HomeMy WebLinkAboutAgreement A-22-124 with Department of State Hospitals.pdf SCO ID: 4440-2176003008 Agreement No. 22-124
STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES
STANDARD AGREEMENT AGREEMENT NUMBER PURCHASING AUTHORITY NUMBER Of Applicable)
STD 213(Rev.04/2020) 21-76003-008 DSH-4440
1.This Agreement is entered into between the Contracting Agency and the Contractor named below:
CONTRACTING AGENCY NAME
Department of State Hospitals
CONTRACTOR NAME
Fresno County Sheriffs Office
2.The term of this Agreement is:
START DATE
July 1,2021
THROUGH END DATE
June 30,2024
3.The maximum amount of this Agreement is:
$180,000.00
One Hundred Eighty Thousand Dollars and Zero Cents
4.The parties agree to comply with the terms and conditions of the following exhibits,which are by this reference made a part of the Agreement.
Exhibits Title Pages
Exhibit A Scope of Work 4
Exhibit B Budget Detail and Payment Provisions 5
Exhibit C General Terms and Conditions-04/2017 4
Exhibit D Special Terms and Conditions 8
t1
Exhibit F Information Privacy and Security Requirements 12
Items shown with an asterisk *),are hereby incorporated by reference and made part of this agreement as if attached hereto.
These documents can be viewed athops://www.dgs ca gov/OLS/Resources
IN WITNESS WHEREOF,THIS AGREEMENT HAS BEEN EXECUTED BY THE PARTIES HERETO.
CONTRACTOR
CONTRACTOR NAME(if other than an individual,state whether a corporation,partnership,etc.)
Fresno County Sheriffs Office
CONTRACTOR BUSINESS ADDRESS CITY STATE ZIP
2200 Fresno Street Fresno CA 93721
PRINTED NAME OF PERSON SIGNING TITLE
Brian Pacheco Chairman of the Board of Supervisors of the County of
Fresno
CONTRA AI�THORIZED SIGNATURE DATE SIGNED
II �It — 5 �-
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By `tit/Yl�i
Deputy
Page 1 of 2
SCO ID: 4440-2176003008
STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES
STANDARD AGREEMENT AGREEMENT NUMBER RCHASING AUTHORITY NUMBER(If Applicable)
PU
STD 213(Rev.04/2020) 21-76003-008 DSH-4440
STATE OF CALIFORNIA
CONTRACTING AGENCY NAME
Department of State Hospitals
CONTRACTING AGENCY ADDRESS CITY STATE ZIP
1215 0 Street,MS-1 Sacramento CA 95814
PRINTED NAME OF PERSON SIGNING TITLE
Tiffany Ladd Section Manager, PCSS
CONTRACTING AGENCY AUTHORIZED SIGNATURE DATE SIGNED
CALIFORNIA DEPARTMENT OF GENERAL SERVICES APPROVAL EXEMPTION(If Applicable)
W&I Code 4335.2(f)
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit A, Scope of Work
EXHIBIT A
SCOPE OF WORK
1. CONTRACTED PARTIES:
A. This Agreement is made and entered into by and between, the Department of State Hospitals
(DSH) and Fresno County Sheriffs Office, hereafter referred to as Contractor, to provide DSH with
relevant inmate medical records, including mental health and behavioral health records, and
coordinate telehealth video interviews of defendants who have been committed to DSH as
Incompetent to Stand Trial (IST) on a felony charge, and are awaiting admission to a DSH facility.
Services are to be provided in accordance with Welfare and Institutions Code (WIC) section 4335.2
and are identified as IST Re-Evaluation services herein. IST Re-Evaluation Services performed by
DSH will be for the purposes of re-evaluating competency status, psychotropic medication status,
and assessment for placement in an alternative community based programs including but not
limited to mental health diversion or community based restoration.
2. SERVICE LOCATIONS:
A. These services will be performed primarily through remote telehealth, video conferencing and other
technologies facilitated by the county jail or other county locations housing felony IST defendants
and in coordination with the DSH.
3. SERVICE HOURS:
A. The services shall be provided upon request during the hours of operation of the locations where
services are required. DSH shall make every effort to assign work to be performed Monday through
Friday, during core hours of 7:00 am to 7:00 pm.
4. PROJECT REPRESENTATIVES:
A. The project representatives during the term of this Agreement will be:
Contract Manager.,
Department of State Hospitals: Contractor
Section/Unit: Section/Unit:
Forensic Services Division Fresno County Sheriffs Office
Attention: Attention:
Gilbert Jackson, SSM I Steve McComas, Assistant Sheriff
Address: Address:
1215 O Street, MS-9 2200 Fresno Street
Sacramento, CA 95814 Fresno, CA 93721
Phone: Fax: Phone: Fax:
(916) 562-2810 (916) 653-2257 (559)-600-8145 N/A
Email: Email:
Gilbert.Jackson@dsh.ca.gov Ste hen.McComas fresnosheriff.or
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit A, Scope of Work
Administrative Contacts all administrative in uiries should be directed to)_:
Department of State Hospitals: Contractor: Insert Contractor's Name,
Section/Unit: Section/Unit:
Forensic Services Division Fresno County Sheriff's Office
Attention: Attention:
Kecia Aldridge-Hall Steve McComas, Assistant Sheriff
Address: Address:
1215 0 Street, MS-9 2200 Fresno Street
Sacramento, CA 95814 Fresno, CA 93721
Phone: Fax: Phone: Fax:
916 562-30221(916) 653-2257 559 -600-8145 N/A
Email: Email:
Kecia.Aldridge@dsh.ca.gov Stephen.McComas fresnosheriff.or
Either party may make changes to the contact names or information above by giving written notice
to the other party_ Said changes shall not require an amendment to this Agreement.
5. SUMMARY OF WORK TO BE PERFORMED:
A. The Contractor shall provide DSH with relevant and updated records of IST defendants who have
been selected by DSH to participate in this program.
B. The Contractor shall coordinate with DSH for the scheduling of interviews of those IST defendants
selected to participate in primarily telehealth video interviews.
C. The Contractor shall provide the necessary secure setting, technology, and security for these
evaluations.
D. The DSH makes no representation as to the minimum amount of services required under this
Agreement.
E. WIC section 4335.2, subdivision (c) provides, DSH shall have the authority and sole discretion to
consider and conduct reevaluations, which will occur primarily through video telehealth.
6. CONTRACTOR RESPONSIBILITIES:
A. The Contractor agrees to provide support services to DSH that shall include but not be limited to:
i. Securing and maintaining all necessary equipment such as a laptop or electronic tablets
installed with appropriate software and having access to a secured internet connection
required to facilitate telehealth video interviews with the DSH-assigned forensic evaluators.
DSH shall reserve the right to approve the software application that will be utilized for tele-
health video interviews of IST defendants.
ii. Coordinating with DSH forensic evaluators and other assigned staff in the scheduling of tele-
health interviews within 24 hours of DSH contact.
iii. Providing DSH with all relevant and updated inmate medical records which include, but are
not limited to, general medical records, mental health records, behavioral health records, and
custodial records, upon request by DSH and, at a maximum of 24 hours from the initial
request.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit A, Scope of Work
iv. Providing DSH with a contact to facilitate any DSH Evaluator requested collateral contacts
with jail and/or medical staff.
V. Providing the necessary logistics to facilitate the scheduled tele-health interview with the IST
defendant. Logistics shall include, but not be limited to, escorting the IST defendant from the
individual's cell to the interview room where the telehealth video interview will take place and
providing securiiy and monitoring of the IST defendant as necessary.
vi. Providing DSH and evaluators with a contact for technical assistance, and an emergency
contact to report any incidents that may arise during the interviews.
vii. Providing evaluators with access and security for any in-person interviews, which may occur
at the sole discretion of DSH.
viii. If services are provided on DSH grounds, then the Contractor shall participate in any of the
DSH workplace violence prevention, infection control-illness prevention, and workplace safety
measures or programs as may be required by DSH. This responsibility includes compliance
with infection control measures, use of Personal Protective Equipment(PPE) as prescribed by
DSH, attending any and all related training or orientation to such measures or programs as
may be required and scheduled by the DSH. DSH will provide the Contractor with electronic
versions of the DSH's current Illness and Injury Prevention Plan (IIPP), Workplace Violence
Prevention Plan (WVPP), DSH Code of Safe Practices, and other appropriate documents to
support worksite safety and infection control.
7. THE DSH RESPONSIBILITIES:
A. The DSH will provide the Contractor access to the DSH document management platform.
B. The DSH will provide the Contractor one-time start-up funds, based on a Flat rate set by DSH, for
reimbursement of information technology support, equipment and software necessary to facilitate
telehealth interviews such as laptops or tablets, internet and the associated licensing for necessary
software in coordination with DSH.
C. The DSH will reimburse Contractor for a portion of staff time utilized to facilitate video telehealth
interviews for each telehealth evaluation conducted. Refusals will only be paid when Defendant
declines to be interviewed to the evaluator, when the evaluator has the opportunity to speak to, see,
and observe the defendant. Reimbursement will be based on a flat rate set by DSH.
D. The DSH will coordinate with the Contractor regarding scheduling interviews, records requests,
and collateral interview contacts for IST defendants.
E. The DSH will provide Contractor with the most current approved IST invoice template. Contractor
will be paid on a quarterly basis in arrears following the conclusion of the telehealth evaluations.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit A, Scope of Work
8. PERFORMANCE MEASURES:
A. Complete and Timely Provision of Services
i. Expectations: Contractor is expected to provide all services which include, but are not limited
to, providing DSH with collateral contacts, relevant records and scheduling interviews, in a
timely manner—in accordance with timelines established by DSH.
9. AMENDMENTS:
A. The parties reserve the right to amend this Agreement by extending the term for up to one (1) one-
year renewal and to add funding sufficient for that period at the same rates. This right to amend is in
addition to the right to amend for other reasons contained in this Agreement. Any amendments shall
be in writing and signed by both parties, and be approved by the Department of General Services if
such approval is required.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit B, Budget Detail and Payment Provisions
EXHIBIT B
BUDGET DETAIL AND PAYMENT PROVISIONS
1. INVOICING AND PAYMENT:
A. Contractor shall submit all invoices not more frequently than monthly in arrears.
B. Invoices should be sent no later than 90-days past the month the evaluation was conducted (e.g.,
April 2022 invoice packet must be submitted no later than July 1, 2022).
C. The invoice shall identify all IST Defendants for whom DSH was provided with relevant updated
inmate medical records and has completed an interview. Refusals will only be paid when Defendant
declines to be interviewed to the evaluator, when the evaluator has the opportunity to speak to, see,
and observe the defendant..
D. For services satisfactorily rendered, and upon receipt and approval of invoices submitted as
described herein, the DSH agrees to compensate Contractor in accordance with the rates specified
in section 5, Budget Detail.
E. The DSH is not responsible for services performed by Contractor outside of this agreement, nor for
services performed other than as outlined in Exhibit A, Scope of Work.
F. The DSH makes no guarantee, either written or implied, as to the actual amount of funds that will
be expended under this Agreement.
2. INSTRUCTIONS TO CONTRACTOR:
A. To expedite the processing of invoices submitted to the DSH for payment. all invoice(s) shall be
submitted to the DSH for review and approval at either.
Department of State Hospitals
Attn: Accounts Payable
1215 O Street, MS-2
Sacramento, CA 95814
OR
E-Mail: DSH Sac.AccountsPayable(a�dsh.ca.gov
B. Contractor shall submit one original and one (1) copy of each invoice, unless emailed.
C. Contractor must utilize the most current DSH approved IST invoice template provided by DSH. The
Contractor shall type, not handwrite, each invoice. Step by step instructions to complete the invoice
will be provided by DSH.
D. DSH Administrators will provide the Contractor with the most current approved IST Invoice template
and detailed Invoice instructions.
E. Contractor shall clearly note Contractor's name and address on each invoice. The name on the
invoice must match the Payee Data Record (Std. 204) and the name listed on this Agreement.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit B, Budget Detail and Payment Provisions
F. Contractor shall list and itemize in accordance with section 5, Budget Detail, all services or
deliverables provided on each invoice.
G. Contractor shall include the following on each submitted invoice:
i. Date(s) during which the services or deliverables were provided and the date in which the
invoice was generated;
ii. Agreement number, which can be found on the Standard Agreement Form (Std. 213);
iii. First initial and last name of IST Defendant evaluated;
iv. Invoice total;
V. Written proof of DSH's approval as required by this Agreement for those services requiring pre-
approval.
3. 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 no
longer be in full force and effect. In this event, the State shall have no liability to pay any funds
whatsoever to Contractor or to furnish any other considerations under this Agreement and
Contractor shall not be obligated to perform any provisions of this Agreement.
B. If funding for any Fiscal Year (FY) 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 Contractor to reflect the reduced amount.
C. If this Agreement overlaps Federal and State FYs, should funds not be appropriated by Congress or
approved by the Legislature for the FY in which the Agreement was entered into, and/or any
subsequent years covered under this Agreement, the State may exercise its option to cancel this
Agreement.
D. In addition, this Agreement is subject to any additional restrictions, limitations, or conditions enacted
by Congress or the Legislature which may affect the provisions or terms of funding of this
Agreement in any manner.
4. PROMPT PAYMENT CLAUSE:
A. Payment will be made in accordance with, and within the time specified in, Government Code
section 927, et seq.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit B, Budget Detail and Payment Provisions
5. BUDGET DETAIL:
A. Contractor shall be compensated in accordance with the following:
Rate Sheet
Jail Support Cost R to
One-time start-up Cost Reimbursement per County (laptops/software $5,000.00
etc.)
Sheriff Logistics and Coordination of re-evaluation (portion of jail staff $500.00 Flat Rate
time to provide support, escort, security and monitoring of the IST Per IST Evaluation
defendant)
i. The portion of staff time utilized to facilitate telehelath interviews and evaluation of felony IST
defendants in the jail will be compensated within the ail-inclusive flat rate fee per each IST
evaluation completed or refusal following articulated protocols referenced above.
ii. Each IST evaluation consist of a completed interview and updated records which include, but
are not limited to, general medical records, mental health records, behavioral health records,
and custodial records.
iii. If the IST Defendant declines to be interviewed to the evaluator, when the evaluator has the
opportunity to speak to, see, and observe the defendant. the completed interview criteria will be
met.
B. The DSH does not expressly or by implication agree that the actual amount of work will correspond
with any estimation provided in this Agreement, and reserves the right to omit portions of the
estimated amount of work as may be deemed necessary or advisable by the DSH. The estimates
listed above are a good faith estimate and are not a guarantee of business and is subject to change
depending on fluctuation in IST defendant referrals. The amounts indicated above/below will be
used solely for the purposes of encumbering funds. The DSH makes no guarantee, expressed or
implied for actual amount of work to be performed. However, the rates contained in Exhibit B shall
be binding for the term of this Agreement.
C. At the sole discretion of the DSH and for the purposes of accounting, the DSH may adjust the total
proposed expenditure for each fiscal year as needed to reflect work validated for completion. In no
event will this change the contract price for the services actually rendered.
D. Contractor must submit each invoice within ninety (90) days from the last day of the month in which
services were rendered; unless Contractor has pre-approval, in writing, from the DSH. If Contractor
fails to provide invoices within this timeframe, the DSH may elect to reject the invoices for payment
as untimely and Contractor will be deemed to have waived any right to payment of the late invoices.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit B. Budget Detail and Payment Provisions
DSH IST Received Stanp DSH IST Approved StanV
IST INVOICE
Month:
Year:
Is this Invoice the original or a Original
supplemental(additional) Supplemental
submission? (Additional)
FSD USE ONLY
Invoice Number:
Dispute Information:
Disputed Date:
Resolved Date:
CONTRACT INFORMATION: TO:
Business/Contract Name California Department of State Hospitals
Contracted Street Address Attn:Accounts Payable,Ms-2
1215 O Street
Contracted City,State,Zip Sacramento,CA95814
Contract Phone Number DSHSAC.AccountsPayable@dsh.ca.gov
Current Contract Number
STOP!
Please read!
The totals will appear
once your contractor
infromation is complete.
Invoice Summary
Evaluations:
Totallnvoice $ -
DATE SIGNED:
CONTRACTOR SIGNATURE:
Smell Business Certification Number' (If applicable)
SWUM Buaness c-vwawn Slanp Dale to DSH Accounlmg Stanp
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit B, Budget Detail and Payment Provisions
IST DOCUMENTATION FOR SERVICES FORM
IST Defendant
Interview Date Last Name & First Evaluator Rate Completed Total
Initial
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Evaluation Total: Service Total:
Required Fields This document is protected. only provide information in the requested areas.
The Total will appear only if Contractor information on cover sheet is complete.
Please make sure Contractor information is completed.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit C, General Terms and Conditions
EXHIBIT C
GENERAL TERMS AND CONDITIONS
1. APPROVAL: This Agreement is of no force or effect until signed by both parties and approved by the
Department of General Services, if required. Contractor may not commence performance until such
approval has been obtained.
2. AMENDMENT: No amendment or variation of the terms of this Agreement shall be valid unless made in
writing, signed by the parties and approved as required. No oral understanding or Agreement not
incorporated in the Agreement is binding on any of the parties.
3. ASSIGNMENT: This Agreement is not assignable by the Contractor, either in whole or in part, without the
consent of the State in the form of a formal written amendment.
4. AUDIT: Contractor agrees that the awarding department, the Department of General Services, 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 the performance of this Agreement. Contractor agrees to
maintain such records for possible audit for a minimum of three (3) years after final payment, unless a
longer period of records retention is stipulated. Contractor 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, Contractor agrees to include a similar right of the State
to audit records and interview staff in any subcontract related to performance of this Agreement. (Gov.
Code §8546.7, Pub. Contract Code §10115 et seq., CCR Title 2, Section 1896).
5. INDEMNIFICATION: Contractor 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 performance of this Agreement, and from any and all
claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged
by Contractor in the performance of this Agreement.
6. DISPUTES: Contractor shall continue with the responsibilities under this Agreement during any dispute.
7. TERMINATION FOR CAUSE: The State may terminate this Agreement and be relieved of any payments
should the Contractor fail to perform the requirements of this Agreement at the time and in the manner
herein provided. In the event of such termination the State may proceed with the work in any manner
deemed proper by the State. All costs to the State shall be deducted from any sum due the Contractor
under this Agreement and the balance, if any, shall be paid to the Contractor upon demand.
8. INDEPENDENT CONTRACTOR: Contractor, and the agents and employees of Contractor, in the
performance of this Agreement, shall act in an independent capacity and not as officers or employees or
agents of the State.
9. RECYCLING CERTIFICATION: The Contractor shall certify in writing under penalty of perjury, the
minimum, if not exact, percentage of post consumer material as defined in the Public Contract Code
Section 12200, in products, materials, goods, or supplies offered or sold to the State regardless of whether
Public Contract Code Section 12209. With respect to printer or
requirements of Pub c
the product meets the e p
P q
duplication cartridges that comply with the requirements of Section 12156(e), the certification required by
this subdivision shall specify that the cartridges so comply(Pub. Contract Code §12205).
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit C, General Terms and Conditions
10. NON-DISCRIMINATION CLAUSE: 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 and 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
§12900 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 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 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 nondiscrimination and compliance provisions of this clause in all subcontracts
to perform work under the Agreement.
11. CERTIFICATION CLAUSES: The CONTRACTOR CERTIFICATION CLAUSES contained in the document
CCC 04/2017 are hereby incorporated by reference and made a part of this Agreement by this reference
as if attached hereto.
12. TIMELINESS: Time is of the essence in this Agreement.
13. COMPENSATION: The consideration to be paid Contractor, as provided herein, shall be in compensation
for all of Contractor's expenses incurred in the performance hereof, including travel, per diem, and taxes,
unless otherwise expressly so provided.
14. GOVERNING LAW: This contract is governed by and shall be interpreted in accordance with the laws of
the State of California.
15.ANTITRUST CLAIMS: The Contractor by signing this agreement hereby certifies that if these services or
goods are obtained by means of a competitive bid, the Contractor shall comply with the requirements of the
Government Codes Sections set out below.
a. The Government Code Chapter on Antitrust claims contains the following definitions:
1) "Public purchase" means a purchase by means of competitive bids of goods, services, or materials
by the State or any of its political subdivisions or public agencies on whose behalf the Attorney
General may bring an action pursuant to subdivision (c) of Section 16750 of the Business and
Professions Code.
2) "Public purchasing body" means the State or the subdivision or agency making a public purchase.
Government Code Section 4550.
b. In submitting a bid to a public purchasing body, the bidder offers and agrees that if the bid is accepted,
it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit C, General Terms and Conditions
have under Section 4 of the Clayton Act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter 2
(commencing with Section 16700) of Part 2 of Division 7 of the Business and Professions Code),
arising from purchases of goods, materials, or services by the bidder for sale to the purchasing body
pursuant to the bid. Such assignment shall be made and become effective at the time the purchasing
body tenders final payment to the bidder. Government Code Section 4552.
c. If an awarding body or public purchasing body receives, either through judgment or settlement, a
monetary recovery for a cause of action assigned under this chapter, the assignor shall be entitled to
receive reimbursement for actual legal costs incurred and may, upon demand, recover from the public
body any portion of the recovery, including treble damages, attributable to overcharges that were paid
by the assignor but were not paid by the public body as part of the bid price, less the expenses incurred
in obtaining that portion of the recovery. Government Code Section 4553.
d. Upon demand in writing by the assignor, the assignee shall, within one year from such demand,
reassign the cause of action assigned under this part if the assignor has been or may have been
injured by the violation of law for which the cause of action arose and (a)the assignee has not been
injured thereby, or (b)the assignee declines to file a court action for the cause of action. See
Government Code Section 4554.
16. CHILD SUPPORT COMPLIANCE ACT: For any Agreement in excess of$100,000, the contractor
acknowledges in accordance with Public Contract Code 7110, that:
a. The contractor recognizes the importance of child and family support obligations and shall fully comply
with all applicable state and federal laws relating to child and family support enforcement, including, but
not limited to, disclosure of information and compliance with earnings assignment orders, as provided in
Chapter 8 (commencing with section 5200) of Part 5 of Division 9 of the Family Code; and
b. The contractor, to the best of its knowledge is fully complying with the earnings assignment orders of all
employees and is providing the names of all new employees to the New Hire Registry maintained by
the California Employment Development Department.
17. UNENFORCEABLE PROVISION: In the event that any provision of this Agreement is unenforceable or
held to be unenforceable, then the parties agree that all other provisions of this Agreement have force and
effect and shall not be affected thereby.
18. PRIORITY HIRING CONSIDERATIONS: If this Contract includes services in excess of$200,000, the
Contractor shall give priority consideration in filling vacancies in positions funded by the Contract to
qualified recipients of aid under Welfare and Institutions Code Section 11200 in accordance with Pub.
Contract Code §10353.
19. SMALL BUSINESS PARTICIPATION AND DVBE PARTICIPATION REPORTING REQUIREMENTS:
a. If for this Contract Contractor made a commitment to achieve small business participation, then
Contractor must within 60 days of receiving final payment under this Contract (or within such other time
period as may be specified elsewhere in this Contract) report to the awarding department the actual
percentage of small business participation that was achieved. (Govt. Code § 14841.)
b. If for this Contract Contractor made a commitment to achieve disabled veteran business enterprise
(DVBE) participation, then Contractor must within 60 days of receiving final payment under this
Contract (or within such other time period as may be specified elsewhere in this Contract) certify in a
Page 3 of 4
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit C, General Terms and Conditions
report to the awarding department: (1) the total amount the prime Contractor received under the
Contract; (2)the name and address of the DVBE(s)that participated in the performance of the
Contract; (3)the amount each DVBE received from the prime Contractor; (4) that all payments under
the Contract have been made to the DVBE; and (5) the actual percentage of DVBE participation that
was achieved. A person or entity that knowingly provides false information shall be subject to a civil
penalty for each violation. (Mil. &Vets. Code § 999.5(d); Govt. Code § 14841.)
20. LOSS LEADER: If this contract involves the furnishing of equipment, materials, or supplies then the
following statement is incorporated: It is unlawful for any person engaged in business within this state to
sell or use any article or product as a "loss leader" as defined in Section 17030 of the Business and
Professions Code. (PCC 10344(e).)
Page 4 of 4
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
EXHIBIT D
SPECIAL TERMS AND CONDITIONS
1. SUBCONTRACTS:
A. Except for subcontracts identified in accordance with the solicitation, Contractor shall submit any
subcontracts in connection with this Agreement to DSH for its prior written approval. No work shall
be subcontracted without the prior written approval of DSH. Upon the termination of any
subcontract, DSH shall be notified immediately. Any subcontract shall include all the terms and
conditions of this Agreement and its attachments.
B. Nothing contained in this Agreement shall create any contractual relationship between DSH and
any subcontractors, and Contractor is solely responsible for payment of any and all fees, expenses,
salaries and benefits of subcontractor. No subcontract shall relieve Contractor of its responsibilities
and obligations hereunder. Contractor is fully responsible to DSH for the acts and omissions of its
subcontractors and of persons either directly or indirectly employed or acting as an agent by any of
them. Contractor agrees to indemnify and hold DSH harmless for any costs, losses or claims,
including reasonable attorney fees, resulting from its subcontractors.
2. PUBLICATIONS AND REPORTS:
A. DSH reserves the right to use and reproduce all publications, reports, and data produced or
delivered pursuant to this Agreement. DSH further reserves the right to authorize others to use or
reproduce such materials, provided the author of the report is acknowledged in any such use or
reproduction.
B. If the publication and/or report are prepared by non-employees of DSH, and the total cost for such
preparation exceeds $5,000, the publication and/or report shall contain the numbers and dollar
amounts of all agreements and subcontracts relating to the preparation of the publication and report
in a separate section of the report (Government Code section 7550).
3. PROGRESS REPORTS:
A. If progress reports are required by the'Agreement, Contractor shall provide a progress report in
writing, or orally if approved by DSH Contract Manager, at least once a month to DSH Contract
Manager. This progress report shall include, but not be limited to; a statement that Contractor is or
is not on schedule, any pertinent reports, and any interim findings if applicable. Contractor shall
cooperate with and shall be available to meet with DSH to discuss any difficulties, or special
problems, so that solutions or remedies can be developed as soon as possible.
4. PRESENTATION:
A. Upon request, Contractor shall meet with DSH to present any findings, conclusions, and
required b th
e Agreement for approval. If set forth in the Agreement, Contractor
recommendationsy g pp 9
a
shall submit a comprehensive final report for approval. Both the final meeting and the final report
shall be completed on or before the date indicated in this Agreement.
Page 1 of 8
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
6. DEPARTMENT OF STATE HOSPITALS STAFF:
A. DSH's staff shall be permitted to work side-by-side with Contractor's staff to the extent and under
conditions as directed by DSH Contract Manager. In this connection, DSH's staff shall be given
access to all data, working papers, etc., which Contractor seeks to utilize.
B. The Contractor shall abide by DSH's written policy and procedures on "nepotism,"which is defined
as "The practice of an employee using their influence or power to aid or hinder another in the
employment setting because of a personal relationship."Accordingly, Contractor shall not use their
influence or power to aid or hinder another in DSH's or Contractor's employment setting because of
a personal relationship. The Contractor shall disclose any personal relationship with any current
DSH workforce member by completing DSH 3215 Verification of Personal Relationships and Hiring
of Relatives. Contractor shall also disclose any personal relationships with any current
subcontractor(s)'workforce member.
6. CONFIDENTIALITY OF DATA AND DOCUMENTS:
A. Contractor shall not disclose data or documents or disseminate the contents of the final or any
preliminary report without written permission of DSH Contract Manager. However, all public entities
shall comply with California Public Records Act(Government Code sections 6250 et seq.).
B. Permission to disclose information or documents on one occasion shall not authorize Contractor to
further disclose such information or documents on any other occasion except as otherwise provided
in the Agreement or required by law.
C. Contractor shall not comment publicly to the press, or any other media, regarding the data or
documents generated, collected, or produced in connection with this Agreement, or DSH's actions
on the same, except to DSH's staff, Contractor's own personnel involved in the performance of this
Agreement, or as required by law.
D. If requested by DSH, Contractor shall require each of its employees or officers who will be involved
in the performance of this Agreement to agree to the above terms in a form to be approved by DSH
and shall supply DSH with evidence thereof.
E. Each subcontract shall contain the foregoing provisions related to the confidentiality of data and
nondisclosure.
F. After any data or documents submitted has become a part of the public records of DSH, Contractor
may at its own expense and upon written approval by DSH Contract Manager, publish or utilize the
same data or documents but shall include the following Notice:
LEGAL NOTICE
This report was prepared as an account of work sponsored by the Department of State Hospitals
(Department) but does not necessarily represent the views of the Department or any of its employees
except to the extent, if any, that it has formally been approved by the Department. For information
regarding any such action, communicate directly with the Department at P.O. Box 952050, Sacramento,
California, 94252-2050. Neither said Department nor the State of California, nor any officer or employee
thereof, or any of its contractors or subcontractors makes any warranty, expressed or implied, or assumes
any legal liability whatsoever for the contents of this document. Nor does any party represent that use of
the data contained herein, would not infringe upon privately owned rights without obtaining permission or
authorization from any party who has any rights in connection with the data.
Page 2 of 8
Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
7. PROVISIONS RELATING TO DATA:
A. "Data" as used in this Agreement means recorded information, regardless of form or characteristics,
of a scientific or technical nature. It may, for example, document research, experimental,
developmental or engineering work; or be usable or be used to define a design or process; or
support a premise or conclusion asserted in any deliverable document called for by this Agreement.
The data may be graphic or pictorial delineations in media, such as drawings or photographs,
charts, tables, mathematical modes, collections or extrapolations of data or information, etc. It may
be in machine form, as punched cards, magnetic tape, computer printouts, or may be retained in
computer memory.
B. "Generated data" is that data, which a Contractor has collected, collated, recorded, deduced, read
out or postulated for utilization in the performance of this Agreement. Any electronic data
processing program, model or software system developed or substantially modified by Contractor in
the performance of this Agreement at the expense of DSH, together with complete documentation
thereof, shall be treated in the same manner as generated data.
C. "Deliverable data" is that data which under terms of this Agreement is required to be delivered to
DSH. Such data shall be property of the State of California and DSH.
D. Prior to the expiration of any legally required retention period and before destroying any data,
Contractor shall notify DSH of any such contemplated action; and DSH may within 30 days of said
notification determine whether or not this data shall be further preserved. DSH shall pay the
expense of further preserving this data. DSH shall have unrestricted reasonable access to the data
that is preserved in accordance with this Agreement.
E. Contractor shall use best efforts to furnish competent witnesses to testify in any court of law
regarding data used in or generated under the performance of this Agreement.
F. All financial, statistical, personal, technical and other data and information relating to DSH's
operation, which are designated confidential by the State or DSH and made available to carry out
the Agreement, or which become available to Contractor in order to carry out this Agreement, shall
be protected by Contractor from unauthorized use and disclosure.
G. If DSH determines that the data and information are inadequately protected by Contractor or its
subcontractors, DSH shall provide notice of its determination and Contractor and/or its
subcontractors shall improve the protections to DSH's satisfaction which shall be evidenced by
written approval of the protections implemented.
8. APPROVAL OF PRODUCT:
A. Each product to be approved under this Agreement shall be approved by the Contract Manager.
DSH's determination as to satisfactory work shall be final, absent fraud or mistake.
9. SUBSTITUTIONS:
A. Contractor's key personnel as indicated in its proposal may not be substituted without the Contract
Manager's prior written approval.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
10. NOTICE:
A. Notice to either party shall be given by first class mail, by Federal Express, United Parcel Service or
similar carrier, properly addressed, postage fully prepaid, to the address beneath the name of each
respective party. Alternatively, notice may be given by personal delivery by any means whatsoever
to the party and such notice shall be deemed effective when delivered.
11.WAIVER:
A. All remedies afforded in this Agreement are cumulative; that is, in addition to every other remedy
provided therein or by law. The failure of DSH to enforce any provision of this Agreement, shall not
waive its right to enforce the provision or any other provision of the Agreement.
12. GRATUITIES AND CONTINGENCY FEES:
A. Contractor shall not provide gratuities to any officer or employee of DSH or the State to secure an
agreement or favorable treatment with respect to an agreement, the occurrence of which shall
constitute a material breach of this Agreement. DSH, by written notice to Contractor, may terminate
this Agreement with cause if it is found that gratuities were offered or given by Contractor or any
agent or representative of Contractor to any officer or employee of the State or DSH with a view
toward securing an agreement or securing favorable treatment with respect to the awarding,
amending, or performance of such agreement.
B. In the event this Agreement is terminated as provided in the paragraph above, DSH shall be entitled
(a)to pursue the same remedies against Contractor as it could pursue in the event of the breach of
the Agreement by Contractor, and (b) as a predetermined amount of liquidated damages,
Contractor shall pay an amount which shall not be less than three times the cost incurred by
Contractor in providing any such gratuities to any such officer or employee.
C. The rights and remedies of DSH provided in this clause shall not be exclusive and are in addition to
any other rights and remedies provided by law or under this Agreement.
D. Contractor warrants by execution of this Agreement that no person or selling agency has been
employed or retained to solicit or secure this Agreement for a commission, percentage, brokerage
or contingent fee, excepting bona fide employees of Contractor, for the purpose of securing
business. For breach or violation of this warranty, DSH shall, among other rights, have the right to
rescind this Agreement without liability, paying only for the values of the work actually returned, or
in its discretion to deduct from the Agreement price or consideration, or otherwise recover, the full
amount of such commission, percentage, brokerage, or contingent fee.
13. INTEGRATION CLAUSE:
A. The parties agree that this Agreement, including only the State standard form 213 and all exhibits,
constitute the entire agreement of the parties and no other understanding or communication,
whether written or oral, shall be construed to be a part of this Agreement.
14. CAPTIONS:
A. The clause headings appearing in this Agreement have been inserted for the purpose of
convenience and ready reference. They do not purport to and shall not be deemed to define, limit
or extend the scope or intent of the clauses to which they pertain.
Page 4 of 8
Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
15. PUBLIC HEARINGS:
A. If public hearings on the subject matter dealt with in this Agreement are held within one year from
the Agreement expiration date, Contractor shall make available to testify the personnel assigned to
this Agreement at the hourly rates specified in Contractor's proposed budget. DSH shall reimburse
Contractor for travel of said personnel at the Agreement, or if none, at State rates for such
testimony as may be requested by DSH.
16. FORCE MAJEURE:
A. Neither DSH nor Contractor shall be deemed to be in default in the performance of the terms of this
Agreement if either party is prevented from performing the terms of this Agreement by causes
beyond its control, which shall include without being limited to: acts of God; interference, rulings or
decision by municipal, Federal, State or other governmental agencies, boards or commissions; any
laws and/or regulations of such municipal, State, Federal, or other governmental bodies; or any
catastrophe resulting from flood, fire, explosion, earthquakes or other similar environmental causes
beyond the control of the defaulting party. If any of the stated contingencies occur, the party
delayed by force majeure shall immediately give the other party written notice of the cause of delay.
The party delayed by force majeure shall use reasonable diligence to correct the cause of the
delay, if correctable.
17. LITIGATION:
A. DSH, promptly after receiving notice thereof, shall notify Contractor in writing of the commencement
of any claim, suit, or action against DSH or its officers or employees for which Contractor must
provide indemnification under this Agreement. The failure of DSH to give such notice, information,
authorization or assistance shall not relieve Contractor of its indemnification obligations. Contractor
shall immediately notify DSH of any claim or action against it which affects, or may affect, this
Agreement, the terms or conditions hereunder, DSH, and shall take such action with respect to said
claim or action which is consistent with the terms of this Agreement and the interest of DSH.
B. Contractor shall be in default of this Agreement (i) upon the institution by or against Contractor of
insolvency, receivership or bankruptcy proceedings or any other proceedings for the settlement of
Contractor's debts, (ii) upon Contractor making an assignment for the benefit of creditors, (iii) upon
either party's dissolution or ceasing to do business or(iv)when the facts and circumstances
indicate that Contractor is insolvent. For purposes of this Agreement, Contractor shall be deemed
insolvent if: (i) Contractor has failed to pay salaries, overtime or benefits required by law of
agreement, (ii) Contractor has failed to pay a subcontractor amounts owed pursuant to its
agreements with a subcontractor, or (iii) Contractor has failed to pay a vendor amounts Contractor
owes the vendor for more than 90 days the past due date for payment.
18. DISPUTES:
A. Contractor shall first discuss and attempt to resolve any dispute arising under or relating to the
performance of this Agreement.
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Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
19. EVALUATION OF CONTRACTOR'S PERFORMANCE:
A. DSH shall evaluate Contractor's performance under this Agreement using standardized evaluation
forms which shall be made available to every state agency pursuant to Public Contracts Code
section 10367.
20.AUDITS, INSPECTION AND ENFORCEMENT:
A. Contractor agrees to allow DSH to inspect its facilities and systems and make available for review
its books and records to enable DSH to monitor compliance with the terms of this Agreement and
audit invoices submitted to DSH.
B. Contractor shall promptly remedy any violation of any provision of this Agreement to the satisfaction
of DSH.
C. The fact that DSH inspects, or falls to inspect, or has the right to inspect Contractor's facilities,
systems, books and records does not relieve Contractor of its responsibility to independently
monitor its compliance with this Agreement.
D. DSH's failure to detect or DSH's detection of any unsatisfactory practices, but failure to notify
Contractor or require Contractor's remediation of the unsatisfactory practices does not constitute
acceptance of such practice or a waiver of DSH's enforcement rights under the Agreement.
21. USE OF STATE FUNDS:
A. Contractor, including its officers and members, shall not use funds received from DSH pursuant to
this Agreement to support or pay for costs or expenses related to the following:
i. Campaigning or other partisan activities to advocate for either the election or defeat of any
candidate for elective office, or for or against the passage of any proposition or ballot
measure; or,
ii. Lobbying for either the passage or defeat of any legislation.
B. This provision is not intended and shall not be construed to limit any expression of a view,
opinion, or position of any member of Contractor as an individual or private citizens, as long as
state funds are not used; nor does this provision limit Contractor from merely reporting the results
of a poll or survey of its membership.
22. CANCELLATION PROVISIONS:
A. Unless otherwise specified, this Agreement may be canceled at any time by DSH, in writing, with
thirty (30) days advance notice. If canceled, payment shall be made only for the provision of
services expressly authorized by this Agreement until the date of cancellation and only at the rates
set forth in Exhibit B, Budget Detail. In the case of early termination, a final payment will be made
to Contractor upon receipt of an invoice covering all authorized costs, at the rates set forth in Exhibit
B, incurred prior to the date of cancellation or termination_ DSH shall not be responsible for
unamortized costs, overhead or capital costs or any other related costs, including but, not limited to
costs incurred in connection with the cancellation of leases or contracts pertaining to facilities,
equipment or supplies, labor and employee benefits costs, and expenditures incurred after the date
of notice of cancellation.
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
B. If DSH determines that Contractor has breached a material term of the Agreement and has not
cured the breach or ended the violation within the time specified by DSH, DSH may terminate the
contract by providing notice to Contractor. DSH Information Security Officer shall report as required
HIPAA violations to the Secretary of the U.S. Department of Health and Human Services.
C. Failure to comply with section 1 or 6 of this Exhibit, or a violation of section 12 of this Exhibit, shall
be deemed a material breach of this Agreement.
23. EMPLOYMENT PROVISIONS:
A. Contractor acknowledges and agrees that neither Contractor, their personnel, subcontractors, nor
other service providers through this Agreement are employees of DSH. Contractor and its
independent contractors shall be solely responsible for:
i. Paying any and all payroll taxes, including, but not limited to Social Security and Medicare
taxes,
ii. Federal or state income tax withholding,
iii_ Providing unemployment insurance and workers compensation insurance, and
iv. Paying compensation to its employees in accordance with federal and state labor laws,
including overtime pay unless otherwise specified in this Agreement, as well as penalties
that may be imposed for failure to comply with these laws. Contractor agrees to indemnify
and hold harmless DSH for any damages, losses, expenses, including reasonable attorney
fees, in connection with its failure to pay salary or overtime, or provide benefits, including,
but not limited to health care benefits or retirement benefits, to its employees, or its failure to
provide to comply with federal or state labor laws.
24. LIABILITY FOR LOSS AND DAMAGES:
A. Any damages by Contractor, their personnel, subcontractors, and other service providers through
this Agreement to DSH's facility, including equipment, furniture, materials, or other State or DSH
property, shall be repaired or replaced by Contractor to the satisfaction of DSH at Contractor's
expense. DSH, at its option, may repair any such damage and deduct the cost thereof from any
sum due Contractor under this Agreement.
26. SECURITY CLEARANCEIFINGERPRINTINGITUBERCULIN SKIN TESTING:
A. DSH reserves the right to conduct fingerprinting, drug testing, and/or security clearance through the
Department of Justice, Bureau of Criminal Identification and Information (BCII), prior to award and
at any time during the term of the Agreement, in order to permit Contractor, their personnel,
subcontractors, and other service providers through this Agreement access to State premises.
DSH further reserves the right to terminate this Agreement should a threat to security be
determined.
B. In the event that the services required under this Agreement will be performed within a DSH facility,
Contractors and their employees who are assigned to work with, near, or around patients shall be
required to be examined and tested or medically evaluated by a licensed healthcare provider for TB
in an infectious or contagious stage prior to the performance of contracted duties, and at least once
a year thereafter (within 12 months of their initial or previous TB test under this contract), or more
Page 7 of 8
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit D, Special Terms and Conditions
often as directed by DSH. Contractors and their employees who have any contact(physical or
nonphysical) with patients, shall be required to furnish to the DSH Contract Manager, at no cost to
DSH, a documented Tuberculosis (TB) evaluation/test for TB infection (Tuberculin Skin Test(TST)
or a blood test Interferon Gamma Release Assay (IGRA) completed within (30) thirty days of the
start date of the services and be certified to be free of TB in an infectious or contagious stage by a
licensed healthcare provider prior to assuming their contracted duties and annually thereafter.
C. If both of the documented results of the TST provided <_ 0-9/mm of induration, then the tested
person may be cleared to provide services. However, if the documented result of the TST is>_
10/mm of induration, then they shall be subject to additional testing and/or clearances before he or
she is allowed to work at a DSH facility.
D. DSH reserves the right, in its sole and absolute discretion, to take measures to minimize the
transmission of influenza. Contractor, their personnel, subcontractors, and other service providers
through this Agreement may be required to either a) show written proof that they have received an
influenza vaccine, or b) complete an Influenza Declination Form, which will be provided upon
request. In addition, all non-vaccinated providers may be required to wear a mask. In its sole and
absolute discretion, DSH may elect to provide free influenza vaccines to Contractor, their
personnel, subcontractors, and other service providers through this Agreement.
26. PHYSICIAN OWNERSHIP AND REFERRAL ACT OF 1993:
A. For applicable medical services contracts, and in accordance with the Physician Ownership and
Referral Act of 1993, Contractor shall not refer any patient to any health care provider or health-
related facility if Contractor has a financial interest with that health care provider or health-related
facility.
B. Contractor may make a referral to or request consultation from a sole source health care provider or
health-related facility in which financial interest is held if Contractor is located where there is no
alternative provider of service within either twenty-five (25) miles or forty (40) minutes travel time,
subject to the prior approval of DSH. Contractor shall disclose, in writing, as well as on a
continuous basis, to DSH, its financial interest at the time of referral or request for consultation. In
no event, will this prohibit patients from receiving emergency health care services.
27. AMENDMENTS:
A. The parties reserve the right to amend this Agreement as mutually agreed upon. This is in addition
to the right to amend for other reasons contained in this Agreement or noted in the solicitation that
resulted in this Agreement, if applicable. Any amendment shall be in writing and signed by both
parties and be approved by the Department of General Services if such approval is required.
Revised 11/1712020
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Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
EXHIBIT F
INFORMATION PRIVACY AND SECURITY REQUIREMENTS
(Non-HIPAA/HITECH Act Contracts)
This Information Privacy and Security Requirements Exhibit (For Non-Health Insurance Portability
and Accountability Act/Health Information Technology for Economic and Clinical Health (Non-
HIPAAMITECH Act Contracts) (hereinafter referred to as "this Exhibit") sets forth the information
privacy and security requirements Contractor is obligated to follow with respect to all personal and
confidential information (as defined herein) disclosed to Contractor, or collected, created, maintained,
stored, transmitted or used by Contractor for or on behalf of the California Department of State
Hospitals (hereinafter "DSH"), pursuant to Contractor's agreement with DSH. (Such personal and
confidential information is referred to herein collectively as "DSH PCI".) DSH and Contractor desire to
protect the privacy and provide for the security of DSH PCI pursuant to this Exhibit and in compliance
with state and federal laws applicable to the DSH PCI.
I. Order of Precedence: With respect to information privacy and security requirements for all
DSH PCI, the terms and conditions of this Exhibit shall take precedence over any conflicting
terms or conditions set forth in any other part of the agreement between Contractor and DSH,
including Exhibit A (Scope of Work), all other exhibits and any other attachments, and shall
prevail over any such conflicting terms or conditions.
Il. Effect on lower tier transactions: The terms of this Exhibit shall apply to all contracts,
subcontracts, and subawards, and the information privacy and security requirements
Contractor is obligated to follow with respect to DSH PCI disclosed to Contractor, or collected,
created, maintained, stored, transmitted or used by Contractor for or on behalf of DSH,
pursuant to Contractor's agreement with DSH. When applicable the Contractor shall
incorporate the relevant provisions of this Exhibit into each subcontract or subaward to its
agents, subcontractors, or independent consultants.
III. Definitions: For purposes of the agreement between Contractor and DSH, including this
Exhibit, the following definitions shall apply:
A. Breach: "Breach" means:
1. the unauthorized acquisition, access, use, or disclosure of DSH PCI in a manner which
compromises the security, confidentiality or integrity of the information; or
2. the same as the definition of"breach of the security of the system" set forth in California
Civil Code section 1798.29(f) (2021).
B. Confidential Information: "Confidential information" means information that:
1. does not meet the definition of"public records" set forth in California Government Code
section 6252(e) (2021), or is exempt from disclosure under any of the provisions of
Section 6250, et seq. of the California Government Code or any other applicable state or
federal laws; or
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
2. is contained in documents, files, folders, books or records that are clearly labeled,
marked or designated with the word "confidential" by DSH.
C. Disclosure: "Disclosure" means the release, transfer, provision of, access to, or divulging in
any manner of information outside the entity holding the information.
D. PCI: "PCI" means "personal information" and "confidential information" collectively (as
these terms are defined herein).
E. Personal Information: "Personal information" means information, in any medium (paper,
electronic, oral) that:
1. directly or indirectly collectively identifies or uniquely describes an individual; or
2. could be used in combination with other information to indirectly identify or uniquely
describe an individual, or link an individual to the other information; or
3. meets the definition of"personal information" set forth in California Civil Code section
1798.3, subdivision (a) (2021); or
4. is one of the data elements set forth in California Civil Code section 1798.29, subdivision
(g)(1) or (g)(2) (2021); or
5. meets the definition of"medical information" set forth in either California Civil Code
section 1798.29, subdivision (h)(2) (2021), or California Civil Code section 56.05,
subdivision Q) (2021); or
6. meets the definition of"health insurance information" set forth in California Civil Code
section 1798.29, subdivision (h)(3) (2021); or
7. is protected from disclosure under applicable state or federal law.
F. Security Incident: "Security Incident" means:
1. an attempted breach; or
2. the attempted or successful unauthorized access or disclosure, modification or
destruction of DSH PCI, in violation of any state or federal law or in a manner not
permitted under the agreement between Contractor and DSH, including this Exhibit; or
3. the attempted or successful modification or destruction of, or interference with,
Contractor's system operations in an information technology system, that negatively
impacts the confidentiality, availability or integrity of DSH PCI; or
4. any event that is reasonably believed to have compromised the confidentiality, integrity,
or availability of an information asset, system, process, data storage, or transmission.
Furthermore, an information security incident may also include an event that constitutes
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Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
a violation or imminent threat of violation of information security policies or procedures,
including acceptable use policies.
G. Use: "Use" means the sharing, employment, application, utilization, examination, or
analysis of information.
IV. Disclosure Restrictions: The Contractor and its employees, agents, and subcontractors shall
protect from unauthorized disclosure any DSH PCI. The Contractor shall not disclose, except
as otherwise specifically permitted by the agreement between Contractor and DSH (including
this Exhibit), any DSH PCI to anyone other than DSH personnel or programs without prior
written authorization from the DSH Program Contract Manager, except if disclosure is required
by State or Federal law.
V. 42 C.F.R. Part 2 compliance: DSH shall receive patient identifying substance use disorder treatment
information for program evaluation and auditing purposes. In accordance with 42 C.F.R. part 2.53, DSH
agrees to:
(1) Maintain and destroy patient identifying information and records covered by 42 C.F.R. Part 2 in
a manner consistent with the policies and procedures established under 42 C.F.R. part 2.16;
(ii) Retain records in compliance with applicable federal, state, and local record retention laws;
and
(iii) Comply with the limitations on disclosure and use in 42 C.F.R. part 2.53(d).
VI. Use Restrictions: The Contractor and its employees, agents, and subcontractors shall not use any
DSH PCI for any purpose other than performing the Contractor's obligations under its agreement with
DSH. DSH and its employees, agents, and subcontractors shall not use any data received from
contractor for any purpose other than noted in this agreement, Welfare and Institutions Code section
4335.2.
VI I. Research compliance: DSH is a covered entity under the Health Insurance Portability and Accountability
Act of 1996 (HIPAA). DSH may receive protected health information and patient identifying substance
use disorder treatment information for research purposes so long as disclosure is consistent with federal
and state laws. Without limiting the generality of the foregoing, in accordance with 42 C.F.R. part 2.52(a)
and 45 C.F.R. part 164.512(i), Contractor shall only disclose the data to DSH for research purposes after
DSH obtains approval from the State of California's Institutional Review Board, the California Health and
Human Services' Committee for the Protection of Human Subjects and furnishes documentation to
Contractor. DSH shall follow all of its internal policies and procedures for obtaining approval for research
using data reported by contractor. DSH agrees to comply with HIPAA and 42 C.F.R. Part 2 regarding all
requirements including retention and destruction.
VIII. Safequards: The Contractor shall implement administrative, physical, and technical
safeguards that reasonably and appropriately protect the privacy, confidentiality, security,
integrity, and availability of DSH PCI, including electronic or computerized DSH PCI. At each
location where DSH PCI exists under Contractor's control, the 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 the Contractor's
operations and the nature and scope of its activities in performing its agreement with DSH,
including this Exhibit, and which incorporates the requirements of Section VII, Security, below.
Contractor shall provide DSH with Contractor's current and updated policies within five (5)
business days of a request by DSH for the policies.
Page 3 of 12
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
IX. Security: The Contractor shall take any and all steps reasonably necessary to ensure the
continuous security of all computerized data systems containing DSH PCI.
X. Security Officer: At each place where DSH PCI is located, the Contractor shall designate a
Security Officer to oversee its compliance with this Exhibit and to communicate with DSH on
matters concerning this Exhibit.
XI. Training: The Contractor shall provide training on its obligations under this Exhibit, at its own
expense, to all of its employees who assist in the performance of Contractor's obligations
under Contractor's agreement with DSH, including this Exhibit, or otherwise use or disclose
DSH PCI.
A. The Contractor shall require each employee who receives training to certify, either in hard
copy or electronic form, the date on which the training was completed.
B. The Contractor shall retain each employee's certifications for DSH inspection for a period of
three years following contract termination or completion.
C. Contractor shall provide DSH with its employee's certifications within five (5) business days
of a request by DSH for the employee's certifications.
XI I. Employee Discipline: Contractor shall impose discipline that it deems appropriate (in its sole
discretion) on such employees and other Contractor workforce members under Contractor's
direct control who intentionally or negligently violate any provisions of this Exhibit.
XIII. Breach and Security Incident Responsibilities:
A. Notification to DSH of Breach or Security Incident: The Contractor shall notify DSH
immediately by telephone call plus email or fax upon the discovery of a breach (as
defined in this Exhibit), and within twenty-four (24) hours by email or fax of the discovery
of any security incident (as defined in this Exhibit), unless a law enforcement agency
determines that the notification will impede a criminal investigation, in which case the
notification required by this section shall be made to DSH immediately after the law
enforcement agency determines that such notification will not compromise the
investigation. Notification shall be provided to the DSH Program Contract Manager, the
DSH Privacy Officer and the DSH Chief Information Security Officer, using the
contact information listed in Section XI(F), below. If the breach or security incident is
discovered after business hours or on a weekend or holiday and involves DSH PCI in
electronic or computerized form, notification to DSH shall be provided by calling the DSH
Information Security Office at the telephone numbers listed in Section XI(F), below. For
purposes of this Section, breaches and security incidents shall be treated as discovered by
Contractor as of the first day on which such breach or security incident is known to the
Contractor, or, by exercising reasonable diligence would have been known to the
Contractor. Contractor shall be deemed to have knowledge of a breach if such breach is
known, or by exercising reasonable diligence would have been known, to any person, other
than the person committing the breach, who is an employee or agent of the Contractor.
Page 4 of 12
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
Contractor shall take:
1. prompt corrective action to mitigate any risks or damages involved with the breach or
security incident and to protect the operating environment; and
2. any action pertaining to a breach required by applicable federal and state laws,
including, specifically, California Civil Code sections 1798.29 and 1798.82 (2021).
B. Investi ation of Breach and Security Incidents: The Contractor shall immediately
investigate such breach or security incident. As soon as the information is known and
subject to the legitimate needs of law enforcement, Contractor shall inform the DSH
Program Contract Manager, the DSH Privacy Officer, and the DSH Chief Information
Security Officer of:
1. what data elements were involved, and the extent of the data disclosure or access
involved in the breach, including, specifically, the number of individuals whose personal
information was breached; and
2. a description of the unauthorized persons known or reasonably believed to have
improperly used the DSH PCI and/or a description of the unauthorized persons known or
reasonably believed to have improperly accessed or acquired the DSH PCI, or to whom
it is known or reasonably believed to have had the DSH PCI improperly disclosed to
them; and
3. a description of where the DSH PCI is believed to have been improperly used or
disclosed; and
4. a description of the probable and proximate causes of the breach or security incident;
and
5. whether Civil Code sections 1798.29 and 1798.82 (2021) or any other federal or state
laws requiring individual notifications of breaches have been triggered.
C. Written Report: The Contractor shall provide a written report of the investigation to the
DSH Program Contract Manager, the DSH Privacy Officer, and the DSH Chief Information
Security Officer as soon as practicable after the discovery of the breach or security
incident. The report shall include, but not be limited to, the information specified above, as
well as a complete, detailed corrective action plan, including information on measures that
were taken to halt and/or contain the breach or security incident, and measures to be taken
to prevent the recurrence or further disclosure of data regarding such breach or security
incident.
D. Notification to Individuals: If notification to individuals whose information was breached is
required under state or federal law, and regardless of whether Contractor is considered
only a custodian and/or non-owner of the DSH PCI, Contractor shall, at its sole expense,
and at the sole election of DSH, either:
Page 5 of 12
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
1 . make notification to the individuals affected by the breach (including substitute
notification), pursuant to the content and timeliness provisions of such applicable state or
federal breach notice laws. Contractor shall inform the DSH Privacy Officer of the time,
manner and content of any such notifications, prior to the transmission of such
notifications to the individuals; or
2. cooperate with and assist DSH in its notification (including substitute notification) to the
individuals affected by the breach.
E. Submission of Sample Notification to Attorney General: If notification to more than 500
individuals is required pursuant to California Civil Code section 1798.29 or 1798.82 (2021),
and regardless of whether Contractor is considered only a custodian and/or non-owner of
the DSH PCI, Contractor shall, at its sole expense, and at the sole election of DSH, either:
1 . electronically submit a single sample copy of the security breach notification, excluding
any personally identifiable information, to the Attorney General pursuant to the format.
content and timeliness provisions of Section 1798.29, subdivision (e), or 1798.82,
subdivision (f) (2021). Contractor shall inform the DSH Privacy Officer of the time.
manner and content of any such submissions, prior to the transmission of such
submissions to the Attorney General; or
2. cooperate with and assist DSH in its submission of a sample copy of the notification to
the Attorney General.
F. DSH Contact Information: To direct communications to the above referenced DSH staff,
the Contractor shall initiate contact as indicated herein. DSH reserves the right to make
changes to the contact information below by verbal or written notice to the Contractor. Said
changes shall not require an amendment to this Exhibit or the agreement to which it is
incorporated.
Contract Chief Privacy Officer Chief Information Security Officer
Managers
See ExhibitChief Privacy Officer Chief Information Security Officer
A - Scope Office of Legal Services Information Security Office
of Work for 1215 O Street, MS-5 1215 O Street, MS-4
contact Sacramento, CA 95814 Sacramento, CA 95814
information
Email: privacy.officer(cDdsh.ca.gov and Email: iso(a),dsh.ca gov and security(d)-dsh.ca.gov
dshsaclegalprivacy@dsh.ca.gov Telephone: 916-654-4218
Telephone: 916-562-3721
[Privacy Officer Name] [Information Security Officer Name]
[Contractor Name] [Contractor Name]
Page 6 of 12
Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
[Address] [Address]
Email: [email address] Email: [email address]
Telephone: [Telephone number] Telephone: [Telephone number]
XIV. Documentation of Disclosures for Requests for Accounting: Contractor shall document and
make available to DSH or (at the direction of DSH) to an Individual such disclosures of DSH
PCI, and information related to such disclosures, necessary to respond to a proper request by
the subject Individual for an accounting of disclosures of personal information as required by
Civil Code section 1798.25 (2021), or any applicable state or federal law.
XV. Requests for DSH PCI by Third Parties: The Contractor and its employees, agents, or
subcontractors shall promptly transmit to the DSH Program Contract Manager all requests for
disclosure of any DSH PCI requested by third parties to the agreement between Contractor
and DSH (except from an Individual for an accounting of disclosures of the individual's
personal information pursuant to applicable state or federal law), unless prohibited from doing
so by applicable state or federal law.
XVI. Audits Inspection and Enforcement: DSH may inspect the facilities, systems, books and
records of Contractor to monitor compliance with this Exhibit. Contractor shall promptly
remedy any violation of any provision of this Exhibit and shall certify the same to the DSH
Program Contract Manager in writing.
XVII. Return or Destruction of DSH PCI on Expiration or Termination: Upon expiration or
termination of the agreement between Contractor and DSH for any reason. Contractor shall
securely return or destroy the DSH PCI. If return or destruction is not feasible, Contractor shall
provide a written explanation to the DSH Program Contract Manager, the DSH Privacy Officer
and the DSH Chief Information Security Officer, using the contact information listed in Section
XI(F), above.
A. Retention Required by Law: If required by state or federal law, Contractor may retain, after
expiration or termination, DSH PCI for the time specified as necessary to comply with the
law.
B. Obligations Continue Until Return or Destruction: Contractor's obligations under this
Exhibit shall continue until Contractor destroys the DSH PCI or returns the DSH PCI to
DSH; provided however, that on expiration or termination of the agreement between
Contractor and DSH, Contractor shall not further use or disclose the DSH PCI except as
required by state or federal law.
C. Notification of Election to Destroy DSH PCI: If Contractor elects to destroy the DSH PCI,
Contractor shall certify in writing within 30 days of the expiration or termination of the
agreement to the DSH Program Contract Manager, the DSH Privacy Officer and the DSH
Chief Information Security Officer, using the contact information listed in Section XI(F),
Page 7 of 12
Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
above, that the DSH PCI has been securely destroyed. The notice shall include the date
and type of destruction method used.
XVIII. Amendment: The parties acknowledge that federal and state laws regarding information
security and privacy rapidly evolves and that amendment of this Exhibit may be required to
provide for procedures to ensure compliance with such laws. The parties specifically agree to
take such action as is necessary to implement new standards and requirements imposed by
regulations and other applicable laws relating to the security or privacy of DSH PCI. The
parties agree to promptly enter into negotiations concerning an amendment to this Exhibit
consistent with new standards and requirements imposed by applicable laws and regulations.
XIX. Assistance in Litigation or Administrative Proceedings: Contractor shall make itself and any
subcontractors, workforce employees or agents assisting Contractor in the performance of its
obligations under the agreement between Contractor and DSH, available to DSH at no cost to
DSH to testify as witnesses, in the event of litigation or administrative proceedings being
commenced against DSH, its director, officers or employees based upon claimed violation of
laws relating to security and privacy, which involves inactions or actions by the Contractor,
except where Contractor or its subcontractor, workforce employee or agent is a named
adverse party.
XX. No Third-Party Beneficiaries: Nothing express or implied in the terms and conditions of this
Exhibit is intended to confer, nor shall anything herein confer, upon any person other than DSH
or Contractor and their respective successors or assignees, any rights, remedies, obligations
or liabilities whatsoever.
XXI. Interpretation: The terms and conditions in this Exhibit shall be interpreted as broadly as
necessary to implement and comply with regulations and applicable State laws. The parties
agree that any ambiguity in the terms and conditions of this Exhibit shall be resolved in favor of
a meaning that complies and is consistent with federal and state laws and regulations.
XXII. Survival: If Contractor does not return or destroy the DSH PCI upon the expiration or
termination of the Agreement, the respective rights and obligations of Contractor under
Sections VI, VII and XI of this Exhibit shall survive the completion or termination of the
agreement between Contractor and DSH.
Page 8 of 12
Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit F. Information Privacy and Security Requirements
Attachment 1
Contractor Data Security Standards
Contractor is exempt from all Contractor Data Security Standards set forth in Exhibit F,
Attachment 1 as it is not applicable to this agreement.
1. Contractor is exempt from all Contractor Data Security Standards set forth in Exhibit F,
Attachment 1 as it is not applicable to this agreement. General Security Controls
A. Confidentiality Statement. All persons that will be working with DSH PCI must sign a
confidentiality statement. The statement must include at a minimum, General Use, Security
and Privacy safeguards, Unacceptable Use, and Enforcement Policies. The statement must
be signed by the workforce member prior to access to DSH PCI. The statement must be
renewed annually. The Contractor shall retain each person's written confidentiality
statement for DSH inspection for a period of three (3) years following contract termination.
B. Background check. Before a member of the Contractor's workforce may access DSH PCI,
Contractor must conduct a thorough background check of that worker and evaluate the
results to assure that there is no indication that the worker may present a risk for theft of
confidential data. The Contractor shall retain each workforce member's background check
documentation for a period of three (3) years following contract termination.
C. Workstation/Laptop encryption. All workstations and laptops that process and/or store
DSH PCI must be encrypted using a FIPS 140-2 certified algorithm. such as Advanced
Encryption Standard (AES), with a 128bit key or higher. The encryption solution must be full
disk unless approved by the DSH Information Security Office.
D. Server Security. Servers containing unencrypted DSH PCI must have sufficient
administrative, physical, and technical controls in place to protect that data, based upon a
risk assessment/system security review.
E. Minimum Necessary. Only the minimum necessary amount of DSH PCI required to
perform necessary business functions may be copied, downloaded, or exported.
F. Removable media devices. All electronic files that contain DSH PCI data must be
encrypted when stored on any removable media or portable device (i.e. USB thumb drives,
floppies, CD/DVD, smart devices tapes etc.). PCI must be encrypted using a FIPS 140-2
certified algorithm, such as Advanced Encryption Standard (AES), with a 128bit key or
higher
G. Antivirus software. All workstations, laptops and other systems that process and/or store
DSH PCI must install and actively use a comprehensive anti-virus software solution with
automatic updates scheduled at least daily.
H. Patch Management. All workstations, laptops and other systems that process and/or store
DSH PCI must have operating system and application security patches applied, with system
Page 9 of 12
Department of State Hospitals Fresno County Sheriff's Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
reboot if necessary. There must be a documented patch management process which
determines installation timeframe based on risk assessment and vendor
recommendations. At a maximum, all applicable patches must be installed within 30 days of
vendor release.
I. User IDs and Password Controls. All users must be issued a unique user name for
accessing DSH PCI. Username must be promptly disabled, deleted, or the password
changed upon the transfer or termination of an employee with knowledge of the password.
Passwords are not to be shared. Must be at least eight characters. Must be a non-
dictionary word. Must not be stored in readable format on the computer. Must be changed
every 60 days. Must be changed if revealed or compromised. Must be composed of
characters from at least three of the following four groups from the standard keyboard:
• Upper case letters (A-Z)
• Lower case letters (a-z)
• Arabic numerals (0-9)
• Non-alphanumeric characters (punctuation symbols)
J. Data Sanitization. All DSH PCI must be sanitized using NIST Special Publication 800-88
standard methods for data sanitization when the DSH PCI is no longer needed.
2. System Security Controls
A. System Timeout. The system must provide an automatic timeout, requiring
reauthentication of the user session after no more than 20 minutes of inactivity.
B. Warning Banners. All systems containing DSH PCI must display a warning banner each
time a user attempts access, stating that data is confidential, systems are logged, and
system use is for business purposes only. User must be directed to log off the system if
they do not agree with these requirements.
C. System Logging. The system must maintain an automated audit trail which can identify
the user or system process which initiates a request for DSH PCI, or which alters DSH PCI.
The audit trail must be date and time stamped, must log both successful and failed
accesses, must be read only, and must be restricted to authorized users This logging must
be included for all user privilege levels including, but not limited to, systems administrators.
If DSH PCI is stored in a database, database logging functionality must be enabled. Audit
trail data must be archived for at least 3 years after occurrence.
D. Access Controls. The system must use role based access controls for all user
authentications, enforcing the principle of least privilege.
E. Transmission encryption. All data transmissions of DSH PCI outside the contractor's
secure internal network must be encrypted using a FIPS 140-2 certified algorithm, such as
Advanced Encryption Standard (AES), with a 128bit key or higher. Encryption can be end
to end at the network level, or the data files containing DSH PCI can be encrypted. This
Page 10 of 12
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
requirement pertains to any type of DSH PCI in motion such as website access, file
transfer, and E-Mail.
F. Intrusion Detection. All systems involved in accessing, holding, transporting, and
protecting DSH PCI that are accessible via the Internet must be protected by a
comprehensive intrusion detection and prevention solution.
3. Audit Controls
A. System Security Review. All systems processing and/or storing DSH PCI must have at
least an annual system risk assessment/security review which provides assurance that
administrative, physical, and technical controls are functioning effectively and providing
adequate levels of protection. Reviews shall include vulnerability scanning tools.
B. Log Reviews. All systems processing and/or storing DSH PCI must have a routine
procedure in place to review system logs for unauthorized access.
C. Change Control. All systems processing and/or storing DSH PCI must have a
documented change control procedure that ensures separation of duties and protects the
confidentiality, integrity and availability of data.
4. Business Continuity / Disaster Recovery Controls
A. Disaster Recovery. Contractor must establish a documented plan to enable continuation
of critical business processes and protection of the security of electronic DSH PCI in the
event of an emergency. Emergency means any circumstance or situation that causes
normal computer operations to become unavailable for use in performing the work required
under this agreement for more than 24 hours.
B. Data Backup Plan. Contractor must have established documented procedures to securely
backup DSH PCI to maintain retrievable exact copies of DSH PCI. The backups shall be
encrypted. The plan must include a regular schedule for making backups, storing backups
offsite, an inventory of backup media, and the amount of time to restore DSH PCI should it
be lost. At a minimum, the schedule must be a weekly full backup and monthly offsite
storage of DSH data.
5. Paper Document Controls
A. Supervision of Data. DSH PCI in paper form shall not be left unattended at any time,
unless it is locked in a file cabinet, file room, desk or office. Unattended means that
information is not being observed by an employee authorized to access the information.
DSH PCI in paper form shall not be left unattended at any time in vehicles or planes and
shall not be checked in baggage on commercial airplanes.
B. Escorting Visitors. Visitors to areas where DSH PCI is contained shall be escorted and
DSH PHI shall be kept out of sight while visitors are in the area.
Page 11 of 12
Department of State Hospitals Fresno County Sheriffs Office
Agreement Number: 21-76003-008
Exhibit F, Information Privacy and Security Requirements
C. Confidential Destruction. DSH PCI must be disposed of through confidential means,
using NIST Special Publication 800-88 standard methods for data sanitization when the
DSH PSCI is no longer needed.
D. Removal of Data. DSH PCI must not be removed from the premises of the Contractor
except with express written permission of DSH.
E. Faxing. Faxes containing DSH PCI shall not be left unattended and fax machines shall be
in secure areas. Faxes shall contain a confidentiality statement notifying persons receiving
faxes in error to destroy them. Fax numbers shall be verified with the intended recipient
before sending.
F. Mailing. DSH PC[ shall only be mailed using secure methods. Large volume mailings of
DSH PHI shall be by a secure, bonded courier with signature required on receipt. Disks
and other transportable media sent through the mail must be encrypted with a DSH
approved solution, such as a solution using a vendor product specified on the CALIFORNIA
STRATEGIC SOURCING INITIATIVE.
Revised 12/21/21
Page 12 of 12
CCC 0412017
CERTIFICATION
I,the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly
authorized to legally bind the prospective Contractor to the clause(s)listed below. This
certification is made under the laws of the State of California.
Contractor/Bidder Firm Name (Printed) Federal ID Number
By (Au on ed Signature)
Y�� ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
Prirn-�ted Name and Title of Person Signing County of Fresno, State of California
!' Y ✓�r Pa heC a, /+ h"?, c-YY ,r, li? By
Deputy
Date Executed Executed in the County of
Fresho
CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has,unless exempted, complied with
the nondiscrimination program requirements. (Gov. Code §12990(a-f) and CCR, Title 2,
Section 11102)(Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 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 the proposed 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 the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
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 DEPARTMENT OF GENERAL SERVICES
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT OFFICE OF LEGAL SERVICES
DGS OLS 04(Rev.01/17)
Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to,or
otherwise proposes to enter into or renew a contract with, a state agency with respect to any
contract in the amount of$100,000 or above shall certify, under penalty of perjury, at the time
the bid or proposal is submitted or the contract is renewed, all of the following:
1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after
January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act(Section
51 of the Civil Code) and the Fair Employment and Housing Act(Section 12960 of the
Government Code); and
2. EMPLOYER DISCRIMINATORY POLICIES: 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 United States government, the Contractor certifies that such
policies arenot used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code)
or the Fair Employment and Housing Act(Section 12960 of the Government Code).
CERTIFICATION
I, the official named below, certify under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.
Proposer/Bidder Firm Name(Printed) Federal ID Number
By(Authorized Signature)
Printed Name and Title of Person Signing
Brian
Executed in the County of Executed in the State of
FC-e'5
Date Executed
- -7-ao
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By_ —
Deputy
i
DARFUR CONTRACTING ACT CERTIFICATION
Public Contract Code Sections 10475 -10481 applies to any company that currently or within the
previous three years has had business activities or other operations outside of the United
States. For such a company to bid on or submit a proposal for a State of California contract, the
company must certify that it is either a) not a scrutinized company; or b) a scrutinized company
that has been granted permission by the Department of General Services to submit a proposal.
If your company has not, within the previous three years, had any business activities or other
operations outside of the United States, you do not need to complete this form.
OPTION #1 -CERTIFICATION
If your company, within the previous three years, has had business activities or other operations
outside of the United States, in order to be eligible to submit a bid or proposal, please insert
your company name and Federal ID Number and complete the certification below.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective
proposer/bidder named below is not a scrutinized company per Public Contract Code 10476;
and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This
certification is made under the laws of the State of California.
Company/Vendor Name (Printed) Federal ID Number
By(Aut on Signature)
Printed Name and Tile of Person Signing
6riarl fP'06heco,
Date Executed Executed In tr`re County and State of
I
OPTION#2—WRITTEN PERMISSION FROM DGS
Pursuant to Public Contract Code section 10477(b), the Director of the Department of General
Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a
proposal for a contract with a state agency for goods or services, if it is in the best interests of
the state. If you are a scrutinized company that has obtained written permission from the DGS
to submit a bid or proposal, complete the information below.
We are a scrutinized company as defined in Public Contract Code section 10476, but we have
received written permission from the Department of General Services to submit a bid or
proposal pursuant to Public Contract Code section 10477(b). A copy of the written permission
from DGS is included with our bid or proposal.
Company/Vendor Name (Printed) Federal ID Number
Initials of Submitter
Printed Name and Title of Person Initialing
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State o California
By_
Deputy
IRAN CONTRACTING ACT
(Public Contract Code sections 2202-22081
Prior to bidding on, submitting a proposal or executing a contract or renewal for a State of California
contract for goods or services of $1,000,000 or more, a vendor must either, a) certify it is not on the
current list of persons engaged in investment activities in Iran created by the California Department of
General Services ("DGS") pursuant to Public Contract Code section 2203(b) and is not a financial
institution extending twenty million dollars ($20,000,000) or more in credit to another person, for 45 days
or more, if that other person will use the credit to provide goods or services in the energy sector in Iran
and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or
b) demonstrate it has been exempted from the certification requirement for that solicitation'or contract
pursuant to Public Contract Code section 2203(c)or(d).
To comply with this requirement, please insert your vendor or financial institution name and Federal ID
Number (if available) and complete one of the options below. Please note: California law establishes
penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or
twice the amount of the contract for which the false certification was made; contract termination; and
three-year ineligibility to bid on contracts. (Public Contract Code section 2205.)
OPTION#1 -CERTIFICATION
1, the official named below, certify I am duty authorized to execute this certification on behalf of the
vendor/financial institution identified below, and the vendor/financial institution identified below is not on
the current list of persons engaged in investment activities in Iran created by DGS and is not a financial
institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for
45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy
sector in Iran and is identified on the current list of persons engaged in investment activities in Iran
created by DGS.
Vendor Name/Financial Institution (Printed) Federal ID Number(or n/a)
By(AC ed Signature)
Printed Name and Title ui PerSOn Signing ATTEST:
r/'!/ Yl Lj-)al y-;YI r? BERNICE E. SEIDEL
Date Executed Executed in Clerk of the Board of Supervisors
I 4j — —d-O 2�a Gpun A- D jr /-'Ye�Sh^ County of Fresno, State of California
By
OPTION#2— EXEMPTION Dep ty
Pursuant to Public Contract Code sections 2203(c) and (d), a public entity may permit a vendor/financial
institution engaged in investment activities in Iran,on a case-by-case basis, to be eligible for, or to bid on,
submit a proposal for, or enters into or renews, a contract for goods and services.
If you have obtained an exemption from the certification requirement under the Iran Contracting Act,
please fill out the information below, and attach documentation demonstrating the exemption approval.
Vendor NamelFinancial Institution(Printed) 7Federal ID Number(or n/a)
By(Authorized Signature)
Printed Name and Title of Person Signing Date Executed
State of California
Financial Information System for California (FI$Cal) FI$Ca
GOVERNMENT AGENCY TAXPAYER ID FORM
2000 Evergreen Street, Suite 215 Financial Information System for California
Sacramento, CA 95815
www.fisr-al.ca.gov
1-855-347-2250
The principal purpose of the information provided is to establish the unique identification of the government entity.
Instructions: You may submit one form for the principal government agency and all subsidiaries sharing the same TIN. Subsidiaries with a
different TIN must submit a separate form. Fields bordered in red are required. Hover over fields to view help information. Please print the
form to sign prior to submittal. You may email the form to vendors@fiscal.ca.gov. or fax it to(916)576-5200, or mail it to the address above.
Principal
Government
Agency Name
Remit-To
Address (Street
or PO Box)
City State Zip Code+4
Government Type: City County Federal
Special District Federal EmployerIdentification
Other(Specify) Number
(FEIN)
List other subsidiary Departments, Divisions or Units under your principal agency's jurisdiction who share the same
FEIN and receives payment from the State of California.
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit Complete
Name Address
Contact Person Title
Phone number E-mail address
Signature Date
FOR ACCOUNTING USE ONLY:
Fund:0001
Subclass:10000
ORG:31114000
Revenue Account: 3575