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HomeMy WebLinkAboutAgreement A-22-376 Amendment V to Agmt. 16-684 w First 5 for Nurse Liaison.pdf Agreement No. 22-376 County of Fresno,Department of Public Health Contract#201617-0950 Nurse Liaison Page 1 Amendment V to Services Agreement Fiscal Years 2022-2024 Parties Commission: Children and Families Commission of Fresno County, California Contractor: County of Fresno,Department of Public Health Administrative Contract Number: 201617-0950 Recitals A. Commission and Contractor are parties to that certain Services Agreement (the"Agreement"),dated December 23,2016,the Term of which is from July 1,2016 to June 30,2018 (the"Original Term"). Commission and Contractor are also parties to Amendment I,dated August 28,2018,Amendment II to the Agreement,dated October 23,2019,Amendment III to the Agreement dated October 14,2020,and Amendment IV to the Agreement dated October 25,2021 extending the Term of the Agreement to June 30,2022. B. The Parties now desire to amend the Agreement to provide for an extension of the Term and to modify the Services and Project Budget all as defined in the Agreement. C. All capitalized terms used in this Amendment V to Services Agreement(this "Amendment V')shall have the meanings provided for in the Agreement unless otherwise specified in this Amendment V. Therefore,in consideration of the above recitals,which are incorporated into this Amendment I by reference,the Parties agree as follows: 1. Term. This Amendment V is made effective as of July 1,2022 (the"Effective Date'. The Term of the Agreement is extended until June 30,2024,unless terminated earlier under the Agreement(the"Term") or as specified in this Amendment V to the contrary. 2. Amendment to Section 2.1. Effective as of July 1,2022,Exhibit A will be replaced with the Exhibit A,"Scope of Work(2022-2024 Fiscal Years)"attached to this Amendment V and incorporated herein by this reference. As of July 1,2022,except as needed to interpret and enforce Contractor's responsibilities and obligations under the original Term of the Agreement,the original and prior Exhibit A attached to the Agreement and prior Amendment will have no further force and effect. Ro522(1&2) County of Fresno,Department of Public Health Contract#201617-0950 Nurse Liaison Page 2 8. Amendment to Section 4.1. Section 4.1 of the Agreement is deleted in its entirety and replaced with the following: 4.1 Project Budget. Compensation for the Services is based on actual costs as described in Exhibit B. Compensation for the Services will in no event exceed the total aggregate amount of$2,966,274(the"Contract Amount'. The Contract Amount includes compensation for Services remaining under the original term of the Agreement,as well as the Services to be performed under the Term,as defined in this Amendment V. Compensation for Services provided prior to July 1,2022 shall be in accordance with the original Agreement,Amendment I,Amendment II,Amendment III,and Amendment IV. 4. Amendment to Section 4.2. The first sentence in Section 4.2 of the Agreement is deleted in its entirely and replaced with the following(the remainder of Section 4.2 is unaffected): Commission will reimburse Contractor for all necessary,reasonable,and justifiable expenses,as determined by Commission,incurred in accordance with the Project Budget for providing the Services on behalf of Commission in an aggregate amount not to exceed the Contract Amount. 5. Controlling Document; No Other Amendment. In the event of any conflict between the terms of this Amendment V and the Agreement,the terms of this Amendment V shall control. Except as amended by this Amendment V,all terms of the Agreement shall remain in full force and effect,including,without limitation,all monitoring,evaluation,data collection,contract review,auditing,inspection,and record retention obligations set forth in the Agreement. 6. Binding Effect. The Agreement,as amended by this Amendment V, is binding upon,and inures to the benefit of,the respective heirs,executors, administrators,successors,and assigns of the Parties. 7. Headings and Construction. The subject headings of the sections and paragraphs of this Amendment V are included for purposes of convenience only and do not affect the construction or interpretation of any of its provisions. All words used in this Amendment V include the plural as well as the singular number,and vice versa;words used in this Amendment V in the present tense include the future as well as the present; and words used in this Amendment V in the masculine gender include the feminine and neuter genders,whenever the context so requires. No provision of this Amendment V will be interpreted for or against a Party because that Party or its legal representative drafted the provision,and this Amendment V will be construed as if jointly prepared by the Parties. 8. Counterparts. This Amendment V may be signed by the Parties in different counterparts and the signature pages combined to create one document binding on all Parties. Ro522(1&2) County of Fresno,Department of Public Health Contract#201617-0950 Nurse Liaison Page 3 g. Sianature Authority. Each Party represents that it has capacity,full power, and authority to enter into this Amendment V and perform under modified terms of the Agreement,and the person signing this Agreement on behalf of each Party has been properly authorized and empowered to enter into this Amendment V. Contractor must sign the signatory authorization,attached as Exhibit C and incorporated into this Amendment V. Contractor must complete and forward to Commission a new signatory authorization each time any name,title,or other information in the existing authorization is no longer current. 10. Electronic Signatures. Each Party acknowledges and agrees that this Amendment V may also be executed by electronic signature,which shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.Without limitation,"electronic signature"shall include faxed versions of an original signature,electronically scanned and transmitted versions of an original signature,or an"e-signed"document(e.g. DocuSign). Signatures COMMISSION CONTRACTOR CHILDREN AND FAMILIES COMMISSION COUNTY OF FRESNO,DEPARTMENT OF OF FRESNO COUNTY PUBLIC HEALTH REVIEWED AND RECOMMENDED FOR AP VA By: 14� 1 uth ri ed presentative By: Fabio o zal ,Ex 4cuve irector Date of Signature: aa- Date of nat re: 20 Name: Sal Quintero Vice Chairman of the Board of Supervisors of Title: the County of Fresno APPROVED AS TO LEGA�FORM A/. Federal Tax ID Number: By: —— ATTEST: Ken eth Price, egal Counsel BERNICE E.SEIDEL Clerk of the Board of Supervisors Date of Signature: County of Fresno,State of California y)J, B•�-+ --- Deputyov -- By: Brian Pacheco,Commission Chair Date of Signature: Ro522(1&2) County of Fresno,Department of Public Health Contract#2o1617-0950 Nurse Liaison Page 4 EXHIBIT A Scope of Work (2022-2024 Fiscal Years) A-1 Direct Services Face Sheet& Scope of Work ©FIRSTSFIRThis FRE COUNTY is document will be completed with First 5 Fresno County(F5FC)staff and Service Provider during a development meeting. A.Face Sheet Agency Name: County of Fresno,Department of Contract Number: 201617-0950 Public Health Project ID Number:0950-17 Project Name: Nurse Liaison GL: io-8518-A 100 °r Start date/End date: 07/01/2016-06/30/2024 FY 16-17:$312,617 FY 17-18:$323,762 Agency Address: 1221 Fulton Street, Fresno, CA FY 18-1g:$368,412 Contract amount: FY 19-20:$384,139 93721 $2,966,374 FY 20-21: $345,i83 FY 21-22: $443,539 FY 22-23:$394,361 FY 23-24:$394,36i Other Project Funding:$3,727,662 BOS District:3 Agency phone#:559-600-3330 Website:www.fcdph.org Project Description: Briefly address what F5FC is funding and why. If applicable,describe the goals/outcomes. This may be placed on the F5FC website. The primary goal of the Nurse Liaison program is to prevent child maltreatment by improving health outcomes and decreasing potential re-hospitalization rates for at-risk infants and children. The Nurse Liaison program provides public health nurse liaison services to Community Regional Medical Center and Valley Children's Hospital to support infants from the Neonatal Intensive Care Unit and their families through the transition to community care,as well as high risk infants and children under six years of age living in Fresno County who because of organic or environmental factors may be at risk for growth and developmental delays and who may face serious health problems. In addition,the program serves children with developmental,or behavior challenges identified through their child care provider and pregnant or parenting teens referred from the CalLearn program. Nurse Liaisons provide assessment,consultation,technical assistance,referral and linkage to a variety of community programs via a home visitation model. F5FC Contract Manager: Liliana Salcec�o Program Contact (Person who runs day to day program operations/supervisor/coordinator/manager) Name: Megan Gunn Title: Superv�isi g Public Health Nurse E-mail: mgunn@fresnocountyca.gov Phone#: 559-600-3330 Finance Contact Person responsible for submitting budgets,financial reports and/or invoices Name: Michael Chu Title: Senior Accountant E-mail: mchu@fresnocountyca.gov Phone#: 559-600-6426 Notice Contact (Person who has legal authority to sign contract) Name: David Luchini Title: Director of Public Health E-mail: dluchini@fresnocountyca.gov Phone#: 559-600-3200 E]FIRST5S Direct Services Face Sheet & Scope of Work FRECOUNTY Public Contact Person responsible for general public calls requesting program info,how to access services,media,etc. Name:Megan Guni Title: Supervising Public Health Nurse E-mail: mgunn@fresnocountyca.gol Phone#: 559-600-3330 Program Contact (Person responsible for entering data) Name:Megan Gunn Title: Supervising Public Health Nurse E-mail: mgunn@fresnocountyca.gov Phone#: 559-600-3330 Program Contact (Person responsible for entering data) Name: Christina Wyrick Title: Program Technician E-mail: cwyrick@fresnocountyca.gov Phone#: 559-600-6347 Program Contact (Person responsible for approving submission of data Name: Megan Gunn Title: Supervising Public Health Nurse E-mail: mgunn@fresnocountyca.gov Phone#:b5g-600-3330 Finance Contact (Person responsible for entering financial information) Name: Michael Chu Title: Senior Accountant E-mail: mchu@fresnocountyca.gov Phone#: 559-600-6426 Finance Contact (Person responsible for approving financial information) Name: Megan Gunn Title: Supervising Public Health Nurse E-mail: mgunn@fresnocountyca.gov Phone#: 559-600-3330 Finance Contact (Person responsible for approving financial information) Name: Aphivanh (Aphi) Xayavath Title: Staff Analyst E-mail:axayavath@fresnocountyca.gov Phone#: 559-600-3330 County of Fresno Department of Public Health,Nurse Liaison,#201617-0950 R0522(1&2) Page 2 of 9 E]FIRST5S Direct Services Face Sheet & Scope of Work FRECOUNTY Agency Service Locations: Location(s) District(s) Location 1: 1221 Fulton Street, Fresno.CA 93721 District 3 First 5 Fresno County Strategic Plan and First 5 CA Result and Service Area Alignment: Investment Area of F5FC Strategic Plan Percent of Funding Families 100% Strategy per F5FC Strategic Plan Percent of Funding Skill Building 100% State Service Area Percent of Percent of State Result Area/Outcome Clients Funding 3.Improved Child Health Early Intervention 100 % 100% Is this an evidence based or research-based program? (Please check one) ❑ Evidence Based ®Research Based ❑ N/A B.Demographic and Geographic Client Served Details Types of Clients Served and Projected Numbers:Please note that these fields reflect the client type options in the contract management database and not family relationships. Include all client level and aggregate clients included in sections C and D. Type of Client Total#of Clients FY2223 Total#of Clients FY2324 Child 0<3 105 105 Child 3-5 25 25 Parent 45 45 Prenatal 0 0 Other(please specify): 0 0 TOTAL: 175 175 Provider Category Total#of Clients FY2223 Total#of Clients FY2324 Internal Program Staff 5 5 TOTAL: 5 5 County of Fresno Department of Public Health,Nurse Liaison,#201617-0950 R0522(1&2) Page 3 of 9 E]FIRST5S Direct Services Face Sheet & Scope of Work FRECOUNTY Projected Numbers Served in Each Geographic Region: Use the countywide box for programs providing services throughout the county. Total#of Clients Geographical Location of Clients to be Served FY2223 FY2324 County Wide 175 175 Total: 175 175 Geographical Total#of Clients Percent Urban(%) Percent Rural(%) Location of Clients to be Served FY2223 FY2324 FY2223 FY2324 FY2223 FY2324 Countywide 175 175 go% go% 10% 10% County of Fresno Department of Public Health,Nurse Liaison,#201617-0950 R0522(1&2) Page 4 of 9 E]FIRST5 Direct Services Face Sheet & Scope of Work FRESNO COUNTY C. Outputs:Services and Contacts 1 1 All services listed in section C are required to be entered in the reporting databases system on a monthly basis,refer to the Funded Partner Manual for details.All clients served by F5FC funds must meet age and residency requirements.Service Provider is required to maintain back-up documentation. The information in the table below will remain the same for the full contract term(from one fiscal year to the next)unless otherwise specified or modified through a contract amendment request.Please note,total unduplicated number of clients are captured per deliverable. Quarterly breakdown of clients may overlap. MM Core Clien Core Client Target# Target# Core (Expected#of clients (Expected#of 7 Se Client Type receiving service) clients receiving Frequency Verification Method service FY2223 FY2324 2 Total':45 Total':45 Parent Q1:5 Q1:5 ase management session -Parenting Teen' Q2:15 Q2:15 3 sessions Service log Q3:10 Q3:10 Q4:15 Q4:15 Total:130 Total:130 Q1:24 Q1:24 ase management session a Child Qz:3o Qz:30 3 sessions s Service log Q3:38 Q3 38 Q4:38 Q4:38 Total:74 Total:74 Child Q1: 3 Q1:13 SQ Q2: 7 Q2:17 Annually and as needed ASQ/ASQ:SE Q3: 2 Q3:z2 Q4: Q4:22 Total: Total:35 Q1: Q1:7 SQ:SE Child Q2: Q2:8 Annually and as needed ASQ/ASQ:SE Q3: Q3:10 Q4: Q4:10 Total: Total:83 Q1: 4 Q1:14 Service log Developmental referral Child Q2: 8 Q2:18 Annually and as needed Q3: 5 Q3:25 Q4:k6 Q4 26 Total:83 Total:83 Q1: 4 Q1:14 Service log Other referral s Child+Parent Q2: 8 Q2:18 Annually and as needed Q3: Q3:25 Q4: Q4:26 Total: Total:5 Q1:5 Q1.5 Attendance Records/Sign-in sheets Reflective practice session Provider Q2:.5 Q2:5 Once a month 6 Q3:5 Q3:5 Q4:5 Q4:5 1 Total unduplicated clients to be served in the entire year 2 Total unduplicated clients to be served in the entire year County of Fresno Department of Public Health,Nurse Liaison,#201617-0950 R0522(1&2) Page 5 of 9 E]FIRST5 Direct Services Face Sheet & Scope of Work FRESNO COUNTY D. Aggregate Services and Narrative The information in the table below will remain the same for the full contract term(from one fiscal year to the next)unless otherwise specified or modified through a contract amendment request. Service Provider is required to maintain back-up documentation. Data due Quarterly. ® Not Applicable-If your program does not provide aQaregate services,pleas County of Fresno Department of Public Health,Nurse Liaison,#201617-0950 R0522(1&2) Page 6 of 9 E]FIRST5 Direct Services Face Sheet & Scope of Work FRESNO COUNTY Service Provider Staff Confidentiality Agreement&Request for Reporting Database System User Logon All staff members of F5FC funded programs and projects(Service Providers)who are responsible for gathering or maintaining confidential information and records must adhere to this agreement. Responsibilities During the performance of Service Provider assigned duties related to the FSFC project,Service Provider might have access to confidential client information and records required for effective coordination and delivery of services to children and their families.All confidential discussions,deliberations,records,and information generated or maintained in connection with these activities shall be disclosed only to persons who have the need to know and authority to access confidential consumer information or records.This includes information obtained and conveyed through all media including the reporting database system.Service Provider must not disclose any confidential client information to any third party without the written authorization from the client or legally authorized representative. Legal Liabilities Service Provider must adhere to the following: • Notice:All applicable employees,agents,and subcontractors shall be notified of state requirements for confidentiality and also notified that any person knowingly or intentionally violating the provisions of the state law is guilty of a misdemeanor. • Records pertaining to any individual recipient of F5FC will be confidential and will not be open to examination for any purpose not directly connected with the administration of local evaluation. • No person will publish,disclose,use,or permit the use of,or cause to be published,disclosed or used,any confidential information pertaining to any individual recipient of F5FC services. Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality Agreement This notice accompanies a disclosure of confidential information concerning a consumer of services funded by the F5FC. The above referenced agency is prohibited from making any further disclosure of this confidential information unless further disclosure is expressly permitted by the written authorization to release the information of the person to whom it pertains or as otherwise permitted by these regulations.A general authorization for the release of confidential information is NOT sufficient for this purpose. Acknowledgement of Confidentiality and Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality Agreement The Agency acknowledges responsibility not to divulge any confidential information or records concerning clients of FSFC funded services without proper written authorization. By signing the Direct Services Agreement,the Agency accepts confidentiality and prohibition of re-disclosing confidential funding requirements. County of Fresno Department of Public Health,Nurse Liaison,#201617-0950 R0522(1&2) Page of 9 E]FIRST5 Direct Services Face Sheet & Scope of Work FRESNO COUNTY Type of Agreement:Amendment-Direct Service Type of Procurement: ❑ Informal ❑ Formal ® Sole Source Annual Contract Review: ® Formal ❑ Informal BFF Policy Agreement Form Completed: ® Yes ❑ No (attach form to contract) ❑ N/A EFT Form Completed: ® Yes ❑ No(attach form to contract) W-g Completed: ❑ Yes ❑ No Database Reporting System Set-Up: (check all that apply) ❑ No data-only basic info for state reporting ❑ Aggregate data ® Financial module ❑ Client level data reporting ❑Monthly reporting ® Narrative ®Quarterly reporting ®Performance module ❑ One time payment ❑Financial module ® State upload Type of Agency:(choose only one) ❑ City Government ❑ Private and/or for Profit Organization ❑ Community Benefit Organization (501(c)3 ❑ School District ® County Government ❑ State Government ❑ Faith Based Organization(attach policy) ❑ Other(please specify): ❑ Federal Government Agency ❑ Higher Education F.SFC Office Use Only Commission Approved Date: 06/01/2016 F5FC Staff Review and Approval FY 22-23 Contract Manager Approved 4/22/2022 Reviewed&Approved by Director 4/26/2022 Agency name: County of Fresno Department of Public Contract number: 201617-0950 Health Program name: Nurse Liaison Contract amount: $2,966,374 R0$22(1&2) Page 8 of g E]FIRST5 Direct Services Face Sheet & Scope of Work FRESNO COUNTY • See Description of Services(end notes) • 'Case management session-Parenting Teen:Case Management sessions include PHN visits at the client's home or field visits as an alternative to the home(examples:school,restaurant,park,etc.). Case management will be provided primarily to pregnant and/or parenting teens but may include case management services to infants and children referred from the community. Referrals come from the CalLearn program or other infant or children referrals. Case management sessions may also include a telephone call,text,email or telehealth visit no less than 5-10 minutes in length for services such as follow-up with the referral source,consultation with medical providers, child care providers,social workers,parents,and representatives of agencies involved with the client's follow- up services. These case management sessions will be recorded in the nursing documentation notes. 'Case management session(Parenting Teen) Frequency:It is expected that there will be an average of three service contacts per client,however it may range from one to as many as needed for case management services based on each client's needs and availability. 3 Case management session-Child:Case Management sessions include PHN visits at the client's home,field or site visits. Field visits are defined as visits with the PHN at alternative sites such as a public park,library or a restaurant.Site visits are defined as visits with the PHN at child care homes or centers. Case management sessions may also include a telephone call, text, email or telehealth visit no less than 5-10 minutes in length for services such as follow-up with the referral source, consultation with medical providers, child care providers, social workers,parents, and representatives of agencies involved with the client's follow- up services. These case management sessions will be recorded in the nursing documentation notes. Primary referral sources are Valley Children's Hospital and Community Regional Medical Center with additional referrals being received from CPS,medical clinics,private doctors,community members,etc. Referral sources also include child care centers,child care homes,preschools,CSN,etc. 4 Case management(Child) frequency:It is expected there will be an average of three service contacts per client,however it may range from one to as many as needed for case management services based on each client's needs and availability. 5 Other Referral(Child):Nurse Liaison will attach other referrals to the child or the parent/caregiver depending on the specificity of the referral.These other referrals are to improve the environment and decrease stressors on the child. 6 Reflective Practice- Frequency: Staff will participate in a group Reflective Practice (RP) and one-on-one sessions with the SPHN. The average RP service per staff member is once a month. The focus of these meetings will be to provide an opportunity to explore experiences, feelings and challenges encountered with clients or with the challenges of the role of home visiting itself. County of Fresno Department of Public Health,Nurse Liaison,#2o1617-0950 R0522(1&2) Page 9 of 9 County of Fresno,Department of Public Health Contract#2o1617-0950 Nurse Liaison Page 5 EXHIBIT B Project Budget (2022-2024 Fiscal Years B-1 1 FIRST 5 FRESNO COUNTY 2 Direct Service Budget 3 4 Agency Name: County of Fresno,Department of Public Health 5 Project Name: Nurse Liaison 6 Contract Term: 07/01/16-06/30/24 7 Contract Number: 201617-0950 11 12 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 13 Actuals Actuals Actuals Actuals Actuals CAR Budget Budget Budget Total Program Amount 14 07/01116-6130/17 07/01/17-06130118 07101/18-06/30119 07101/19-06/30120 07101/20-06/30/21 07/01/21-06/30122 07101/22-06/30/23 07101123-06/30/24 15 Category 16 I. Personnel 17 A. Salaries 144,171 135,693 173,854 187,729 0 193,886 180,171 184,003 1,199,507 18 B. Benefits 96,882 96,858 117,470 128,942 0 149,905 117,081 119,067 826,205 19 C. Taxes 11,188 10,006 12,397 14,361 0 14,832 13,783 14,076 90,643 20 Total Personnel 252,241 242,557 303,721 331,032 315,223 358,623 311,035 317,146 2,431,578 21 II.Operating Expenses 0 22 A. Facilities Costs 4,579 4,826 4,705 5,366 0 5,789 5,870 5,870 37,005 23 B. Operational/Supplies 3,069 2,611 3,080 1,832 0 1,326 3,067 1,711 16,696 24 C. Training/Travel 2,832 1,200 2,764 4,575 0 4,386 9,338 8,893 33,988 25 Total Operating Expenses 10,480 8,637 10,549 11,773 8,693 11,501 18,275 16,474 96,382 26 III.Program Expenses 27 A. Materials and Sup lies 2,889 2,983 4,000 14,929 4,103 10,396 6,169 45,469 xp 28 Total Program Eenses 2,889 2,983 4,000 14,929 4,030 4,103 10,396 6,169 49,499 29 IV.Professional Services 7,000 6,060 4,585 8,000 1,475 6,500 8,000 7,000 48,620 30 V. Unallocated 0 0 0 0 0 26,950 0 0 26,950 31 VI.Indirect Costs 40,007 63,525 45,557 18,405 15,762 35,862 46,655 47,572 313,346 32 33=WTotal Program 312,617 L 345,183 443,539 394,361 394,361 $ 34 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Total Other 35 VII.Other Funding Actuals Actuals Actuals Actuals Actuals Budget Budget Budget Funding 36 A. Leveraged 344,725 376,600 504,244 459,245 572,353 521,222 470,754 478,520 3,727,662 37 B. Select Other Funding Source: 0 0 0 0 0 0 0 0 0 38 C. Other Funding Source: 0 0 0 0 0 0 0 0 0 39 Total Other Funding 1 lAgency Name: lCounty of Fresno, Department of Public Health Contract Term: 07/01/16-06/30/24 2 1 Project Name: Nurse Liaison Contract Number: 201617-0950 3 4 YEAR 8 First 5 Amounts Leveraged Select Other Funding Source: 5 6 07/01/23-6/30/24 07/01/23-6/30/24 07/01/23-6/30/24 7 I. Personnel Title FTE Amount Title FTE Amount Title FTE Amount 8 Supervising Public Health Nurse 0.33 40,433 Supervising Public Health Nurse 0.37 46,532 - 9 Public Health Nurse II 0.41 30,112 Public Health Nurse II 0.59 43,777 10 The "Amount" should be: Annual Public Health Nurse II 0.40 41,338 Public Health Nurse II 0.60 62,006 Salary X the FTE whenever possible. 11 Public Health Nurse 1 0.45 32,988 Public Health Nurse 1 0.55 40,901 12 1 FTE = 40 hours /week Public Health Nurse 1 0.50 39,132 Public Health Nurse 1 0.50 38,451 13 14 15 A. Total Salaries & FTE 2.09 184,003 2.61 231,667 - - 16 B. Benefits 64.709% 119,067 149,909 - 17 C. Taxes 7.65% 14,076 17,723 - 18 Personnel Subtotal 317,146 399,299 - Justification of Benefits and Taxes: Estimated benefits rates reflect Unemployment Insurance (.0032718), Retirement (.5141-.6527), OASDI (.0765), Health Insurance 19 ($9605-$12476 per FTE per year) and Benefits Administration ($122 per FTE per year). 20 II. Operating Expenses 21 A. Facilities Costs 5,870 7,330 - 22 Narrative/Justification - Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation Fresno County Department of Public Health, 1221 Fulton St, 4th floor, Fresno, CA 93721. Telephones ($2,000), facility operation/maintenance/household services Narrative/Justification - ($5,600), utilities ($4,000), and security/alarm ($1,600). These are all Internal Service Funds charges by square footage and assigned phone lines for the program. General Services Administration provides base amount for the department. Nurse Liaison staff account for approximately 950 sq ft. 23 24 B. Operational/Supplies 1,711 889 - 25 Narrative/Justification - Explain these costs and how they apply to the program, then state methodology (materials, services, leases) for these costs and provide the calculation General office supplies such as paper, pencils, envelopes and filing supplies ($1000), printing ($300) and postage ($300). Medical supplies for PHNs to use during Narrative/Justification - home visits ($1000). 26 27 C. Training/Travel 8,893 11,107 - 28 Narrative/Justification - Explain these costs and how they apply to the program, then state methodology (name of local conferences & trainings) for these costs and provide the calculation Fees for staff to attend local meetings, conferences, and trainings ($2,000). Staff private auto mileage reimbursement at a rate of$0.585 per mile ($15,000). Narrative/Justification - County vehicle maintenance/usage/garage ($3,000). 29 33 Operating Expenses Subtotal 16,474 19,326 - 34 III. Program Expenses Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program 35 participants (include calculations where applicable). 36 A. Materials and Supplies 6,169 - - 37 Subtotal 1 6,169 - - 38 Narrative/Justification - Provide the number of participants, cost per item, a description of the item, and justification for all expenses that support the clients of the program. Forms, pamphlets, educational materials (books and toys for children) to evaluate, educate and foster physical/mental/social growth in Nurse Liaison clients. Narrative/Justification for Materials and Supplies 39 40 IV. Professional Services (Contracts, MOU's, Sub agreements, etc.) Instructional Information In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or 41 staff (include calculations where applicable). Any services exceeding $5,000 must have attached a narrative delineating services. 43 Subtotal 7,000 1 - - Estimated costs for interpreters/translators who provide services for various languages through a Countywide contract. Interpreting services at a rate of$40.00 per Narrative/Justification - 44 hou 50 Program Totals 346,789 418,625 - 51 VI. Indirect (= Program Totals - Equipment x Percentage of Indirect) 52 Instructional Information In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined. 53 A. Indirect Rate 15.000% 47,572 59,895 Fresno County Department of Public Health's indirect cost rate is 22.579% of the total personnel costs, prepared following OMB's 2 CFR Part 200 guidelines and Narrative/Justification - approved by County of Fresno's Auditor-Controller/Treasure-Tax Collector Department. Lower rate applied to this budget to ensure sufficient funding for direct 541 costs and remaining within funding award amount. 55 Total Proposed Budget 1 1 394,361 478,520 - 1 lAgency Name: lCounty of Fresno, Department of Public Health Contract Term: 07/01/16-06/30/24 2 1 Project Name: Nurse Liaison Contract Number: 201617-0950 3 4 YEAR 7 First 5 Amounts Leveraged Select Other Funding Source: 5 6 07/01/22-6/30/23 07/01/22-6/30/23 07/01/22-6/30/23 7 I. Personnel Title FTE Amount Title FTE Amount Title FTE Amount 8 Supervising Public Health Nurse 0.33 40,433 Supervising Public Health Nurse 0.37 46,532 - 9 Public Health Nurse II 0.41 30,112 Public Health Nurse II 0.59 43,777 10 The "Amount" should be: Annual Public Health Nurse II 0.40 39,369 Public Health Nurse II 0.60 59,054 Salary X the FTE whenever possible. 11 Public Health Nurse 1 0.45 32,988 Public Health Nurse 1 0.55 40,901 12 1 FTE = 40 hours /week Public Health Nurse 1 0.50 37,269 Public Health Nurse 1 0.50 36,620 13 14 15 A. Total Salaries & FTE 2.09 180,171 2.61 226,884 - - 16 B. Benefits 64.983% 117,081 147,436 - 17 C. Taxes 7.65% 13,783 17,357 - 18 Personnel Subtotal 311,035 391,677 - Justification of Benefits and Taxes: Estimated benefits rates reflect Unemployment Insurance (.0032718), Retirement (.5141-.6527), OASDI (.0765), Health Insurance 19 ($9605-$12476 per FTE per year) and Benefits Administration ($122 per FTE per year). 20 II. Operating Expenses 21 A. Facilities Costs 5,870 7,330 - 22 Narrative/Justification - Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation Fresno County Department of Public Health, 1221 Fulton St, 4th floor, Fresno, CA 93721. Telephones ($2,000), facility operation/maintenance/household services Narrative/Justification - ($5,600), utilities ($4,000), and security/alarm ($1,600). These are all Internal Service Funds charges by square footage and assigned phone lines for the program. General Services Administration provides base amount for the department. Nurse Liaison staff account for approximately 950 sq ft. 23 24 B. Operational/Supplies 3,067 1,333 - 25 Narrative/Justification - Explain these costs and how they apply to the program, then state methodology (materials, services, leases) for these costs and provide the calculation General office supplies such as paper, pencils, envelopes and filing supplies ($1800), printing ($300) and postage ($300). Medical supplies for PHNs to use during Narrative/Justification - home visits ($2000). 26 27 C. Training/Travel 9,338 11,662 - 28 Narrative/Justification - Explain these costs and how they apply to the program, then state methodology (name of local conferences & trainings) for these costs and provide the calculation Fees for staff to attend local meetings, conferences, and trainings ($2,000). Staff private auto mileage reimbursement at a rate of $0.585 per mile ($15,000). Narrative/Justification - County vehicle maintenance/usage/garage ($4,000). 29 33 Operating Expenses Subtotal 18,275 20,325 - 34 III. Program Expenses Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program 35 participants (include calculations where applicable). 36 A. Materials and Supplies 10,396 - - 37 Subtotal 1 10,396 - - 38 Narrative/Justification - Provide the number of participants, cost per item, a description of the item, and justification for all expenses that support the clients of the program. Forms, pamphlets, educational materials (books and toys for children) to evaluate, educate and foster physical/mental/social growth in Nurse Liaison clients. Narrative/Justification for Materials and Supplies 39 40 IV. Professional Services (Contracts, MOU's, Sub agreements, etc.) Instructional Information In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or 41 staff (include calculations where applicable). Any services exceeding $5,000 must have attached a narrative delineating services. 43 Subtotal - Estimated costs for interpreters/translators who provide services for various languages through a Countywide contract. Interpreting services at a rate of $40.00 per Narrative/Justification - 44 hour. 50 Program Totals 347,706 412,002 - 51 VI. Indirect (= Program Totals - Equipment x Percentage of Indirect) 52 Instructional Information In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined. 53 A. Indirect Rate 15.000% 46,655 58,752 Fresno County Department of Public Health's indirect cost rate is 22.579% of the total personnel costs, prepared following OMB's 2 CFR Part 200 guidelines and Narrative/Justification - approved by County of Fresno's Auditor-Controller/Treasure-Tax Collector Department. Lower rate applied to this budget to ensure sufficient funding for direct 54 costs and remaining within funding award amount. 55 Total Proposed Budget 1 1 394,361 470,754 - County of Fresno,Department of Public Health Contract#201617-0950 Nurse Liaison Page 5 EXHIBIT C Signature Authorization I CERTIFY THE AGENCY OFFICIAL LISTED BELOW IS AUTHORIZED AND EMPOWERED TO SIGN AND ENTER INTO THIS AGREEMENT ON BEHALF OF THE AGENCY (CONTRACTOR) AND BY VIRTUE OF THAT PERSON'S SIGNATURE, BIND THE AGENCY. ORGANIZATION/AGENCY NAME (CONTRACTOR): County of Fresno SIGNATURE OF GOVERNING BODY OFFICIAL: DATE SIGNED: PRINTED NAME: Sal Quintero TITLE: Vice Chairman of the Board of Supervisors of the County of Fresno SIGNATURE OF AUTHORIZED AGENCY OFFICIAL: DATE SIGNED: TYPED NAME: Sal Quintero TITLE: Vice Chairman of the Board of Supervisors of the County of Fresno NOTE: SHOULD CIRCUMSTANCES REQUIRE A CHANGE IN THE ABOVE, A NEW SIGNATORY AUTHORIZATION MUST BE COMPLETED AND FORWARDED TO THE COMMISSION. ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of I"resno,State of California By Deputy B-1