HomeMy WebLinkAboutSaint Agnes Medical Center-Rural Mobile Health Services_A-23-020.pdf COt, County of Fresno Hall of Records,Room 301
2281 Tulare Street
Fresno,California
Board of Supervisors 93721-2198
1856 Telephone:(559)600-3529
FRE`' Minute Order Toll Free: 1-800-742-1011
www.co.fresno.ca.us
January 3, 2023
Present: 5- Supervisor Steve Brandau, Supervisor Nathan Magsig, Supervisor Buddy Mendes,
Chairman Brian Pacheco, and Vice Chairman Sal Quintero
Agenda No. 25. Public Health File ID: 22-0795
Re: Make a finding that it is in the best interest of the County to suspend the competitive bidding process
consistent with Administrative Policy No. 34 for unusual or extraordinary circumstances as Saint
Agnes Medical Center is able to provide Rural Mobile Health services and will be contracting with the
California State University, Fresno nursing program to provide health screenings, immunizations, and
linkage for patients to primary care clinics in the County's rural areas; and approve and authorize the
Chairman to execute a Retroactive Subrecipient Agreement for American Rescue Plan Act State Local
Fiscal Recovery Funds with Saint Agnes Medical Center to provide health screenings, immunizations,
and linkage for patients to primary care clinics in the County's rural areas in collaboration with the
California State University, Fresno nursing program, effective December 13, 2022, not to exceed three
consecutive years,which includes a two-year base contract and one optional one-year extension,total
not to exceed$1,038,211;and make a finding that it is in the best interest of the County to suspend
the competitive bidding process consistent with Administrative Policy No.34 for unusual or
extraordinary circumstances as The Regents of the University of California, San Francisco is able to
provide Rural Mobile Health services and has the largest university resident training program available
for future physicians in the Central Valley to provide health screenings, immunizations, and linkage for
patients to primary care clinics in the County's rural areas;and approve and authorize the Chairman to
execute a Retroactive Subrecipient Agreement for American Rescue Plan Act State Local Fiscal
Recovery Funds with The Regents of the University of California,San Francisco to utilize the university
resident training program to provide health screenings, immunizations, and linkage for patients to
primary care clinics in the County's rural areas, effective December 13, 2022, not to exceed three
consecutive years,which includes a two-year base contract and one optional one-year extension,total
not to exceed$4,144,993
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco, and Quintero
Agreement No.23-020,Agreement No.23-021
County of Fresno Page 29
co
Board Agenda Item 25
O 1856 O
FRE`5
DATE: January 3, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Subrecipient Agreements for Rural Mobile Health Program
RECOMMENDED ACTION(S):
1. Make a finding that it is in the best interest of the County to suspend the competitive
bidding process consistent with Administrative Policy No. 34 for unusual or extraordinary
circumstances as Saint Agnes Medical Center is able to provide Rural Mobile Health
services and will be contracting with the California State University, Fresno nursing
program to provide health screenings, immunizations, and linkage for patients to primary
care clinics in the County's rural areas; and
2. Approve and authorize the Chairman to execute a Retroactive Subrecipient Agreement for
American Rescue Plan Act State Local Fiscal Recovery Funds with Saint Agnes Medical
Center to provide health screenings, immunizations, and linkage for patients to primary care
clinics in the County's rural areas in collaboration with the California State University,
Fresno nursing program, effective December 13, 2022, not to exceed three consecutive
years,which includes a two-year base contract and one optional one-year extension, total
not to exceed $1,038,211; and
3. Make a finding that it is in the best interest of the County to suspend the competitive
bidding process consistent with Administrative Policy No. 34 for unusual or extraordinary
circumstances as The Regents of the University of California, San Francisco is able to
provide Rural Mobile Health services and has the largest university resident training
program available for future physicians in the Central Valley to provide health screenings,
immunizations, and linkage for patients to primary care clinics in the County's rural areas;
and
4. Approve and authorize the Chairman to execute a Retroactive Subrecipient Agreement for
American Rescue Plan Act State Local Fiscal Recovery Funds with The Regents of the
University of California, San Francisco to utilize the university resident training program to
provide health screenings, immunizations, and linkage for patients to primary care clinics in
the County's rural areas, effective December 13, 2022, not to exceed three consecutive
years, which includes a two-year base contract and one optional one-year extension, total
not to exceed $4,144,993.
There is no Net County Cost associated with the recommended actions. Approval of the recommended
actions will allocate Coronavirus State and Local Fiscal Recovery Funds (SLFRF)to Saint Agnes Medical
Center(SAMC)and The Regents of the University of California, San Francisco (UCSF)to provide health
screenings, immunizations, and linkage for patients to primary care clinics in the County's rural areas. This
item is countywide.
ALTERNATIVE ACTION(S):
County of Fresno Page 1 File Number:22-0795
File Number:22-0795
There are no viable alternative actions. Should your Board elect not to approve the recommended actions,
SAMC and UCSF will not be able to provide rural mobile health clinic services to the vulnerable population in
the County's rural areas. This will leave a gap in healthcare services to vulnerable populations in the
County's rural areas who currently have limited access to proper healthcare.
SUSPENSION OF COMPETITION/SOLE SOURCE CONTRACT:
The Department's request to suspend the competitive bidding process consistent with Administrative Policy
No. 34 is due to SAMC's unique ability to provide Rural Mobile Health services in partnership with the
California State University, Fresno (CSU Fresno)nursing program's Fresno State Mobile Health Unit. SAMC
and CSU Fresno will continue their successful collaboration from the County's COVID Food and Ag Initiative.
SAMC will also collaborate with Saint Agnes Residency Program (Family Medicine, Internal Medicine,
Emergency Medicine) and Saint Agnes Health Hub for the Rural Mobile Health Program. SAMC has no rural
clinics and by utilizing the nursing program at CSU Fresno, SAMC will be able to give nurses in-training the
opportunity to experience different medical careers in the rural community. SAMC will allow the nurses to
provide patients with health screenings, immunizations, and linkages to a primary care clinic. The nurses
will also be able to address patient social health needs by working directly with community agencies to
provide navigation support. This is a familiar model SAMC has implemented with the County's vulnerable
population. CSU Fresno has the largest nursing program in the Central Valley and has successfully
provided influenza and COVID vaccines in the rural areas these past several years.
The Department's request to suspend the competitive bidding process consistent with Administrative Policy
No. 34 is due to UCSF's unique ability to provide Rural Mobile Health services with the largest university
resident training program in the Central Valley. UCSF will be able to provide the physicians with exposure to
Rural Mobile Health and provide rural populations with greater access to healthcare. Providing an additional
residency option to future UCSF physicians will help them obtain great insight into serving the vulnerable
community and may assist a resident in deciding to stay in the Central Valley. The goal of the Rural Mobile
Health program is to provide screenings or minimal health services in the field and connect patients to a
primary medical home such as a federally qualified health center or rural health clinics. Utilizing UCSF will
prevent any issues with competition amongst clinics providing rural mobile health services because UCSF
does not operate any rural clinics.
RETROACTIVE AGREEMENT:
The recommended agreements are retroactive to December 13, 2022. Approval signatures from UCSF and
Saint Agnes for the final recommended agreements were received on November 23, 2022 and December 5,
2022. The time required to prepare the recommended agreements did not allow presentation to your Board
at an earlier date.
FISCAL IMPACT:
There is no Net County Cost associated with the recommended actions. The agreements will be funded by
the Department's allocation of the American Rescue Plan Act-State Local Fiscal Recovery Funds
(ARPA-SLRF)funding for the Rural Mobile Health - Medical Services. The maximum amount payable under
the agreement with SAMC is$1,038,211. The maximum amount payable under the agreement with UCSF is
$4,144,993. Sufficient appropriations and estimated revenues are included in the Department's Org 5620 FY
2022-23 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
On August 9, 2022, your Board approved the Department's allocation of the ARPA-SLFRF for the Rural
Mobile Health - Medical Services in the underserved agricultural and rural communities. This project is an
enumerated Eligible Use of SLFRF as it responds to the COVID-19 public health emergency or its negative
County of Fresno page 2 File Number.22-0795
File Number.22-0795
impacts within underserved agricultural and rural communities.
Rural Mobile Health Program- Medical Services
Project Expenditure Category E.C. 1.14 Public Health, Other Public Health Services
Funding Amount: $6,000,000
Total Expenditures to Date: $0
Estimated Start Date: December 14, 2022
Estimated Completion Date: November 7, 2025
In the Interim Final Rule and Final Rule, the Treasury has determined several enumerated uses for the
SLFRF including programs that address health disparities within impacted communities and increase
access to health and social services, in order to promote and reach health equity. Given that many rural
communities do not have access to high-quality healthcare services at close proximity, this project will close
the distance gap and increase access to healthcare services in an effort to address health disparities and
increase access to health. In the Final Rule, the Treasury determined a program that is provided to a
disproportional impacted community including service to address health disparities is an enumerated
Eligible Use of SLFRF under Category A, as it responds to the COVID-19 public health emergency or its
negative impacts.
Approval of the recommended actions will allow the Department to provide targeted support to the vulnerable
populations in Fresno County's rural areas who remain affected by not only COVID-19, but other chronic
health conditions. The goal of the Rural Mobile Health program is to identify gaps in health care among
residents living in Fresno County's rural areas, connecting patients to community services and primary care
doctors. Both SAMC and UCSF will travel to multiple rural cities in Fresno County on a regular schedule and
provide screenings, immunizations, and linkages to primary care to patients who are at risk of diabetes and
other chronic health conditions. The County supported rural mobile health program will be supplemented by
the CSU Fresno - Mobile Health Unit's recently announced plan to expand into rural communities,where
Rural Mobile Health will be collaborating with physicians and linking patients to a medical home. The Rural
Mobile Health program is not a replacement for primary care services but will help build a referral system
that will allow patients to connect to a primary care facility.
Through the recommended agreements, the Department seeks to mobilize partners and build upon the
unique community ties that they have developed over the years of working directly with vulnerable residents
in the County. UCSF continues to operate its mobile clinic five days a week and since April 14, 2021, has
administered more than 75,000 doses of COVID-19 vaccines, including 3,058 doses to ages 5-11 years old.
UCSF has also conducted over 86,000 polymerase chain reaction (PCR)tests, administered 1,551 flu
vaccine doses, and provided over 500 courses of monoclonal antibodies for the treatment of COVID-19.
During the County's Food and Ag Initiative, SAMC, in collaboration with CSU Fresno, helped administer over
35,144 doses of COVID-19 vaccines. This initiative was the Department's project of vaccinating
farmworkers at their worksites.
The Rural Mobile Health clinic locations will be finalized once the agreements are in place and events
schedules are discussed with local partners to avoid duplication of similar services. The Department will
invite local agriculture businesses that previously hosted COVID-19 vaccine clinics at their workplace to be a
clinic site location for the Rural Mobile Health program as well. Other agricultural and rural locations will be
selected based on the following criteria: the absence of a nearby medical clinic, within Healthy Places Index
(HPI) Quartile 1, and/or alignment with other organizations conducting similar work in the rural areas of the
County. The Department may adjust the location criteria based on participation from partners to expand into
other underserved areas.
The Department will document the number of services provided at each Rural Mobile Health clinic and
attempt to validate if patients receiving services followed up with scheduling and attending their medical
appointments at nearby clinics during this project term. The Department will utilize the recently approved
health information exchange and assess whether these patients visited the local emergency rooms for
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File Number:22-0795
non-emergency medical care. The additional goal of the Rural Mobile Health program is to provide patients
with knowledge on how to access medical services to reduce the amount of emergency room utilization and
move the population towards a permanent medical home.
The recommended agreements deviate from the County's standard indemnification language thereby
including mutual indemnity in connection with the performance of the agreement.
REFERENCE MATERIAL:
BAI #47, August 9, 2022
BAI #3, February 1, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
Suspension of Competition Acquisition Request
On file with Clerk-Agreement with Saint Agnes Medical Center
Suspension of Competition Acquisition Request
On file with Clerk-Agreement with The Regents of the University of California, San Francisco
CAO ANALYST:
George Uc
County of Fresno Page 4 File Number:22-0795
F COS
[HI Email Me]
Suspension of Competition Acquisition Request Double click!
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1. Fully describe the product(s) and/or service(s) being requested.
Partnership with Saint Agnes Medical Center(SAMC)to identify gaps in healthcare among residents living in Fresno
County's rural areas by providing screening, immunization, and connecting patients to community services and
primary care doctors.
2. Identify the selected vendor and contact person; include the address, phone number and e-mail address for each.
Saint Agnes Medical Center
1303 E. Herndon Ave.
Fresno, CA 93720
Ivonne Der Torosian, Ivonne.dertorosian@samc.com, 559-450-5222
3. What is the total cost of the acquisition? If an agreement, state the total cost of the initial term and the amounts for
potential renewal terms.
The total compensation is $1,038,210.80 for the term effective upon execution of agreement, not to exceed three
consecutive years, which includes a two-year base contract and one optional one-year extension.
4. Identify the unique qualities and/or capabilities of the service(s) and/or product(s)that qualify this as a Suspension of
Competition acquisition.
SAMC has demonstrated its ability to be an excellent partner for Fresno County through the services provided during
the County's Food and Ag Initiative. During the County's Food and Ag Initiative, SAMC collaborated with
California State University, Fresno's (CSU Fresno) nursing program to administer 35,144 COVID-19 vaccinations
to the vulnerable populations in the County's rural areas. Through this joint effort, SAMC and CSU Fresno were
able to streamline their collaboration in providing services to the County's rural areas.
SAMC partially funds the CSU Fresno nursing program's "Fresno State Mobile Health Unit", that offers free health
services and health screenings to underserved communities in Fresno County. This includes free health
education, blood pressure and blood sugar screenings, cholesterol screenings, flu and COVID vaccines, and
more. Fresno County's partnership with SAMC will also open the opportunity to collaborate with the Fresno State
Mobile Health Unit to provide vital hands-on training, experimental learning opportunities and clinical experience
for hundreds of students at Fresno State.
5. Identify from Administrative Policy#34 what circumstances constitute a Suspension of Competition.
❑ In an emergency when goods or services are immediately necessary for the preservation of the public health,welfare,or safety,or for the
protection of County property.
❑When the contract is with a federal,state,or local governmental agency.
❑When the department head,with the concurrence of the Purchasing Agent,finds that the cost of preparing and administering a competitive
bidding process in a particular case will equal or exceed the estimated contract amount or$2,500 whichever is more.
❑When a contract provides only for payment of per diem and travel expenses and there is to be no payment for services rendered.
❑When obtaining the services of expert witnesses for litigation or special counsel to assist the County.
®When in unusual or extraordinary circumstances,the Board of Supervisors or the Purchasing Agent/Purchasing Manager determines that
the best interests of the County would be served by not securing competitive bids or issuing a request for proposal.
6. Explain why the unique qualities and/or capabilities described above are essential to your department.
The proposed partnership with SAMC will provide the vulnerable populations in the County's rural areas with
increased access to healthcare services and connection to primary care doctors. SAMC's services will help identify
gaps in healthcare among the County's rural areas where response efforts can be increased to ensure all our
communities have access to healthcare services and no communities are left unreached. SAMC will also work with
the Regents of the University of California, San Francisco (UCSF)to plan weekly events, preventing the same
vendors from being at the same location.
The proposed partnership with SAMC will also open the opportunity to collaborate with the Fresno State Mobile
Health Unit at CSU Fresno, to increase workforce capacity and allow nurses in-training the opportunity to experience
different medical careers in the rural community. SAMC will allow the nurses to provide health screenings,
immunizations, and linkage for patients to a primary care clinic. The nurses will also be able to address patient social
health needs by working directly with community agencies to provide navigation support. This is a familiar model
SAMC has implemented with the County's vulnerable population.
7. Provide a comprehensive explanation of the research done to verify that the recommended vendor is the only vendor
with the unique qualities and/or capabilities stated above. Include a list of all other vendors contacted, what they were
asked, and their responses.
E-PD-048 (Rev 07/2021)
The County's previous partnership with SAMC during the County's Food and Ag Initiative has made SAMC a well-
known, respected provider in the County's rural farmworker population and agricultural businesses. Through this
initiative, SAMC developed a strong partnership with the Fresno State Mobile Health Unit to provide much
needed services to the County's rural communities. CSU Fresno has the largest bachelor-prepared nursing
program in the Central Valley and its Fresno State Mobile Health Unit has a unique partnership with SAMC.
Partnering with SAMC for the County's Rural Mobile Health Program will open the opportunity for the County to
also collaborate and utilize the Fresno State Mobile Health Unit to provide services to more families in the
County's rural areas.
The County will also be able to utilize the Saint Agnes Residency Program (Family Medicine, Internal Medicine,
Emergency Medicine)and Saint Agnes Health Hub in the Rural Mobile Health Program. SAMC will utilize its
community health workers for the Rural Mobile Health Program at no added cost to the County. SAMC will also
leverage other funding sources to continue rural mobile health services. The goal with the rural mobile health
program is to provide screening and/or minimal health services in the field while also connecting patients with a
primary medical home such as a federally qualified health center or rural health clinic. Utilizing SAMC will prevent
issues with competition amongst clinics providing rural mobile health services because SAMC does not operate
any rural clinics.
jprado 9/28/2022 9:25:00 AM [Q Sign] Double click!
Requested By: Title
approve this request to suspend competition for the service(s) and/or product(s) identified herein.
dluchini 9/28/2022 12:11:33 PM [a Sign] Double click!
Department Head Signature
gcornuelle 9/30/2022 3:05:11 PM [a Sign] Double click!
Purchasing Manager Signature
E-PD-048 (Rev 07/2021)
Agreement No. 23-020
1 CORONAVIRUS STATE LOCAL FISCAL RECOVERY FUNDS
2 SUBRECIPIENT AGREEMENT
3 THIS AGREEMENT ("Agreement") is made and entered into this 13th day of December. 2022
4 ("Effective Date"), by and between the COUNTY OF FRESNO, a political subdivision of the state of
5 California ("COUNTY"), and Saint Agnes Medical Center, a non-profit public benefit corporation, whose
6 address is 1303 E. Herndon Avenue, Fresno, California 93720 ("SUBRECIPIENT").
7 WITNESSETH:
8 WHEREAS, on March 11, 2021, the President signed into law the American Rescue Plan Act of
9 2021 ("ARPA")which established the Coronavirus State and Local Fiscal Recovery Funds ("SLFRF")
10 Program; and
11 WHEREAS, the ARPA authorizes the COUNTY to expend SLFRF awarded to the COUNTY for
12 the following eligible purposes, outlined in the Interim Final Rule and Final Rule as follows (each an
13 "Eligible Use," collectively "Eligible Uses"):
14 (1) To respond to the COVID-119 public health emergency or its negative economic impacts;
15 (2) To respond to workers performing essential work during the COVID-19 public health
16 emergency;
17 (3) For the provision of government services to the extent of the reduction in revenue due to
18 the COVID-19 public health;
19 (4) To make necessary investments in water, sewer, or broadband infrastructure; and
20 WHEREAS, the COUNTY intends to allocate a portion of its SLFRF to SUBRECIPIENT for one or
21 more Eligible Uses; and
22 WHEREAS, under Section 602(c)(3) of the ARPA, the COUNTY may transfer SLFRF to nonprofit
23 organizations for Eligible Uses for the purpose of meeting ARPA's goals; and
24 WHEREAS, COUNTY has determined that the Program to be provided by SUBRECIPIENT is an
25 Eligible Use of SLFRF under the ARPA, in reliance on information provided by SUBRECIPIENT; and
26 WHEREAS, the COUNTY and SUBRECIPIENT desire to enter into this Agreement so that the
27 COUNTY may provide SLFRF to the SUBRECIPIENT for appropriate and qualifying expenditures, as
28 permitted under the Interim Final Rule and Final Rule.
1
1 WHEREAS, COUNTY, through its Department of Public Health, is in need of vendors for its Rural
2 Mobile Health program to identify gaps in healthcare among residents living in Fresno County's rural areas,
3 provide preventative care screenings, treatment, immunization, and connect patients to community services
4 and primary care doctors ("Program"); and
5 WHEREAS, COUNTY, has determined that vulnerable populations in the rural areas have
6 consistently been disproportionally impacted due to a lack of medical services available in the rural areas;
7 and
8 WHEREAS, SUBRECIPIENT, maintains and operates general acute care hospital facilities and has
9 sufficient available clinical preceptors for mobile clinical services in the rural areas; and
10 WHEREAS, SUBRECIPIENT, will collaborate with the California State University— Fresno nursing
11 program, to provide nurses in-training the opportunity to experience different medical settings in the rural
12 community by exposing nurses to Rural Mobile Health;
13 NOW, THEREFORE, in consideration of the mutual covenants, terms and conditions herein
14 contained, the parties hereto agree as follows:
15 1. GENERAL OBLIGATIONS
16 A. SUBRECIPIENT shall perform all services and fulfill all responsibilities identified
17 in Exhibit A, Scope of Work, attached hereto and by this reference incorporated herein.
18 B. SUBRECIPIENT represents that each of the recitals, stated hereinabove and in
19 Exhibit A to this Agreement, concerning SUBRECIPIENT, and made by SUBRECIPIENT, are true and
20 correct, and that COUNTY may rely upon each of those representations in granting the SLFRF to
21 SUBRECIPIENT under this Agreement.
22 C. SUBRECIPIENT acknowledges that the SLFRF granted under this Agreement are
23 a subaward of SLFRF to carry out the Program.
24 D. SUBRECIPIENT understands and agrees that the SLFRF disbursed under this
25 award may only be spent on Eligible Uses in compliance with the ARPA, the United States Department
26 of the Treasury ("TREASURY") regulations implementing section 602 of the ARPA, and guidance issued
27 by the TREASURY regarding the foregoing.
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1 E. SUBRECIPIENT shall abide by local and state pandemic guidelines in place at
2 any given time during the pandemic response and shall make every reasonable effort to follow safe and
3 appropriate public health protection measures to minimize risk of exposures.
4 F. Compliance. SUBRECIPIENT is obligated by this Agreement, and is responsible
5 to ensure that SLFRF granted under this Agreement are spent in compliance with all ordinances of-.the
6 County of Fresno, and laws of the State of California, and all laws of the federal government. This
7 includes, but is not limited to, compliance with all requirements set forth in the Uniform Administrative
8 Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 Code of Federal
9 Regulations (CFR) Part 200, the TREASURY's Compliance and Reporting Guidance: State and Local
10 Fiscal Recovery Funds ("Compliance Guidance"), Department of the Treasury 31 CFR Part 35
11 Coronavirus State and Local Fiscal Recovery Funds Interim Final Rule ("Interim Final Rule") (for
12 expenditures before April 1, 2022) and Final Rule ("Final Rule") (for expenditures on April 1, 2022, or
13 later), and any subsequent updates, including TREASURY's Frequently Asked Questions. The award
14 terms and conditions required by the TREASURY are set forth in Exhibit E, which is attached and
15 incorporated by this reference, as provided by the TREASURY. Notwithstanding anything provided in
16 Section 8 of this Agreement, or in this Subsection 1(F), SUBRECIPIENT has the sole responsibility for
17 compliance under this Section 1(F).
18 G. No Litigation. SUBRECIPIENT shall not use any SLFRF provided by the
19 COUNTY in litigation, or to pay any enforcement agency, including, but not limited to, any fines or
20 penalties, or similar charges, and shall notify the COUNTY of any legal action which is filed by or against
21 SUBRECIPIENT. To the extent permitted by law, and except for causes of action arising from the
22 negligent or wrongful acts or omissions of COUNTY, its agents or employees, SUBRECIPIENT shall not
23 institute any action or suit at law or in equity against COUNTY, nor institute, prosecute, or any way aid in
24 the institution or prosecution of any claim, demand, action, or cause of action for equitable relief,
25 damage, loss, or injury either to person or property, or both, whether developed or undeveloped,
26 resulting or to result, known or unknown, past, present, or future, arising out of, in any way, the terms of
27 this Agreement.
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1 H. In addition to billing COUNTY for services, if SUBRECIPIENT has the opportunity
2 to bill patients' private medical insurance and/or other governmental program for services, including, but
3 not limited to Medicare, Medicaid, Medi-Cal, and/or the Health Resources and Services Administration
4 (HRSA), COUNTY expects that SUBRECIPIENT will explore such opportunities.
5 I. SUBRECIPIENT agrees that if SUBRECIPIENT receives SLFRF from any other
6 local or state entity for all or any part of the Program for which SUBRECIPIENT has received SLFRF
7 from COUNTY under this Agreement, the SUBRECIPIENT shall contact COUNTY in writing within five
8 (5) business days. SUBRECIPIENT agrees that it may be required to return all or part of the SLFRF
9 received from the COUNTY if the total amount of SLFRF from all local and state entities exceeds the
10 Program's budget, and if SUBRECIPIENT does not intend to expand the Program.
11 J. None of the personnel employed in the administration of the Program shall be in
12 any way, or to any extent engaged in, the conduct of political activities prohibited by Chapter 15 of Title
13 5, U.S. Code, as applicable.
14 K. None of the SLFRF to be paid under this Agreement shall be used for any
15 partisan political activity, or to support or defeat legislation pending before Congress.
16 L. SUBRECIPIENT shall require its subcontractors pursuant to this Agreement to
17 indemnify the COUNTY as set forth in the first paragraph of section nine (9); to carry insurance as set
18 forth in section ten (10), including and not limited to the additional requirements relating to insurance
19 requirements of this Agreement; to comply with the invoicing and documentation provisions, as set forth
20 in section five (5) of this Agreement; to pay back to COUNTY advance payments deemed in excess of
21 actual costs, as determined by the COUNTY; to comply with the Audits and Inspections provisions, as
22 set forth in section eleven (11) of this Agreement; to comply with the Health Insurance Portability and
23 Accountability Act provisions, as set forth in section twelve (12) of this Agreement; to comply with the
24 Non-Discrimination provisions, as set forth in section fourteen (14) of this Agreement; and to comply
25 with the Single Audit Clause provisions, as set forth in section fifteen (15) of this Agreement.
26 M. COUNTY shall provide guidance and assistance in the determination and
27 implementation of safe and appropriate public health practices.
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1 N. COUNTY shall collaborate on media communication and public messages to
2 ensure cohesive, unified messaging.
3 O. COUNTY shall review and approve all survey and assessment tools developed
4 for use among the public. COUNTY shall review and approve publications of data prior to public release
5 to ensure data integrity and confidentiality.
6 2. PROCUREMENT REQUIREMENTS
7 A. SUBRECIPIENT shall comply with all procurement requirements specified in the
8 Uniform Guidance to the extent applicable, including, but not limited to, 2 CFR Part 200 et. seq.
9 B. SUBRECIPIENT shall take all necessary affirmative steps to assure that minority
10 businesses, women's business enterprises, and labor surplus area firms are used when possible, when
11 procuring goods and services under this Agreement, including the affirmative steps described in 2 CFR§
12 200.321.
13 C. As appropriate, and to the extent consistent with law, SUBRECIPIENT shall provide a
14 preference for the purchase, acquisition, or use of goods, products, or materials produced in the United
15 States (including but not limited to iron, aluminum, steel, cement, and other manufactured products).
16 3. REPORTING REQUIREMENTS
17 A. Monthly Program Expenditure Report: SUBRECIPIENT shall work with
18 COUNTY to create an appropriate reporting mechanism in accordance with the scope of work attached
19 hereto as Exhibit A. SUBRECIPIENT shall submit monthly reports by the twentieth (20th)working day
20 following the prior month's services. The reports shall contain, but not be limited to, the information
21 described in Exhibit B, which is attached and incorporated by this reference, and must include a
22 statement, signed by the SUBRECIPIENT, indicating that all expenditures in the report comply with the
23 Interim Rule and the Final Rule, as applicable, and ARPA guidelines for the SLFRF, as set forth by the
24 TREASURY.
25 B. Annual Performance Report: Within fifteen (15) days after each June 30,
26 SUBRECIPIENT shall submit one "Annual Performance Report" to the COUNTY, covering all
27 performance by the SUBRECIPIENT under this Agreement for the fiscal year ending that June 30. The
28
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1 report shall contain, but not limited to, the information contained in Exhibit C, which is attached and
2 incorporated by this reference.
3 C. Final Report: A Final Program Report shall be submitted to COUNTY within thirty
4 (30) days upon completion of the Program. A Final Report shall include an accounting of all costs and
5 expenses incurred by SUBRECIPIENT, and any other information as the COUNTY deems necessary to
6 facilitate closeout of the Program and ensure that the COUNTY's obligations and requirements under
7 the SLFRF Program are met. The Final Program Report is not complete until COUNTY has delivered to
8 SUBRECIPIENT written acceptance of the Final Program Report.
9 4. NONDISCRIMINATION
10 A. During any period in which SUBRECIPIENT is in receipt of SLFRF from COUNTY,
11 SUBRECIPIENT and its Board, officers, employees, agents, representatives or subcontractors shall not
12 unlawfully discriminate in violation of any Federal, State or local law, rule or regulation against any
13 employee, applicant for employment or person receiving services under this Agreement because of race,
14 religious creed, color, national origin, ancestry, physical or mental disability including perception of
15 disability, medical condition, genetic information, pregnancy related condition, marital status, gender/sex,
16 sexual orientation, gender identity, gender expression, age (over 40), political affiliation or belief, or military
17 and veteran status. SUBRECIPIENT and its officers, employees, agents, representatives or subcontractors
18 shall comply with all applicable Federal, State and local laws and regulations related to non-discrimination
19 and equal opportunity, including, without limitation, the COUNTY's non-discrimination policy; Title VI of the
20 Civil Rights Act of 1964 (42 US.C. sections 2000d et seq.) and TREASURY's implementing regulations at
21 31 C.F.R. Part 22, which prohibit discrimination on the basis of race, color, or national origin under
22 programs or activities receiving federal financial assistance; The Fair Housing Act, Title VIII of the Civil
23 Rights Act of 1968 (42 U.S.C. sections 3601 et seq.), which prohibits discrimination in housing on the basis
24 of race, color, religion, national origin, sex,familial status, or disability; Section 504 of the Rehabilitation Act
25 of 1973, as amended (42 U.S.C. sections 6101 et seq.), and the TREASURY's implementing regulations at
26 31 C.F.R. part 23, which prohibit discrimination on the basis of age in programs or activities receiving
27 federal financial assistance; and Title II of the Americans with Disabilities Act of 1990, as amended (42
28 U.S.C. sections 12101 et seq.), which prohibits discrimination on the basis of disability under programs,
6
1 activities, and services provided or made available by state and local governments or instrumentalities or
2 agencies thereto; The Fair Employment and Housing Act(Government Code sections 12900 et seq.);
3 California Labor Code sections 1101, and 1102; the Federal Civil Rights Act of 1964 (P.L. 88-352), as
4 amended; and all applicable regulations promulgated in the California Code of Regulations or the Code of
5 Federal Regulations. Notwithstanding the above, COUNTY acknowledges and agrees that
6 SUBRECIPIENT shall provide services for the Program and pursuant to this Agreement in a manner
7 consistent with the Ethical and Religious Directives for Catholic Health Care Services.
8 B. SUBRECIPIENT shall include the non-discrimination and compliance provisions of
9 this Section 4 in all subcontracts to perform work under this Agreement.
10 C. SUBRECIPIENT shall provide a system by which recipients of service shall have the
11 opportunity to express, and have considered, their views, grievances, and complaints regarding
12 SUBRECIPIENT's delivery of services.
13 5. CONFLICTS OF INTEREST; ETHICS
14 A. SUBRECIPIENT understands and agrees that it must maintain a conflict-of-interest
15 policy consistent with 2 CFR§ 200.318(c), and that such conflict-of-interest policy is applicable to each
16 activity funded under this award. Subrecipient must disclose in writing to the TREASURY and to COUNTY
17 any potential conflict of interest affecting the awarded SLFRF in accordance with 2 CFR§200.12. Further,
18 no officer, agent, consultant, or employee of SUBRECIPIENT may seek or accept any gifts, service, favor,
19 employment, engagement, remuneration, or economic opportunity which would tend to improperly influence
20 a reasonable person in that position to depart from the faithful and impartial discharge of the duties of that
21 position.
22 B. No officer, agent, consultant, or employee of SUBRECIPIENT may use his or her
23 position to secure or grant any unwarranted privilege, preference, exemption, or advantage for himself or
24 herself, any member of his or her household, any business entity in which he or she has a financial interest,
25 or any other person.
26 C. No officer, agent, consultant, or employee of SUBRECIPIENT may participate as an
27 agent of SUBRECIPIENT in the negotiation or execution of any contract between SUBRECIPIENT and any
28 private business in which he or she has a financial interest.
1 D. No officer, agent, consultant, or employee of SUBRECIPIENT may suppress any
2 report or other document because it might tend to affect unfavorably his or her private financial interests.
3 E. No officer, agent, consultant, employee, or elected or appointed official of the
4 COUNTY, or SUBRECIPIENT, shall have any interest, direct or indirect, financial, or otherwise, in any
5 contract, subcontract, or agreement with respect thereto, or the proceeds thereof, either for himself or
6 herself, or for those whom he or she has family or business ties, during his or her tenure, or for one year
7 thereafter, for any of the work to be performed pursuant to the Program.
8 6. REQUIRED LICENSES, CERTIFICATES, AND PERMITS
9 A. Any licenses, certificates or permits required by the federal, state, county, or municipal
10 governments for SUBRECIPIENT to provide the services and operate the Program described in Exhibit A
11 must be procured by SUBRECIPIENT, and be valid at the time SUBRECIPIENT enters into this
12 Agreement.
13 B. SUBRECIPIENT must maintain such licenses, certificates and permits in full force and
14 effect. Licenses, certificates and permits may include, but are not limited to, driver's licenses, professional
15 licenses or certificates, and business licenses. Such licenses, certificates, and permits will be procured and
16 maintained by SUBRECIPIENT at no expense to the COUNTY.
17 C. SUBRECIPIENT must show proof of established "indirect cost rates," as defined by
18 the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, (5
19 U.S.C. 301; 2 CFR 200)with either the Federal Government, or a final negotiated "indirect cost rate" with
20 COUNTY that complies with the Uniform Guidelines within 3 months of receipt of SLFRF.
21 7. OFFICE SPACE, SUPPLIES, EQUIPMENT, AND OPERATING OVERHEAD
22 A. SUBRECIPIENT shall provide all office space, supplies, equipment, vehicles, reference
23 materials, and telephone service necessary for SUBRECIPIENT to provide the services and operate the
24 Program identified in Exhibit A to this Agreement. COUNTY is not obligated to reimburse or pay
25 SUBRECIPIENT for any expense or cost incurred by SUBRECIPIENT in procuring or maintaining such
26 items. Responsibility for the costs and expenses incurred by SUBRECIPIENT in providing and maintaining
27 such items is the sole responsibility and obligation of SUBRECIPIENT, and if funded by SLFRF, shall
28 comply with the Uniform Cost Administrative Principles, and Audit Requirements for Federal Awards.
8
1 8. SUBRECIPIENT'S ACKNOWLEDGEMENT OF COUNTY'S REPORTING TO TREASURY
2 A. SUBRECIPIENT acknowledges that COUNTY is obligated to comply with
3 TREASURY's Compliance and Reporting Guidance, which includes submitting mandatory periodic
4 reports to TREASURY.
5 B. SUBRECIPIENT acknowledges that COUNTY is accountable to the TREASURY for
6 SUBRECIPIENT oversight, including ensuring SUBRECIPIENT's compliance with the SLFRF program,
7 SLFRF Award Terms and Conditions, Treasury's Interim Final Rule or Final Rule, as applicable, and
8 reporting requirements, as applicable.
9 C. Notwithstanding anything to the contrary in this Section 8, (i) SUBRECIPIENT's
10 compliance with ARPA and this Agreement are a pre-condition to COUNTY's obligations under
11 Subsections A and B of this Section 8, (ii) nothing in Subsections A or B of this Section 8 relieve
12 SUBRECIPIENT of its obligations under ARPA and this Agreement, and (iii) Subsections A and B of this
13 Section 8 are for the purpose of informing SUBRECIPIENT that COUNTY has certain obligations to
14 TREASURY, the performance of which depend on SUBRECIPIENT's compliance with ARPA and this
15 Agreement, and in no way create any enforceable obligation by SUBRECIPIENT against COUNTY.
16 9. PENALTIES
17 SUBRECIPIENT acknowledges that under ARPA, failure to comply with the restrictions on use as
18 described herein, may result in the TREASURY's recoupment of SLFRF from the COUNTY, and that in
19 such an event, COUNTY would recoup the SLFRF from SUBRECIPIENT if recoupment arises from
20 SUBRECIPIENT's failure to comply the restrictions on use.
21 SUBRECIPIENT also acknowledges that if SUBRECIPIENT fails to comply with the U.S.
22 Constitution, Federal statutes, regulations or the terms and conditions of this Federal award, the COUNTY
23 may impose additional conditions, as described in 2 CFR§ 200.208. If the COUNTY determines that
24 noncompliance cannot be remedied by imposing additional conditions, the COUNTY may take one or more
25 of the following actions, as appropriate in the circumstances:
26 A. Demand repayment of SLFRF issued to SUBRECIPIENT. SUBRECIPIENT shall
27 refund SLFRF upon demand by COUNTY.
28 B. Temporarily withhold cash payments pending correction of the deficiency by
9
1 SUBRECIPIENT, or more severe enforcement action by the COUNTY;
2 C. Disallow (that is, deny both use of funds and any applicable matching credit for) all
3 or part of the cost of the activity or action not in compliance;
4 D. Wholly or partly suspend or terminate the SLFRF subaward;
5 E. Recommend the TREASURY initiate suspension or debarment proceedings;
6 F. Withhold further SLFRF for the Program; and
7 G. Take other remedies that may be legally available.
8 10. FINANCIAL MANAGEMENT
9 A. All of the SLFRF received by SUBRECIPIENT shall be maintained by
10 SUBRECIPIENT in a separate account (the "SLFRF Account"), which shall be distinct from any and all
11 other accounts or funds of the SUBRECIPIENT, and any interest, income, or increase in such SLFRF as
12 a result of any investment thereof shall be maintained in such SLFRF Account for the sole authorized
13 use under this Agreement, provided that, in the event SUBRECIPIENT has more than one authorized
14 use of such SLFRF under this Agreement, SUBRECIPIENT may have such number of such separate
15 accounts that correspond to each such authorized use provided further that such separate accounts are
16 subject to this Section 10(A), and are segregated and identified by a unique identifier. In no event shall
17 any such SLFRF be placed in any investment that may be withdrawn only upon payment of penalty, fee,
18 or charge.
19 B. SUBRECIPIENT must provide to COUNTY evidence of SUBRECIPIENT's
20 financial accountability. SUBRECIPIENT shall comply with all applicable Uniform Guidance
21 requirements. SUBRECIPIENT shall consult with COUNTY if SUBRECIPIENT is not certain which
22 Uniform Guidance requirements apply or how they apply.
23 C. Pursuant to 2 CFR 200.303, the SUBRECIPIENT shall develop and implement
24 written internal controls that are effective to ensure that funding decisions under the SLFRF constitute
25 Eligible Uses of SLFRF, and shall document all funding decisions. Upon request by COUNTY, the
26 SUBRECIPIENT shall provide the written internal controls and documentation of funding decisions to
27 the COUNTY.
28
10
1 D. SUBRECIPIENT shall submit to the COUNTY a copy of SUBRECIPIENT's most
2 recent single audit under 2 CFR Part 200, or a certification that SUBRECIPIENT expended less than
3 seven hundred fifty thousand dollars and no cents ($750,000) of Federal funds during that reporting
4 period. If SUBRECIPIENT submits a letter stating it expended less than seven hundred fifty thousand
5 dollars and no cents ($750,000) in Federal funds, SUBRECIPIENT shall provide a recent financial
6 statement certified by an appropriate officer or employee of the SUBRECIPIENT. Financial
7 accountability submissions shall be provided to County of Fresno, Department of Public Health, 6tn
8 Floor, 1221 Fresno St, Fresno, CA 93721, Attention: Business Office, or electronically to e-mail address
9 DPHBOAP(o)fresnocountyca.gov.
10 E. SUBRECIPIENT certifies that neither it, nor its principals, are presently debarred,
11 suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
12 transaction by any federal department or agency. This certification is made pursuant to the regulations
13 implemented by 2 CFR Part 200, Subpart 200.214, Debarment and Suspension, and any relevant
14 program-specific regulations. This provision shall be required of every subcontractor receiving any
15 payment in whole or in part from Federal funds.
16 F. SUBRECIPIENT shall record all costs of the Program by budget line items, which
17 shall be supported by adequate source documentation, including payroll ledgers, time records, invoices,
18 contracts, vouchers, orders, and other accounting documents evidencing in proper detail the nature and
19 propriety of all costs. At any time during normal business hours, SUBRECIPIENT's financial transactions
20 with respect to the Program may be audited by the COUNTY or independent auditors contracted by the
21 COUNTY, or any combination thereof. The representatives of the auditing agency or agencies shall
22 have access to all books, documents, accounts, records, reports, files, papers, things, property,
23 contractors of program services, and other persons pertaining to such financial transactions and
24 necessary to facilitate the audit.
25 G. Copies, excerpts, or transcripts of all of the books, documents, papers, and
26 records, including invoices, payroll registers, time records, contracts, and accounting documents
27 concerning matters that are reasonably related to the Program shall be provided upon request to the
28 COUNTY.
11
1 H. Expenditures eligible for reimbursement from the SLFRF are described in Exhibit
2 B, which is attached and incorporated by this reference. SUBRECIPIENT shall not make any changes in
3 the line-item expenditures in Exhibit B without prior written approval of the COUNTY.
4 I. No cash reimbursement for purchases of any kind is allowable.
5 11. TERM
6 The term of this Agreement shall comply with ARPA Guidelines and shall be for a period of two (2)
7 years, commencing on December 13, 2022 through and including November 12, 2024. This Agreement
8 may be extended for one (1) additional consecutive twelve (12) month period upon written approval of both
9 parties no later than the last day of the current term. The Director of the Department of Public Health or his
10 or her designee is authorized to execute such written approval on behalf of COUNTY based on
11 CONTRACTOR'S satisfactory performance.
12 The COUNTY's written acceptance of the Final Program Report under Section 3(C)of this
13 Agreement shall include the COUNTY's written notification to the SUBRECIPIENT, on behalf of COUNTY,
14 that the Agreement term has ended. The Director of the Department of Public Health or his or her designee
15 is authorized to execute this written acceptance of the Final Program Report and notification of term end to
16 SUBRECIPIENT.
17 12. TERMINATION
18 A. Non-Allocation of Funds: The terms of this Agreement, and the services to be
19 provided hereunder, are contingent on the approval of funds by the appropriating government agency.
20 Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
21 terminated by either party, at any time without penalty to either party by giving the other party thirty (30)
22 days advance written notice.
23 B. Breach of Contract: The COUNTY may immediately suspend or terminate this
24 Agreement in whole or in part, where in the determination of the COUNTY there is:
25 1) An illegal or improper use of funds;
26 2) A failure to comply with any term of this Agreement;
27 3) A substantially incorrect or incomplete report submitted to the COUNTY;
28 4) Improperly performed service.
12
1 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any breach
2 of this Agreement or any default which may then exist on the part of the SUBRECIPIENT. Neither shall
3 such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
4 default. The COUNTY shall have the right to demand of the SUBRECIPIENT the repayment to the
5 COUNTY of any SLFRF disbursed to the SUBRECIPIENT under this Agreement, which in the judgment of
6 the COUNTY were not expended in accordance with the terms of this Agreement. The SUBRECIPIENT
7 shall promptly refund any such SLFRF upon demand.
8 C. Without Cause: Under circumstances other than those set forth above, this
9 Agreement may be terminated by either party by giving thirty (30) days advance written notice of an
10 intention to terminate to the other party.
11 13. GRANT FUNDING/COMPENSATION
12 A. The parties understand that funding for this Agreement is SLFRF provided pursuant to
13 ARPA, codified at Title 31 CFR Part 35, and any amendments thereafter. COUNTY agrees to grant
14 SUBRECIPIENT, and SUBRECIPIENT agrees to receive such grants, up to the total SLFRF grant, in an
15 amount not to exceed One Million Thirty-Eight Thousand Two Hundred Ten and 80/100 Dollars
16 ($1,038,210.80) during the term of this Agreement.
17 SUBRECIPIENT shall submit written drawdown requests monthly for the payment of eligible
18 necessary expenses in support of the Program. Drawdown requests for the COUNTY to make a such
19 payment shall be in accordance with the sample Drawdown Request Form, attached as Exhibit B, and
20 incorporated by this reference. Drawdowns requests shall detail purchase orders, receipts, and
21 reimbursement requests, detailing items purchased, and expenses incurred in support of the Program for
22 items listed in Exhibit B of this Agreement. Requests should include supporting cost documentation such
23 as payroll records, equipment/supply invoices, lease payment, payment records for
24 marketing/education/outreach costs, utility/janitorial payments, mileage records if applicable.
25 SUBRECIPIENT shall submit documentation to the County of Fresno, Department of Public Health,
26 6th Floor, 1221 Fresno St, Fresno, CA 93721, Attention: Business Office or electronically,to e-mail address
27 DPHBOAP(a,fresnocountyca.gov. Payment by COUNTY shall be in arrears for services provided during
28 the preceding period of time, within forty-five (45) days from date of receipt, verification and approval of
13
1 SUBRECIPIENT's invoice and supporting documentation by COUNTY. If SUBRECIPIENT fails to comply
2 with any provision of this Agreement, COUNTY shall be relieved of its obligations for further compensation.
3 B. To ensure compliance with Federal and State regulations, COUNTY may require
4 additional supporting documentation or clarification of claimed expenses as follows:
5 i. COUNTY staff shall notify SUBRECIPIENT to obtain necessary additional
6 documentation or clarification.
7 ii. SUBRECIPIENT shall respond within five (5) business days with required
8 additional documentation or clarification to avoid disallowances/partial payment of invoice.
9 iii. All invoices containing expenses that need additional documentation or
10 clarification not provided to COUNTY within five (5) business days of request shall have those expenses
11 disallowed, and only the allowed expenses shall be paid.
12 iv. SUBRECIPIENT may resubmit disallowed expenses as a supplemental invoice
13 only, and must be accompanied by required documentation.
14 C. All expenses incidental to SUBRECIPIENT'S performance of services in carrying out
15 its Program under this Agreement shall be borne by SUBRECIPIENT. Except as expressly provided in this
16 Agreement, SUBRECIPIENT shall not be entitled to, nor receive from COUNTY, any additional
17 consideration, compensation, salary, wages, or other type of remuneration for services rendered under
18 this Agreement. COUNTY shall not withhold any Federal or State income taxes or Social Security tax from
19 any payments made by COUNTY to SUBRECIPIENT under the terms and conditions of this Agreement.
20 Payment of all taxes and assessments on such sums is the sole responsibility of SUBRECIPIENT. County
21 has no responsibility or liability for payment of SUBRECIPIENT's taxes or assessments.
22 14. INDEPENDENT CONTRACTOR
23 In performance of the work, duties and obligations assumed by SUBRECIPIENT under this
24 Agreement, it is mutually understood and agreed that SUBRECIPIENT, including any and all of the
25 SUBRECIPIENT'S officers, agents, and employees will at all times be acting and performing as an
26 independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
27 employee,joint venturer, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right
28 to control or supervise or direct the manner or method by which SUBRECIPIENT shall perform its work and
14
1 function. However, COUNTY shall retain the right to administer this Agreement so as to verify that
2 SUBRECIPIENT is performing its obligations in accordance with the terms and conditions thereof.
3 SUBRECIPIENT and COUNTY shall comply with all applicable provisions of law and the rules and
4 regulations, if any, of governmental authorities having jurisdiction over all matters subject thereto.
5 Because of its status as an independent contractor, SUBRECIPIENT shall have absolutely no right
6 to employment rights and benefits available to COUNTY employees. SUBRECIPIENT shall be solely liable
7 and responsible for providing to, or on behalf of, its employees all legally-required employee benefits. In
8 addition, SUBRECIPIENT shall be solely responsible and save COUNTY harmless from all matters relating
9 to payment of SUBRECIPIENT'S employees, including compliance with Social Security withholding and all
10 other regulations governing such matters. It is acknowledged that during the term of this Agreement,
11 SUBRECIPIENT may be providing services to others unrelated to the COUNTY or to this Agreement.
12 15. MODIFICATION
13 Any matters of this Agreement may be modified from time to time by the written consent of all the
14 parties without, in any way, affecting the remainder.
15 Notwithstanding the above, changes to object level in the budget, attached hereto as Exhibit B, that
16 do not exceed ten percent (10%) of the maximum compensation payable to SUBRECIPIENT may be made
17 with written approval of COUNTY Department of Public Health Director or designees. Said budget object
18 level changes shall not result in any change to the maximum compensation amount payable to
19 SUBRECIPIENT, as stated herein.
20 16. NON-ASSIGNMENT
21 Neither party shall assign, transfer, or sub-contract this Agreement, nor their rights or duties under
22 this Agreement without the prior written consent of the other party.
23 17. HOLD HARMLESS
24 SUBRECIPIENT agrees to indemnify, save, hold harmless, and at COUNTY'S request, defend
25 the COUNTY, its officers, agents, and employees from any and all costs and expenses (including
26 attorney's fees and costs), penalties, fines, damages, liabilities, claims, and losses occurring or resulting
27 to COUNTY in connection with the performance, or failure to perform, by SUBRECIPIENT, its officers,
28 agents, or employees under this Agreement, and from any and all costs and expenses (including
15
1 attorney's fees and costs), penalties, fines, damages, liabilities, claims, and losses occurring or resulting
2 to any person, firm, or corporation who may be injured or damaged by the performance, or failure to
3 perform, of SUBRECIPIENT, its officers, agents, or employees under this Agreement.
4 SUBRECIPIENT shall indemnify COUNTY against any and all actions of recoupment by the
5 TREASURY arising from this Agreement arising from an act or omission of SUBRECIPIENT pursuant to
6 this Agreement. Such indemnification shall not be limited to the term of this Agreement.
7 COUNTY agrees to indemnify, save, hold harmless, and at SUBRECIPIENT's request, defend
8 SUBRECIPIENT, its officers, agents and employees from any and all costs and expenses (including
9 attorney fees and costs), damages, liabilities, claims, and losses occurring or resulting to SUBRECIPIENT
10 in connection with the performance, or failure to perform, by COUNTY, its officers, agents, or employees
11 under this Agreement, and from any and all costs and expenses (including attorney fees and costs),
12 damages, liabilities, claims, and losses occurring or resulting to any person, firm or corporation who may be
13 injured or damaged by the performance, of failure to perform, of COUNTY, its officers, agents, or
14 employees under this Agreement.
15 The provisions of this Section 17 shall survive the termination or expiration of this Agreement.
16 18. INSURANCE
17 Without limiting the COUNTY's right to obtain indemnification from SUBRECIPIENT or any third
18 parties, SUBRECIPIENT, at its sole expense, shall maintain in full force and effect, the following
19 insurance policies or a program of self-insurance, including but not limited to, an insurance pooling
20 arrangement or Joint Powers Agreement (JPA) throughout the term of the Agreement:
21 A. Commercial General Liabilitv
22 Commercial General Liability Insurance with limits of not less than Two Million Dollars
23 ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This
24 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
25 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
26 liability or any other liability insurance deemed necessary because of the nature of this contract.
27 B. Automobile Liabilitv
28 Comprehensive Automobile Liability Insurance with limits of not less than One Million Dollars
16
1 ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should include any auto
2 used in connection with this Agreement.
3 C. Professional Liability
4 If SUBRECIPIENT employs licensed professional staff, (e.g., Ph.D., R.N., L.C.S.W., M.F.C.C.) in
5 providing services, Professional Liability Insurance with limits of not less than One Million Dollars
6 ($1,000,000.00) per occurrence, Three Million Dollars ($3,000,000.00) annual aggregate.
7 D. Worker's Compensation
8 A policy of Worker's Compensation insurance as may be required by the Labor Code.
9 E. Molestation
10 Sexual abuse/molestation liability insurance with limits of not less than Two Million Dollars
11 ($2,000,000.00) per occurrence. Four Million Dollars ($4,000,000.00) annual aggregate. This policy
12 shall be issued on a per occurrence basis.
13 F. Cyber Liability
14 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or claim,
15 $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as
16 is undertaken by SUBRECIPIENT in this Agreement and shall include, but not limited to, claims
17 involving infringement of intellectual property, including but not limited to infringement of copyright,
18 trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of
19 electronic information, release of private information, alteration of electronic information, extortion and
20 network security. The policy shall provide coverage for breach response costs as well as regulatory
21 fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these
22 obligations.
23 Additional Requirements Relating to Insurance
24 SUBRECIPIENT shall include the County of Fresno, its officers, agents, and employees, individually
25 and collectively, as additional insured, but only insofar as the operations under this Agreement are
26 concerned. Such coverage for additional insured shall apply as primary insurance and any other insurance,
27 or self-insurance, maintained by COUNTY, its officers, agents and employees shall be excess only and not
28 contributing with insurance provided under SUBRECIPIENT's policies herein. This insurance shall not be
17
1 cancelled or changed without a minimum of thirty(30) days advance written notice given to COUNTY.
2 Within Thirty (30) days from the date SUBRECIPIENT signs and executes this Agreement,
3 SUBRECIPIENT shall provide certificates of insurance for all of the foregoing policies, as required herein, to
4 the County of Fresno, Department of Public Health, P.O. Box 11867, Fresno, CA 93775, Attention:
5 Contracts Section—6th Floor or electronically, to e-mail address DPHContracts(a)fresnocountyca.gov,
6 stating that such insurance coverages have been obtained and are in full force; that the County of Fresno,
7 its officers, agents and employees will not be responsible for any premiums on the policies; that for such
8 worker's compensation insurance the SUBRECIPIENT has waived its right to recover from the COUNTY,
9 its officers, agents, and employees any amounts paid under the insurance policy and that waiver does not
10 invalidate the insurance policy; that such Commercial General Liability insurance names the County of
11 Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only
12 insofar as the operations under this Agreement are concerned; that such coverage for additional insured
13 shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY, its
14 officers, agents and employees, shall be excess only and not contributing with insurance provided under
15 SUBRECIPIENT's policies herein; and that this insurance shall not be cancelled or changed without a
16 minimum of thirty(30)days advance, written notice given to COUNTY.
17 In the event SUBRECIPIENT fails to keep in effect at all times insurance coverage as herein
18 provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate this
19 Agreement upon the occurrence of such event.
20 19. RECORDKEEPING AND CONFIDENTIALITY
21 A. Pursuant to the Compliance Guidance published by TREASURY, the SUBRECIPIENT
22 must maintain records and financial documents for five (5)years after all SLFRF have been expended or
23 returned to TREASURY. SUBRECIPIENT acknowledges that the Compliance Guidance published by
24 TREASURY may change, and understands that any changes must be complied with. SUBRECIPIENT is
25 responsible to comply with any changes made to the Compliance Guidance, and COUNTY has no
26 responsibility to notify the SUBRECIPIENT of any changes to the Compliance Guidance by TREASURY.
27 B. SUBRECIPIENT shall maintain reasonable security measures to protect records
28 containing personal information from unauthorized access, acquisition, destruction, use, modification, or
18
1 disclosure pursuant to the California Consumer Privacy Act (CCPA) to ensure against a breach of
2 security of personal information of clients, staff, or other individuals. SUBRECIPIENT shall have
3 established written policies and procedures that align with CCPA, and shall follow such procedures.
4 Upon request, SUBRECIPIENT shall make available to COUNTY staff such written policies and
5 procedures, and shall be monitored for compliance.
6 20. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
7 COUNTY and SUBRECIPIENT each consider and represent themselves as covered
8 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
9 104-191 (HIPAA) and agree to use and disclose Protected Health Information (PHI)as required by law.
10 COUNTY and SUBRECIPIENT acknowledge that the exchange of PHI between them is
11 only for treatment, payment, and health care operations.
12 COUNTY and SUBRECIPIENT intend to protect the privacy and provide for the security of
13 PHI pursuant to the Agreement in compliance with HIPAA, the Health Information Technology for
14 Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
15 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations)and other
16 applicable laws.
17 21. AUDITS AND INSPECTIONS:
18 A. SUBRECIPIENT shall, at anytime during business hours, and as often as the
19 COUNTY may deem necessary, make available to the COUNTY for examination all of its records and data
20 with respect to the matters covered by this Agreement. The SUBRECIPIENT shall, upon request by the
21 COUNTY, permit the COUNTY to audit and inspect all of such records and data necessary to ensure
22 SUBRECIPIENT'S compliance with the terms of this Agreement. SUBRECIPIENT shall allow duly
23 authorized representatives of the COUNTY or independent auditors contracted by the COUNTY, or any
24 combination thereof, to conduct such reviews, audits, and on-site monitoring of the Program as the
25 reviewing entity deems to be appropriate in order to determine:
26 1) Whether the objectives of the Program are being achieved;
27 2) Where the Program is being operated in an efficient and effective
28 manner;
19
1 3) Whether management control systems and internal procedures have
2 been established to meet the objectives of the Program;
3 4) Whether the financial operations of the Program are being conducted
4 properly;
5 5) Whether the periodic reports to the COUNTY contain accurate and
6 reliable information;
7 6) Whether all of the activities of the Program are conducted in compliance
8 with the provisions of state and federal laws and regulations and this
9 Agreement; and
10 7) Whether all activities associated with the Program are in compliance with
11 the Interim Final Rule and Final Rule for the SLFRF, the Compliance
12 Guidance, and any subsequent guidance issued by TREASURY.
13 B. SUBRECIPIENT shall maintain all books, documents, and other materials relevant to
14 its performance under this Agreement. These records shall be subject to the inspection, review, and audit
15 by the COUNTY or its designees, and the TREASURY, for five (5)years following termination of this
16 Agreement. If it is determined during the course of the audit that the SUBRECIPIENT was reimbursed for
17 unallowable costs under this Agreement, the ARPA Guidelines, or the Final Rule, SUBRECIPIENT agrees
18 to promptly reimburse the COUNTY for such payments upon request.
19 C. SUBRECIPIENT agrees and acknowledges that if SUBRECIPIENT expends more
20 than Seven Hundred Fifty Thousand Dollars ($750,000) in Federal awards during a fiscal year,
21 SUBRECIPIENT shall be subject to an audit under the Single Audit Act and its implementing regulation at
22 2 CFR Part 200, Subpart F, regarding audit requirements. SUBRECIPIENT shall submit said audit and
23 management letter to COUNTY. The audit must include a statement of findings or a statement that there
24 were no findings. If there were negative findings, SUBRECIPIENT must include a corrective action plan
25 signed by an authorized individual. SUBRECIPIENT agrees to take action to correct any material non-
26 compliance or weakness found as a result of such audit. Such audit shall be delivered to COUNTY'S DPH
27 Administration for review within nine (9) months of the end of any fiscal year in which funds were
28 expended and/or received for the program. Failure to perform the requisite audit functions as required by
20
1 this Agreement may result in COUNTY performing the necessary audit tasks, or at the COUNTY'S option,
2 contracting with a public accountant to perform said audit, or, may result in the inability of COUNTY to
3 enter into future agreements with SUBRECIPIENT.
4 D. A single audit report is not applicable if all SUBRECIPIENT'S Federal contracts do not
5 exceed the Seven Hundred Fifty Thousand Dollars ($750,000) requirement or SUBRECIPIENT'S federal
6 funding is through Drug Medi-Cal.
7 22. NOTICES
8 The persons and their addresses having authority to give and receive notices under this Agreement
9 include the following:
10 COUNTY SUBRECIPIENT
11 Director, County of Fresno Saint Agnes Medical Center
Department of Public Health Attn: Ivonne Der Torosian
12 P.O. Box 11687 115 N. Fresno St.
Fresno, CA 93775 Fresno, CA 93701
13 DPHContracts@fresnocountyca.gov Ivonne.dertorosian@samc.com
14 All notices between the COUNTY and SUBRECIPIENT provided for or permitted under this
15 Agreement must be in writing and delivered either by personal service, by first-class United States mail, by
16 an overnight commercial courier service, or by telephonic facsimile transmission. A notice delivered by
17 personal service is effective upon service to the recipient. A notice delivered by first-class United States
18 mail is effective three COUNTY business days after deposit in the United States mail, postage prepaid,
19 addressed to the recipient. A notice delivered by an overnight commercial courier service is effective one
20 COUNTY business day after deposit with the overnight commercial courier service, delivery fees prepaid,
21 with delivery instructions given for next day delivery, addressed to the recipient. A notice delivered by
22 telephonic facsimile is effective when transmission to the recipient is completed (but, if such transmission is
23 completed outside of COUNTY business hours, then such delivery shall be deemed to be effective at the
24 next beginning of a COUNTY business day), provided that the sender maintains a machine record of the
25 completed transmission. For all claims arising out of or related to this Agreement, nothing in this section
26 establishes, waives, or modifies any claims presentation requirements or procedures provided by law,
27 including but not limited to the Government Claims Act(Division 3.6 of Title 1 of the Government Code,
28 beginning with section 810).
21
1 23. GOVERNING LAW
2 Venue for any action arising out of or related to this Agreement shall only be in Fresno County,
3 California.
4 The rights and obligations of the parties and all interpretation and performance of this Agreement
5 shall be governed in all respects by the laws of the State of California.
6 24. ADVICE OF ATTORNEY
7 Each party warrants and represents that in executing this Agreement, it has received
8 independent legal advice from its attorneys, or the opportunity to seek such advice.
9 25. DISCLOSURE OF SELF-DEALING TRANSACTIONS
10 This provision is only applicable if the SUBRECIPIENT is operating as a corporation (a for-profit
11 or non-profit corporation) or if during the term of the agreement, the SUBRECIPIENT changes its status
12 to operate as a corporation.
13 Members of the SUBRECIPIENT's Board of Directors shall disclose any self-dealing transactions
14 that they are a party to while SUBRECIPIENT is providing goods or performing services under this
15 agreement. A self-dealing transaction shall mean a transaction to which the SUBRECIPIENT is a party
16 and in which one or more of its directors has a material financial interest. Members of the Board of
17 Directors shall disclose any self-dealing transactions that they are a party to by completing and signing a
18 Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit D and incorporated herein by
19 reference, and submitting it to the COUNTY prior to commencing with the self-dealing transaction or
20 immediately thereafter.
21 26. ELECTRONIC SIGNATURES
22 The parties agree that this Agreement may be executed by electronic signature as provided in
23 this section. An "electronic signature" means any symbol or process intended by an individual signing
24 this Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a faxed
25 version of an original handwritten signature; or(3) an electronically scanned and transmitted (for
26 example by PDF document) of a handwritten signature. Each electronic signature affixed or attached to
27 this Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing
28 this Agreement for all purposes, including but not limited to evidentiary proof in any administrative or
22
1 judicial proceeding, and (2) has the same force and effect as the valid original handwritten signature of
2 that person. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
3 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5,
4 beginning with section 1633.1). Each party using a digital signature represents that it has undertaken
5 and satisfied the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
6 through (5), and agrees that each other party may rely upon that representation. This Agreement is not
7 conditioned upon the parties conducting the transactions under it by electronic means and either party
8 may sign this Agreement with an original handwritten signature.
9 27. SEVERABILITY
10 The positions of this Agreement are severable. The invalidity or unenforceability of any one
11 provision in the Agreement shall not affect the other provisions.
12 28. ENTIRE AGREEMENT
13 This Agreement, including all exhibits, constitutes the entire agreement between the
14 SUBRECIPIENT and COUNTY with respect to the subject matter hereof, and supersedes all previous
15 Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
16 understanding of any nature whatsoever unless expressly included in this Agreement, the inconsistency
17 shall be resolved by giving precedence in the following order of priority: (1)the text of this Agreement
18 (excluding exhibits) and (2)the exhibits attached hereto. Notwithstanding this provision, any additional
19 requirements and/or guidelines set forth by the TREASURY regarding the uses and reporting
20 requirements for ARPA SLFRF after the execution of this Agreement shall be understood to be
21 integrated into this Agreement, and binding on the parties.
22 //
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1 IN WITNESS WHEREOF,the parties hereto have executed this Agreement as of the day and year i
i
2 first hereinabove written.
3 SUBRECIPIENT COUNTY OF FRESNO
4 '5�" 7VI&lv
5 Ivonne Der Torosian,Vice President al Qu r�tero ), Chairman of the Board of
Community Health and Wellbeing Supervisors of the County of Fresno
6 Saint Agnes Medical Center
7
ATTEST:
8 Mailing Address: Bernice E. Seidel
Saint Agnes Medical Center Clerk of the Board of Supervisors
9 Community Health and Wellbeing County of Fresno, State of California
10 Administrative Plaza
1111 E. Spruce Avenue, MS 77
11 Fresno, CA 93720
12
13 By.
' Deputy
14 FOR ACCOUNTING USE ONLY:
Fund: 0001
15
Subclass: 10000
16
ORG: 56201018, 56201019
17
Account:7295
18
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Exhibit A
SCOPE OF WORK
The County of Fresno (County) Department of Public Health (DPH) is in need of vendors to identify
gaps in health care among residents living in Fresno County's rural areas, connecting patients to
community services and a primary care doctor. Licensed and unlicensed medical staff(Registered
Nurses, Licensed Vocational Nurses and Medical Assistants or Certified Nursing Assistants with valid
licensure and/or certification in the State of California) and clerical staff will need to organize and
conduct clinics that will provide communicable disease and chronic disease screenings, immunizations,
preventative care, treatment, and linkage for patients to a primary care clinic. Clinics will be held
through employers or through community medical clinic/vaccination events that may be open to the
general public.
The vendor will work with County staff to determine the size, date and time of the clinic request. Lead
time to clinic scheduling will be 5 days—4 weeks. The County anticipates 10 to 12 clinics per month,
providing services to approximately 200 patients per clinic. Clinic times will vary as follows:
Mobile Clinic
• Mobile clinics are intended to operate a minimum of 2 days per week, any day of the week,
including weekends and evenings.
• Clinic hours will vary from 2— 8 hours depending on event needs.
• Approximately 200 patients reached per day (may be over multiple locations).
• Events may be held inside, outside or as a drive thru.
• Events may be located anywhere within Fresno County rural areas and disadvantaged
communities.
• Vendor will be required to work with the venue host to determine if the vendor will need to
provide tables, chairs, popup tents, etc.
• Optional: Vendor may make direct payment to venue for any rental costs.
The County will provide the following_
• Venue and direct payment to venue for any rental costs.
• Clinic date, time, location and venue contact information.
• County will work with the vendor to develop an aggregate monthly report that demonstrates the
type of services provided, patient demographics, location, and number of unique patients per
event.
• County will work with the vendor to identify the appropriate reporting mechanism and access to
data to assess emergency room utilization and primary care access for rural mobile health
patients.
The Vendor will be responsible for the following_
Page 1 of 4
Exhibit A
• Vendor will provide screening for communicable diseases including but not limited to Influenza,
COVID-19, and certain sexually transmitted diseases identified by County.
o Providers are expected to follow the standard of care for follow-up/treatment of abnormal
test results.
• Vendor will be a COVID-19 test to treat site.
• Vendor shall follow all applicable State and Federal pharmaceutical regulations.
• Vendor shall follow all applicable Clinical Laboratory Improvement Amendments (CLIA).
• Vendor will provide screening for chronic conditions including but not limited to diabetes and
high blood pressure.
• Vendor may provide refills of certain medications to prevent emergency room utilization.
• Vendor will provide immunizations.
• Vendor will provide treatment of minor injuries.
• Vendor shall offer referral services in connecting patients to a primary care clinic.
• In addition to billing County for services, if vendor has the opportunity to bill patients' private
medical insurance and/or other governmental programs for services, including, but not limited to
Medicare, Medicaid, Medi-Cal, and/or the Health Resources and Services Administration
(HRSA), County expects that vendor will explore such opportunities.
• Vendor shall provide monthly aggregate data as required by County.
• Vendor will collaborate with County to collect data of its rural mobile health patients to assess
emergency room utilization and primary care access throughout duration of the agreement.
Vendor's Responsibilities Regarding COVID-19 Vaccinations
• County prefers vendor to enroll as a Provider in the federal COVID-19 Vaccination Program,
utilizing the California Department of Public Health's (CDPH) COVIDReadi portal and agree
and adhere to all requirements specified in the Provider agreement. If provider is not currently an
approved California COVID vaccine provider, then provider must adhere to all COVID vaccine
handling and reporting requirements established by the State of California.
• Vendor shall enter all immunizations administrations into the appropriate State system within 24
hours of administration.
• Vendor is to provide all office supplies, ancillary medical supplies not included with vaccine,
PPE, tables, chairs, tents, etc., when needed.
• Vaccine will be transferred according to CDC or VFC recommendations, such as noted in the
CDC's Vaccine Storage and Handling Toolkit, linked here:
https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html
• Return unused/unopened vaccines to DPH the day of the event, or the day following, as directed
by DPH when scheduling each event (to be determined prior to each event). However, with
County's permission, vendor may retain unused vaccine for use on the following clinic date
provided vendor has appropriate cold storage capacity and the vaccine will not have expired per
manufacturer guidelines.
Page 2 of 4
Exhibit A
• If vendor has vaccine that may expire before it can be used at an upcoming vendor event, vendor
will work with the County to ensure any surplus or short-dated doses are transferred to an
approved provider in a timely manner.
• Document and notify DPH of any wasted vaccine doses.
• Staff in charge of storage and handling, will complete the 7 EZIZ training modules at the
following website: https://eziz.org/eziz-training/
• Per federal regulations, vendor is required to provide the appropriate EUA document to all
vaccine recipients:
o Pfizer: https://www.fda.gov/media/144414/download
o Moderna: https://www.fda.gov/media/144638/download
o Janssen: Janssen COVID-19 Vaccine EUA Fact Sheet for Recipients and Caregivers (fda.gov)
• COVID-19 vaccination providers are required to report the following adverse events after
COVID-19 vaccination, and other adverse events if later revised by CDC, to VAERS:
https://vaers.hhs.gov/reportevent.html or calling 1-800-822-7967.
• Vaccination administration errors, whether or not associated with an adverse event
• Severe COVID-19 illness (e.g., resulting in hospitalization)
• Serious adverse events (AE) regardless of causality. Serious AEs are defined as:
o Death
o A life-threatening AE
o Inpatient hospitalization or prolongation of existing hospitalization
o Persistent or significant incapacity or substantial disruption of the ability to
conduct normal life functions
o A congenital anomaly/birth defect
o Multisystem Inflammatory Syndrome
;ospitalization
Important medical events that may not result in death, be life-threatening, or require
may be considered serious when, based upon appropriate medical judgment,
they may jeopardize the patient and may require medical or surgical intervention to prevent
one of the outcomes listed above
• Also report any additional select adverse events and/or any revised safety reporting requirements
per FDA's conditions of authorized use of vaccine(s) throughout the duration of any COVID-19
vaccine being authorized under an Emergency Use Authorization (EUA).
• Vendor must make provision for patients with a history of anaphylaxis (due to any cause) to
remain for observation for 30 minutes. For all other persons, observation period is 15 minutes.
• In the event of anaphylactic reaction, vendor must maintain appropriate emergency equipment at
the event to manage anaphylaxis resulting from vaccination. See CDC recommended equipment
linked here: https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/anaphylaxis-
management.html. Equipment supply should be sufficient to manage multiple patients
experiencing anaphylaxis.
Vendor shall submit invoices to:
County of Fresno Department of Public Health
1221 Fresno Street, 6th fl. (Business Office)
Fresno, CA 93721
Page 3 of 4
Exhibit A
DPHBOAP(a-,fresnocountyca. ov
KEY RESOURCES
• CDC's Storage and Handling TooMt
• CDC's COVID-19 Vaccination Information Page
Page 4 of 4
Saint Agnes Medical Center Exhibit B
Subrecipient Expenditure Plan
Budget:December 2022 through November 2024 Total
Personnel
Lead Community Health Worker(Mobile Health Coord) $ 24,465.00
Physician $ 318,540.00
Translator $ 15,000.00
Social Worker $ 91,500.00
Medical Van Driver $ 54,900.00
Security $ 54,900.00
Community Health Worker $ 58,656.00
Personnel Sub-Total $ 617,961.00
Fringe $ 126,776.00
Total Personnel $ 744,737.00
Operating Costs
Equipment/Technology $ 68,942.00
Therapeautics $ 130,149.00
Total Operating $ 199,091.00
Direct Costs $ 943,828.00
Indirect Costs @ 10% 1 $ 94,382.80
Total Direct and Indirect $ 1,038,210.80
Other Costs
Other Costs Subtotal
Grand Total $ 1,038,210.80
Page 1 of 2
Exhibit B
1 Exhibit B (continued)
2 Drawdown Request Form
3 Date:
4 County of Fresno
5 Department of Public Health, 61h Floor
1221 Fresno St
6 Fresno, CA 93721
7
Subject: Drawdown Request for
8
Subrecipient Program Subrecipient Name
9
10 In accordance with the executed Agreement for the above-referenced Program, the
11 [SUBRECIPIENT NAME] is requesting drawdown payment of$ [AMOUNT] in support of the
12 Program for services provided during the period of[DATE] through [DATE].
13 The [SUBRECIPIENT NAME] certifies that this request for payment is consistent with the
14 amount of work that has been completed to date, detailing items purchased, and expenses
15 incurred in support of the Program in accordance with the Subrecipient Expenditure Plan
16 (Exhibit B) documented in the executed Agreement, and as evidenced by the enclosed invoices
17 and supporting documents.
18 Payee Invoice#/ Contract# Amount
19
20
21
22
23 Sincerely,
24
25 [Subrecipient Officer]
26 [Subrecipient Name]
27 Enclosure(s)
28
1
Page 2 of 2
1 Exhibit C
2 Annual Performance Report
3 All SUBRECIPIENTs that receive State and Local Fiscal Recovery Funds (SLFRF) awards are
4 required to produce an Annual Report. The Annual Report provides information on the
5 SUBRECIPIENT's Program, and how it plans to ensure program outcomes are achieved in an
6 effective and equitable manner.
7 The initial Annual Report must cover the period from the date of award to the following June 30th and
8 must be submitted to the County within 15 calendar days after the end of the reporting period.
9 Thereafter, the Annual Report will cover a 12-month period and subrecipients will be required to
10 submit the report to the County within 15 calendar days after the end of the 12-month period (by July
11 15th).
12 Annual Peri. . Witte
Report
13 1 Award —June 30, 2023 July 15, 2023
2 July 1, 2023 — June 30, 2024 July 15, 2024
14 3 July 1, 2024 — June 30, 2025 July 15, 2025
15 4 July 1, 2025 — June 30, 2026 July 15, 2026
5 July 1, 2026 — December 31, 2026 January 15, 2027
16
17 Instructions:
18 SUBRECIPIENT should consult the SLFRF Guidance on Recipient Compliance and Reporting
19 Responsibilities (Reporting Guidance) located at: https:Hhome.treasurV.gov/system/files/136/SLFRF-
20 Compliance-and-Reporting-Guidance.pdf for detailed guidance on the submission of this report.
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Exhibit D
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Page 1 of 2
Exhibit D
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a):
(5)Authorized Signature
Signature: Date:
Page 2 of 2
1 Exhibit E
2 U.S. DEPARTMENT OF THE TREASURY CORONAVIRUS LOCAL FISCAL RECOVERY FUND
3 AWARD TERMS AND CONDITIONS
4 1. Use of Funds.
5 a) Subrecipient understands and agrees that the funds disbursed under this award may only be used
6 in compliance with section 603(c)of the Social Security Act(the Act), Treasury's regulations
7 implementing that section, and guidance issued by Treasury regarding the foregoing.
8 b) Subrecipient will determine prior to engaging in any project using this assistance that it has the
9 institutional, managerial, and financial capability to ensure proper planning, management, and
10 completion of such project.
11
12 2. Period of Performance. The period of performance for this award begins on the date hereof and
13 ends on December 31, 2026. As set forth in Treasury's implementing regulations, Subrecipient may use
14 award funds to cover eligible costs incurred during the period that begins on March 3, 2021 and ends on
15 December 31, 2024.
16
17 3. Reporting. Subrecipient agrees to comply with any reporting obligations established by Treasury as
18 they relate to this award.
19
20 4. Maintenance of and Access to Records.
21 a) Subrecipient shall maintain records and financial documents sufficient to evidence compliance with
22 section 603(c) of the Act, Treasury's regulations implementing that section, and guidance issued by
23 Treasury regarding the foregoing.
24 b) The Treasury Office of Inspector General and the Government Accountability Office, or their
25 authorized representatives, shall have the right of access to records (electronic and otherwise) of
26 Subrecipient in order to conduct audits or other investigations.
27
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1
1 c) Records shall be maintained by Subrecipient for a period of five (5)years after all funds have been
2 expended or returned to Treasury, whichever is later.
3
4 5. Pre-award Costs. Pre-award costs, as defined in 2 C.F.R. § 200.458, may not be paid with funding
5 from this award.
6
7 6. Administrative Costs. Subrecipient may use funds provided under this award to cover both direct
8 and indirect costs as specified in the Scope of Work.
9
10 7. Cost Sharing. Cost sharing or matching funds are not required to be provided by Subrecipient.
11
12 8. Conflicts of Interest. Subrecipient understands and agrees it must maintain a conflict-of-interest
13 policy consistent with 2 C.F.R. § 200.318(c), and that such conflict-of-interest policy is applicable to each
14 activity funded under this award. Subrecipient and subrecipients must disclose in writing to Treasury or the
15 pass-through entity, as appropriate, any potential conflict of interest affecting the awarded funds in
16 accordance with 2 C.F.R. § 200.112.
17
18 9. Compliance with Applicable Law and Regulations.
19 a) Subrecipient agrees to comply with the requirements of section 602 of the Act, regulations adopted
20 by Treasury pursuant to section 602(f)of the Act, and guidance issued by Treasury regarding the
21 foregoing. Subrecipient also agrees to comply with all other applicable federal statutes, regulations,
22 and executive orders, and Subrecipient shall provide for such compliance by other parties in any
23 agreements it enters into with other parties relating to this award.
24 b) Federal regulations applicable to this award include, without limitation, the following:
25 i. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal
26 Awards, 2 C.F.R. Part 200, other than such provisions as Treasury may determine are
27 inapplicable to this Award and subject to such exceptions as may be otherwise provided by
28
2
1 Treasury. Subpart F -Audit Requirements of the Uniform Guidance, implementing the
2 Single Audit Act, shall apply to this award.
3 ii. Universal Identifier and System for Award Management(SAM), 2 C.F.R. Part 25, pursuant
4 to which the award term set forth in Appendix A to 2 C.F.R. Part 25 is hereby incorporated
5 by reference.
6 iii. Reporting Subaward and Executive Compensation Information , 2 C.F.R. Part 170, pursuant
7 to which the award term set forth in Appendix A to 2 C.F.R. Part 170 is hereby incorporated
8 by reference.
9 iv. OMB Guidelines to Agencies on Governmentwide Debarment and Suspension
10 (Nonprocurement), 2 C.F.R. Part 180, including the requirement to include a term or
11 condition in all lower tier covered transactions (contracts and subcontracts described in 2
12 C.F.R. Part 180, subpart B)that the award is subject to 2 C.F.R. Part 180 and Treasury's
13 implementing regulation at 31 C.F.R. Part 19.
14 V. Subrecipient Integrity and Performance Matters, pursuant to which the award term set forth
15 in 2 C.F.R. Part 200, Appendix XII to Part 200 is hereby incorporated by reference.
16 vi. Governmentwide Requirements for Drug-Free Workplace, 31 C.F.R. Part 20.
17 vii. New Restrictions on Lobbying, 31 C.F.R. Part 21.
18 viii. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42
19 ix. U.S.C. §§4601-4655) and implementing regulations.
20 X. Generally applicable federal environmental laws and regulations.
21 c) Statutes and regulations prohibiting discrimination applicable to this award include,without
22 limitation, the following:
23 i. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d et seq.) and Treasury's
24 ii. implementing regulations at 31 C.F.R. Part 22, which prohibit discrimination on the basis of
25 race, color, or national origin under programs or activities receiving federal financial
26 assistance;
27
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1 iii. The Fair Housing Act, Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§ 3601 et seq.),
2 which prohibits discrimination in housing on the basis of race, color,
3 iv. religion, national origin, sex, familial status, or disability;
4 V. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which
5 prohibits discrimination on the basis of disability under any program or activity receiving
6 federal financial assistance;
7 vi. The Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101 et seq.), and
8 Treasury's implementing regulations at 31 C.F.R. Part 23, which prohibit discrimination on
9 the basis of age in programs or activities receiving federal financial assistance; and
10 vii. Title II of the Americans with Disabilities Act of 1990, as amended (42 U.S.C. §§ 12101 et
11 seq.), which prohibits discrimination on the basis of disability under programs, activities, and
12 services provided or made available by state and local governments or instrumentalities or
13 agencies thereto.
14
15 10. Remedial Actions. In the event of Subrecipient's noncompliance with section 602 or 603 of the Act,
16 other applicable laws, Treasury's implementing regulations, guidance, or any reporting or other program
17 requirements, Treasury may impose additional conditions on the receipt of a subsequent tranche of future
18 award funds, if any, or take other available remedies as set forth in 2 C.F.R. § 200.339. In the case of a
19 violation of section 602 (c) (1) or 603 (c) (1) of the Act regarding the use of funds, previous payments shall
20 be subject to recoupment as provided in section 602(e)of the Act and any additional payments may be
21 subject to withholding as provided in sections 602(b)(6)(A)(ii)(III) of the Act, as applicable.
22
23 11. Hatch Act. Subrecipient agrees to comply, as applicable, with requirements of the Hatch Act (5
24 U.S.C. §§ 1501-1508 and 7324-7328), which limit certain political activities of State or local government
25 employees whose principal employment is in connection with an activity financed in whole or in part by this
26 federal assistance.
27
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1 12. False Statements. Subrecipient understands that making false statements or claims in connection
2 with this award is a violation of federal law and may result in criminal, civil, or administrative sanctions,
3 including fines, imprisonment , civil damages and penalties, debarment from participating in federal awards
4 or contracts, and/or any other remedy available by law.
5
6 13. Publications. Any publications produced with funds from this award must display the following
7 language: "This project[is being] [was] supported, in whole or in part, by federal award number SLFRP
8 3678 awarded to County of Fresno by the U.S. Department of the Treasury."
9
10 14. Debts Owed the Federal Government.
11 a) Any funds paid to Subrecipient(1) in excess of the amount to which Subrecipient is finally
12 determined to be authorized to retain under the terms of this award; (2)that are determined by the
13 Treasury Office of Inspector General to have been misused; or(3)that are determined by Treasury
14 to be subject to a repayment obligation pursuant to sections 602(e) and 603(b)(2)(D)of the Act and
15 have not been repaid by Subrecipient shall constitute a debt to the federal government.
16 b) Any debts determined to be owed the federal government must be paid promptly by Subrecipient. A
17 debt is delinquent if it has not been paid by the date specified in Treasury's initial written demand for
18 payment, unless other satisfactory arrangements have been made or if the Subrecipient knowingly
19 or improperly retains funds that are a debt as defined in paragraph 14(a). Treasury will take any
20 actions available to it to collect such a debt.
21
22 15. Disclaimer.
23 a) The United States expressly disclaims any and all responsibility or liability to Subrecipient or third
24 persons for the actions of Subrecipient or third persons resulting in death, bodily injury, property
25 damages, or any other losses resulting in any way from the performance of this award or any
26 contract, or subcontract under this award.
27
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1 b) The acceptance of this award by Subrecipient does not in any way establish an agency relationship
2 between the United States and Subrecipient.
3
4 16. Protections for Whistleblowers.
5 a) In accordance with 41 U.S.C. §4712, Subrecipient may not discharge, demote, or otherwise
6 discriminate against an employee in reprisal for disclosing to any of the list of persons or entities
7 provided below, information that the employee reasonably believes is evidence of gross
8 mismanagement of a federal contract or grant, a gross waste of federal funds, an abuse of authority
9 relating to a federal contract or grant, a substantial and specific danger to public health or safety, or
10 a violation of law, rule, or regulation related to a federal contract(including the competition for or
11 negotiation of a contract)or grant.
12 b) The list of persons and entities referenced in the paragraph above includes the following:
13 i. A member of Congress or a representative of a committee of Congress;
14 ii. An Inspector General;
15 iii. The Government Accountability Office;
16 iv. A Treasury employee responsible for contract or grant oversight or management;
17 V. An authorized official of the Department of Justice or other law enforcement agency;
18 vi. A court or grand jury; or
19 vii. A management official or other employee of Subrecipient, contractor, or subcontractor who
20 has the responsibility to investigate, discover, or address misconduct.
21 c) Subrecipient shall inform its employees in writing of the rights and remedies provided under this
22 section, in the predominant native language of the workforce.
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24 17. Increasing Seat Belt Use in the United States. Pursuant to Executive Order 13043, 62 FR 19217
25 (Apr. 18, 1997), Subrecipient should encourage its contractors to adopt and enforce on-the-job seat belt
26 policies and programs for their employees when operating company-owned, rented or personally owned
27 vehicles.
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2 18. Reducing Text Messaging While Driving. Pursuant to Executive Order 13513, 74 FR 51225 (Oct. 6,
3 2009), Subrecipient should encourage its employees, subrecipients, and contractors to adopt and enforce
4 policies that ban text messaging while driving, and Subrecipient should establish workplace safety policies
5 to decrease accidents caused by distracted drivers.
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8 ASSURANCES OF COMPLIANCE WITH CIVIL RIGHTS REQUIREMENTS
9 ASSURANCES OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
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11 As a condition of receipt of federal financial assistance from the Department of the Treasury, the
12 Subrecipient provides the assurances stated herein. The federal financial assistance may include federal
13 grants, loans, and contracts to provide assistance to the Subrecipient's beneficiaries, the use or rent of
14 Federal land or property at below market value, Federal training, a loan of Federal personnel, subsidies,
15 and other arrangements with the intention of providing assistance. Federal financial assistance does not
16 encompass contracts of guarantee or insurance, regulated programs, licenses, procurement contracts by
17 the Federal government at market value, or programs that provide direct benefits.
18 The assurances apply to all federal financial assistance from, or funds made available through the
19 Department of the Treasury, including any assistance that the Subrecipient may request in the future.
20 The Civil Rights Restoration Act of 1987 provides that the provisions of the assurances apply to all of
21 the operations of the Subrecipient's program(s) and activity(ies), so long as any portion of the
22 Subrecipient's program(s) or activity(ies) is federally assisted in the manner prescribed above.
23
24 1. Subrecipient ensures its current and future compliance with Title VI of the Civil Rights Act of 1964,
25 as amended, which prohibits exclusion from participation, denial of the benefits of, or subjection to
26 discrimination under programs and activities receiving federal financial assistance, of any person in
27 the United States on the ground of race, color, or national origin (42 U.S.C. § 2000d et seq.), as
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1 implemented by the Department of the Treasury Title VI regulations at 31 CFR Part 22 and other
2 pertinent executive orders such as Executive Order 13166, directives, circulars, policies,
3 memoranda, and/or guidance documents.
4 2. Subrecipient acknowledges that Executive Order 13166, "Improving Access to Services for Persons
5 with Limited English Proficiency," seeks to improve access to federally assisted programs and
6 activities for individuals who, because of national origin, have Limited English proficiency(LEP).
7 Subrecipient understands that denying a person access to its programs, services, and activities
8 because of LEP is a form of national origin discrimination prohibited under Title VI of the Civil Rights
9 Act of 1964 and the Department of the Treasury's implementing regulations. Accordingly,
10 Subrecipient shall initiate reasonable steps, or comply with the Department of the Treasury's
11 directives, to ensure that LEP persons have meaningful access to its programs, services, and
12 activities. Subrecipient understands and agrees that meaningful access may entail providing
13 language assistance services, including oral interpretation and written translation where necessary,
14 to ensure effective communication in the Subrecipient's programs, services, and activities.
15 3. Subrecipient agrees to consider the need for language services for LEP persons when Subrecipient
16 develops applicable budgets and conducts programs, services, and activities. As a resource, the
17 Department of the Treasury has published its LEP guidance at 70 FR 6067. For more information
18 on taking reasonable steps to provide meaningful access for LEP persons, please visit
19 http://www.lep.gov.
20 4. Subrecipient acknowledges and agrees that compliance with the assurances constitutes a condition
21 of continued receipt of federal financial assistance and is binding upon Subrecipient and
22 Subrecipient's successors, transferees, and assignees for the period in which such assistance is
23 provided.
24 5. Subrecipient acknowledges and agrees that it must require any sub-grantees, contractors,
25 subcontractors, successors, transferees, and assignees to comply with assurances 1-4 above, and
26 agrees to incorporate the following language in every contract or agreement subject to Title VI and
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1 its regulations between the Subrecipient and the Subrecipient's sub-grantees, contractors,
2 subcontractors, successors, transferees, and assignees:
3 The sub-grantee, contractor, subcontractor, successor, transferee, and assignee shall
4 comply with Title Vl of the Civil Rights Act of 1964, which prohibits subrecipients of federal
5 financial assistance from excluding from a program or activity, denying benefits of, or
6 otherwise discriminating against a person on the basis of race, color, or national origin (42
7 U.S.C. §2000d et seq.), as implemented by the Department of the Treasury's Title VI
8 regulations, 31 CFR Part 22, which are herein incorporated by reference and made a part of
9 this contract(or agreement). Title Vl also includes protection to persons with "Limited
10 English Proficiency"in any program or activity receiving federal financial assistance, 42
11 U.S.C. §2000d et seq., as implemented by the Department of the Treasury's Title Vl
12 regulations, 31 CFR Part 22, and herein incorporated by reference and made a part of this
13 contract or agreement.
14 6. Subrecipient understands and agrees that if any real property or structure is provided or improved
15 with the aid of federal financial assistance by the Department of the Treasury, this assurance
16 obligates the Subrecipient, or in the case of a subsequent transfer, the transferee, for the period
17 during which the real property or structure is used for a purpose for which the federal financial
18 assistance is extended or for another purpose involving the provision of similar services or benefits.
19 If any personal property is provided, this assurance obligates the Subrecipient for the period during
20 which it retains ownership or possession of the property.
21 7. Subrecipient shall cooperate in any enforcement or compliance review activities by the Department
22 of the Treasury of the aforementioned obligations. Enforcement may include investigation,
23 arbitration, mediation, litigation, and monitoring of any settlement agreements that may result from
24 these actions. The Subrecipient shall comply with information requests, on-site compliance reviews
25 and reporting requirements.
26 8. Subrecipient shall maintain a complaint log and inform the Department of the Treasury of any
27 complaints of discrimination on the grounds of race, color, or national origin, and limited English
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1 proficiency covered by Title VI of the Civil Rights Act of 1964 and implementing regulations and
2 provide, upon request, a list of all such reviews or proceedings based on the complaint, pending or
3 completed, including outcome. Subrecipient also must inform the Department of the Treasury if
4 Subrecipient has received no complaints under Title VI.
5 9. Subrecipient must provide documentation of an administrative agency's or court's findings of non-
6 compliance of Title VI and efforts to address the non-compliance, including any voluntary
7 compliance or other agreements between the Subrecipient and the administrative agency that
8 made the finding. If the Subrecipient settles a case or matter alleging such discrimination, the
9 Subrecipient must provide documentation of the settlement. If Subrecipient has not been the subject
10 of any court or administrative agency finding of discrimination, please so state.
11 10. If the Subrecipient makes sub-awards to other agencies or other entities, the Subrecipient is
12 responsible for ensuring that sub-recipients also comply with Title VI and other applicable
13 authorities covered in this document. State agencies that make sub-awards must have in place
14 standard grant assurances and review procedures to demonstrate that they are effectively
15 monitoring the civil rights compliance of subrecipients.
16 The United States of America has the right to seek judicial enforcement of the terms of this assurances
17 document, and nothing in this document alters or limits the federal enforcement measures that the United
18 States may take in order to address violations of this document or applicable federal law.
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