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HomeMy WebLinkAboutAgreement A-22-232 with CDPH.pdf Agreement No. 22-232 State of California — Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) CALIFORNIA ORAL HEALTH PROGRAM Moving California Oral Health Forward Awarded By THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter "Department" TO County of Fresno , hereinafter "Grantee" Implementing the "Fresno County Local Oral Health Program," hereinafter "Project" GRANT AGREEMENT NUMBER 22-10163 The Department awards this Grant and the Grantee accepts and agrees to use the Grant funds as follows: AUTHORITY: The Department has authority to grant funds for the Project under Health and Safety Code, Section 104750 & 131085 and Revenue and Taxation Code 30130.57 PURPOSE: The Department shall award this Grant Agreement to and for the benefit of the Grantee; the purpose of the Grant is to provide establish or expand upon existing Local Oral Health Programs by including the following program activities related to oral health in their communities: education, disease prevention, facilitating community-clinical linkages, and surveillance. These activities will improve the oral health of Californians. This goal shall be achieved by providing funding for activities that support demonstrated oral health needs and prioritize underserved areas and populations. I GRANT AMOUNT: The maximum amount payable under this Grant Agreement shall not exceed the amount of Two Million Six Hundred Forty-Four Thousand Two Hundred Eighty Dollars ($2,644,280.00) TERM OF GRANT AGREEMENT: The term of the Grant shall begin on July 1 , 2022 and terminates on June 30, 2027]. No funds may be requested or invoiced for services performed or costs incurred after June 30, 2027. PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will be: California Department of Public Health Grantee: �[ County of Fresno Page 1 of 4 State of California — Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) Name: Melanie Ruvalcaba, Division Name: David James Manager ddress: MS 7218, 1616 Capitol Avenue, (Address: 1221 Fulton Street Suite 74.420 [City, ZIP: Sacramento, CA 95814 City, ZIP: Fresno, CA, 93721 [Phone: (916) 440-7197 [Phone: 559-600-6449 [E-mail: DentalDirector@cdph.ca.gov [E-mail: mruvalcaba@fresnocountyca.gov Direct all inquiries to the following representatives: California Department of Public Health, —F [Office of Oral Health] Grantee:[ County of Fresno ] Attention: David James Attention: Allegra Chacon, Health Educator ddress: MS 7218, 1616 Capitol Avenue, Address: 1221 Fulton Street Suite 74.420 [City, Zip: Sacramento, CA 95814 [City, Zip: Fresno, CA, 93721 [Phone: (916) 440-7197 [Phone: 559-600-6449 �E-mail: DentalDirector@cdph.ca.gov �E-mail: alchacon@fresnocountyca.gov All payments from CDPH to the Grantee; shall be sent to the following address: Remittance Address [Grantee: [County of Fresno] (Attention "Cashier": Bruna Chavez Address: PO Box 11867 [City, Zip: Fresno, CA, 93775 [Phone: 559-600-6415 �E-mail: dphboap@fresnocountyca.gov Either party may make changes to the Project Representatives, or remittance address, by giving a written notice to the other party, said changes shall not require an amendment to this agreement but must be maintained as supporting documentation. Note: Remittance address changes will require the Grantee to submit a completed CDPH 9083 Governmental Entity Taxpayer ID Form or STD 204 Payee Data Record Form and the STD 205 Payee Data Supplement which can be requested through the CDPH Project Representatives for processing. Page 2 of 4 State of California— Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) STANDARD GRANT PROVISIONS. The Grantee must adhere to all Exhibits listed and any subsequent revisions. The following Exhibits are attached hereto or attached by reference and made a part of this Grant Agreement: Exhibit A, GRANT APPLICATION —Application Checklist, Grantee Information Form, Narrative Summary Form, Scope of Work and Deliverables Note: Once the Grant Agreement has been fully executed, requests for modifications/changes thereafter to the existing Exhibit A, do not require a formal amendment but must be agreed to in writing by both parties. The CDPH/Grantee Project Representatives are responsible for keeping records of approved modifications/changes. Such modifications/changes must be made at least 30 days prior to implementation. A formal written amendment is required when there is an increase or decrease in funding or a change in the term of the agreement. Exhibit B BUDGET DETAIL AND PAYMENT PROVISIONS Exhibit C STANDARD GRANT CONDITIONS Exhibit D REQUEST FOR APPLICATION (RFA) - https://oralhealthsupport.ucsf.edu/moving-california-oral-health-forward-rfa-2022-2027 Exhibit E ADDITIONAL PROVISIONS GRANTEE REPRESENTATIONS: The Grantee(s) accept all terms, provisions, and conditions of this grant, including those stated in the Exhibits incorporated by reference above. The Grantee(s) shall fulfill all assurances and commitments made in the application, declarations, other accompanying documents, and written communications (e.g., e-mail, correspondence) filed in support of the request for grant funding. The Grantee(s) shall comply with and require its subgrantee's to comply with all applicable laws, policies, and regulations. Page 3 of 4 State of California—Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) IN WITNESS THEREOF, the parties have executed this Grant on the dates set forth below. Executed By: OL tv ►L Date. /7/22 Brian Pacheco, Chairman of the Board of Supervisors of the County of Fresno 1221 Fulton Street Fresno, CA, 93721 Digitally signed by Joseph Torrez Date: Joseph TO r reZ Date:2022.06.14 08:24:05-07'00' _ Joseph Torrez, Chief ;Contracts Management Unit California Department of Public Health 1616 Capitol Avenue Sacramento, CA 95899-7377 ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of California By /*V/, @alr?w1w Depu Page 4 of 4 Exhibit A 22-10163 Grant Application County of Fresno Moving California Oral Health Forward 2022 — 2027 Document A Application Checklist DUE: 12/15/21 DATE OF SUBMISSION: December 15, 2021 ORGANIZATION Fresno County Department of Public Health, Division of Health NAME: Policy and Wellness APPLICATION CONTACT NAME: PHONE NUMBER: Melanie Ruvalcaba 559-600-6449 EMAIL ADDRESS: mruvalcaba@fresnocountyca.gov Complete this Application Checklist and email it along with the following documents to: Dental Di rector(a_)cd ph.ca.gov by 12/15/21* *Note:A supplemental submission containing Document E (Supplemental Submission Checklist) and Document F (Detailed Budget and Justification) is due on 01131122.This is to accommodate additional program and fiscal planning as part of an interactive process with OOH. APPLICATION CONTENTS: Please Check Application Checklist (Document A) Grantee Information Form (Document B) Narrative Summary Form (Document C) Governmental Payee Form CDPH 9083 (Document D) Grant Activities and Reporting/Tracking Measures (Exhibit A) Document B Grantee Information Form This is the information that will appear in your grant agreement. Federal Tax ID # c Name Fresno County Department of Public Health N Mailing Address P.O. Box 11867, Fresno, CA 93775 ° Street Address (If Different) 1221 Fulton Street Fresno, CA 93721 a� L O County Fresno Phone 559-600-6449 Fax Website www.fcdph.org The Grant Signatory has authority to sign the grant agreement cover. Name Brian Pacheco cTitle Chairman of the Board of Supervisors of the County of Fresno r ° = If address(es) are the same as the organization above,just check this box and go to Phone 0 aM y Mailing Address Street Address (If Different) Phone 559-600-6449 Email bpacheco@fresnocountyca.gov The Project Director is responsible for all of the day-to-day activities of project implementation and for seeing that all grant requirements are met. This person will be in contact with Oral Health Program staff, will receive all programmatic, budgetary, and accounting mail for the project and will be responsible for the proper dissemination of program information. Name Allegra Chacon L ° Title Health Educator 0 m GL Supervisor Name and Title Melanie Ruvalcaba, Division Manager Supervisor Email and Phone mruvalcaba(o-)_fresnocountyca.gov 559-600-6449 m If address(es) are the same as the organization above,just check this box and go to Phone 0 a Mailing Address Street Address (If Different) Phone 559-600-6449 Fax Email alchacon(@fresnocountyca.gov These are the annual Funding amounts your LHJ will accept for grant purposes. Year 1 (FY 22/23) $528,856 a� __ Year 2 (FY 23/24) $528,856 U_ Year 3 (FY 24/25) $528,856 Year 4 (FY 25/26) $528,856 r 5 (FY 26/27) $528,856 Document C Narrative Summary Form (Fresno County) NARRATIVE SUMMARY Include a Narrative Summary about your Local Oral Health Program (LOHP). Please describe the following elements: Legacy Programs (current grantees 2018-2022 grant cycle) • An overview of your county or jurisdiction's current status of oral health, your vulnerable and/or underserved population(s), demographics, and geography. • LOHP accomplishments during the 2017-2022 grant cycle. • A general description of how the LOHP has evolved over the five-year grant term. • Describe how you envision the LOHP evolving in the next five-year grant term (2022-2027). What do you hope to accomplish in the next grant cycle? • Barriers and potential strategies for the next 5 years. New Programs (new programs in 2022-2027 grant cycle) • Your county or jurisdiction's current status of oral health. • Your vulnerable and/or underserved population(s), demographics, and geography. • Include whether your LHJ has an Oral Health Program currently in place, and if so, please describe. • Please provide a general description of how you envision the LOHP evolving over the five-year grant term, and how you shall accomplish these activities. The Narrative Summary cannot exceed 2 pages, single-spaced, using 12 pt. font, with one-inch margins on all sides. Please use the Narrative Summary Form to prepare this application component. This will be the third document to include in your grant application. (Document C) According to the US Census Bureau, nearly 1 million residents live in Fresno County making it the most populated county in the San Joaquin Valley. From 2010 to 2018, the population increased by approximately 6.9%. In terms of Fresno County's racial/ethnic composition, Latinos (53%) are the largest group followed by Whites (29%). Among the 58 counties in California, Fresno County is ranked fourth highest in the percentage of residents enrolled in Medi-Cal with nearly 50% of the total population. The Annual Dental Visits (ADV) utilization among Medi-Cal Dental children aged 0-20 years old in the county has shown a slight increase from 2016 to 2018. The percentage has increased by 3.1% from 43% in 2016 to 46.1% in 2018. Compared to the California average, the children's ADV has also increased from 44.5% to 47.6% from 2016 to 2018 respectively, with a similar percentage increase to Fresno County (3.1%) (Central Valley Health Policy Institute, Fresno County Oral Health Needs Assessment (2020)). https://www.co.fresno.ca.us/home/showpublisheddocument/52957/637509839406670000 Page 1 of 3 Document C Narrative Summary Form (Fresno County) One of the first accomplishments of the Fresno County LOHP was establishing the Oral Health Advisory Committee (OHAC). Through the committee, many partnerships have been established that have been instrumental in implementing key workplan activities. Key participants have included local dental providers, Registered Dental Hygienists in Alternative Practice (RDHAP), community-based organizations (CBOs), the Fresno Madera Dental Society, the Fresno City College Dental Hygiene Program, and local health plan representatives. Another accomplishment was the implementation of the school-based sealant program (SBSP). The SBSP subcontractor, Fresno Economic Opportunities Commission (Fresno ECO), was selected in October 2019 through a request for proposals process. The SBSP was piloted in three school districts in Fresno County: Fowler Unified, Kings Canyon Unified, and Washington Unified. Fresno County LOHP and Fresno EOC were planning to implement SBSP in the Fresno Unified School District in March 2020, but the pandemic brought the program in all districts to a halt. With the SBSP on pause, staff shifted resources to providing virtual education to students and partnering with local Head Starts to provide dental screenings. During this time, LOHP staff and the Oral Health Consultant, were able to connect with the Director of Health Services for the Fresno County Superintendent of Schools and school nurses to discuss increasing Kindergarten Oral Health Assessment (KOHA) participation. This partnership will be important as we move into the next funding cycle and continue to work with all school districts in Fresno County. Other accomplishments include hiring an Oral Health Consultant to help champion local oral health initiatives, establishing two mini-grant contracts to promote oral health during pregnancy and oral health literacy, conducting media campaigns to highlight Medi-Cal dental benefits and the importance of KOHA, and partnering with local organizations to provide dental kits to children. These activities have helped keep oral health as a topic of priority amongst the plethora of issues our communities face and has elevated discussions around policy, systems, and environmental changes that will have a positive impact on children's oral health. Over the past five years, the Fresno County LOHP has successfully established a network of partners that have been instrumental in promoting local oral health initiatives. Much of the work and drive that the Fresno County LOHP has built was possible through the Dental Transformation Initiative's Local Dental Pilot Project (LDPP). The LDPP enabled care coordination and increased Medi-Cal dental providers in Fresno County, which in turn helped families enroll in dental benefits and establish a dental home. When the LDPP program ended in December 2020, Fresno LOHP provided local providers and CBOs dental resources in the form of educational materials, toothbrush kits, and OHAC membership, but much more needs to be done to fully reinstate care coordination for dental health. Fresno County LOHP is developing a flowchart for dental care coordination modeled from other LOHPs. This will be a resource and tool that community organizations can use to help establish dental care for families they provide services for, and to possibly bring other partners on board. In the past year, Fresno LOHP's focus has been to keep current partners engaged, especially schools. Providing KOHA training has been successful in fostering this relationship. Conducting screening events has also been a focus, but a more structured schedule will Page 2 of 3 Document C Narrative Summary Form (Fresno County) be important to maintain sustainability. In the next 5-year cycle, KOHA and dental screenings will continue to be the focus, but with more participation from local providers. In the next five-year grant cycle, Fresno County LOHP hopes to accomplish the goals and objectives listed in the workplan. This includes continuing the work in sustaining oral health infrastructure, continuing to implement evidence-based programs, such as the school-based or school-linked sealant program, continuing to promote and assess KOHA reporting, and fostering current relationships with community partners who work with the same target population. There will be a greater emphasis on screening for kindergarten children via the school-based or school-linked program which will be facilitated through the dental referral system. This will require Fresno County LOHP to recruit local dental providers to use the system and provide training. Fresno County LOHP will also implement tobacco cessation and sugar consumption resources in the oral health community via the OHAC and promote these resources through the Fresno Madera Dental Society. This will create a new opportunity for connecting with additional partners, the opportunity to expand the local OHAC network, and to become a partner and or champion for creating equitable oral health changes. Potential barriers that Fresno County LOHP foresees in the next 5 years are the COVID-19 pandemic and recruiting providers to use the dental referral coordination system. The pandemic is still very much in full swing here in Fresno County. Although Fresno LOHP has learned to work through many of these challenges by opting for virtual or reduced capacity events, schools are still very reluctant and wary of on-site activities. Fresno County LOHP may need to explore virtual screenings and provide more virtual education as a way to progress to in-person dental activities. Recruiting providers will also be difficult as we move dental coordination forward in Fresno County. Membership in OHAC will be a way to initiate buy-in, especially now that Fresno LOHP has a few unofficial dental champions. Having our public health administration be supportive of dental coordination by recognizing the benefits to the community at large will also be important and will be key to leverage high level stakeholders in creating a sustainable system change in Fresno County. Page 3 of 3 Slate of Catifomla-Health and Human Serv',ces Agency CaGfomia Department cl Public Health 1616 Capitol Ave.,Suite 74.262 P.O.Boa%7377.PAS 1800 Sacramento, CA 95099.7377 Submit wvnv COO ca.aov GOVERNMENT AGENCY TAXPAYER ID FORM The pnnopal pulpm of the information provided is to establish the unique identification of the government entity_ laslwUicias You may submit one form for the principal government agency and all subsidiaries sharing the same TIN.Subkli&rie$with a d iferont TIN must submit a separate totm,Fields bordered in red are required,Pime pit the form to sign prior to submittal You may email the form to:CovSupphersacdph.ca gov or fax it to(916)650 0100,or ma,l it to the address above. Principal County of Fresno Government Agency Name Remit-To PC Box 11867 Address(Street or PC Box) City: Fresno State: CA Zip Code+4: 93775 Government City Fa County Federal --� Type: Special District Federal Employer IdentiFcation 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 Califomia. FISCal10X — DepllDtulsJon"l Complete aww Name Address ICal 108 F13Ga DeptlDivisionlUnit Compilele Name Address FISCal lop DeptUivisiorvUnd Complete M."o Name Address rISC1111E?t Dept)DrvisioWUrot 1 COmdate Name J Address Contact Person Duna Chavez Title Business Manager Phone number I559-600-6t11 5 E-mail address Idphoap@fresracountyea.gov Signature Date r COPH 9083(1118) Exhibit A Grant Activities 2022—2027 REVISED 111512021 Local Health Jurisdictions (LHJs) shall implement selected strategies outlined in the California Oral Health Plan and make progress toward achieving the California Oral Health Plan's goals and objectives. The activities may include convening, coordination, and collaboration to support planning, disease prevention, surveillance, education, and linkage to treatment programs. LHJs will maintain regular reporting to demonstrate progress towards implementing grant activities. LHJs or designees must select Grant Activities and Reporting/Tracking Measures for objectives 1, 2, and 3 and will be responsible for selecting, at a minimum, one additional objective (from objectives 4 — 7) of their choice for the entire grant term. LHJs or designees can choose one or all objectives from 4-7. A more comprehensive summary of expectations for grant objectives, activities, and reporting/tracking measures is included in a separate LOHP Work Plan in Appendix 2. Based on the guidance above, please indicate which of the objectives and activities your local health jurisdiction will implement by placing an X'in the appropriate check box below. Maintain records of reporting/tracking measures for all selected objectives and submit documentation annually, bi-annually, or as necessary, including all relevant documentation in progress report and data form submissions: Activities Reporting/Tracking Measures Timeline X Objective 1: By June 30, 2027, establish or sustain program infrastructure, partnerships, and processes to ensure implementation and evaluation of the Work Plan. ❑x 1.1: Build or maintain capacity and engage 1.1.a(A): LOHP staff trainings list 07/1/22- 06/30/27 community stakeholders to provide qualified professional 1.1.b(A): Advisory Committee (AC) members list expertise in dental public health for program direction, 1.1.c(A): AC meeting agendas coordination, and collaboration. 1.1.c(B): Number of AC meetings convened 1.1.c(C): AC meeting participation list 1.1.d(A): Community engagement summary 1.1.e(A): List of partner communications 1.1.f(A): AC meeting minutes 1.1. A : AC satisfaction survey evaluation ® 1.2: Assess and monitor social and other 1.2(A): List of prominent social determinants of 07/1/22- 12/31/25 determinants of health, health status, health needs, and health in LHJ health care services available to local communities, with 1.2(B): 2020 census data on vulnerable/ underserved demographics in LHJ Page 1 of 11 Exhibit A Grant Activities 2022—2027 REVISED 111512021 a special focus on underserved areas and vulnerable 1.2.a(A): Needs Assessment (NA) work group population groups. roster 1.2.b(A): Summary resources and service gaps 1.2.c(A): NA instrument 1.2.d(A): Data gathered and inventoried 1.2.d(B): Summary of analysis and data gaps 1.2.d(C): Identified resources to fill data gaps 1.2.d(D): Description of methods selected 1.2.e(A): Action plan to collect missing NA data 1.2.e(B): Summary of data collected 1.2.f A : Data summary report ® 1.3: Identify assets and resources that will help to 1.3.a(A): Inventory of community assets and 07/1/22- 12/31/25 address the oral health needs of the community with an resources emphasis on underserved areas and vulnerable 1.3.b(A): Published inventory of community population groups within the jurisdiction. assets/resources and service gaps ® 1.4: Develop a new or update an existing community 1.4.a(A): CHIP timeframe 07/1/22 —08/31/26 health improvement plan (CHIP) and create an action 1.4.a(B): Summary of objectives and strategies plan to address the oral health needs of underserved 1.4.a(C): List of participants in CHIP planning areas and vulnerable population groups for the 1.4.b(A): List of planning meetings and meeting implementation phase and to achieve the state oral minutes health objectives. 1.4.c(A): Action plan 1.4.d A : Summary report ® 1.5: Develop a new, or continue implementing an 1.5.a(A): List of stakeholders in evaluation 07/1/22- 12/31/25 existing Evaluation Plan, to monitor and assess the process progress and success of the Local Oral Health Program 1.5.b(A): Program logic model (LOHP)Work Plan objectives. Update objectives, 1.5.c(A): Evaluation Plan grid evaluation questions, and plan as needed. 1.5.d(A): Evaluation Plan progress summary ® 1.6: Complete progress reports (PR) bi-annually 1.6(A): PR 1 July 1st— December 31, 2022 07/1/22- 06/30/27 using the progress report template provided. Detailed o DUE January 31, 2023 instructions will be provided. 1.6(B): PR 2 January 1st—June 30, 2023 o DUE July 31, 2023 1.6(C): PR 3 July 1 st— December 31, 2023 o DUE January 31, 2024 Page 2 of 11 Exhibit A Grant Activities 2022 —2027 REVISED 111512021 1.6(D): PR 4 January 1st— June 30, 2024 o DUE July 31, 2024 1.6(E): PR 5 July 1 st— December 31, 2024 o DUE January 31, 2025 1.6(F): PR 6 January 1 st— June 30, 2025 o DUE July 30, 2025 1.6(G): PR 7 July 1 st— December 31, 2025 o DUE January 31, 2026 1.6(H): PR 8 January 1 st— June 30, 2026 o DUE July 30, 2026 1.6(1): PR 9 July 1 st— December 31, 2026 o DUE January 31, 2027 1.6(J): PR 10 January 1 st— June 30, 2027 o DUE July 30, 2027 ❑x Objective 2: By June 30, 2027, implement evidence-based programs to achieve California Oral Health Plan objectives. ® 2.1: Conduct planning to support the development of 2.1.a(A): Strengths Weaknesses Opportunities 07/01/22-06/30/23 community-clinical linkages and school-based/ school- Threats (SWOT) analysis summary report linked programs. 2.1.b(A): List of participating and identified schools and grades 2.1.b(B): Program model selected and tracking system 2.1.b(C): List of partners and roles 2.1.b(D): List of services 2.1.b(E): Early prevention intervention selected 2.1.b(F): Implementation plan 2.1.b(G): List of equipment purchased 2.1.b H : Invoices for billing ® 2.2: Identify, maintain, and expand partnerships with 2.2(A): Memorandums of Understanding 07/01/22-06/30/27 dental providers and schools to implement, administer, (MOUs) and other partnership agreements and sustain school dental programs in targeted sites. 2.2.a(A): List of participating and identified schools and grades 2.2.b(A): List of dental providers with partnership agreements 2.2.c A : Activity to Page 3 of 11 Exhibit A Grant Activities 2022—2027 REVISED 111512021 2.2.d(A): Sealant education materials 2.2.d(B): Fluoride education materials 2.2.d(C): Preventive dental services education materials 2.2.e(A): Distribution list and format 2.2.e(B): Number of stakeholders reached 2.2.e(C): List of educational materials provided 2.2.e(D): Consent forms on file 2.2.f(A): Implementation schedule 2.2.g(A): Number of education sessions delivered 2.2.g(B): List of trainings provided and site 2.2.h(A): Number of schools with a dental program 2.2.h B : Number of children screened ® 2.3: Implement a dental screening program with a 2.3(A): Number and proportion of eligible 07/01/22-06/30/27 robust community-clinical linkage system using a referral schools participating management electronic platform for connecting with 2.3(B): Number and proportion of eligible parents/caregivers and linking children to a source of children screened dental care, tracking the progress of care from referral to 2.3(C): Referral acceptance completion of treatment plan. 2.3(D): Patient contact 2.3(E): Receipt of services 2.3(F): Need resolution 2.3.a(A): Number of dental providers accepting referrals 2.3.a(B): List of participating providers 2.3.b(A): Written care coordination protocol 2.3.c(A): Estimated number and proportion of high-risk children needing sealants and referrals 2.3.c(B): Referral criteria 2.3.d(A): Check-list for school-based program readiness 2.3.e(A): Narrative summary of preventive services implemented Page 4 of 11 Exhibit A Grant Activities 2022—2027 REVISED 111512021 2.3.e(B): Number of sealants 2.3.e(C): Number of fluoride varnish applications received 2.3.e(D): Number of toothbrush prophylaxis treatments received 2.3.e(E): Total number of students receiving preventive services 2.3.f(A): Communications 2.3.f(B): Success of referrals 2.3.f(C): Data findings 2.3.f(D): Number of successful referrals 2.3.f(E): Quality improvement (QI) strategies 2.3.f(F): Increase in children served 2.3.f G : Timelines for data review ® 2.4: Conduct training for community 2.4(A): Training agenda 07/01/22-06/30/27 members/partners/stakeholders who desire to learn 2.4(B): Training materials about the safety, benefits and cost effectiveness of 2.4(C): Number of community trainees for community water fluoridation and its role in preventing community water fluoridation trainings dental disease. 2.4.a(A): Number of engineers/operators trained 2.a(B): List of trainees and trainings 2.4.b(A): Marketing materials 2.4.b(B): Number of public awareness campaigns 2.4.c(A): Webpage URL 2.4.d(A): Evaluation report 2.4.d(B): Assurances for successful referral 2.4.e(A): School dental program success stories 2.4.e B : Dissemination plan ® Objective 3: By June 30, 2027, work with partners to promote oral health by developing and implementing prevention and health care policies and guidelines for programs, health care providers, and institutional settings (e.g., schools) including integration of oral health care and overall health care. Page 5 of 11 Exhibit A Grant Activities 2022 —2027 REVISED 111512021 ® 3.1: Assess the number of schools currently not 3.1(A): List and number of KOHA non- 07/01/22-06/30/27 reporting Kindergarten assessments to the System for participating schools identified California Oral Health Reporting (SCOHR). 3.1.a(A): List of KOHA best practices 3.1.b(A): List of KOHA target schools 3.1.c(A): List and number of KOHA champions 3.1.c(B): KOHA champion onboarding and training materials 3.1.c(C): Number of school districts participating in KOHA intervention 3.1.c(D): Number of children served by KOHA intervention 3.1.d(A): KOHA toolkit 3.1.d(B): List of KOHA presentations made 3.1.d(C): Copy of KOHA letters written 3.1.d(D): Number of schools adopting policies or participating in KOHA because of efforts 3.1.f(A): KOHA guidance documents for schools 3.1.f(B): KOHA fact sheets 3.1.g(A): List of KOHA key partners 3.1.g(B): Schedule of KOHA key partners meetings held 3.1.g(C): KOHA targets identified 3.1.h(A): KOHA summary in progress reports 3.1.h(B): KOHA policies revised and developed 3.1.h(C): Number of school districts reporting KOHA data 3.1.h(D): Number of children receiving KOHA screening 3.1.h(E): Number of oral health assessment activities, number of assessment events, number of assessment messages, and number of new schools participating in assessments 3.1.i(A): KOHA success stories 3.1.i B : KOHA success stories dissemination Page 6 of 11 Exhibit A Grant Activities 2022—2027 REVISED 111512021 plan ® 3.2: Develop and implement a plan to identify and 3.2(A): Key partner recruitment plan 07/01/22-06/30/27 recruit key partners that work with underserved 3.2(B): Key partner recruitment letters populations: First 5 commission, County Office of 3.2(C): List of key partners recruited Education, local Child Health and Disability Prevention 3.2(D): List of Home Visiting programs (CHDP), Women, Infants, and Children (WIC), Early 3.2.a(A): Role of key partners summary Head Start/Head Start, Maternal, Child, and Adolescent 3.2.b(A): Schedule of key partners meetings Health (MCAH), Black Infant Health (BIH), schools, 3.2.c(A): Facilitators and barriers to care Community-based organizations (CBOs), and Home identified Visiting (HV) Programs. 3.2.d(A): Activities to address barriers to care 3.2.e(A): Key partner training and implementation plan 3.2.e(B): List of key partner trainings 3.2.e(C): Evaluation of key partner trainings 3.2.e(D): Evaluation of key partner implementation plan 3.2.f(A): Key partner oral health guidance document 3.2.g(A): List of key partners with oral health component 3.2.h(A): Home Visiting survey results in progress reports 3.2.i(A): Key partners sustainability plan 3.2.j(A): Key partners success stories 3.2.j(B): Key partners success stories dissemination plan ❑x Objective 4: By June 30, 2027, address common risk factors for oral diseases and chronic diseases, including tobacco and sugar consumption, and promote protective factors that will reduce disease burden. ® 4.1: Conduct a survey of dental offices 4.1(A): Summary of tobacco cessation survey 07/01/22-06/30/27 to gauge interest in CEU credits for tobacco findings and plans for using survey information cessation training. Use survey findings to support 4.1(B): Number of dental offices assessed tobacco cessation activities. 4.1.a(A): Risk assessment training materials 4.1.a(B): Risk assessment toolkit 4.1.a C : Referral resources for identified risk Page 7 of 11 Exhibit A Grant Activities 2022 —2027 REVISED 111512021 factors 4.1.a(D): Number of dental offices connected to resources 4.1.b(A): List and dates of tobacco cessation trainings 4.1.b(B): Number of dental offices trained for tobacco cessation 4.1.c(A): Number of dental offices receiving tobacco cessation toolkits 4.1.d(A): Tobacco cessation marketing materials 4.1.d(B): Tobacco cessation social media views and interaction data 4.1.d(C): Tobacco cessation radio messaging impressions data 4.1.e(A): Tobacco cessation summary analysis in progress reports ® 4.2: Collaborate with local partners to participate in 4.2(A): SSB reduction event narrative 07/01/22-06/30/27 sugar-sweetened beverage (SSB) reduction activities. 4.2(B): Number of SSB reduction event Participate in an event(ex: Rethink Your Drink statewide activities day of action) in a dental setting, school, health fair, or 4.2.a(A): SSB reduction training materials community setting; provide dental-specific material in 4.2.a(B): SSB reduction training summary addition to the Rethink Your Drink event in a box; use 4.2.b(A): Number of SSB reduction trainings social media messaging (ex: hashtags) to promote and webinars event. 4.2.c(A): Narrative description of oral health guidelines integrated into partner chronic disease prevention and control activities 4.2.d(A): SSB reduction webpage URL 4.2.e(A): SSB reduction summary analysis in progress reports 4.2.f(A): SSB reduction success stories 4.2.f(B): SSB reduction success stories dissemination plan Page 8 of 11 Exhibit A Grant Activities 2022 —2027 REVISED 111512021 ❑x Objective 5: By June 30, 2027, coordinate outreach programs; implement education, health literacy campaigns and promote integration of oral health and primary care. N 5.1: Collaborate with primary care providers or school 5.1(A): Evidence-based health literacy 07/01/22-06/30/27 administrators to implement an evidence-based oral campaign identified health literacy campaign for parents and caregivers such 5.1(B): Health literacy campaign plan as the American Academy of Pediatrics Brush, 5.1(C): List of health literacy champions for Book, Bed (BBB)Campaign. Identify a BBB champion providers and schools who will coordinate the program and inspire partners: 5.1.a.(A): Health literacy campaign summary e.g., the county's oral health program manager. analysis in progress report submissions N 5.2: Identify a champion and coordinate oral health 5.2(A): List and number health literacy 07/01/22-06/30/27 literacy activities with partners: e.g., key partner, champions for partner outreach stakeholder, health educator, provider, or others. 5.2.a(A): Oral health literacy workforce action plan 5.2.b(A): Number of dental offices with added oral health literacy component 5.3(A): Oral health literacy training plan 5.3(B): List of oral health literacy trainings 5.3(C): Number of oral health literacy trainees 5.3(D): Evaluation of oral health literacy trainings 5.3(E): Number of oral health literacy trainings 5.3.a(A): List of oral health literacy materials provided 5.3.a(B): List of partner organizations receiving oral health literacy materials ❑ Objective 6: By June 30, 2027, assess, support, and ensure establishment of effective oral healthcare delivery and care coordination systems and resources, including workforce development, language services, collaborations, and processes that support continuous quality improvement to serve underserved areas and vulnerable populations. ❑ 6.1: Identify and recruit key partners such as the local 6.1(A): List of key partners recruited 07/01/22-06/30/27 dental society, local dental association, local primary 6.1.a(A): Summary analysis of dental office care association, etc. to support effective oral healthcare inventory delivery and care coordination systems. 6.1.a(B): Number of dental office assessments conducted. Page 9 of 11 Exhibit A Grant Activities 2022 —2027 REVISED 111512021 6.1.b(A): Summary of service gaps and underserved areas 6.1.c(A): Dental office outreach materials 6.1.c(B): Number of outreach resources developed 6.1.d(A): Summary of pilot test proposal 6.1.d(B): List of primary care offices and CBOs identified 6.1.e(A): List of providers and CBOs trained and onboarded 6.1.e(B): Number of providers and systems engaged 6.1.f(A): List of partnerships and roles developed to support warm hand-off referrals ❑ 6.2: Launch and sustain a Community of Practice for 6.2(A): List of community of practice members 07/01/22-06/30/27 representatives from the primary care offices, CBOs, 6.2(B): Community of practice meeting schedule and dental offices to meet in-person or virtually on a regular and re-occurring basis to foster performance management, process redesign, and quality improvement. ❑ 6.3: Develop a sustainability plan to maintain efforts. 6.3(A): Sustainability plan 07/01/22-06/30/27 6.3.a(A): Fluoride varnish guidance document ❑ 6.4: Recruit providers for preventive dentistry 6.4(A): List of providers recruited for preventive 07/01/22-06/30/27 mentorship program. dentistry program 6.4.a(A): Summary of Quality Improvement (QI) trainings or coaching provided 6.4.b(A): QI Plan 6.4.c(A): Oral healthcare delivery and care coordination systems success stories 6.4.c(B): Oral healthcare delivery and care coordination systems success stories dissemination plan 6.4.d(A): Performance management trainees 6.4.d B : Performance management software Page 10 of 11 Exhibit A Grant Activities 2022—2027 REVISED 111512021 used 6.4.d(C): List of performance measures 6.4.e(A): QI project qualitative case study 6.4.e B : QI project stor board Objective 7: By June 30, 2027, create or expand existing local oral health networks to achieve oral health improvements through policy, financing, education, dental care, and communityen a ement strategies. ® 7.1: Convene a core group or identify a workgroup 7.1(A): List of oral health networks workgroup 07/01/22-06/30/27 from existing AC to support the creation or expansion of members existing local oral health networks identify policy 7.1.a(A): List of organizations recruited for solutions, address workforce issues, and develop plans expanded oral health network for sustainability and community engagement. 7.1.a(B): Number of organizations, partners, and champions recruited for expanded oral health networks 7.1.b(A): Oral health network meeting schedule 7.1.b(B): Oral health network meeting agenda 7.1.b(C): Oral health network meeting minutes 7.1.c(A): List of oral health network action plan priorities 7.1.d(A): Oral health network Communication Plan 7.1.e(A): List of organizations in oral health network workgroup 7.1.f(A): Oral health network mission and core values 7.1.g(A): Oral health network action plan 7.1.h(A): Opportunities identified to share resources and leverage additional funding 7.1.i(A): Key insights from community engagement 7.1.j(A): Oral health network summary in progress report submissions Page 11 of 11 County of Fresno 22-10163 Exhibit B Budget Detail and Payment Provisions 1. Invoicing and Payment A. Upon completion of project activies as provided in Exhibit A Grant Application/Attachment 1 Grantee Written Modificaton, and upon receipt and approval of the invoices, the State agrees to reimburse the Grantee for activities performed and expenditures incurred in accordance with the total amount of this agreement. B. Invoices shall include the Grant Number and shall be submitted electronically or in triplicate not more frequently than monthly in arrears to: David James California Department of Public Health Office of Oral Health MS 7218 1616 Capitol Avenue, Suite 74.420 P.O. Box 997377, Sacramento, CA 95899-7377 LOHPlnvoices@cdph.ca.gov C. Invoices shall: 1) Be prepared on Grantee letterhead. If invoices are not on produced letterhead invoices must be signed by an authorized official, employee or agent certifying that the expenditures claimed represent activities performed and are in accordance with Exhibit A Grant Application under this Grant. 2) Bear the Grantee's name as shown on the Grant. 3) Identify the billing and/or performance period covered by the invoice. 4) Itemize costs for the billing period in the same or greater level of detail as indicated in this Grant. Subject to the terms of this Grant, reimbursement may only be sought for those costs and/or cost categories expressly identified as allowable and approved by CDPH. D. Amount Awarded under this Grant is identified in the CDPH 1229 Grant Agreement. 2. Budget Contingency Clause A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Grantee or to furnish any other considerations under this Agreement and Grantee shall not be obligated to fulfill any provisions of this Agreement. B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to Grantee to reflect the reduced amount. Page 1 of 2 County of Fresno 22-10163 Exhibit B Budget Detail and Payment Provisions 3. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in, Government Code Chapter 4.5, commencing with Section 927. 4. Timely Submission of Final Invoice A. A final undisputed invoice shall be submitted for payment no more than ninety (90) calendar days following the expiration or termination date of this Grant, unless a later or alternate deadline is agreed to in writing by the program grant manager. Said invoice should be clearly marked "Final Invoice", indicating that all payment obligations of the State under this Grant have ceased and that no further payments are due or outstanding. B. The State may, at its discretion, choose not to honor any delinquent final invoice if the Grantee fails to obtain prior written State approval of an alternate final invoice submission deadline. 5. Travel and Per Diem Reimbursement Any reimbursement for necessary travel and per diem shall, unless otherwise specified in this Agreement, be at the rates currently in effect, as established by the California Department of Human Resources (Cal HR). If the Cal HR rates change during the term of the Agreement, the new rates shall apply upon their effective date and no amendment to this Agreement shall be necessary. No travel outside the State of California shall be reimbursed without prior authorization from the CDPH. Verbal authorization should be confirmed in writing. Written authorization may be in a form including fax or email confirmation. Page 2 of 2 County of Fresno 22-10163 Page 1 of 4 EXHIBIT C STANDARD GRANT CONDITIONS 1. APPROVAL: This Grant is of no force or effect until signed by both parties and approved by the Department of General Services, if required. The Grantee may not commence performance until such approval has been obtained 2. AMENDMENT: No amendment or variation of the terms of this Grant shall be valid unless made in writing, signed by the parties, and approved as required. No oral understanding or Agreement not incorporated in the Grant is binding on any of the parties. In no case shall the Department materially alter the scope of the Project set forth in Exhibit A. 3. ASSIGNMENT: This Grant is not assignable by the Grantee, either in whole or in part, without the written consent of the Grant Manager in the form of a written amendment to the Grant. 4. AUDIT: Grantee agrees that the Department, the Bureau of State Audits, or their designated representative shall have the right to review and to copy any records and supporting documentation pertaining to this Grant. Grantee agrees to maintain such records for a possible audit for a minimum of three (3) years after final payment or completion of the project funded with this Grant, unless a longer period of records retention is stipulated. Grantee agrees to allow the auditor(s) access to such records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Grantee agrees to include a similar right of the State to audit records and interview staff in any subcontract related to the project. 5. CONFLICT OF INTEREST: Grantee certifies that it is in compliance with all applicable state and/or federal conflict of interest laws. 6. INDEMNIFICATION: Grantee agrees to indemnify, defend and save harmless the State, its officers, agents and employees from any and all claims and losses accruing or resulting to any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or corporation furnishing or supplying work services, materials, or supplies in connection with the project, and from any and all claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged by Grantee in the performance of any activities related to the Project. 7. FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS: Grantee agrees that, at a minimum, its fiscal control and accounting procedures will be sufficient to permit tracing of all grant funds to a level of expenditure adequate to establish that such funds have not been used in violation of any applicable state or federal law, or the provisions of this Grant. Grantee further agrees that it will maintain separate Project accounts in accordance with generally accepted accounting principles. 8. GOVERNING LAW: This Grant is governed by and shall be interpreted in accordance with the laws of the State of California. County of Fresno 22-10163 Page 2 of 4 9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other amounts (including any interest thereon) accruing to or received by the Grantee under this Grant shall be paid by the Grantee to the Department, to the extent that they are properly allocable to costs for which the Grantee has been reimbursed by the Department under this Grant. 10. INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the performance of the Project, shall act in an independent capacity and not as officers, employees or agents of the Department. 11. MEDIA EVENTS: Grantee shall notify the Department's Grant Manager in writing at least twenty (20)working days before any public or media event publicizing the accomplishments and/or results of the Project and provide the opportunity for attendance and participation by Department's representatives. 12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any rights or remedies for any third- party as a beneficiary of this Grant or the project. 13. NOTICE: Grantee shall promptly notify the Department's Grant Manager in writing of any events, developments or changes that could affect the completion of the project or the budget approved for this Grant. 14. PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform services under this Grant where such services are called for. 15. RECORDS: Grantee certifies that it will maintain Project accounts in accordance with generally accepted accounting principles. Grantee further certifies that it will comply with the following conditions for a grant award as set forth in the Request for Applications (Exhibit D) and the Grant Application (Exhibit A). A. Establish an official file for the Project which shall adequately document all significant actions relative to the Project; B. Establish separate accounts which will adequately and accurately depict all amounts received and expended on this Project, including all grant funds received under this Grant; C. Establish separate accounts which will adequately depict all income received which is attributable to the Project, especially including any income attributable to grant funds disbursed under this Grant; D. Establish an accounting system which will adequately depict final total costs of the Project, including both direct and indirect costs; and, E. Establish such accounts and maintain such records as may be necessary for the state to fulfill federal reporting requirements, including any and all reporting requirements under federal tax statutes or regulations. 16. RELATED LITIGATION: Under no circumstances may Grantee use funds from any disbursement under this Grant to pay for costs associated with any litigation between the Grantee and the Department. County of Fresno 22-10163 Page 3 of 4 17. RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings, specifications, reports, computer programs, operating manuals, notes, and other written or graphic work submitted under Exhibit A in the performance of the Project funded by this Grant shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part, any final form data and information received, collected, and developed under this Project, subject to appropriate acknowledgment of credit to the Department for financial support. Grantee shall not utilize the materials submitted to the Department (except data)for any profit making venture or sell or grant rights to a third-party who intends to do so. The Department has the right to use submitted data for all governmental purposes. 18. VENUE: (This provision does not apply to Local Governmental Entities) The Department and Grantee agree that any action arising out of this Grant shall be filed and maintained in the Superior Court, California. Grantee waives any existing sovereign immunity for the purposes of this Grant, if applicable. 19. STATE-FUNDED RESEARCH GRANTS: A. Grantee shall provide for free public access to any publication of a department-funded invention or department-funded technology. Grantee further agrees to all terms and conditions required by the California Taxpayer Access to Publicly Funded Research Act (Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the Government Code). B. As a condition of receiving the research grant, Grantee agrees to the following terms and conditions which are set forth in Government Code section 13989.6 ("Section 13989.E"): 1) Grantee is responsible for ensuring that any publishing or copyright agreements concerning submitted manuscripts fully comply with Section 13989.6. 2) Grantees shall report to the Department the final disposition of the research grant, including, but not limited to, if it was published, when it was published, where it was published, when the 12-month time period expires, and where the manuscript will be available for open access. 3) For a manuscript that is accepted for publication in a peer-reviewed journal, the Grantee shall ensure that an electronic version of the peer-reviewed manuscript is available to the department and on an appropriate publicly accessible database approved by the Department, including, but not limited to, the University of California's eScholarship Repository at the California Digital Library, PubMed Central, or the California Digital Open Source Library, to be made publicly available not later than 12 months after the official date of publication. Manuscripts submitted to the California Digital Open Source Library shall be exempt from the requirements in subdivision (b) of Section 66408 of the Education Code. Grantee shall make reasonable efforts to comply with this requirement by ensuring that their manuscript is accessible on an approved publicly accessible database, and notifying the Department that the manuscript is available on a department-approved database. If Grantee is unable to ensure that their manuscript is accessible on an approved publicly accessible database, Grantee may comply by providing the manuscript to the Department not later than 12 months after the official date of publication. County of Fresno 22-10163 Page 4 of 4 4) For publications other than those described inparagraph B.3 above„ including meeting abstracts, Grantee shall comply by providing the manuscript to the Department not later than 12 months after the official date of publication. 5) Grantee is authorized to use grant money for publication costs, including fees charged by a publisher for color and page charges, or fees for digital distribution. County of Fresno 22-10163 Exhibit E Additional Provisions 1. Additional Incorporated Documents A. The following documents and any subsequent updates are not attached, but are incorporated herein and made a part hereof by this reference. CDPH will maintain on file, all documents referenced herein and any subsequent updates, as required by program directives. CDPH shall provide the Contractor with copies of said documents and any periodic updates thereto, under separate cover. 1. Local Health Jurisdiction Local Oral Health Program Guidelines for Grant Application https:Horalhealthsupport.ucsf.edu/moving-california-oral-health-forward-rfa-2022-2027 2. Cancellation /Termination A. This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days advance written notice to the Grantee. B. CDPH reserves the right to cancel or terminate this Grant immediately for cause. The Grantee may submit a written request to terminate this Grant only if CDPH substantially fails to perform its responsibilities as provided herein. C. The term "for cause" shall mean that the Grantee fails to meet the terms, conditions, and/or responsibilities of this agreement. Causes for termination include, but are not limited to the following occurrences: 1) If the Grantee knowingly furnishes any statement, representation, warranty, or certification in connection with the agreement, which representation is materially false, deceptive, incorrect, or incomplete. 2) If the Grantee fails to perform any material requirement of this Grant or defaults in performance of this agreement. 3) If the Grantee files for bankruptcy, or if CDPH determines that the Grantee becomes financially incapable of completing this agreement. D. Grant termination or cancellation shall be effective as of the date indicated in CDPH's notification to the Grantee. The notice shall stipulate any final performance, invoicing or payment requirements. E. In the event of early termination or cancellation, the Grantee shall be entitled to compensation for services performed satisfactorily under this agreement and expenses incurred up to the date of cancellation and any non-cancelable obligations incurred in support of this Grant. F. In the event of termination, and at the request of CDPH, the Grantee shall furnish copies of all proposals, specifications, designs, procedures, layouts, copy, and other materials related to the services or deliverables provided under this Grant, whether finished or in progress on the termination date. Page 1 of 4 County of Fresno 22-10163 Exhibit E Additional Provisions G. The Grantee will not be entitled to reimbursement for any expenses incurred for services and deliverables pursuant to this agreement after the effective date of termination. H. Upon receipt of notification of termination of this Grant, and except as otherwise specified by CDPH, the Grantee shall: 1) Place no further order or subgrants for materials, services, or facilities. 2) Settle all outstanding liabilities and all claims arising out of such termination of orders and subgrants. 3) Upon the effective date of termination of the Grant and the payment by CDPH of all items properly changeable to CDPH hereunder, Grantee shall transfer, assign and make available to CDPH all property and materials belonging to CDPH, all rights and claims to any and all reservations, grants, and arrangements with owners of media/PR materials, or others, and shall make available to CDPH all written information regarding CDPH's media/PR materials, and no extra compensation is to be paid to Grantee for its services. 4) Take such action as may be necessary, or as CDPH may specify, to protect and preserve any property related to this agreement which is in the possession of the Grantee and in which CDPH has or may acquire an interest. I. CDPH may, at its discretion, require the Grantee to cease performance of certain components of the Scope of Work as designated by CDPH and complete performance of other components prior to the termination date of the Grant. 3. Avoidance of Conflicts of Interest by Grantee A. CDPH intends to avoid any real or apparent conflict of interest on the part of the Grantee, subgrants, or employees, officers and directors of the Grantee or subgrants. Thus, CDPH reserves the right to determine, at its sole discretion, whether any information, assertion or claim received from any source indicates the existence of a real or apparent conflict of interest; and, if a conflict is found to exist, to require the Grantee to submit additional information or a plan for resolving the conflict, subject to CDPH review and prior approval. B. Conflicts of interest include, but are not limited to: 1) An instance where the Grantee or any of its subgrants, or any employee, officer, or director of the Grantee or any subgrant or has an interest, financial or otherwise, whereby the use or disclosure of information obtained while performing services under the grant would allow for private or personal benefit or for any purpose that is contrary to the goals and objectives of the grant. 2) An instance where the Grantee's or any subgrant's employees, officers, or directors use their positions for purposes that are, or give the appearance of being, motivated by a desire for private gain for themselves or others, such as those with whom they have family, business or other ties. Page 2 of 4 County of Fresno 22-10163 Exhibit E Additional Provisions C. If CDPH is or becomes aware of a known or suspected conflict of interest, the Grantee will be given an opportunity to submit additional information or to resolve the conflict. A Grantee with a suspected conflict of interest will have five (5) working days from the date of notification of the conflict by CDPH to provide complete information regarding the suspected conflict. If a conflict of interest is determined to exist by CDPH and cannot be resolved to the satisfaction of CDPH, the conflict will be grounds for terminating the grant. CDPH may, at its discretion upon receipt of a written request from the Grantee, authorize an extension of the timeline indicated herein. 4. Dispute Resolution Process A. A Grantee grievance exists whenever there is a dispute arising from CDPH's action in the administration of an agreement. If there is a dispute or grievance between the Grantee and CDPH, the Grantee must seek resolution using the procedure outlined below. 1) The Grantee should first informally discuss the problem with the CDPH Program Grant Manager. If the problem cannot be resolved informally, the Grantee shall direct its grievance together with any evidence, in writing, to the program Branch Chief. The grievance shall state the issues in dispute, the legal authority or other basis for the Grantee's position and the remedy sought. The Branch Chief shall render a decision within ten (10) working days after receipt of the written grievance from the Grantee. The Branch Chief shall respond in writing to the Grantee indicating the decision and reasons therefore. If the Grantee disagrees with the Branch Chief's decision, the Grantee may appeal to the second level. 2) When appealing to the second level, the Grantee must prepare an appeal indicating the reasons for disagreement with Branch Chief's decision. The Grantee shall include with the appeal a copy of the Grantee's original statement of dispute along with any supporting evidence and a copy of the Branch Chief's decision. The appeal shall be addressed to the Deputy Director of the division in which the branch is organized within ten (10) working days from receipt of the Branch Chief's decision. The Deputy Director of the division in which the branch is organized or his/her designee shall meet with the Grantee to review the issues raised. A written decision signed by the Deputy Director of the division in which the branch is organized or his/her designee shall be directed to the Grantee within twenty (20) working days of receipt of the Grantee's second level appeal. B. If the Grantee wishes to appeal the decision of the Deputy Director of the division in which the branch is organized or his/her designee, the Grantee shall follow the procedures set forth in Division 25.1 (commencing with Section 38050) of the Health and Safety Code and the regulations adopted thereunder. (Title 1, Division 2, Chapter 2, Article 3 (commencing with Section 1140) of the California Code of Regulations). C. Disputes arising out of an audit, examination of an agreement or other action not covered by subdivision (a) of Section 20204, of Chapter 2.1, Title 22, of the California Code of Regulations, and for which no procedures for appeal are provided in statute, regulation or the Agreement, shall be handled in accordance with the procedures identified in Sections 51016 through 51047, Title 22, California Code of Regulations. Page 3 of 4 County of Fresno 22-10163 Exhibit E Additional Provisions D. Unless otherwise stipulated in writing by CDPH, all dispute, grievance and/or appeal correspondence shall be directed to the CDPH Grant Manager. E. There are organizational differences within CDPH's funding programs and the management levels identified in this dispute resolution provision may not apply in every contractual situation. When a grievance is received and organizational differences exist, the Grantee shall be notified in writing by the CDPH Grant Manager of the level, name, and/or title of the appropriate management official that is responsible for issuing a decision at a given level. Page 4 of 4 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 are not 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 County of Fresno By (Authorized Signature) L OL Printed Name and Title of Person Signing Brian Pacheco, Chairman of the Board of Supervisors, of the County of Fresno Executed in the County of Executed in the State of Fresno CA Date Executed 06/07/2022 ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County off�Frresno,// Dep State of California By lf�� 1T7l �11�CQ.0/YY Contractor Certification Clauses CCC 04/2017 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 County of Fresno B (Authorized Signature) ATTEST: BERNICE E.SEIDEL • Clerk of the Board of Supervisors County of Fresno,State of California Printed Name and Title of Person Signing ByDeoLA Brian Pacheco, Chairman of the Board of Supervisors, of the County of Fresno Date Executed Executed in the County of June 7, 2022 Fresno 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. Agreement Between the County of Fresno and the California Department of Public Health Agreement Name: CDPH Local Oral Health Program Agreement No. 22-10163 Fund/Subclass: 0001/10000 Organization #: 56201553 Revenue Account #: 4380