONTRACTOR is required to disclose if any of the following conditions apply to them, their
owners, officers, corporate managers and partners (hereinafter collectively referred to as
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“CONTRACTOR”):
A.Within the three (3) year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1)Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal, state, or local) transaction or
contract under a public transaction;
2)Violation of a federal or state antitrust statute;
3)Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
or
4)False statements or receipt of stolen property.
B.Within a three (3) year period preceding their Agreement award, they have had a
public transaction (federal, state, or local) terminated for cause or default.
Disclosure of the above information will not automatically eliminate CONTRACTOR from
further business consideration. The information will be considered as part of the determination of whether
to continue and/or renew the Agreement and any additional information or explanation that a
CONTRACTOR elects to submit with the disclosed information will be considered. If it is later determined
that the CONTRACTOR failed to disclose required information, any contract awarded to such
CONTRACTOR may be immediately voided and terminated for material failure to comply with the terms
and conditions of the award.
CONTRACTOR must sign a “Certification Regarding Debarment, Suspension, and Other
Responsibility Matters- Primary Covered Transactions” in the form set forth in Exhibit F, attached hereto
and by this reference incorporated herein and made part of this Agreement. Additionally, CONTRACTOR
must immediately advise the COUNTY in writing if, during the term of this Agreement: (1)
CONTRACTOR becomes suspended, debarred, excluded or ineligible for participation in federal or state
funded programs or from receiving Federal funds as listed in the excluded parties’ list system
(http://www.epls.gov); or (2) any of the above listed conditions become applicable to CONTRACTOR.
CONTRACTOR shall indemnify, defend and hold the COUNTY harmless for any loss or damage
resulting from a conviction, debarment, exclusion, ineligibility or other matter listed in the signed
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Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
25.DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a for-
profit or non-profit corporation) or if during the term of this Agreement, the CONTRACTOR changes its
status to operate as a corporation.
Members of the CONTRACTOR’s Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR is
a party and in which one or more of its directors has a material financial interest. Members of the Board
of Directors shall disclose any self-dealing transactions that they are a party to by completing and signing
a “Self-Dealing Transaction Disclosure Form”, attached hereto as Exhibit G and incorporated herein by
reference and made part of this Agreement, and submitting it to the COUNTY prior to commencing with
the self-dealing transaction or immediately thereafter.
26.SUBCONTRACTS
CONTRACTOR shall obtain written approval from COUNTY’s DBH Director, or designee,
before subcontracting any of the services delivered under this Agreement, unless previously budgeted at
time of award. COUNTY’s DBH Director, or designee, retains the right to approve or reject any request for
subcontracting services. Any transferee, assignee, or subcontractor will be subject to all applicable
provisions of this Agreement, and all applicable State and Federal regulations. CONTRACTOR shall be
held primarily responsible by COUNTY for the performance of any transferee, assignee, or subcontractor
unless otherwise expressly agreed to in writing by COUNTY’s DBH Director, or designee. The use of
subcontractors by CONTRACTOR shall not entitle CONTRACTOR to any additional compensation that is
provided for under this Agreement.
27.AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as COUNTY may
deem necessary, make available to COUNTY for examination all of its records and data with respect to
the matters covered by this Agreement. CONTRACTOR shall, upon request by COUNTY, permit
COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTOR's
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compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State of California Auditor General
for a period of three (3) years after final payment under contract (California Government Code section
8546.7).
28.NOTICES
The persons having authority to give and receive notices under this Agreement and their
addresses include the following:
COUNTY CONTRACTOR
Director, County of Fresno Director, California State University Fresno
Department of Behavioral Health Foundation
1925 E. Dakota Ave Cc to: Director, Social Research Institute
Fresno, CA 93726 California State University, Fresno Foundation
4910 N. Chestnut Ave
Fresno, CA 93726
All notices between the COUNTY and CONTRACTOR provided for or permitted under this Agreement
must be in writing and delivered either by personal service, by first-class United States mail, by an
overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
personal service is effective upon service to the recipient. A notice delivered by first-class United States
mail is effective three (3) COUNTY business days after deposit in the United States mail, postage
prepaid, addressed to the recipient. A notice delivered by an overnight commercial courier service is
effective one (1) COUNTY business day after deposit with the overnight commercial courier service,
delivery fees prepaid, with delivery instructions given for next day delivery, addressed to the recipient. A
notice delivered by telephonic facsimile is effective when transmission to the recipient is completed (but, if
such transmission is completed outside of COUNTY business hours, then such delivery shall be deemed
to be effective at the next beginning of a COUNTY business day), provided that the sender maintains a
machine record of the completed transmission. For all claims arising out of or related to this Agreement,
nothing in this Section establishes, waives, or modifies any claims presentation requirements or
procedures provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1
of the Government Code, beginning with Section 810).
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29.SEVERABILITY
If any non-material term, provision, covenant, or condition of this Agreement is held by a
court of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions shall
remain in full force and effect, and shall in no way be affected, impaired or invalidated.
30.GOVERNING LAW
Venue for any action arising out of or related to the Agreement shall only be in Fresno
County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
31.ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understandings of any nature whatsoever unless expressly included in this Agreement.
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1 IN WITNESS WHEREOF , the parties hereto have executed this Agreement as of the day and year
2 first hereinabove written .
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Keith Komps i . Director Fb.J.i ~dations Financial Serv ices
James Marshall , De ~R~~earch and Graduate Stud ies
Print Name & Title
4910 N Chest nut Ave M/S OF123
Fresno, CA 93726
Ma iling Address
Steve an au , Chairman of the Board of
Supervisors of the County of Fresno
ATTEST:
Bern ice E . Seidel
Clerk of the Board of Supervisors
County of Fresno, State of California
----------By : -~~~.Q.O.t...• '~., ____:C~·~_.,:44=/.4--~---
(Authorized Signature) Deputy U
Print Name
Title : Secretary (of Corporation), or
any Assistant Secretary , or
Chief F inancial Officer, or
any Assistant Treasurer
FOR ACCOUNTING USE ONLY :
Fund : 0001
Subclass : 10000
ORG: 56304793
Account: 7 295/0
29
Exhibit A - Page 1 of 5
SUMMARY OF SERVICES
ORGANIZATION: California State University, Fresno Foundation
Social Research Institute
SERVICE: Evaluation for The Lodge Innovation Program
OFFICE ADDRESS: 4910 N Chestnut Ave
Fresno, CA 93726
OFFICE TELEPHONE: (559)278-2234 Sociology Department
(559) 960-0595 Personal Cell
CONTACT(S): Timothy J. Kubal, PhD., Director of Social Research Institute
CONTRACT PERIOD: Effective Upon Execution – June 30, 2023
(One optional 6-month extension through December 31, 2023)
AMOUNT: Effective Upon Execution – June 30, 2021: $21,447
FY 21-22: $ 50,557
FY 22-23: $ 46,516
July 1, 2023 through December 31, 2023: $ 31,480
Total: $ 150,000
A.SUMMARY OF SERVICES
CONTRACTOR, hereinafter referred to as “Evaluator”, shall provide an evaluation of The
Lodge, an innovation program in which daily operations are run by RH Community
Builders. The Lodge, a research targeted engagement approach, serves individuals who
are homeless or at risk of homelessness and have an early onset of a severe mental
illness or a chronic mental illness, who are in a pre-contemplation stage of change, thus
not engaged in care. The evaluation will not evaluate all aspects of The Lodge program,
but will instead analyze two program outcomes: Did the program increase individuals
served engagement in care services? Did the program change attitudes among
stakeholders and participants about peer facilitators? The work shall be completed by
using the data provided to the evaluator by the Fresno County Department of
Behavioral Health (DBH).
Exhibit A - Page 2 of 5
B. CONTRACTOR RESPONSIBILITIES
Evaluator shall perform the activities below.
1) Provide advice about data collection
a. Evaluator shall review and suggest edits for data collection instruments prior
to data collection by The Lodge staff (hereafter “provider”) actually begins.
This includes both quantitative and qualitative instruments already included
in the proposal as well as instruments that may be later used in the project.
This may entail advising work by the Evaluator with DBH and the provider to
advise them regarding training their own staff for proper data collection. The
provider will work with the evaluator and DBH to assess the best method of
communicating the data to the evaluator.
b. Evaluator’s review of the data collection shall occur informally throughout
the three-year process, but more formally, during each of the annual reports.
2) Analysis of the Data
a. Evaluator shall analyze the data provided by DBH and the provider that
address the research questions.
b. The Evaluator shall not collect data or decide on individual program eligibility
or have access to names or identifying information of The Lodge participants.
c. The Evaluator shall not be involved in any way in any sort of decisions about
individual referrals or delivery service to any individuals served.
d. The evaluator’s analysis shall be based on the data provided.
e. The evaluator shall address the research questions by providing both simple
and advanced analysis of data on the individuals admitted to the program
(i.e. intake data, personal medical records, the quantitative and qualitative
data collected by the provider about each of the individuals served).
throughout their stay in the program and exit interviews.
f. Evaluators shall analyze research questions that seek to explain two things:
1) The willingness of individuals served to access treatment (i.e.
“engagement”) and 2) the staff and individuals’ interpretation of peer
facilitators.
1. What explains the variation in the individuals served’s willingness to
access mental health treatment (i.e. how do we explain their level of
engagement)?
• Does addressing an individuals’ basic needs (as per the Maslow
Hierarchy of Needs) through the uses of a low-barrier Lodge
setting shape engagement of clients?
• What role do trained peers applying motivational interviewing in
such a setting play in shaping engagement?
Exhibit A - Page 3 of 5
• What role do other factors (such as individual histories and
demographic factors) have in explaining the variation in
engagement?
• How do individuals served describe and explain their own
decisions about levels of engagement?
2. Does the program influence the perception of peer facilitators among
participants and stakeholders?
• Evaluator shall provide support to answering this question by
providing advice on the provider’s pre and post survey that will be
distributed among the relevant population of participants and
stakeholders.
• Evaluator should be able to answer this question definitely, that
is, if relevant data is collected at the beginning and end of the
project, and they have individual tracking markers, they will be
able to explain quantitatively why perceptions have (or have not)
changed based on demographic and other important questions
also asked in the survey.
g. The Evaluator shall address the innovation questions from the program by
using intake and ongoing data from individuals served, as well as records
from peer facilitators; data collection will be completed by the provider
and/or DBH.
h. The Evaluator shall address the innovation questions from the program by
collecting intake and ongoing data from individuals served, as well as records
from peer facilitators.
i. Evaluator shall statistically explain the individual’s perception about how
much each factor facilitated their engagement with care.
j. Evaluator shall statistically explain how objective variables such as time in the
program and amount of exposure to motivational interviewing have on
individuals’ engagement with care.
k. Evaluator shall statistically explain how demographic factors and exposure to
peer facilitators shape individuals served and stakeholders’ perceptions of
the idea of peer facilitators.
3) Provide written reports
a. The data analysis for this evaluation shall be communicated from the
Evaluator to DBH through annual written reports, as well as a final report at
the end of the three-year term.
b. The Evaluator will produce three annual reports of the data that address the
research questions in the proposal, and a final research report at the end of
year three that synthesizes the three annual reports, assesses the research
questions after looking at all of the data, and offers suggestions about
program viability.
Exhibit A - Page 4 of 5
c.Each of the reports shall include both a short executive summary, and full
detailed analysis (with supporting documentation of data in appendices).
The reports will be based on the analyses described in the previous section.
4)Provide assistance in communication of findings
a.Evaluator shall work with and assist DBH with communicating the produced
research findings to stakeholders, public, and social media.
b.Evaluator shall help DBH to both interpret the findings and craft effective
public communication, as well as providing an Evaluator representative to
attend meetings where they will help DBH disseminate the findings.
5)Compliance with County
Evaluators shall comply with all contract monitoring and compliance protocols,
procedures, data collection methods, and reporting requirements conducted by the
COUNTY.
6)Participate in DBH and Third-Party Meetings
Evaluator’s staff shall participate in meetings to discuss the program, contracts
issues or data findings when requested by DBH or provider. DBH shall coordinate the
meetings.
C.COUNTY RESPONSIBILITIES
County shall:
1)Participate in monthly meetings with Evaluator to discuss program, contractual
issues, and/or findings. Meetings frequency may be changed after the first year of
implementation. DBH will be responsible for coordination of these meetings.
2)Participate in evaluation of the progress of the overall program and the efficiency of
the collaboration with Evaluator’s staff and will be available to Evaluator for ongoing
consultation.
3)Gather outcome information from Evaluator throughout each term of this
Agreement. COUNTY DBH staff shall notify the Evaluator when its participation is
required. The performance outcome measurement process will not be limited to
survey instruments but also include, as appropriate, client and staff interviews, chart
reviews, and other methods of obtaining required information.
4)DBH shall include Evaluator’s staff in DBH trainings that are relevant to the services
as described in this Agreement, if there is sufficient space available, at no cost.
Exhibit A - Page 5 of 5
D.REPORTS
1)Evaluator shall provide an annual report of collected data and analysis. The annual
reports of the data shall address the research questions in the proposal, assess the
research questions after looking at all of the data, and offers suggestions about
program viability. Each of the reports shall include both a short executive summary,
and full, detailed analysis (with supporting documentation of data in appendices).
2)Evaluator shall provide a final report of analysis over the three years of this
Innovation Plan.
3)Additional reports/outcomes may also be requested by the COUNTY’s DBH and/or
State, as needed.
Guiding Principles of Care Delivery
1
rev 2017 Dec
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
•Deliver quality care
•Maximize resources while focusing on efficiency
•Provide an excellent care experience
•Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1.Principle One - Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
Exhibit B - Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2
rev 2017 Dec
2.Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3.Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4.Principle Four - Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person’s quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5.Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
Exhibit B - Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
3
rev 2017 Dec
6.Principle Six - Culturally Responsive
o Values, traditions, and beliefs specific to an individual’s or family’s culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7.Principle Seven - Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8.Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9.Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the client’s stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
Exhibit B - Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
4
rev 2017 Dec
10.Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11.Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
Exhibit B - Page 4 of 4
Fresno County Department of Behavioral Health
Exhibit C - Page 1 of 16
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Evaluator - Dr. Timothy Kubal 0.17 -$ 5,526$ 5,526$
1102 Evaluator - Dr. Deborah Helsel 0.03 - 992 992
1103 Evaluator - Dr. Amber Crowell 0.03 - 764 764
1104 Evaluator - Dr. Edward Nelson 0.09 - 1,800 1,800
1105 Evaluator - Victoria Kubal 0.09 - 1,800 1,800
1106 Student Research Assistant 0.53 - 3,600 3,600
Personnel Salaries Subtotal 0.94 -$ 14,482$ 14,482$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1304 - 1,088 1,088
1305 - 80 80
-$ 1,168$ 1,168$
-$ 15,650$ 15,650$
3000: OPERATING EXPENSES
Acct #Amount
3003 3,000
3,000$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 2,797
2,797$
Acct #MHSA Component Amount
8303 INN - Innovations 21,447
21,447$
Description
Office, Household & Program Supplies
1000: SALARIES & BENEFITS
Fringe @ 10%
Line Item Description
Administrative Overhead
The Lodge
MHSA Program Name
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
NET PROGRAM COST:
PROGRAM FUNDING SOURCES
21,447$ TOTAL PROGRAM EXPENSES
PROGRAM EXPENSES
TOTAL PROGRAM FUNDING SOURCES:21,447$
-$
ADMINISTRATIVE EXPENSES TOTAL
MHSA TOTAL
OPERATING EXPENSES TOTAL:
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
From contract execution to June 30, 2021
Payroll Taxes & Expenses Subtotal:
Line Item Description
Student Fringe @ 2.23% (Workers Comp & UI)
EMPLOYEE SALARIES & BENEFITS TOTAL:
Exhibit C - Page 2 of 16
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 15,650
Employee Salaries 14,482
1101 Evaluator - Dr. Timothy Kubal 5,526 Estimated Fresno State Salary - $70 * 1360 hours (academic year) = $95,200
Estimated FTE on Evaluation Contract - $5,526 / $95,200 / (4/12 months) = 0.17 FTE
Provides advisory and research services, and managing the evaluation as director of
the Social Research Institute. Specialties include social psychology, homelessness,
basic quantitative methods, and advanced qualitative methods. Management
duties include, among other things, facilitating communication and paperwork
among all relevant parties.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1102 Evaluator - Dr. Deborah Helsel 992 Estimated Fresno State Salary - $73 * 1360 hours (academic year) = $99,280
Estimated FTE on Evaluation Contract - $992 / $99,280 / (4/12 months) = 0.03 FTE
Provides advisory and research services, with a specialty in health and medicine
among disenfranchised groups, and advanced qualitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1103 Evaluator - Dr. Amber Crowell 764 Estimated Fresno State Salary - $56 * 1360 hours (academic year) = $76,160
Estimated FTE on Evaluation Contract - $764 / $76,160 / (4/12 months) = 0.03 FTE
Provides advisory and research services, with a specialty in demography, inequality,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
California State University, Fresno Foundation
Evaluation for The Lodge Innovation Program
From contract execution to June 30, 2021
Exhibit C - Page 3 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1104 Evaluator - Dr. Edward Nelson 1,800 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $1,800 / $61,200 / (4/12 months) = 0.09 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1105 Evaluator - Victoria Kubal 1,800 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $1,800 / $61,200 / (4/12 months) = 0.09 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1106 Student Research Assistant 3,600 Estimated Fresno State Salary - $15 * 1360 hours (academic year) = $20,400
Estimated FTE on Evaluation Contract - $3,600 / $20,400 / (4/12 months) = 0.53 FTE
Provides clerical and communications support, as well as providing simple research
tasks such as preliminary cleaning of the data.
Payroll Taxes & Expenses:1,168
1304 Fringe @ 10%1,088 Fringe for additional employment hours and other employee are calculated at 10-
percent to cover the expense of employment taxes. This is a cost estimate as rates
fluctuate. Rate covers the cost of workers compensation, unemployment insurance,
FICA and Medicare
$10,882 * .10 = $1,088
1305 Student Fringe @ 2.23% (Workers Comp & UI)80 Fringe for Student Assistant covers unemployment insurance and workers
compensation.
$3,600 * .0223 = $80
3000: OPERATING EXPENSES 3,000
3003 Office, Household & Program Supplies 3,000 Costs for office supplies include, but are not limited, to: Printer toner, paper, pens,
notepads, peripheral devices associated with technological needs, and copier fees.
Exhibit C - Page 4 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6000: ADMINISTRATIVE EXPENSES 2,797
6001 Administrative Overhead 2,797 Administrative Overhead has been calculated at the university approved rate of 15%
for contractual services with a county agency.
$18,650 * .15 = $2,797
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:21,447
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:21,447
-
Exhibit C - Page 5 of 16
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Evaluator - Dr. Timothy Kubal 0.23 -$ 22,023$ 22,023$
1102 Evaluator - Dr. Deborah Helsel 0.05 - 4,959 4,959
1103 Evaluator - Dr. Amber Crowell 0.05 - 3,818 3,818
1104 Evaluator - Dr. Edward Nelson 0.03 - 1,800 1,800
1105 Evaluator - Victoria Kubal 0.03 - 1,800 1,800
1106 Student Research Assistant 0.27 - 5,500 5,500
Personnel Salaries Subtotal 0.66 -$ 39,900$ 39,900$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1304 - 3,440 3,440
1305 - 123 123
-$ 3,563$ 3,563$
-$ 43,463$ 43,463$
3000: OPERATING EXPENSES
Acct #Amount
3003 500
500$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 6,594
6,594$
Acct #MHSA Component Amount
8303 INN - Innovations 50,557
50,557$
TOTAL PROGRAM FUNDING SOURCES:50,557$
NET PROGRAM COST: -$
MHSA TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
The Lodge
PROGRAM FUNDING SOURCES
TOTAL PROGRAM EXPENSES 50,557$
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Line Item Description
OPERATING EXPENSES TOTAL:
Office, Household & Program Supplies
Line Item Description
Fringe @ 10%
Student Fringe @ 2.23% (Workers Comp & UI)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Description
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
Fiscal Year (FY 2021-22)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Exhibit C - Page 6 of 16
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 43,463
Employee Salaries 39,900
1101 Evaluator - Dr. Timothy Kubal 22,023 Estimated Fresno State Salary - $70 * 1360 hours (academic year) = $95,200
Estimated FTE on Evaluation Contract - $22,023 / $95,200 = 0.23 FTE
Provides advisory and research services, and managing the evaluation as director of
the Social Research Institute. Specialties include social psychology, homelessness,
basic quantitative methods, and advanced qualitative methods. Management
duties include, among other things, facilitating communication and paperwork
among all relevant parties.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1102 Evaluator - Dr. Deborah Helsel 4,959 Estimated Fresno State Salary - $73 * 1360 hours (academic year) = $99,280
Estimated FTE on Evaluation Contract - $4,959 / $99,280 = 0.05 FTE
Provides advisory and research services, with a specialty in health and medicine
among disenfranchised groups, and advanced qualitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1103 Evaluator - Dr. Amber Crowell 3,818 Estimated Fresno State Salary - $56 * 1360 hours (academic year) = $76,160
Estimated FTE on Evaluation Contract - $3,818 / $76,160 = 0.05 FTE
Provides advisory and research services, with a specialty in demography, inequality,
and advanced quantitative methods
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
Fiscal Year (FY 2021-22)
Exhibit C - Page 7 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1104 Evaluator - Dr. Edward Nelson 1,800 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $1,800 / $61,200 = 0.03 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1105 Evaluator - Victoria Kubal 1,800 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $1,800 / $61,200 = 0.03 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1106 Student Research Assistant 5,500 Estimated Fresno State Salary - $15 * 1360 hours (academic year) = $20,400
Estimated FTE on Evaluation Contract - $5,500 / $20,400 = 0.27 FTE
Provides clerical and communications support, as well as providing simple research
tasks such as preliminary cleaning of the data.
Payroll Taxes & Expenses:3,563
1304 Fringe @ 10%3,440 Fringe for additional employment hours and other employee are calculated at 10-
percent to cover the expense of employment taxes. This is a cost estimate as rates
fluctuate. Rate covers the cost of workers compensation, unemployment insurance,
FICA and Medicare
$34,440 * .10 = $3,440
1305 Student Fringe @ 2.23% (Workers Comp & UI)123 Fringe for Student Assistant covers unemployment insurance and workers
compensation.
$5,500 * .0223 = $123
3000: OPERATING EXPENSES 500
3003 Office, Household & Program Supplies 500 Costs for office supplies include, but are not limited, to: Printer toner, paper, pens,
notepads, peripheral devices associated with technological needs, and copier fees.
Exhibit C - Page 8 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6000: ADMINISTRATIVE EXPENSES 6,594
6001 Administrative Overhead 6,594 Administrative Overhead has been calculated at the university approved rate of 15%
for contractual services with a county agency.
$43,963 * .15 = $6,594
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:50,557
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:50,557
-
Exhibit C - Page 9 of 16
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Evaluator - Dr. Timothy Kubal 0.22 -$ 21,352$ 21,352$
1102 Evaluator - Dr. Deborah Helsel 0.04 - 4,215 4,215
1103 Evaluator - Dr. Amber Crowell 0.05 - 3,663 3,663
1104 Evaluator - Dr. Edward Nelson 0.03 - 1,530 1,530
1105 Evaluator - Victoria Kubal 0.03 - 1,530 1,530
1106 Student Research Assistant 0.23 - 4,700 4,700
Personnel Salaries Subtotal 0.60 -$ 36,990$ 36,990$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1204 - 3,229 3,229
1205 - 105 105
-$ 3,334$ 3,334$
-$ 40,324$ 40,324$
3000: OPERATING EXPENSES
Acct #Amount
3003 125
125$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 6,067
6,067$
Acct #MHSA Component Amount
8303 INN - Innovations 46,516
46,516$
TOTAL PROGRAM FUNDING SOURCES:46,516$
NET PROGRAM COST: -$
MHSA TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
The Lodge
PROGRAM FUNDING SOURCES
TOTAL PROGRAM EXPENSES 46,516$
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Line Item Description
OPERATING EXPENSES TOTAL:
Office, Household & Program Supplies
Line Item Description
Fringe @ 10%
Student Fringe @ 2.23% (Workers Comp & UI)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Description
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
Fiscal Year (FY 2022-23)
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Exhibit C - Page 10 of 16
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 40,324
Employee Salaries 36,990
1101 Evaluator - Dr. Timothy Kubal 21,352 Estimated Fresno State Salary - $70 * 1360 hours (academic year) = $95,200
Estimated FTE on Evaluation Contract - $21,352 / $95,200 = 0.22 FTE
Provides advisory and research services, and managing the evaluation as director of
the Social Research Institute. Specialties include social psychology, homelessness,
basic quantitative methods, and advanced qualitative methods. Management
duties include, among other things, facilitating communication and paperwork
among all relevant parties.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1102 Evaluator - Dr. Deborah Helsel 4,215 Estimated Fresno State Salary - $73 * 1360 hours (academic year) = $99,280
Estimated FTE on Evaluation Contract - $4,215 / $99,280 = 0.04 FTE
Provides advisory and research services, with a specialty in health and medicine
among disenfranchised groups, and advanced qualitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1103 Evaluator - Dr. Amber Crowell 3,663 Estimated Fresno State Salary - $56 * 1360 hours (academic year) = $76,160
Estimated FTE on Evaluation Contract - $3,663 / $76,160 = 0.05 FTE
Provides advisory and research services, with a specialty in demography, inequality,
and advanced quantitative methods
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
Fiscal Year (FY 2022-23)
Exhibit C - Page 11 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1104 Evaluator - Dr. Edward Nelson 1,530 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $1,530 / $61,200 = 0.03 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1105 Evaluator - Victoria Kubal 1,530 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $1,530 / $61,200 = 0.03 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1106 Student Research Assistant 4,700 Estimated Fresno State Salary - $15 * 1360 hours (academic year) = $20,400
Estimated FTE on Evaluation Contract - $4,700 / $20,400 = 0.23 FTE
Provides clerical and communications support, as well as providing simple research
tasks such as preliminary cleaning of the data.
Payroll Taxes & Expenses:3,334
1204 Fringe @ 10%3,229 Fringe for additional employment hours and other employee are calculated at 10-
percent to cover the expense of employment taxes. This is a cost estimate as rates
fluctuate. Rate covers the cost of workers compensation, unemployment insurance,
FICA and Medicare
$32,290 * .10 = $3,229
1205 Student Fringe @ 2.23% (Workers Comp & UI)105 Fringe for Student Assistant covers unemployment insurance and workers
compensation.
$4,700 * .0223 = $105
3000: OPERATING EXPENSES 125
3003 Office, Household & Program Supplies 125 Costs for office supplies include, but are not limited, to: Printer toner, paper, pens,
notepads, peripheral devices associated with technological needs, and copier fees.
Exhibit C - Page 12 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6000: ADMINISTRATIVE EXPENSES 6,067
6001 Administrative Overhead 6,067 Administrative Overhead has been calculated at the university approved rate of 15%
for contractual services with a county agency.
$40,449 * .15 = $6,067
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:46,516
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:46,516
-
Exhibit C - Page 13 of 16
Employee Salaries
Acct #Position FTE Admin Direct Total
1101 Evaluator - Dr. Timothy Kubal 0.27 -$ 12,942$ 12,942$
1102 Evaluator - Dr. Deborah Helsel 0.05 - 2,376 2,376
1103 Evaluator - Dr. Amber Crowell 0.04 - 1,411 1,411
1104 Evaluator - Dr. Edward Nelson 0.07 - 2,070 2,070
1105 Evaluator - Victoria Kubal 0.07 - 2,070 2,070
1106 Student Research Assistant 0.41 - 4,200 4,200
Personnel Salaries Subtotal 0.91 -$ 25,069$ 25,069$
Payroll Taxes & Expenses:
Acct #Admin Direct Total
1204 - 2,087 2,087
1205 - 93 93
-$ 2,180$ 2,180$
-$ 27,249$ 27,249$
3000: OPERATING EXPENSES
Acct #Amount
3003 125
125$
6000: ADMINISTRATIVE EXPENSES
Acct #Amount
6001 4,106
4,106$
Acct #MHSA Component Amount
8303 INN - Innovations 31,480
31,480$
TOTAL PROGRAM FUNDING SOURCES:31,480$
NET PROGRAM COST: -$
MHSA TOTAL
8300 - MENTAL HEALTH SERVICE ACT (MHSA)
MHSA Program Name
The Lodge
PROGRAM FUNDING SOURCES
TOTAL PROGRAM EXPENSES 31,480$
ADMINISTRATIVE EXPENSES TOTAL
Administrative Overhead
Line Item Description
OPERATING EXPENSES TOTAL:
Office, Household & Program Supplies
Line Item Description
Fringe @ 10%
Student Fringe @ 2.23% (Workers Comp & UI)
Payroll Taxes & Expenses Subtotal:
EMPLOYEE SALARIES & BENEFITS TOTAL:
Description
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
July 1, 2023 to December 31, 2023
PROGRAM EXPENSES
1000: SALARIES & BENEFITS
Exhibit C - Page 14 of 16
Budget Narrative
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000: SALARIES & BENEFITS 27,249
Employee Salaries 25,069
1101 Evaluator - Dr. Timothy Kubal 12,942 Estimated Fresno State Salary - $70 * 1360 hours (academic year) = $95,200
Estimated FTE on Evaluation Contract - $12,942 / $95,200 / (6/12 months) = 0.27
FTE
Provides advisory and research services, and managing the evaluation as director of
the Social Research Institute. Specialties include social psychology, homelessness,
basic quantitative methods, and advanced qualitative methods. Management
duties include, among other things, facilitating communication and paperwork
among all relevant parties.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1102 Evaluator - Dr. Deborah Helsel 2,376 Estimated Fresno State Salary - $73 * 1360 hours (academic year) = $99,280
Estimated FTE on Evaluation Contract - $2,376 / $99,280 / (6/12 months) = 0.05 FTE
Provides advisory and research services, with a specialty in health and medicine
among disenfranchised groups, and advanced qualitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1103 Evaluator - Dr. Amber Crowell 1,411 Estimated Fresno State Salary - $56 * 1360 hours (academic year) = $76,160
Estimated FTE on Evaluation Contract - $1,411 / $76,160 / (6/12 months) = 0.04 FTE
Provides advisory and research services, with a specialty in demography, inequality,
and advanced quantitative methods
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
Evaluation for The Lodge Innovation Program
California State University, Fresno Foundation
July 1, 2023 to December 31, 2023
Exhibit C - Page 15 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1104 Evaluator - Dr. Edward Nelson 2,070 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $2,070 / $61,200 / (6/12 months) = 0.07 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1105 Evaluator - Victoria Kubal 2,070 Estimated Fresno State Salary - $45 * 1360 hours (academic year) = $61,200
Estimated FTE on Evaluation Contract - $2,070 / $61,200 / (6/12 months) = 0.07 FTE
Provides advisory and research services, with a specialty in managing evaluations,
and advanced quantitative methods.
“Advisory and research services” refers to many different tasks, all of which are
directed toward producing an excellent, scientifically-sound evaluation that fully and
accurately completes the scope of work for 3 annual reports, including tasks such as
referencing scientific literature, producing and evaluating data instruments, cleaning
data to prepare for analysis, analyzing data, evaluating data analyzed, writing
scientific reports, writing public reports, and evaluating data collection procedures.
1106 Student Research Assistant 4,200 Estimated Fresno State Salary - $15 * 1360 hours (academic year) = $20,400
Estimated FTE on Evaluation Contract - $4,200 / $20,400 / (6/12 months) = 0.41 FTE
Provides clerical and communications support, as well as providing simple research
tasks such as preliminary cleaning of the data.
Payroll Taxes & Expenses:2,180
1204 Fringe @ 10%2,087 Fringe for additional employment hours and other employee are calculated at 10-
percent to cover the expense of employment taxes. This is a cost estimate as rates
fluctuate. Rate covers the cost of workers compensation, unemployment insurance,
FICA and Medicare
$20,869 * .10 = $2,087
1205 Student Fringe @ 2.23% (Workers Comp & UI)93 Fringe for Student Assistant covers unemployment insurance and workers
compensation.
$4,200 * .0223 = $93
3000: OPERATING EXPENSES 125
3003 Office, Household & Program Supplies 125 Costs for office supplies include, but are not limited, to: Printer toner, paper, pens,
notepads, peripheral devices associated with technological needs, and copier fees.
Exhibit C - Page 16 of 16
ACCT #LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
6000: ADMINISTRATIVE EXPENSES 4,106
6001 Administrative Overhead 4,106 Administrative Overhead has been calculated at the university approved rate of 15%
for contractual services with a county agency.
$27,374 * .15 = $4,106
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE:31,480
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE:31,480
-
Exhibit D - Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 et seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit D - Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY’s Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f)
and CCR, Title 2, Section 111 02) (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:
1) 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 this Agreement will:
1) 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 this Agreement.
Exhibit D - Page 3 of 6
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this 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 certification by failing to carry out the requirements as noted above. (Gov.
Code §8350 et seq.)
3.NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court by a
Federal court has been issued against CONTRACTOR within the immediately preceding
two (2) year period because of CONTRACTOR’s failure to comply with an order of a
Federal court, which orders CONTRACTOR to comply with an order of the National
Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4.CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with
the requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the lessor of
30 multiplied by the number of full time attorneys in the firm’s offices in the State, with
the number of hours prorated on an actual day basis for any contract period of less than
a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5.EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6.SWEATFREE CODE OF CONDUCT:
a.All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract, declare
under penalty of perjury that no apparel, garments or corresponding accessories,
equipment, materials, or supplies furnished to the state pursuant to the contract have
been laundered or produced in whole or in part by sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation
of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor,
convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at www.dir.ca.gov, and
Public Contract Code Section 6108.
Exhibit D - Page 4 of 6
b.CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR’s records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the Department of
Industrial Relations, or the Department of Justice to determine the contractor’s
compliance with the requirements under paragraph (a).
7.DOMESTIC PARTNERS: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8.GENDER IDENTITY: For contracts of $100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1.CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or has a financial
interest and which is sponsored or funded by any state agency, unless the employment,
activity or enterprise is required as a condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he or she
engaged in any of the negotiations, transactions, planning, arrangements or any part of
the decision-making process relevant to the contract while employed in any capacity by
any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a contract with any state
agency if he or she was employed by that state agency in a policy-making position in the
same general subject area as the proposed contract within the twelve (12) month period
prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Exhibit D - Page 5 of 6
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2.LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3.AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4.CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR’s name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment. Payment of
invoices presented with a new name cannot be paid prior to approval of said
amendment.
5.CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a.When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently qualified to do
business in California in order to ensure that all obligations due to the state are fulfilled.
b."Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c.Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the Office of
the Secretary of State.
6.RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local governing
body, which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7.AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge
prohibitions; or (3) finally determined to be in violation of provisions of federal law
relating to air or water pollution.
Exhibit D - Page 6 of 6
8.PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9.INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for ten (10) years from the final date of the
contract period or from the date of completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must confirm the
identity and determine the exclusion status of CONTRACTOR, any subcontractor, as
well as any person with an ownership or control interest, or who is an agent or managing
employee of CONTRACTOR through routine checks of Federal databases. This
includes the Social Security Administration's Death Master File, the National Plan and
Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE),
the System for Award Management (SAM), and any other databases as the State or
Secretary may prescribe. These databases must be consulted upon contracting and no
less frequently than monthly thereafter. If the State finds a party that is excluded, it must
promptly notify the CONTRACTOR and take action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial
institution located outside of the U.S. are considered in the development of actuarially
sound capitation rates.
Exhibit E – Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I.Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II.Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A.Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B.Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C.Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III.A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B.Type of entity: ❒ Sole proprietorship ❒Partnership ❒Corporation❒Unincorporated Associations ❒Other (specify)
C.If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D.Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. .......................................................................................................... ❒❒
NAME ADDRESS PROVIDER NUMBER
Exhibit E – Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... ❒ ❒
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... ❒ ❒
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ ❒ ❒
If yes, when?
V.Is the facility operated by a management company or leased in whole or part by another organization?.......... ❒ ❒
If yes, give date of change in operations.
VI.Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... ❒ ❒
VII. A. Is this facility chain affiliated? ...................................................................................................................... ❒ ❒
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
B.If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address (number, name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative (typed) Title
Signature Date
Remarks
Exhibit F - Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1.By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2.The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3.The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4.The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5.The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1)The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b)Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit F - Page 2 of 2
(c)Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2)Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)
Exhibit G - Page 1 of 2
SELF-DEALING TRANSAC TION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “COUNTY”),
members of a CONTRACTOR(S)’ board of directors (hereinafter referred to as “County
Contractor”), must disclose any self-dealing transactions that they are a party to while
providing goods, performing services, or both for the COUNTY. A self-dealing transaction is
defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1)Enter board member’s name, job title (if applicable), and date this disclosure is being
made.
(2)Enter the board member’s company/agency name and address.
(3)Describe in detail the nature of the self-dealing transaction that is being disclosed to
the COUNTY. At a minimum, include a description of the following:
a.The name of the agency/company with which the corporation has the
transaction; and
b.The nature of the material financial interest in the corporation’s transaction that
the board member has.
(4)Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5)Form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit G - Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: