HomeMy WebLinkAboutAgreement A-18-047 with CDPH.pdfState of California -Health and Human Services Agency-California Department of Public Health
CDPH 1229 (10/2016)
CALIFORNIA Oral Health Program
Local Oral Health Plan
Awarded By
Agreement No. 18-047
THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter "Department"
TO
Fresno County Department of Public Health, hereinafter "Grantee"
Implementing the project, Fresno County Local Oral Health Program," hereinafter "Project"
GRANT AGREEMENT NUMBER 17-10690
The Department awards this Grant and the Grantee accepts and agrees to use the Grant funds as
follows:
AUTHORITY: The Department has authority to grant funds for the Project under Health and
Safety Code, Section 104750, and 131085(a).
I
PURPOSE: The Department shall provide a grant to and for the benefit of the Grantee; the
purpose of the Grant is to provide activities that support the state oral health plan build capacity at the
local level for the facilitation and implementation of education, prevention, linkage to treatment,
surveillance, and case management services in the community. The Grantee will assess the oral health
needs of the California communities, develop a strategic action plan to address the oral health needs of
the population groups within the communities, and implement evidence based or evidence informed
programs.
GRANT AMOUNT: The maximum amount payable under this Grant shall not exceed Two
Million Six Hundred Forty Four Thousand Two Hundred Eighty dollars $2,644,280.
TERM OF GRANT: The term of the Grant shall begin on January 1, 2018, or upon approval of this
grant, and terminates on June 30, 2022. No funds may be requested or invoiced for work
performed or costs incurred after June 30, 2022.
PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will be:
California Department of Public Health Grantee: Fresno County Department of Public Health
Name: Angela Wright, Grant Manager
Name: David Luchini, Assistant Director
Address: MS 7208, 1616 Capitol Avenue, Suite 74.420 Address: 1221 Fulton Mall
City, Zip: Sacramento, CA 95814 City, Zip: Fresno, CA 93721
Phone: (916) 552-9898 Phone:559-600-6402
Page 1 of 3
State of California – Health and Human Services Agency – California Department of Public Health
CDPH 1229 (10/2016)
Page 2 of 3
Fax: (916) 552‐9729 Fax: 559‐600‐7687
E‐mail: Angela.Wright@cdph.ca.gov E‐mail: dluchini@co.fresno.ca.us
Direct all inquiries to:
California Department of Public Health,
California Oral Health Program
Grantee: Fresno County Department of Public
Health
Attention: Angela Wright, Grant Manager Attention: David Luchini, Assistant Director
Address: MS 7208, 1616 Capitol Avenue, Suite 74.420 Address: 1221 Fulton Mall
City, Zip: Sacramento, CA 95814 City, Zip: Fresno, CA 93721
Phone: (916) 552‐9898 Phone: 559‐600‐6402
Fax: (916) 552‐9729 Fax: 559‐600‐7687
E‐mail: Angela.Wright@cdph.ca.gov E‐mail: dluchini@co.fresno.ca.us
Either party may change its Project Representative upon written notice to the other party.
STANDARD PROVISIONS. The following exhibits are attached and made a part of this Grant by this
reference:
Exhibit A GRANT APPLICATION – Application Checklist, Grantee Information Form, Narrative
Summary Form, Scope of Work and Deliverables.
The Grant Application provides the description of the project and associated cost.
Exhibit B BUDGET DETAIL AND PAYMENT PROVISIONS
Exhibit C STANDARD GRANT CONDITIONS
Exhibit D LETTER OF INTENT
Including all the requirements and attachments contained therein
Exhibit E ADDITIONAL PROVISIONS
GRANTEE REPRESENTATIONS: The Grantee(s) accept all terms, provisions, and conditions of this
grant, including those stated in the Exhibits incorporated by reference above. The Grantee(s) shall
fulfill all assurances and commitments made in the application, declarations, other accompanying
documents, and written communications (e.g., e‐mail, correspondence) filed in support of the
request for grant funding. The Grantee(s) shall comply with and require its contractors and
subcontractors to comply with all applicable laws, policies, and regulations.
Document A
Exhibit A
Application Checklist
DUE: Wednesday, September 20, 2017
DATE OF
SUBMISSION September 18, 2017
ORGANIZATION
NAME Fresno County Public Health Department
Application Contact Name: David Luchini Phone Number: 559-600-6402
E-mail Address: dluchini@co.fresno.ca.us
The following documents must be completed and submitted with this Application Checklist
by September 20, 2017, in hard copy and by E-mail.
APPLICATION CONTENTS:Please Check
Application Checklist (This Form)
Grantee Information Form (Document B)
Narrative Summary Form (Document C)
Scope of Work and Deliverables (Document D)
Documentation Checklist for Established LOHPs only (Document E)
m)One copy must be mailed to:
IROeragluHlaeraMlthajP' rogramCalifornia Department of Public Health
P.0. Box 997377, MS 7208
Sacramento, CA 95899-7377
I
Express Delivery
Oral Health Program
California Department of Public Health
1616 Capitol Avenue, Suite 74.420
MS-7208
Sacramento, CA 95814
(916) 552-9900
Also e-mail the documents to: DentalDirector@cdph.ca.qov.
Grantee Information Form
Document B
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This is the information that will appear in your grant agreement.
Federal Tax ID # 94-6000512
Name Fresno County Department of Public Heallth
Mailing Address p.o. Box 11867, Fresno, CA 93775
Street Address (lf Different) 1221 Fulton Mall, Fresno, CA 93721
County Fresno
Phone 559-600-3200 Fax
Website www.fcdph.org
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The Gmnt Signatory has authority to sign the grant agreement cover.
Name David Pomaville
Title Director, Department of Public Health
If address(es) are the same as the organization above, just check this box and go to Phone [gl
Mailing Address
Street Address (lf Different)
Phone 559-600-6401 Fax 559-600-7687
Email dpomaville@co.fresno.ca.us
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The Project Director is responsible-for all of the day-to-day activities of project implementation and for
seeing that all grant requirements are met. This person will be in contact with Oral Health Program staff, will
receive all programmatic, budgetary, and accounting mail for the project and will be responsible for the
proper dissemination of program inforrnation.
Name David Luchini
Title Assistant Director, Department of Public Health
/f address(es) are the same as the organization above, just check this box and go to Phone §
Mailing Address
Street Address (lf Different)
Phone 559-600-6402 Fax 559-600-7687
Email dluchini@co.fresno.ca.us
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These are the annual Funding amounts your LHJ will accept for grant purposes.
Year I (FY I 7/1 8)$528,856
Year 2 (FY I 8/1 9)$528,856
Year 3 (FY I 9/20)$528,856
Year 4 (FY 20/21)$528,856
Year 5 (FY 21/22)$528,856
Document C
Narrative Summaiy Form
Fresno County Department of Public Health
Fresno County, located in the heart of California's Central Valley, is one of the world's most
productive agricultural areas, yet is also among the nation's most impoverished regions. Fresno
County is the 6th largest county in California (spanning 6,000 square miles) and contains 15
incorporated and 37 unincorporated cities. Referred to as the "Appalachia of the West," Fresno
and the surrounding counties of the San Joaquin Valley are characterized by chronic
unemployment, high incidence of poverty, and low levels of educational attainment. Twenty-
seven percent of the 946,895 Fresno County residents live in poverty. As described in the
Measure of America's "A Portrait of California 2014-15," the state can be categorized into five
different Californias based upon the American Human Development (HD) Index. Fresno
County's HD not only rates it as part of the "Struggling California" it is also the county within
this profile with the largest population.
Only 72.9% of Fresno County residents have received a high school diploma, and just 18.8%
have obtained a bachelor's degree or higher (Census, 2012). The county's average 2015
unemployment rate of 10.18% compares to a statewide 2015 average unemployment rate of
6.25% (u.s. Bureau of Labor Statistics 2015). Having one of the fastest growing and most
diverse populations, the County has been growing at a rate nearly twice that of
California. More than half of Fresno County residents live in a single metropolitan area (nearly
60%). Fresno County is a minority majority County with more than 50% of the population being
Latino, 9.6% Asian, 5.9%, African American, 3.0% American Indian/Alaska Native, and 0.1%
Native Hawaiian and other Pacific Islander in 2013. 31.9% were White (non-Hispanic). Nearly
43.4% of the County population speaks a primary language other than English at home.
With nearly 50% of our total population enrolled in Medi-Cal and greater than 75% of children
aged 0-5 in Medi-Cal, Fresno is ranked as the fourth highest county in the state for proportion
of population enrolled in Medi-Cal (DHCS Medi-Cal Quick Stats, September 2015). Currently,
data shows that only 44% of 0-20 population return year after year for follow up dental
preventive care in Fresno County. Our Medi-Cal children 0-6 years old had a high restorative
procedure rate of 46.23% in 2014-15, and a low preventive procedure rate of 53.77% (DHCS
Beneficiary Utilization Performance Measures).
Fresno County dentists per 100,000 population is 55.7 versus the California rate of 77.5
(Community Commons' Report, August 2015). There are approximately 813 active dentists
licensed in Fresno County (Department of Consumer Affairs - Dental Board of California) and
only 147 (18%) are Denti-Cal providers with only 87 (59%) of these providers accepting new
patients (DHCS report of Fee For Service Providers).
The Fresno County Smile Survey (February-April 2005) of 1,473 Kindergarten and 3rd grade
students who received dental screenings at 18 elementary schools provided a local "snapshot"
of the oral health status of children in Fresno County. Sixty-five percent of Kindergarten and
almost 80% of 3rd grade students had experienced dental disease. Four out of ten children had
untreated dental disease.
Page 1 of 2
Document C
Narrative Summary Form
Fresno County Department of Public Health
The need for health services in Fresno County is extensive and well documented. Dental caries,
the disease that causes cavities, is an infectious, transmittable, but preventable disease. By
focusing on prevention, thousands of lost school days and millions of dollars can be saved.
Fresno County Dental Transformation Initiative (FCDTI) and Fresno Community Health
Improvement Partnership (FCHIP) stakeholders have been engaged to support the Fresno
County Oral Health Program (FCOHP). In the first year, FCOHP will expand the Advisory
Committee around shared mission and values to oversee the needs and asset assessments and
work collaboratively to develop the health improvement and evaluation plans. At minimum, the
Advisory Committee stakeholder will include DTI staff and contractors, CHDP staff, school
districts, Denti-Cal dental providers, federally qualified health clinics, Fresno City College,
California State Unaiversity Fresno, and community based organizations that engage residents
for health improvement.
While completing objectives 1 through 5, FCOHP will work with the Advisory Committee to
identify target school districts and locations to implement evidence-based programs beginning
in year 2 that increase oral health education and administration of sealants and supplements.
The introduction to oral health and preventative care will be leveraged to connect families to a
primary dental home and DTI services. (Objective 6)
The needs assessment will include the facilitators and barriers to oral healthcare, and gaps in
care. with the goal of oral health care integration, informed by the needs assessment, the
Advisory Committee will use the health improvement plan to target programs, healthcare
providers, and institutions for the development and implementation of prevention and
healthcare policies and guidelines. (Objective 7)
The health improvement plan will also include additional prioritized policy, financing,
education, dental care, and/or community engagement strategies informed by the needs and
asset assessments. The Advisory Committee will work toward the completion of the short and
medium-term objectives of these strategies in years 2 through 5. (Objective 11)
The FCHIP Health Literacy and Empowerment Workgroup is working to increase the use of
preventative healthcare services by young adults age 18-24. To increase health literacy skills,
the group is gathering stakeholders to identify and/or develop interventions that leverage
existing infrastructure and programs for youth age 11 to 18. Working collaboratively with the
Workgroup, FCOHP will integrate oral health literacy into curricula, programs, and campaigns.
Oral health literacy skills will include brushing, flossing, regularly visiting an oral healthcare
provider, and reducing sugary beverages. (Objective 9)
FCOHP will use a combination of staff and contracted services to accomplish the scope of work.
Page 2 of 2
Document D
Scope of Work and Deliverables
FY2017-2022
GOAL: The California Department of Public Health, Oral Health Program (CDPH/OHP)
shall grant funds to Local Health Jurisdictions (LHJ) from Proposition 56, the California
Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) for the purpose
and goal of educating about oral health, dental disease prevention, and linkage to
treatment of dental disease including dental disease caused by the use of cigarettes and
other tobacco products. LHJs are encouraged to implement the strategies recommended
in the California Oral Health Plan and shall establish or expand upon existing Local Oral
Health Programs (LOHP) to include the following program activities related to oral health in
their communities: education, dental disease prevention, linkage to treatment, surveillance,
and case management. These activities will improve the oral health of Californians.
Objectives 1-5 below represent public health best practices for planning and
establishmg new LOHPs. LHJs are required to complete these prelimmary
Objectives before implementing Ob3ectives 6-1 1 outlmed below. LHJs that have
completed these planning activities may submit documentation m support of their
accomplishments. Please review the LOHP Guidelines for information regarding
the required documentation that must be submitted to CDPH OHP for approval.
Objective I : Build c.apacity and enqaqe community stakeholders to provide q.ualified
professional expertise in dental public health for proqram direction, coordination, and
collaboration.
Create a staffing pattern and engage community stakeholders to increase the capacity to
achieve large-scale improvements in strategies that support evidence-based interventions
health system interventions, community-clinical linkages, and disease surveillance and
evaluation. At a minimum an Oral Health Program Coordinator position should be
developed to coordinate the LOHP efforts. Recruit and engage key stakeholders to form
an Advisory Committee or task force. Convene and schedule meetings, identify goals and
oblectives, and establish communication methods. This group can leverage individual
members' expertise and connections to achieve measurable improvements in oral health.
Objective 2: Assess and monitor social and other determinants of health, health status,
health needs, and health care services available to California communities, with a special
focus on underserved areas and vulnerable population qroups.
Identify partners and form a workgroup to conduct an environmental scan to gather data,
create an inventory of resources, and plan a needs assessment. Conduct a needs
assessment to determine the need for primary data, identify resources and methods, and
develop a work plan to collect missing data. Collect, organize, and analyze data. Prioritize
needs assessment issues and findings, and use for program planning, advocacy, and
education. Prepare a report and publish.
Page 1 of 8
Document D
Scope of Work and Deliverables
FY 20'l7-2022
Objective 3: Identify assets and resources that will help to address the oral health needs of
the community with an emphasis on underserved areas and vulnerable population qroups
within the jurisdiction.
Take an inventory of the jurisdiction's communities to identify associations, organizations,
institutions and non-traditional partners to provide a comprehensive picture of the LHJ.
Conduct key informant interviews, focus groups, and/or surveys, create a map, and publish
the assets identified on your website or newsletter.
Objective 4: Develop a Community Health Improvement Plan (CHIP) and an action plan to
address oral health needs of underserved areas and vulnerable population qroups for the
implementation phase to achieve local and state oral health ob)ectives.
Identify a key staff person or consultant to guide the community oral health improvement
plan process, tncluding a Umeline, objectives, and strategies to achieve the California Oral
Health Plan. Recruit stakeholders, community gatekeepers, and non-traditional partners
identified in the asset mapping process and members of the AC to participate in a
workgroup to develop the CHIP and the Action Plan. The Action Plan will a timeline to
address and implement priority ob)ectives and strategies identified in the CHIP. The
workgroup will identify the "who, what, where, when, how long, resources, and
communication" aspects of the Action Plan.
Objective 5: Develop an Evaluation Plan that will be used to monitor and assess the
proqress and success of the Local Oral Health Proqram.
Participate with the CDPH OHP to engage stakeholders in the Evaluation Plan process,
including those involved, those affected, and the primary intended users. Describe the
program using a Logic Model, and document the purpose, intended users, evaluation
questtons and methodology, and timeline for the evaluation. Gather and ana)yze credible
evidence to document the indicators, sources, quality, quantity, and logistics. Justify the
conclusrons by documenting the standards, analyses, interpretation, and
recommendations. Ensure that the Evaluation Plan is used and shared.
Objective 6: lmplement evidence-based proqrams to achieve California Oral Health Plan
objectives
To accomplish this Objective, LHJs can choose evidence-based or best practice strategies
such as, but not limited to increase the number of low-income schools with a school-based
or school-linked dental program; increase the number of children in grades K-6 receiving
fluoride supplements, such as fluoride rinse, fluoride varnish, or fluoride tablets; increase
the number of children in grades K-6 receiving dental sealants and increase or maintain the
percent of the population receiving community fluoridated water.
Page 2 of 8
Document D
Scope of Work and Deliverables
FY2017-2022
Objective 7: Work with partners to promote oral health by developinq and implementinq
prevention and healthcare policies and quidelines for proqrams, health care providers, and
institutional settinqs (e.q., schools) includinq inteqration of oral health care and overall
health care.
To accomplish this Objective, LHJs can choose evidence-based or best practice strategies
such as, but not limited to. convene partners (e.g., First 5, Early Head Start/Head Start,
Maternal Child and Adolescent Health (MCAH), Child Health and Disability Prevention
(CHDP), Black Infant Health (BIH), Denti-Cal, Women, Infant and Children (WIC), Home
Visiting, schools, community-based organizations, etc.) to improve the oral health of O-6 year
old children by identifying facilitators for care, barriers to care, and gaps to be addressed;
and/or increase the number of schools implementing the kindergarten oral health
assessment by assessing the number of schools currently not reporting the assessments to
the System for California Oral Health Reporting (SCOHR), identifying target schools for
intervention, providing guidance to schools, and assessing progress.
Objective 8: Address common risk factors for preventable oral and chronic diseases,
includinq tobacco and suqar consumption, and promote protective factors that will reduce
disease burden.
To accomplish this Objective, LHJs can choose evidence-based or best practice strategies
such as, but not limited to: increase the number of dental offices providing tobacco
cessation counseling; and/or increase the number of dental office utilizing Rethink Your
Drink materials and resources to guide clients toward drinking water, especia)ly tap water,
instead of sugar-sweetened beverages.
Objective 9: Coordinate outreach proqrams, implement education and health literacy
campaiqns, and promote inteqration of oral health and primary care.
To accomplish this Objective, LHJs can choose evidence-based or best practice strategies
such as, but not limited to: increase the number of dental offices, primary care offices, and
community-based organizations (CBO) (e.g., Early Head Start/Head Start, WIC, Home
Visiting, BIH, CHDP, Community Health Worker/Promotora programs, etc.) using the
American Academy of Pediatrics' Brush, Book, Bed (BBB) impiementation guide; and/or
increase the number of dental offices, primary care clinics, and CBOs using the Oral Health
Literacy implementation guide to enhance communication in dental/medical offices; and/or
increase the number CBOs that incorporate oral health education and referrals into routine
business activities.
Page 3 of 8
Document D
Scope of Work and Deliverables
FY2017-2022
Objective 10: Assess, support, and assure establishment and improvement of effective oral
healthcare delivery and care coordination systems and resources, includinq workforce
development and collaborations to serve vulnerable and underserved populations by
inteqratinq oral health care and overall health care.
To accomplish this Objective, LHJs can choose evidence-based or best practice strategies
such as, but not limited to: regularly convene and lead a jurisdiction-Wide Community of
Practice comprised of Managed Care Plans, Federally Qualified Health Centers, CBOs,
and/or Dental Offices focused on implementing the Agency for Health Care Research and
Quality's Design Guide for Implementing Warm Handoffs in Primary Care Settings or the ;
and/or identifying a staff person or consultant to facilitate quality improvement coaching to
jurisdiction-wide Community of Practice members focused on increasing the number of at-
risk persons who are seen in both a medical and dental office; and/or improve the
operationalization of an existing policy or guideline, such as the increasing the number of
infants who are seen by a dentist by age I ; and/or promote effectiveness of best practices at
statewide and national quality improvement conferences.
Objective ll : Create or expand existinq local oral health networks to achieve oral health
improvements throuqh policy, financinq, education, dental care, and community
enqaqement strateqies.
To accomplish this Objective, LHJs can choose evidence-based or best practice strategies
such as, but not limited to: create a new (or expand an existing) Oral Health Network,
Coalition, or Partnership by identifying key groups and organizations; planning and holding
meetings; defining issues and problems; creating a common vision and shared values; and
developing and implementing an Action Plan that will result in oral health improvements.
LHJs are also encouraged, where possible, to collaborate with local Dental Transformation
Initiative (DTI) Local Dental Pilot Pro)ects to convene stakeholders and partners in
innovative ways to leverage and expand upon the existing momentum towards improving
oral health. LHJs that are currently implementing local DTI prolects should develop
complementary, supportive, but not duplicative activities.
Page 4 of 8
Document D
Scope of Work and Deliverables
FY2017-2022
DELIVERABLES/OUTCOME MEASURES: LHJs are encouraged to implement the strategies
recommended in the California Oral Health Plan. Funds are made available through Prop 56 to
achieve these deliverables. The activities may include convening, coordination, and collaboration
to support planning, disease prevention, education, surveillance, and linkage to treatment
programs. To ensure that CDPH fulfills the Prop 56 requirements, LHJs are responsible for
meehng the assurances and the following checked deliverables. Deliverables not met will result in a
corrective action plan and/or denial or reduction in future Prop 56 funding.
Local Health Jurisdiction Deliverables
Deliverable Activities Selected deliverable
D:,:;,.b:e I
I
Develop Advisory
Committee/Coalition/Partnership/Task Force (AC)
and recruit key organizations/members representing
diverse stakeholders and non-traditional partners.
A. List of diverse stakeholders engaged to develop
and mentor the Community Health
ImprovemenUAction Plan.
B. List number of meetings/conference calls held to
develop a consensus of AC to determine best
practice to address priorities and identify evidence-
based programs to implement.
C. Develop communication plan/methods to share
consistent messaging to increase collaboration.
D. Develop a consensus on how to improve access
to evidence based programs and clinical services.
[X
Deliverable 2
Objective I
Document staff participation in required training
webinars, workshops and meetings.[X
Deliverable 3
Objective 2 & 3
Conduct needs assessment of available data to
determine LHJs health status, oral health status,
needs, and available dental and health care services
to resources to support underserved communities and
vulnerable population groups.
[X
I
Deliverable 4
Objective 4
Five-year oral health improvement plan (the "Plan")
and an actiori plan (also called the "work plan"),
updated annually, describing disease prevention,
surveillance, education, linkage to treatment
programs, and evaluation strategies to improve the
oral health of the target population based on an
assessment of needs, assets and resources.
I
[X
I
Deliverable 5
Objective 5
Create a program logic model describing the local
oral health program and update annually [X
Deliverable 6
Objective 5
Coordinate with CDPH to develop a surveillance
report to determine the status of children's oral health
and develop an evaluation work plan for
Implementation ob3ectives.
[X
Page 5 of 8
Document D
Scope of Work and Delgverables
FY 2017 2022
Deliverable Activities Selected deliverable
Deliverable 7
Objective 6
IsScchhooool-Linked
Based/
I
Compile data for and report annually on educational
activities, completing all relevant components on the
Data Form:
A. Schools meeting criteria of low-income and
high-need for dental program (>50%
participation in Free or Reduced Price Meals
(FRPM) participating in a fluoride program.
B. Schools, teachers, parents and students
receiving educational materials and/or
educational sessions.
C. Children provided preventive services.
[X
Deliverable 8
Objective 6
School-Based/
School-Linked
' Compile data for and report annually on School-
based/linked program activities, completing all
relevant components on the Data Form:
A. Schools meeting criteria of low-income and
high-need for dental program (>50%
participation in Free or Reduced Price Meals
(FRPM) participating in a School-
based/linked program.
B. Schools, teachers, parents and students
receiving dental sealant educational
materials and/or educational sessions.
C. Children screened, linked or provided
preventive services including dental sealants.
I
[X
I
11
I
IDeliverable 9
i Objective 6
Fluoridation
I
I
ICompile data for and report annually on Community
Water Fluoridation program activities, completing all
relevant components on the Data Form:
I A. Regional Water District engineer/operator
training on the benefits of fluoridation.
B. Training for community members who desire
I to educate others on the benefits offluoridation at Board of Supervisor, City
Council, or Water Board meetings.
C. pommunity-specific fluoridation Education
Materials
D. Community public awareness campaign such
as PSAs, Radio Advertisements
[X I
i
!:;t:e '10
Kinder-Assessment
I
I
Compile data for and report annually on kindergarten
oral health assessment activities, completing all
relevant components on the Data Form:
A. Schools currently not reporting the
assessments to SCHOR
B. Champions trained to promote kindergarten
oral health assessment activities
C. Community public relations events and
community messages promoting oral health.
[X
Page 6 of 8
Document D
Scope of Work and Deliverables
FY 2017 2022
Deliverable Activities Selected deliverable
I
D. New schools participating in the kindergarten
oral health assessment activities.
E. Screening linked to essential services.
F. Coordination efforts of programs such as
kindergarten oral health assessment,
WIC/Head Start, pre-school/school
based/linked programs, Denti-Cal, Children's
Health and Disability Prevention Program,
Home Visiting and other programs.
G. Identify prevention and healthcare policies
and guidelines implemented.
Deliverable Il
Objective 8
Compile data for and report annually on tobacco
cessation activities, completing all relevant
components on the Data Form:
A. Assessment of readiness of dental offices to
provide tobacco cessation counseling.
B. Training to dental offices for providing
tobacco cessation counseling.
C. Dental offices connected to resources
a
Deliverable 12
Objective 8
Compile data for and report annually on Rethink Your
Drink activities, completing all relevant components
on the Data Form:
A. Assessment of readiness of dental offices to
implement Rethink Your Drink materials and
resources for guiding patients towardI
B. Tdrranikn.'inngg Wtoadleerntal offices for implementing '
Rethink Your Drink materials.
C. Dental offices connected to resources
a
D::;:e 13
I
Compile data for and report annually on health '
literacy and communication activities, completing all
relevant components on the Data Form:
A. Partners and champions recruited to launch
.health literacy campaigns
B. Assessments conducted to assess
opportunities for implementation
C. Training and guidance provided
D. Sites/organizations implementing health
literacy activities
I
[X
Deliverable 14
Ob3ective 10
I
Compile data for and report annually on health care
delivery and care coordination systems and
resources, completing all relevant components on the
Data Form:
A. Assessments conducted to assess
opportunities for implementation of
community-clinical linkages and care
coordination
a
Page 7 of 8
Document D
Scope of Work and Deliverables
FY 2017 2022
Deliverable Activities Selected deliverable
B. Resources such as outreach, Community of
Practice, and training developed
C. Providers and systems engaged
Deliverable 15
Objective 1l
Compile data for and report annually on community
engagement activities, completing all relevant
components on the Data Form:
A. Develop a core workgroup to identify
strategies to achieve local oral health
improvement.
B. Provide a list of community engagement
strategies to address policy, financing,
education, and dental care.
[X
I
Deliverable 16
Objective 1-11
Progress reporting: submit bi-annual progress
reports describing in detail progress of program and
evaluation activities and progress towards completing
deliverables. Provide documentation in sufficient
detail to support the reported activities on planning
and intervention activities for required and selected
objectives.
Itx
I
Deliverable 17
Objective 1-11
Expense documenting: submit all expenses
incurred during each state fiscal year with the ability
to provide back-up documentation for expenses in
sufficient detail to allow CDPH-OHP to ascertain
compliance with Proposition 56, the California
Healthcare, Research and Prevention Tobacco Tax
Act of 2016 Likewise, provide biannual Progress
Reports describing in detail the program activities
conducted, and the ability to provide source
documentation in sufficient detail to support the
reported activities.
[X
I
I
Page 8 of 8
Fresno County Department of Public Health
Grant # 17-10690
Exhibit B
Budget Detail and Payment Provisions
Page 1 of 2
1. Invoicing and Payment
A. Upon completion of project activies as provided in Exhibit A Grant Application, and upon
receipt and approval of the invoices, the State agrees to reimburse the Grantee for activities
performed and expenditures incurred in accordance with the costs specified herein.
B. Invoices shall include the Grant Number and shall be submitted not more frequently than
monthly in arrears to:
Angela Wright
California Department of Public Health
Oral Health Program
MS 7208
1616 Capitol Avenue, Suite 74.420
P.O. Box 997377, Sacramento, CA 95899-7377
C. Invoices shall:
1) Be prepared on Grantee letterhead. If invoices are not on produced letterhead invoices
must be signed by an authorized official, employee or agent certifying that the
expenditures claimed represent activities performed and are in accordance with Exhibit A
Grant Application under this Grant.
2) Bear the Grantee’s name as shown on the Grant.
3) Identify the billing and/or performance period covered by the invoice.
4) Itemize costs for the billing period in the same or greater level of detail as indicated in this
Grant. Subject to the terms of this Grant, reimbursement may only be sought for those
costs and/or cost categories expressly identified as allowable and approved by CDPH.
2. Budget Contingency Clause
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years
covered under this Agreement does not appropriate sufficient funds for the program, this
Agreement shall be of no further force and effect. In this event, the State shall have no
liability to pay any funds whatsoever to Grantee or to furnish any other considerations under
this Agreement and Grantee shall not be obligated to fulfill any provisions of this Agreement.
B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, the State shall have the option to either cancel this Agreement with no liability
occurring to the State, or offer an agreement amendment to Grantee to reflect the reduced
amount.
3. Prompt Payment Clause
Payment will be made in accordance with, and within the time specified in, Government Code
Chapter 4.5, commencing with Section 927.
Fresno County Department of Public Health
Grant # 17-10690
Exhibit B
Budget Detail and Payment Provisions
Page 2 of 2
4. Amounts Payable
A. The amounts payable under this Grant shall not exceed:
1) $528,856 for the budget period of 01/01/2018 through 06/30/2018.
2) $528,856 for the budget period of 07/01/2018 through 06/30/2019.
3) $528,856 for the budget period of 07/01/2019 through 06/30/2020.
4) $528,856 for the budget period of 07/01/2020 through 06/30/2021.
5) $528,856 for the budget period of 07/01/2021 through 06/30/2022.
B. Payment allocations shall be made for allowable expenses up to the amount annually
encumbered commensurate with the state fiscal year in which services are fulfilled and/or
goods are received.
5. Timely Submission of Final Invoice
A. A final undisputed invoice shall be submitted for payment no more than ninety (90) calendar
days following the expiration or termination date of this Grant, unless a later or alternate
deadline is agreed to in writing by the program grant manager. Said invoice should be clearly
marked “Final Invoice”, indicating that all payment obligations of the State under this Grant
have ceased and that no further payments are due or outstanding.
B. The State may, at its discretion, choose not to honor any delinquent final invoice if the
Grantee fails to obtain prior written State approval of an alternate final invoice submission
deadline.
6. Travel and Per Diem Reimbursement
Any reimbursement for necessary travel and per diem shall be at the rates currently in effect as
established by the California Department of Human Resources (CalHR).
Fresno County Department of Public Health
Grant #17-10690
Page 1 of 4
EXHIBIT C
STANDARD GRANT CONDITIONS
1. APPROVAL: This Grant is of no force or effect until signed by both parties and approved by
the Department of General Services, if required. The Grantee may not commence
performance until such approval has been obtained
2. AMENDMENT: No amendment or variation of the terms of this Grant shall be valid unless
made in writing, signed by the parties, and approved as required. No oral understanding or
Agreement not incorporated in the Grant is binding on any of the parties. In no case shall
the Department materially alter the scope of the Project set forth in Exhibit A.
3. ASSIGNMENT: This Grant is not assignable by the Grantee, either in whole or in part,
without the written consent of the Grant Manager in the form of a written amendment to the
Grant.
4. AUDIT: Grantee agrees that the Department, the Bureau of State Audits, or their designated
representative shall have the right to review and to copy any records and supporting
documentation pertaining to this Grant. Grantee agrees to maintain such records for a
possible audit for a minimum of three (3) years after final payment or completion of the
project funded with this Grant, unless a longer period of records retention is stipulated.
Grantee agrees to allow the auditor(s) access to such records during normal business hours
and to allow interviews of any employees who might reasonably have information related to
such records. Further, Grantee agrees to include a similar right of the State to audit records
and interview staff in any subcontract related to the project.
5. CONFLICT OF INTEREST: Grantee certifies that it is in compliance with all applicable state
and/or federal conflict of interest laws.
6. INDEMNIFICATION: Grantee agrees to indemnify, defend and save harmless the State, its
officers, agents and employees from any and all claims and losses accruing or resulting to
any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or
corporation furnishing or supplying work services, materials, or supplies in connection with
the project, and from any and all claims and losses accruing or resulting to any person, firm
or corporation who may be injured or damaged by Grantee in the performance of any
activities related to the Project.
7. FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS: Grantee agrees
that, at a minimum, its fiscal control and accounting procedures will be sufficient to permit
tracing of all grant funds to a level of expenditure adequate to establish that such funds have
not been used in violation of any applicable state or federal law, or the provisions of this
Grant. Grantee further agrees that it will maintain separate Project accounts in accordance
with generally accepted accounting principles.
8. GOVERNING LAW: This Grant is governed by and shall be interpreted in accordance with
the laws of the State of California.
Fresno County Department of Public Health
Grant #17-10690
Page 2 of 4
9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other
amounts (including any interest thereon) accruing to or received by the Grantee under this
Grant shall be paid by the Grantee to the Department, to the extent that they are properly
allocable to costs for which the Grantee has been reimbursed by the Department under this
Grant.
10. INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the
performance of the Project, shall act in an independent capacity and not as officers,
employees or agents of the Department.
11. MEDIA EVENTS: Grantee shall notify the Department’s Grant Manager in writing at least
twenty (20) working days before any public or media event publicizing the accomplishments
and/or results of the Project and provide the opportunity for attendance and participation by
Department’s representatives.
12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any
rights or remedies for any third- party as a beneficiary of this Grant or the project.
13. NOTICE: Grantee shall promptly notify the Department’s Grant Manager in writing of any
events, developments or changes that could affect the completion of the project or the budget
approved for this Grant.
14. PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform
services under this Grant where such services are called for.
15. RECORDS: Grantee certifies that it will maintain Project accounts in accordance with
generally accepted accounting principles. Grantee further certifies that it will comply with the
following conditions for a grant award as set forth in the Request for Applications (Exhibit D)
and the Grant Application (Exhibit A).
A. Establish an official file for the Project which shall adequately document all
significant actions relative to the Project;
B. Establish separate accounts which will adequately and accurately depict all
amounts received and expended on this Project, including all grant funds received
under this Grant;
C. Establish separate accounts which will adequately depict all income received which
is attributable to the Project, especially including any income attributable to grant
funds disbursed under this Grant;
D. Establish an accounting system which will adequately depict final total costs of the
Project, including both direct and indirect costs; and,
E. Establish such accounts and maintain such records as may be necessary for the
state to fulfill federal reporting requirements, including any and all reporting
requirements under federal tax statutes or regulations.
16. RELATED LITIGATION: Under no circumstances may Grantee use funds from any
disbursement under this Grant to pay for costs associated with any litigation between the
Grantee and the Department.
Fresno County Department of Public Health
Grant #17-10690
Page 3 of 4
17. RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings,
specifications, reports, computer programs, operating manuals, notes, and other written or
graphic work submitted under Exhibit A in the performance of the Project funded by this Grant
shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part,
any final form data and information received, collected, and developed under this Project,
subject to appropriate acknowledgment of credit to the Department for financial support.
Grantee shall not utilize the materials submitted to the Department (except data) for any profit
making venture or sell or grant rights to a third-party who intends to do so. The Department
has the right to use submitted data for all governmental purposes.
18. VENUE: The Department and Grantee agree that any action arising out of this Grant shall be
filed and maintained in the Superior Court, California. Grantee waives any existing sovereign
immunity for the purposes of this Grant, if applicable.
19. STATE-FUNDED RESEARCH GRANTS:
A. Grantee shall provide for free public access to any publication of a department-funded
invention or department-funded technology. Grantee further agrees to all terms and
conditions required by the California Taxpayer Access to Publicly Funded Research Act
(Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the
Government Code).
B. As a condition of receiving the research grant, Grantee agrees to the following terms and
conditions which are set forth in Government Code section 13989.6 (“Section 13989.6”):
1) Grantee is responsible for ensuring that any publishing or copyright agreements
concerning submitted manuscripts fully comply with Section 13989.6.
2) Grantees shall report to the Department the final disposition of the research grant,
including, but not limited to, if it was published, when it was published, where it was
published, when the 12-month time period expires, and where the manuscript will be
available for open access.
3) For a manuscript that is accepted for publication in a peer-reviewed journal, the
Grantee shall ensure that an electronic version of the peer-reviewed manuscript is
available to the department and on an appropriate publicly accessible database
approved by the Department, including, but not limited to, the University of California’s
eScholarship Repository at the California Digital Library, PubMed Central, or the
California Digital Open Source Library, to be made publicly available not later than 12
months after the official date of publication. Manuscripts submitted to the California
Digital Open Source Library shall be exempt from the requirements in subdivision (b)
of Section 66408 of the Education Code. Grantee shall make reasonable efforts to
comply with this requirement by ensuring that their manuscript is accessible on an
approved publicly accessible database, and notifying the Department that the
manuscript is available on a department-approved database. If Grantee is unable to
ensure that their manuscript is accessible on an approved publicly accessible
database, Grantee may comply by providing the manuscript to the Department not
later than 12 months after the official date of publication.
Fresno County Department of Public Health
Grant #17-10690
Page 4 of 4
4) For publications other than those described inparagraph B.3 above,, including
meeting abstracts, Grantee shall comply by providing the manuscript to the
Department not later than 12 months after the official date of publication.
5) Grantee is authorized to use grant money for publication costs, including fees charged
by a publisher for color and page charges, or fees for digital distribution.
Exhibit D
Request for Application
State of California—Health and Human Services Agency
California Department of Public Health
KAREN L. SMITH, MD, MPH EDMUND G. BROWN JR.
Director and State Public Health Officer Governor
Oral Health Program, MS 7210 ● P.O. Box 997377 ● Sacramento, CA 95899-7377
(916) 324-1715 ● (916) 552-9729 FAX
Department Website (www.cdph.ca.gov)
September 27, 2017
Dear California Local Health Officer:
NOTIFICATION OF INTENT TO SUPPORT LOCAL ORAL HEALTH PROGRAMS
This letter provides notification of the intent to award funds to local health departments
or jurisdictions (LHJs) through Proposition 56, The California Healthcare, Research and
Prevention Tobacco Tax Act of 2016 (Prop 56), pending approval of the State Budget
for Fiscal Year 2017/18. The California Department of Public Health (CDPH), Oral
Health Program (OHP) has a unique opportunity to build capacity at the local level to
address oral health which is essential for overall health. Tooth decay is the number one
chronic disease of childhood.
The purpose of this award is to support the proposed California Oral Health Plan
activities. We are confident that the LHJs, in collaboration with the CDPH/OHP, will
strive to achieve improvements in oral health and accomplish the state oral health
objectives within their jurisdictions. The activities should address problems identified by
LHJ needs assessments and reflect the California Oral Health Plan priorities.
The activities in Year 1 may be focused on planning for implementation of interventions
in subsequent years. The planning exercise should lead to a three ye ar action plan.
Smaller counties may choose to form a consortium with other LHJs and pool resources
to implement local oral health programs. LHJs that prefer a resource pool approach
should notify CDPH. Based on the interest expressed by local First 5 Comm issions and
local Child Health and Disability Prevention Programs, LHJs are strongly encouraged to
collaborate with them in developing a local oral health program.
We anticipate that approximately $18 million will be available for distribution. Award
amounts to LHJs will vary and be determined by the estimated low income population
based on the United States Department of Agriculture Economic Research Service
estimate of county poverty rate (https://data.ers.usda.gov/reports.aspx?ID=17826).
It is anticipated that awards will be for a term of three years with an option to extend for
two additional years. CDPH will provide program guidance regarding requirements,
California Local Health Officer
Page 2
June 2, 2017
Scope of Work, and Budget once that information becomes final. Funds from Prop 56
will become available on July 1, 2017.
Please complete the attached Letter of Intent form and submit by June 30, 2017,
to indicate whether you intend to participate or not.
Additional information about the Local Oral Health Programs will be forthcoming. If you
have questions in the meantime, please contact Rosanna Jackson, Oral Health
Program Manager, at Rosanna.Jackson@cdph.ca.gov, or at (916) 552-9896.
The next few years will provide California with a unique opportunity to work together to
improve oral health for all Californians, while also furthering the California Oral Health
Plan objectives. We look forward to working with you.
Sincerely,
Jayanth V. Kumar, DDS, MPH
State Dental Director
Enclosure
Fresno County Department of Public Health
Grant #17-10690
Page 1 of 4
Exhibit E
Additional Provisions
Page 1 of 4
1. Additional Incorporated Documents
A. The following documents and any subsequent updates are not attached, but are
incorporated herein and made a part hereof by this reference. CDPH will maintain on file, all
documents referenced herein and any subsequent updates, as required by program
directives. CDPH shall provide the Contractor with copies of said documents and any
periodic updates thereto, under separate cover.
1. Local Health Jurisdiction Local Oral Health Program Guidelines for Grant Application
https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CDCB/CDPH%20Document%20Li
brary/Oral%20Health%20Program/2017-2022PHASEILHJLOHPGuidelines_8-23-
17_ADA.pdf
2. Cancellation / Termination
A. This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days
advance written notice to the Grantee.
B. CDPH reserves the right to cancel or terminate this Grant immediately for cause. The
Grantee may submit a written request to terminate this Grant only if CDPH substantially fails
to perform its responsibilities as provided herein.
C. The term “for cause” shall mean that the Grantee fails to meet the terms, conditions, and/or
responsibilities of this agreement. Causes for termination include, but are not limited to the
following occurrences:
1) If the Grantee knowingly furnishes any statement, representation, warranty, or
certification in connection with the agreement, which representation is materially false,
deceptive, incorrect, or incomplete.
2) If the Grantee fails to perform any material requirement of this Grant or defaults in
performance of this agreement.
3) If the Grantee files for bankruptcy, or if CDPH determines that the Grantee becomes
financially incapable of completing this agreement.
D. Grant termination or cancellation shall be effective as of the date indicated in CDPH’s
notification to the Grantee. The notice shall stipulate any final performance, invoicing or
payment requirements.
E. In the event of early termination or cancellation, the Grantee shall be entitled to
compensation for services performed satisfactorily under this agreement and expenses
incurred up to the date of cancellation and any non-cancelable obligations incurred in
support of this Grant.
F. In the event of termination, and at the request of CDPH, the Grantee shall furnish copies of
all proposals, specifications, designs, procedures, layouts, copy, and other materials related
Fresno County Department of Public Health
Grant #17-10690
Page 2 of 4
Exhibit E
Additional Provisions
Page 2 of 4
to the services or deliverables provided under this Grant, whether finished or in progress on
the termination date.
G. The Grantee will not be entitled to reimbursement for any expenses incurred for services
and deliverables pursuant to this agreement after the effective date of termination.
H. Upon receipt of notification of termination of this Grant, and except as otherwise specified by
CDPH, the Grantee shall:
1) Place no further order or subgrants for materials, services, or facilities.
2) Settle all outstanding liabilities and all claims arising out of such termination of orders
and subgrants.
3) Upon the effective date of termination of the Grant and the payment by CDPH of all
items properly changeable to CDPH hereunder, Grantee shall transfer, assign and make
available to CDPH all property and materials belonging to CDPH, all rights and claims to
any and all reservations, grants, and arrangements with owners of media/PR materials,
or others, and shall make available to CDPH all written information regarding CDPH’s
media/PR materials, and no extra compensation is to be paid to Grantee for its services.
4) Take such action as may be necessary, or as CDPH may specify, to protect and
preserve any property related to this agreement which is in the possession of the
Grantee and in which CDPH has or may acquire an interest.
I. CDPH may, at its discretion, require the Grantee to cease performance of certain
components of the Scope of Work as designated by CDPH and complete performance of
other components prior to the termination date of the Grant.
3. Avoidance of Conflicts of Interest by Grantee
A. CDPH intends to avoid any real or apparent conflict of interest on the part of the Grantee,
subgrants, or employees, officers and directors of the Grantee or subgrants. Thus, CDPH
reserves the right to determine, at its sole discretion, whether any information, assertion or
claim received from any source indicates the existence of a real or apparent conflict of
interest; and, if a conflict is found to exist, to require the Grantee to submit additional
information or a plan for resolving the conflict, subject to CDPH review and prior approval.
B. Conflicts of interest include, but are not limited to:
1) An instance where the Grantee or any of its subgrants, or any employee, officer, or
director of the Grantee or any subgrant or has an interest, financial or otherwise,
whereby the use or disclosure of information obtained while performing services under
the grant would allow for private or personal benefit or for any purpose that is contrary to
the goals and objectives of the grant.
2) An instance where the Grantee’s or any subgrant’s employees, officers, or directors use
their positions for purposes that are, or give the appearance of being, motivated by a
Fresno County Department of Public Health
Grant #17-10690
Page 3 of 4
Exhibit E
Additional Provisions
Page 3 of 4
desire for private gain for themselves or others, such as those with whom they have
family, business or other ties.
C. If CDPH is or becomes aware of a known or suspected conflict of interest, the Grantee will
be given an opportunity to submit additional information or to resolve the conflict. A Grantee
with a suspected conflict of interest will have five (5) working days from the date of
notification of the conflict by CDPH to provide complete information regarding the suspected
conflict. If a conflict of interest is determined to exist by CDPH and cannot be resolved to
the satisfaction of CDPH, the conflict will be grounds for terminating the grant. CDPH may,
at its discretion upon receipt of a written request from the Grantee, authorize an extension of
the timeline indicated herein.
4. Dispute Resolution Process
A. A Grantee grievance exists whenever there is a dispute arising from CDPH’s action in the
administration of an agreement. If there is a dispute or grievance between the Grantee and
CDPH, the Grantee must seek resolution using the procedure outlined below.
1) The Grantee should first informally discuss the problem with the CDPH Program Grant
Manager. If the problem cannot be resolved informally, the Grantee shall direct its
grievance together with any evidence, in writing, to the program Branch Chief. The
grievance shall state the issues in dispute, the legal authority or other basis for the
Grantee's position and the remedy sought. The Branch Chief shall render a decision
within ten (10) working days after receipt of the written grievance from the Grantee. The
Branch Chief shall respond in writing to the Grantee indicating the decision and reasons
therefore. If the Grantee disagrees with the Branch Chief’s decision, the Grantee may
appeal to the second level.
2) When appealing to the second level, the Grantee must prepare an appeal indicating the
reasons for disagreement with Branch Chief’s decision. The Grantee shall include with
the appeal a copy of the Grantee's original statement of dispute along with any
supporting evidence and a copy of the Branch Chief’s decision. The appeal shall be
addressed to the Deputy Director of the division in which the branch is organized within
ten (10) working days from receipt of the Branch Chief’s decision. The Deputy Director
of the division in which the branch is organized or his/her designee shall meet with the
Grantee to review the issues raised. A written decision signed by the Deputy Director of
the division in which the branch is organized or his/her designee shall be directed to the
Grantee within twenty (20) working days of receipt of the Grantee's second level appeal.
B. If the Grantee wishes to appeal the decision of the Deputy Director of the division in which
the branch is organized or his/her designee, the Grantee shall follow the procedures set
forth in Division 25.1 (commencing with Section 38050) of the Health and Safety Code and
the regulations adopted thereunder. (Title 1, Division 2, Chapter 2, Article 3 (commencing
with Section 1140) of the California Code of Regulations).
C. Disputes arising out of an audit, examination of an agreement or other action not covered by
subdivision (a) of Section 20204, of Chapter 2.1, Title 22, of the California Code of
Regulations, and for which no procedures for appeal are provided in statute, regulation or
Fresno County Department of Public Health
Grant #17-10690
Page 4 of 4
Exhibit E
Additional Provisions
Page 4 of 4
the Agreement, shall be handled in accordance with the procedures identified in Sections
51016 through 51047, Title 22, California Code of Regulations.
D. Unless otherwise stipulated in writing by CDPH, all dispute, grievance and/or appeal
correspondence shall be directed to the CDPH Grant Manager.
E. There are organizational differences within CDPH’s funding programs and the management
levels identified in this dispute resolution provision may not apply in every contractual
situation. When a grievance is received and organizational differences exist, the Grantee
shall be notified in writing by the CDPH Grant Manager of the level, name, and/or title of the
appropriate management official that is responsible for issuing a decision at a given level.
CCC 04/2017
CERTIFICATION
I, th e officia l named below, CER TIF Y UND E R PENALTY OF P E RJURY that I am dul y
a utho ri zed to legall y bind the prospecti ve Contra c to r to the c la use(s) li sted below. This
certifi cati o n is made unde r the laws of the S ta t e of Cal ifo rni a.
Co ntractor/Bidder Fir m Name (Printed) Federal ID Nu mber
County of Fresno 94-6000512
By (A uthori~Signature) ATTEST: .AO-~ ··-BERNICE E. SEIDEL ( } -Clerk to the Board of Superviso rs
Prm ted Name and Title of Person S igning County of Fre sno, State of Cal iforni a
Sal Quintero , Chairman , Board of Supervisors By ~ AS.0.~ ~~a:? Dep u ty
Date Executed Executed in the Co unty of
February 6, 2018 Fresno
CONTRACTOR CERTIFICATION C LAUSES
1. STATEMENT OF COMPLIANCE: Co ntracto r has, unless exempted, complie d w ith
the no ndiscriminatio n progra m re quirements. (Gov . Cod e§ 12990 (a-f) and CC R, Title 2,
Sectio n 111 02) (Not appli cabl e to public e ntiti es.)
2. DR UG -FREE WORKP LACE REQUIREMENTS: Contrac to r wi ll compl y w ith the
r e quirements of the Drug -F ree Workplace Act of 1990 and w ill provide a drug -free
workplace by ta k in g the fo ll owing actions:
a. Publish a s tatement n o ti fy in g e mployees that unl awful m a nufac ture , d istributi o n ,
di spen sati o n, possess io n o r u se of a contro lled s ub s tance is proh ibi ted and s p ecify ing
actions to b e taken aga in s t e mpl oyees for v io la ti o n s.
b . Establi sh a Drug -Free Awareness P rogra m to in fo rm e mpl oyees about:
I) th e danger s of drug abu se in the workplace;
2) the person's o r organ ization's p o li cy of m a intaining a dru g -free workplace;
3) a ny availab le counseling, rehabi litatio n and e mpl oyee a ss ist a n ce program s; a nd ,
4) p e n a lti es th at may b e im posed upo n e mpl oyees fo r drug abuse vi o la ti o ns.
c. Every e mployee who works o n the proposed Agreement will :
1) rece ive a copy of the com pa ny's dru g -free workplace p o li cy stateme nt ; a nd ,
2) agree to ab id e b y t he te rm s of the co mpa n y's s tateme nt as a conditi o n of employment
o n the Agreement.
Fai lu re to com pl y w ith these r e quirements m ay re sult in su sp e n s io n of pay m ents unde r
t he Agree m e nt o r terminatio n of th e Agreeme nt or bo th and Contractor m ay b e in e li g ibl e
for award of a n y future State agreeme nts if th e departme nt d ete rmines that an y of th e
fo ll owin g h as occurred : the Con tractor has m a de fa lse certificatio n , or v io la te d 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-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. The 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.
b. The 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 the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). 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.
2). 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):
1). For the two-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.
2). For the twelve-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 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)
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.
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.
STATE OF CALIFORNIA
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT
DGS OLS 04 (Rev. 01/17)
DEPAR TM EN T OF GEN ERAL SERVICES
OFFICE OF LEGAL SER VlCES
Pursuant to Publi c Contract Code section 2010, a person t hat submits a b id or proposal to. or
otherwise proposes to enter into or renew a contract wi th . a state agency with respect to any
contract in th e amount of $100,000 or above shall certify , under penalty perj ury, at the time the
bid or proposal is submitted o r t he contract is renewed, all of the following:
1. CALI FORNIA CIVI L R I GHTS LAWS: For contracts executed or renewed after J anuary 1,
2017, the contr actor certifies comp liance wit h the Unruh Civil R ights Act (Section 51 of the C ivi l
Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code);
and
2. EMPLOYER DISCRIMINATORY POLICI ES: For contracts executed or renewed after
January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples
recognized by the U n ited States government, the Contractor certmes that such policies are not
used in vio lation of the Unruh Civil R ights Act (Section 51 of the Civil Code) or the Fa ir
Employment and Housing Act (Section 12960 of the Government Code).
CERTIFICATION
,------------------· -----. ---------------------------,--;:-----------·-------, , I , the official named below, certify under penalty of perjury under Federal ID Number •
I the laws of the State of California that the foregoing is tru e and !
I I I correct . 946000512 1
I Proposer/Bidder Firm Name (Printed) i
! County of Fresno __ I
1------------------------------------------------------.J..----------------,
Ly (A"l!fF8) -----------______________________ J
I Printed Name and TTtle of Perso n Signing I
I Sa l Quintero, Cha irman , Board of Supervisors i
r-------------------------------,---------------------------------------------~ I Date Executed I Executed in the County and State o f I
! J_ -Ll)-1 ~ ! Fresno California !
L-----· ----------· -----------L-----------------------------------------· t
ATTEST :
BERN ICE E. SE IDE L
Clerk to the Board of Supervisors
Co unt y of Fresn o, State of Cal ifo rnia
By ~J':i\,10 b-\ShDf> Deputy
STATE DPH Agreement – Local Oral Health Program Grant (No. 17-10690)
FOR FRESNO COUNTY ACCOUNTING USE ONLY:
Fund/Subclass 0001/10000
Org. No. 56201553
Account No. 4380