HomeMy WebLinkAboutAgreement A-22-566 with Iran Barrera.pdf Agreement 22-566
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated December 13, 2022 and is between
3 Iran Barrera, a sole proprietorship ("Contractor"), and the County of Fresno, a political
4 subdivision of the State of California ("County").
5 Recitals
6 A. The County, through its DBH, is a Mental Health Plan (MHP) as defined in Title 9 of the
7 California Code of Regulations, section 1810.226; and
8 B. County's DBH recognizes the need for a qualified agency to provide evaluation on the
9 Mental Health Services Act (MHSA) Innovation (INN) California Reducing Disparities Project
10 (CRDP) which will provide culturally responsive, community-defined, and innovative program,
11 which will utilize community-defined mental health strategies to help reduce disparities that exist
12 among underserved populations; and
13 C. The Contractor, is qualified, have the staffing, facilities, support services, and is willing
14 and able to provide services required by the County, pursuant to the terms and conditions of this
15 Agreement.
16 The parties therefore agree as follows:
17 Article 1
18 Contractor's Services
19 1.1 Scope of Services. The Contractor shall perform all of the services provided in
20 Exhibit A to this Agreement, titled "Scope of Services."
21 Contractor shall align evaluations, services, and practices with the vision, mission,
22 and guiding principles of the DBH, as further described in Exhibit B, "Fresno County Department
23 of Behavioral Health Guiding Principles of Care Delivery".
24 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
25 able to perform all of the services provided in this Agreement.
26 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
27 applicable federal, state, and local laws and regulations in the performance of its obligations
28 under this Agreement, including but not limited to workers compensation, labor, and
1
1 confidentiality laws and regulations.
2 1.4 Meetings. Contractor shall participate in monthly, or as needed, meetings consisting
3 of staff from County's DBH and other CRDP contracted staff to discuss program requirements,
4 data reporting, outcomes, training, policies and procedures, overall program operations, and
5 any problems or foreseeable problems that may arise. Contractor shall also attend other County
6 DBH meetings, as required by the County.
7 1.5 Reports. Contractor shall collect, maintain and report all data and outcomes for
8 CRDP programs, including but not limited to program goals, program outcomes, and MHSA
9 demographic data. Contractor shall also participate in annual reporting requirements as
10 requested by DBH.
11 Article 2
12 County's Responsibilities
13 2.1 The County shall provide oversight, support, coordination and ongoing monitoring of
14 the CRDP programs and evaluation.
15 2.2 The County shall notify Contractor of process changes or additional responsibilities
16 that fall within the Scope of Services of this Agreement (Exhibit A) through written
17 communication, conference, trainings, meetings and individual staff consultation.
18 2.3 The County shall provide consultation on a regular basis, including but not limited to
19 facilitating monthly meetings between Contractor and DBH.
20 2.4 The County shall include Evaluator in DBH trainings that are relevant to the services
21 as described in this Agreement, if there is sufficient space available, at no cost.
22 Article 3
23 Compensation, Invoices, and Payments
24 3.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
25 the performance of its services under this Agreement as described in Exhibit C to this
26 Agreement, titled "Budget Summary." Payment shall be made upon certification or other proof
27 satisfactory to County's DBH that services have actually been performed by Contractor as
28 specified in this Agreement. The Contractor is not entitled to any compensation except as
2
1 expressly provided in Exhibit C.
2 3.2 Maximum Compensation. The maximum compensation payable to the Contractor
3 under this Agreement for the period effective upon execution through June 30, 2023 is Sixty-
4 Five Thousand and No/100 Dollars ($65,000.00).
5 The maximum compensation payable to the Contractor under this Agreement for the
6 period of July 1, 2023 through June 30, 2024 is Ninety Thousand and No/100 Dollars
7 ($90,000.00).
8 The maximum compensation payable to the Contractor under this Agreement for the
9 period of July 1, 2024 through December 31, 2024 is Forty-Five Thousand and No/100 Dollars
10 ($45,000.00).
11 In no event shall the maximum contract amount for the services provided by the
12 Contractor under the terms and conditions of this Agreement exceed Two Hundred Thousand
13 and No/100 Dollars ($200,000.00).
14 The Contractor acknowledges that the County is a local government entity, and does
15 so with notice that the County's powers are limited by the California Constitution and by State
16 law, and with notice that the Contractor may receive compensation under this Agreement only
17 for services performed according to the terms of this Agreement and while this Agreement is in
18 effect, and subject to the maximum amount payable under this section. The Contractor further
19 acknowledges that County employees have no authority to pay the Contractor except as
20 expressly provided in this Agreement.
21 3.3 Invoices. The Contractor shall submit monthly invoices to 1)
22 DBHlnvoiceReview@fresnocountyca.gov, 2) DBH-Invoices@fresnocountyca.gov, and 3) the
23 assigned DBH Staff Analyst. The Contractor shall submit each invoice by the tenth (10th) day of
24 each month for expenses incurred during the prior month. No reimbursement for costs incurred
25 by Contractor for services delivered under this Agreement shall be made until the invoice and
26 supporting documentation is received, verified and approved by County's DBH.
27 At the discretion of County's DBH Director, or designee, if an invoice is incorrect or is
28 otherwise not in proper form or substance, County's DBH Director, or designee, shall have the
3
1 right to withhold payment as to only that portion of the invoice that is incorrect or improper after
2 five (5) days prior notice to Contractor. Contractor agrees to continue to provide services for a
3 period of ninety (90) days after notification of an incorrect or improper invoice. If after the ninety
4 (90) day period, the invoice(s) is still not corrected to County DBH's satisfaction, County's DBH
5 Director, or designee, may elect to terminate this Agreement, pursuant to the termination
6 provisions stated in Article 5 of this Agreement. In addition, for invoices received ninety (90)
7 days after the expiration of each term of this Agreement or termination of this Agreement, at the
8 discretion of County's DBH Director, or designee, County's DBH shall have the right to deny
9 payment of any additional invoices received.
10 All final invoices and/or any final budget modification requests shall be submitted by
11 Contractor within sixty (60) days following the final month of service for which payment is
12 claimed. No action shall be taken by County on invoices submitted beyond the sixty (60) day
13 closeout period. Any compensation which is not expended by Contractor pursuant to the terms
14 and conditions of this Agreement shall automatically revert to County.
15 3.4 Payment. The County shall pay each correctly completed and timely submitted
16 invoice within 45 days after receipt. The County shall remit any payment to the Contractor's
17 address specified in the invoice.
18 3.5 Incidental Expenses. The Contractor is solely responsible for all of its costs and
19 expenses that are not specified as payable by the County under this Agreement.
20 3.6 Budget Modifications. The DBH Director has the authority to adjust the budget line
21 item/expense categories by fiscal year at the request of the Contractor in accordance with
22 Section 17.1 as long as the total maximum compensation of this Agreement is not exceeded.
23 Article 4
24 Term of Agreement
25 4.1 Term. This Agreement is effective upon execution and terminates on December 31,
26 2024, except as provided in Article 6, "Termination and Suspension," below.
27
28
4
1 Article 5
2 Notices
3 5.1 Contact Information. The persons and their addresses having authority to give and
4 receive notices provided for or permitted under this Agreement include the following:
5
For the County:
6 Director, Department of Behavioral Health
County of Fresno
7 1925 E. Dakota Avenue
Fresno, CA 93726
8
For the Contractor:
9 Iran Barrera
1938 E. Brandon Lane
10 Fresno, CA 93720
driranbarrera@gmail.com
11
12 5.2 Change of Contact Information. Either party may change the information in section
13 5.1 by giving notice as provided in section 5.3.
14 5.3 Method of Delivery. Each notice between the County and the Contractor provided
15 for or permitted under this Agreement must be in writing, state that it is a notice provided under
16 this Agreement, and be delivered either by personal service, by first-class United States mail, by
17 an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
18 Document Format (PDF) document attached to an email.
19 (A) A notice delivered by personal service is effective upon service to the recipient.
20 (B) A notice delivered by first-class United States mail is effective three County
21 business days after deposit in the United States mail, postage prepaid, addressed to the
22 recipient.
23 (C)A notice delivered by an overnight commercial courier service is effective one
24 County business day after deposit with the overnight commercial courier service,
25 delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
26 the recipient.
27 (D)A notice delivered by PDF document attached to an email is effective when
28 transmission to the recipient is completed (but, if such transmission is completed outside
5
1 of County business hours, then such delivery is deemed to be effective at the next
2 beginning of a County business day), provided that the sender maintains a record of the
3 completed transmission.
4 5.4 Claims Presentation. For all claims arising from or related to this Agreement,
5 nothing in this Agreement establishes, waives, or modifies any claims presentation
6 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
7 of Title 1 of the Government Code, beginning with section 810).
8 Article 6
9 Termination and Suspension
10 6.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
11 contingent on the approval of funds by the appropriating government agency. If sufficient funds
12 are not allocated, then the County, upon at least 30 days' advance written notice to the
13 Contractor, may:
14 (A) Modify the services provided by the Contractor under this Agreement; or
15 (B) Terminate this Agreement.
16 6.2 Termination for Breach.
17 (A) Upon determining that a breach (as defined in paragraph (C) below) has
18 occurred, the County may give written notice of the breach to the Contractor. The written
19 notice may suspend performance under this Agreement, and must provide at least 30
20 days for the Contractor to cure the breach.
21 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
22 time stated in the written notice, the County may terminate this Agreement immediately.
23 (C) For purposes of this section, a breach occurs when, in the determination of the
24 County, the Contractor has:
25 (1) Obtained or used funds illegally or improperly;
26 (2) Failed to comply with any part of this Agreement;
27 (3) Submitted a substantially incorrect or incomplete report to the County; or
28 (4) Improperly performed any of its obligations under this Agreement.
6
1 6.3 Termination without Cause. In circumstances other than those set forth above, the
2 County may terminate this Agreement by giving at least 30 days advance written notice to the
3 Contractor.
4 6.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
5 under this Article 6 is without penalty to or further obligation of the County.
6 6.5 County's Rights upon Termination. Upon termination for breach under this Article
7 6, the County may demand repayment by the Contractor of any monies disbursed to the
8 Contractor under this Agreement that, in the County's sole judgment, were not expended in
9 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
10 demand. This section survives the termination of this Agreement.
11 Article 7
12 Independent Contractor
13 7.1 Status. In performing under this Agreement, the Contractor, including its officers,
14 agents, employees, and volunteers, is at all times acting and performing as an independent
15 contractor, in an independent capacity, and not as an officer, agent, servant, employee,joint
16 venturer, partner, or associate of the County.
17 7.2 Verifying Performance. The County has no right to control, supervise, or direct the
18 manner or method of the Contractor's performance under this Agreement, but the County may
19 verify that the Contractor is performing according to the terms of this Agreement.
20 7.3 Benefits. Because of its status as an independent contractor, the Contractor has no
21 right to employment rights or benefits available to County employees. The Contractor is solely
22 responsible for providing to its own employees all employee benefits required by law. The
23 Contractor shall save the County harmless from all matters relating to the payment of
24 Contractor's employees, including compliance with Social Security withholding and all related
25 regulations.
26 7.4 Services to Others. The parties acknowledge that, during the term of this
27 Agreement, the Contractor may provide services to others unrelated to the County.
28
7
1 Article 8
2 Indemnity and Defense
3 8.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
4 County (including its officers, agents, employees, and volunteers) against all claims, demands,
5 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
6 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
7 the performance or failure to perform by the Contractor (or any of its officers, agents,
8 subcontractors, or employees) under this Agreement. The County may conduct or participate in
9 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
10 defend the County.
11 8.2 Survival. This Article 8 survives the termination of this Agreement.
12 Article 9
13 Insurance
14 9.1 The Contractor shall comply with all the insurance requirements in Exhibit D to this
15 Agreement.
16 Article 10
17 Inspections, Audits, and Public Records
18 10.1 Inspection of Documents. The Contractor shall make available to the County, and
19 the County may examine at any time during business hours and as often as the County deems
20 necessary, all of the Contractor's records and data with respect to the matters covered by this
21 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
22 request by the County, permit the County to audit and inspect all of such records and data to
23 ensure the Contractor's compliance with the terms of this Agreement.
24 10.2 State Audit Requirements. If the compensation to be paid by the County under this
25 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
26 California State Auditor, as provided in Government Code section 8546.7, for a period of three
27 years after final payment under this Agreement. This section survives the termination of this
28 Agreement.
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1 10.3 Public Records. The County is not limited in any manner with respect to its public
2 disclosure of this Agreement or any record or data that the Contractor may provide to the
3 County. The County's public disclosure of this Agreement or any record or data that the
4 Contractor may provide to the County may include but is not limited to the following:
5 (A) The County may voluntarily, or upon request by any member of the public or
6 governmental agency, disclose this Agreement to the public or such governmental
7 agency.
8 (B) The County may voluntarily, or upon request by any member of the public or
9 governmental agency, disclose to the public or such governmental agency any record or
10 data that the Contractor may provide to the County, unless such disclosure is prohibited
11 by court order.
12 (C)This Agreement, and any record or data that the Contractor may provide to the
13 County, is subject to public disclosure under the Ralph M. Brown Act (California
14 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
15 (D)This Agreement, and any record or data that the Contractor may provide to the
16 County, is subject to public disclosure as a public record under the California Public
17 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
18 with section 6250) ("CPRA").
19 (E) This Agreement, and any record or data that the Contractor may provide to the
20 County, is subject to public disclosure as information concerning the conduct of the
21 people's business of the State of California under California Constitution, Article 1,
22 section 3, subdivision (b).
23 (F) Any marking of confidentiality or restricted access upon or otherwise made with
24 respect to any record or data that the Contractor may provide to the County shall be
25 disregarded and have no effect on the County's right or duty to disclose to the public or
26 governmental agency any such record or data.
27 10.4 Public Records Act Requests. If the County receives a written or oral request
28 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
9
1 and which the County has a right, under any provision of this Agreement or applicable law, to
2 possess or control, then the County may demand, in writing, that the Contractor deliver to the
3 County, for purposes of public disclosure, the requested records that may be in the possession
4 or control of the Contractor. Within five business days after the County's demand, the
5 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
6 possession or control, together with a written statement that the Contractor, after conducting a
7 diligent search, has produced all requested records that are in the Contractor's possession or
8 control, or (b) provide to the County a written statement that the Contractor, after conducting a
9 diligent search, does not possess or control any of the requested records. The Contractor shall
10 cooperate with the County with respect to any County demand for such records. If the
11 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
12 CPRA or other applicable law, it must deliver the record or data to the County and assert the
13 exemption by citation to specific legal authority within the written statement that it provides to
14 the County under this section. The Contractor's assertion of any exemption from disclosure is
15 not binding on the County, but the County will give at least 10 days' advance written notice to
16 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
17 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
18 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
19 failure to produce any such records, or failure to cooperate with the County with respect to any
20 County demand for any such records.
21 Article 11
22 Disclosure of Self-Dealing Transactions
23 11.1 Applicability. This Article 11 applies if the Contractor is operating as a corporation,
24 or changes its status to operate as a corporation.
25 11.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
26 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
27 "Self-Dealing Transaction Disclosure Form" (Exhibit E to this Agreement) and submitting it to the
28 County before commencing the transaction or immediately after.
10
1 11.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
2 a party and in which one or more of its directors, as an individual, has a material financial
3 interest.
4 Article 12
5 Federal and State Laws
6 12.1 Confidentiality. All services performed by Contractor under this Agreement shall be
7 in strict conformance with all applicable Federal, State of California and/or local laws and
8 regulations relating to confidentiality.
9 12.2 Tax Equity and Fiscal Responsibility Act. To the extent necessary to prevent
10 disallowance of reimbursement under section 1861(v)(1) (1) of the Social Security Act, (42
11 U.S.C. § 1395x, subd. (v)(1)[1]), until the expiration of four (4) years after the furnishing of
12 services under this Agreement, Contractor shall make available, upon written request to the
13 Secretary of the United States Department of Health and Human Services, or upon request to
14 the Comptroller General of the United States General Accounting Office, or any of their duly
15 authorized representatives, a copy of this Agreement and such books, documents, and records
16 as are necessary to certify the nature and extent of the costs of these services provided by
17 Contractor under this Agreement. Contractor further agrees that in the event Contractor carries
18 out any of its duties under this Agreement through a subcontract, with a value or cost of Ten
19 Thousand and No/100 Dollars ($10,000.00) or more over a twelve (12) month period, with a
20 related organization, such Agreement shall contain a clause to the effect that until the expiration
21 of four (4) years after the furnishing of such services pursuant to such subcontract, the related
22 organizations shall make available, upon written request to the Secretary of the United States
23 Department of Health and Human Services, or upon request to the Comptroller General of the
24 United States General Accounting Office, or any of their duly authorized representatives, a copy
25 of such subcontract and such books, documents, and records of such organization as are
26 necessary to verify the nature and extent of such costs.
27 12.3 Compliance with State Requirements. Contractor recognizes that County operates
28 its mental health programs under an agreement with the State Department of Health Care
11
1 Services, and that under said agreement the State imposes certain requirements on County and
2 its subcontractors. Contractor shall adhere to all State requirements, including those identified in
3 Exhibit F, "State Mental Health Requirements", attached hereto and by this reference
4 incorporated herein and made part of this Agreement. Contract shall also file an incident report
5 for all incidents involving clients, following the Protocol and using the Worksheet identified in
6 Exhibit G, Incident Reporting, attached hereto and by this reference incorporated herein and
7 made part of this Agreement or a protocol and worksheet presented by the Contractor that is
8 accepted by County's DBH Director or designee.
9 Article 13
10 Data Security
11 13.1 Security Requirements. For the purpose of preventing the potential loss,
12 misappropriation or inadvertent access, viewing, use or disclosure of County data including
13 sensitive or personal client information; abuse of County resources; and/or disruption to County
14 operations, individuals and/or agencies that enter into a contractual relationship with the County
15 for the purpose of providing services under this Agreement must employ adequate data security
16 measures to protect the confidential information provided to Contractor by the County, including
17 but not limited to the following:
18 (A) Contractor-Owned Mobile, Wireless or Handheld Devices
19 Contractor may not connect to County networks via personally-owned mobile,
20 wireless, or handheld devices, unless the following conditions are met:
21 (1) Contractor has received authorization by County for telecommuting
22 purposes;
23 (2) Current virus protection software is in place;
24 (3) Mobile device has the remote wipe feature enabled; and
25 (4) A secure connection is used.
26 (B) Contractor-Owned Computers or Computer Peripherals
27 Contractor may not bring Contractor-owned computers or computer peripherals
28 into County for use without prior authorization from the County's Chief Information Officer,
12
1 and/or designee(s), including but not limited to mobile storage devices. If data is approved to be
2 transferred, data must be stored on a secure server approved by the County and transferred by
3 means of a Virtual Private Network (VPN) connection, or another type of secure connection.
4 Said data must be encrypted.
5 (C) County-Owned Computer Equipment
6 Contractor may not use County computers or computer peripherals on non-
7 County premises without prior authorization from the County Chief Information Officer and/or
8 designee(s).
9 (D) Contractor may not store County's private, confidential, or sensitive data on any
10 hard-disk drive, portable storage device, or remote storage installation unless encrypted.
11 (E) Contractor shall be responsible to employ strict controls to ensure the integrity
12 and security of County's confidential information and to prevent unauthorized access, viewing,
13 use or disclosure of data maintained in computer files, program documentation, data processing
14 systems, data files and data processing equipment which stores or processes County data
15 internally and externally.
16 (F) Confidential client information transmitted to one party by the other by means of
17 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES)
18 of 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
19 (G)Contractor is responsible to immediately notify County of any violations,
20 breaches or potential breaches of security related to County's confidential information, data
21 maintained in computer files, program documentation, data processing systems, data files and
22 data processing equipment which stores or processes County data internally or externally.
23 (H) County shall provide oversight to Contractor's response to all incidents arising
24 from a possible breach of security related to County's confidential client information provided to
25 Contractor. Contractor will be responsible to issue any notification to affected individuals as
26 required by law or as deemed necessary by County in its sole discretion.
27
28
13
1 Article 14
2 Publicity Prohibition
3 14.1 Self-Promotion. None of the funds, materials, property, or services provided directly
4 or indirectly under this Agreement shall be used for Contractor's advertising, fundraising, or
5 publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-
6 promotion.
7 14.2 Public Awareness. Notwithstanding the above, publicity of the services described in
8 Article 1 of this Agreement shall be allowed as necessary to raise public awareness about the
9 availability of such specific services when approved in advance by County's DBH Director or
10 designee and at a cost to be provided in Exhibit C for such items as written/printed materials,
11 the use of media (i.e., radio, television, newspapers), and any other related expense(s).
12 Article 15
13 Disclosure of Ownership and/or Control Interest Information
14 15.1 Code of Federal Regulations. This provision is only applicable if Contractor is a
15 disclosing entity, fiscal agent, or managed care entity as defined in Code of Federal Regulations
16 (C.F.R), Title 42 § 455.101 455.104, and 455.106(a)(1),(2).
17 In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and
18 455.106(a)(1),(2), the following information must be disclosed by Contractor by completing
19 Exhibit H, "Disclosure of Ownership and Control Interest Statement", attached hereto and by
20 this reference incorporated herein and made part of this Agreement. Contractor shall submit
21 this form to County's DBH within thirty (30) days of the effective date of this Agreement.
22 Additionally, Contractor shall report any changes to this information within thirty-five (35) days of
23 occurrence by completing Exhibit H. Contractor is required to submit a set of fingerprints for
24 any person with a five (5) percent or greater direct or indirect ownership interest in Contractor.
25 County may terminate this Agreement where any person with a five (5) percent or greater direct
26 or indirect ownership interest in the Contractor did not submit timely and accurate information
27 and cooperate with any screening method required in CFR, Title 42, Section 455.416.
28 Submissions shall be scanned portable document format (pdf) copies and are to be sent via
14
1 email to DBHAdministration@fresnocountyca.gov, Attention: Contracts Administration. County
2 may deny enrollment or terminate this Agreement where any person with a five (5) percent or
3 greater direct or indirect ownership interest in Contractor has been convicted of a criminal
4 offense related to that person's involvement with the Medicare, Medicaid, or Title XXI program
5 in the last ten (10) years.
6 Article 16
7 Disclosure— Criminal History and Civil Actions
8 16.1 Disclosure. Contractor is required to disclose if any of the following conditions apply to
9 them, their owners, officers, corporate managers, and partners (hereinafter collectively referred to
10 as "Contractor"):
11 (A) Within the three (3) year period preceding the Agreement award, they have been
12 convicted of, or had a civil judgment rendered against them for:
13 (1) Fraud or a criminal offense in connection with obtaining, attempting to
14 obtain, or performing a public (federal, state, or local) transaction or
15 contract under a public transaction;
16 (2) Violation of a federal or state antitrust statute;
17 (3) Embezzlement, theft, forgery, bribery, falsification, or destruction of records;
18 or
19 (4) False statements or receipt of stolen property.
20 (B) Within a three (3) year period preceding their Agreement award, they have had a
21 public transaction (federal, state, or local)terminated for cause or default.
22 Disclosure of the above information will not automatically eliminate Contractor from further
23 business consideration. The information will be considered as part of the determination of whether
24 to continue and/or renew the Agreement and any additional information or explanation that a
25 Contractor elects to submit with the disclosed information will be considered. If it is later
26 determined that the Contractor failed to disclose required information, any contract awarded to
27 such Contractor may be immediately voided and terminated for material failure to comply with the
28 terms and conditions of the award.
15
1 Contractor must sign a "Certification Regarding Debarment, Suspension, and Other
2 Responsibility Matters- Primary Covered Transactions" in the form set forth in Exhibit I, attached
3 hereto and by this reference incorporated herein and made part of this Agreement. Additionally,
4 Contractor must immediately advise the County in writing if, during the term of this Agreement:
5 (1) Contractor becomes suspended, debarred, excluded or ineligible for participation in federal or
6 state funded programs or from receiving Federal funds as listed in the excluded parties' list
7 system ( )ttp://www.epls.g( ); or(2) any of the above listed conditions become applicable to
8 Contractor. Contractor shall indemnify, defend and hold the County harmless for any loss or
9 damage resulting from a conviction, debarment, exclusion, ineligibility, or other matter listed in the
10 signed Certification Regarding Debarment, Suspension, and Other Responsibility Matters.
11 Article 17
12 General Terms
13 17.1 Modification. Any matters of this Agreement may be modified from time to time by
14 the written consent of all the parties without, in any way, affecting the remainder.
15 Changes to expense category (i.e., Salary & Benefits, Client Support,
16 Facilities/Equipment, Operating Expenses, Administrative Expenses, Special Expenses, Fixed
17 Assets, etc.) subtotals in the budgets, and changes to line items in the budget as set forth in
18 Exhibit C, that when added together during the term of the agreement do not exceed 10% of the
19 maximum compensation payable to the Contractor may be made with the written approval of
20 County's DBH Director, or designee. Said modifications shall not result in any change to the
21 scope of services or annual maximum compensation amount payable to Contractor, as stated in
22 this Agreement.
23 17.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
24 under this Agreement without the prior written consent of the other party.
25 17.3 Governing Law. The laws of the State of California govern all matters arising from
26 or related to this Agreement.
27 17.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno
28 County, California. Contractor consents to California jurisdiction for actions arising from or
16
1 related to this Agreement, and, subject to the Government Claims Act, all such actions must be
2 brought and maintained in Fresno County.
3 17.5 Construction. The final form of this Agreement is the result of the parties' combined
4 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
5 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
6 against either party.
7 17.6 Days. Unless otherwise specified, "days" means calendar days.
8 17.7 Headings. The headings and section titles in this Agreement are for convenience
9 only and are not part of this Agreement.
10 17.8 References to Laws and Rules. In the event any law, regulation, or policy referred
11 to in this Agreement is amended during the term thereof, the parties hereto agree to comply with
12 the amended provision as of the effective date of such amendment.
13 17.9 Severability. If anything in this Agreement is found by a court of competent
14 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
15 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
16 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
17 intent.
18 17.10 Nondiscrimination. During the performance of this Agreement, the Contractor shall
19 not unlawfully discriminate against any employee or applicant for employment, or recipient of
20 services, because of race, religious creed, color, national origin, ancestry, physical disability,
21 mental disability, medical condition, genetic information, marital status, sex, gender, gender
22 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
23 all applicable State of California and federal statutes and regulation.
24 17.11 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
25 of the Contractor under this Agreement on any one or more occasions is not a waiver of
26 performance of any continuing or other obligation of the Contractor and does not prohibit
27 enforcement by the County of any obligation on any other occasion.
28
17
1 17.12 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
2 between the Contractor and the County with respect to the subject matter of this Agreement,
3 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
4 publications, and understandings of any nature unless those things are expressly included in
5 this Agreement. If there is any inconsistency between the terms of this Agreement without its
6 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
7 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
8 exhibits.
9 17.13 No Third-Party Beneficiaries. This Agreement does not and is not intended to
10 create any rights or obligations for any person or entity except for the parties.
11 17.14 Authorized Signature. The Contractor represents and warrants to the County that:
12 (A) The Contractor is duly authorized and empowered to sign and perform its
13 obligations under this Agreement.
14 (B) The individual signing this Agreement on behalf of the Contractor is duly
15 authorized to do so and his or her signature on this Agreement legally binds the
16 Contractor to the terms of this Agreement.
17 17.15 Electronic Signatures. The parties agree that this Agreement may be executed by
18 electronic signature as provided in this section.
19 (A) An "electronic signature" means any symbol or process intended by an individual
20 signing this Agreement to represent their signature, including but not limited to (1) a
21 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
22 electronically scanned and transmitted (for example by PDF document) version of an
23 original handwritten signature.
24 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
25 equivalent to a valid original handwritten signature of the person signing this Agreement
26 for all purposes, including but not limited to evidentiary proof in any administrative or
27 judicial proceeding, and (2) has the same force and effect as the valid original
28 handwritten signature of that person.
18
1 (C)The provisions of this section satisfy the requirements of Civil Code section
2 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
3 Part 2, Title 2.5, beginning with section 1633.1).
4 (D) Each party using a digital signature represents that it has undertaken and
5 satisfied the requirements of Government Code section 16.5, subdivision (a),
6 paragraphs (1) through (5), and agrees that each other party may rely upon that
7 representation.
8 (E) This Agreement is not conditioned upon the parties conducting the transactions
9 under it by electronic means and either party may sign this Agreement with an original
10 handwritten signature.
11 17.16 Counterparts. This Agreement may be signed in counterparts, each of which is an
12 original, and all of which together constitute this Agreement.
13 [SIGNATURE PAGE FOLL0INS]
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I The parties are signing this Agreement on the date stated in the introductory clause.
2
IRAN BARRERA COUNTY OF FRESNO
3
5 Iran Barre Brian Pacheco, Chairman of the Board of
1938 E. Brandon Lane Supervisors of the County of Fresno
6 Fresno, CA 93720
Attest:
7 Bernice E. Seidel
Clerk of the Board of Supervisors
8 County of Fresno, State of California
9 _
By:
10 Deputy
11 For accounting use only:
12 Org No.: 56304797
Account No.: 7295/0
13 Fund No.: 0001
Subclass No.: 10000
14
15 FY 2022-23: $65,000
FY 2023-24: $90,000
16 FY 2024-25: $45,000
Total: $200,000
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Exhibit A- Page 1 of 5
SUMMARY OF SERVICES
SERVICE: Evaluation for the California Reducing Disparities - Evolutions
Innovation Pilot Project
OFFICE ADDRESS: 1838 E. Brandon Lane
Fresno, CA 93720
OFFICE TELEPHONE: (559) 312-8811
CONTACT: Iran Barrera, PhD., LCSW
CONTRACT PERIOD: Effective Upon Execution— December 31, 2024
AMOUNT: Effective Upon Execution—June 30, 2023: $65,000
FY 23-24: $90,000
FY 24-25: $45,000
Total: $ 200,000
A. SUMMARY OF SERVICES
CONTRACTOR, hereinafter referred to as "Evaluator", shall provide an evaluation of the
California Reducing Disparities- Evolutions Innovation Pilot Project, an innovation
program in which utilizes three community-derived mental health strategies to reduce
disparities that exist among underserved populations. The project would examine three
Fresno area programs (Hmong Helping Hands, Sweet Potato and Atencion Plena and
Platicas) to adapt these from community defined practices to support culturally-specific
populations in a manner that will align with MHSA Prevention and Early Intervention
(PEI) funding criteria and outcome measures. The programs will focus specifically on the
adult Hmong population, African American/Black youth, and Latino/x youth.
The evaluation will focus on the program learning question: Can the community-defined
projects be adapted through community planning/community action learning to allow
the original program to adhere to MHSA-PEI funding requirements without
compromising the effectiveness of the original, community-defined program? The
evaluation will also evaluate to see if the programs increase access to mental health
services for the identified underserved groups and if the programs increase the quality
of mental health services, including measured outcomes. The work shall be completed
by using the data collected by the evaluator, the three contracted partners providing
the population specific programs and the Fresno County Department of Behavioral
Health (DBH).
Exhibit A- Page 2 of 5
B. CONTRACTOR RESPONSIBILITIES
Evaluator shall perform the activities below.
1) Evaluation of Community Planning Meetings
a. Adaptation
i. The adaptation should be clearly identified and demonstrate which
PEI strategy the program seeks to align with based on adaptations.
b. Community Participation in Adaptation
i. The Evaluator shall document how the decisions were reached in the
selection process by the community and detail any specific models or
approaches used. Evaluator shall also survey participants to
determine how empowered participants felt in the decision making
process.
ii. The Evaluator shall survey the community to determine how much
ownership did they feel they had in the selection and decision-making
process.
iii. The Evaluator shall measure the impact of the adaptions on the
programs through:
1. Qualitative data (including narratives) measure how the
adaptations have impacted programs from provider
perspectives, and
2. Qualitative data (including narrative/interviews) measure
perceptions of what changes the adaptation has had on the
program from participants.
c. Community Perceptions on Adaptation
i. The Evaluator shall assess community perceptions of how the
adaptations supported the community defined programs, or have
they changed the community defined program?
ii. The Evaluator shall assess if the community feels the programs are still
community defined and driven by community needs. Measure used
may include but are not limited to data collected through specifically
developed perception surveys or personal narratives.
d. Program Effectiveness
i. The Evaluator shall monitor the effectiveness of the programs based
on their PEI strategy defined outcomes.
1. Do the programs continue to provide effective outcomes in
meeting the identified need/purpose of the program for the
targeted population?
2. Based on PEI data and analysis, assess the programs'
effectiveness in meeting the PEI strategies outcomes.
Exhibit A- Page 3 of 5
2) Data collection
a. Evaluator shall develop a data tracking tools and provide training on how to
utilize the tool for The Fresno Center, West Fresno Family Resource Center,
and Integral Community Solutions Institute (hereafter "providers").
b. Evaluator shall review and suggest edits for data collection as the program
ramps up. This may entail advising work by the Evaluator with DBH and the
providers to advise them regarding training their own staff for proper data
collection.
c. Evaluator shall manage the data collection, organization, and distribution of
aggregate information in the form of alerts and regularly scheduled
information sharing.
d. Evaluator's review of the data collection shall occur throughout the three-
year process; each year, Evaluator shall produce a formal review and analysis
of the data for the annual report.
3) Analysis of the Data
a. Evaluator shall analyze the data provided by the providers and DBH that
address the research questions.
b. The Evaluator shall have access to identifying data for individuals served by in
the pilot project.
c. The Evaluator's analysis shall be based on the data provided.
d. The Evaluator shall use all appropriate evaluation and analysis methods to
address the research questions of this project. Data collection sources shall
include, but is not limited to, intake assessments, discharge assessments,
other information gathered by providers.
e. Evaluators shall analyze research questions that seek to explain three things:
1. Can the community-defined projects be adapted through community
planning/community action learning to allow the original program to
adhere to MHSA-PEI funding requirements without compromising the
effectiveness of the original, community-defined program?
2. Did the adapted programs increase access to mental health services
for the identified underserved groups?
3. Did the adapted programs increase the quality of mental health
services, including measured outcomes?
f. The Evaluator shall address the innovation questions from the program by
collecting data on prevention efforts from the pilot project or DBH.
4) Provide written reports
a. The data analysis for this evaluation shall be communicated from the
Evaluator to DBH through annual written reports, as well as a final report at
the end of the three-year term.
b. The Evaluator will produce annual reports of the data that address the
research questions in the proposal, and a final research report at the end of
year three that synthesizes the three annual reports, assesses learnings
Exhibit A- Page 4 of 5
related to the research questions and offers suggestions about program
viability.
c. Each of the reports shall include both a short executive summary, and full
detailed analysis (with supporting documentation of data in appendices).
The reports will be based on the analyses described in the previous section.
5) Provide assistance in communication of findings
a. Evaluator shall assist DBH with communicating the produced research
findings to stakeholders, public, and social media.
b. Evaluator shall assist DBH in crafting effective public communication, as well
as providing an Evaluator representative to attend meetings to assist DBH in
disseminating the findings.
c. Evaluator shall utilize software capabilities for initial translation of materials
into Fresno County's threshold languages, including Spanish and Hmong.
6) Comply with County Requirements
Evaluators shall comply with all contract monitoring and compliance protocols,
procedures, data collection methods, and reporting requirements conducted by the
COUNTY.
7) Participate in DBH and Third-Party Meetings
Evaluator shall participate in meetings to discuss the program, contract issues or
data findings when requested by DBH or provider. DBH shall coordinate the
meetings.
8) Provide Technical Assistance and Support to Programs
Evaluator shall provide technical assistance and support to programs to ensure
necessary adaptions are made to meet MHSA PEI regulations. Such activities may
include but are not limited to logic model development, client questionnaire or
survey development, administration of questionnaires or surveys, data capturing
and outcomes development.
C. COUNTY RESPONSIBILITIES
County shall:
1) Participate in monthly meetings with Evaluator to discuss program, contractual
issues, and/or findings. Meeting frequency may be changed after the first year of
implementation. DBH will be responsible for coordination of these meetings.
2) Participate in evaluation of the progress of the overall program and the efficiency of
the collaboration with Evaluator and will be available to Evaluator for ongoing
consultation.
Exhibit A- Page 5 of 5
3) Gather outcome information from Evaluator throughout each term of this
Agreement. COUNTY DBH staff shall notify the Evaluator when its participation is
required.
4) DBH shall include Evaluator in DBH trainings that are relevant to the services as
described in this Agreement, if there is sufficient space available, at no cost.
D. REPORTS
1) Evaluator shall provide a report of collected data and analysis at the completion of
each program's cohort. The reports of the data shall address the research questions
in the proposal, assess learnings related to the research questions, and offer
suggestions about program viability. Each of the reports shall include both a short
executive summary, and full, detailed analysis (with supporting documentation of
data in appendices).
2) Evaluator shall provide a final report of analysis over the three years of this
Innovation Plan.
3) Additional reports/outcomes may also be requested by the COUNTY's DBH and/or
State, as needed.
Exhibit B - Page 1 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
DBH VISION:
Health and well-being for our community.
DBH MISSION:
The Department of Behavioral Health is dedicated to supporting the wellness of individuals,
families and communities in Fresno County who are affected by, or are at risk of, mental illness
and/or substance use disorders through cultivation of strengths toward promoting recovery in
the least restrictive environment.
DBH GOALS:
Quadruple Aim
• Deliver quality care
• Maximize resources while focusing on efficiency
• Provide an excellent care experience
• Promote workforce well-being
GUIDING PRINCIPLES OF CARE DELIVERY:
The DBH 11 principles of care delivery define and guide a system that strives for excellence in the
provision of behavioral health services where the values of wellness, resiliency, and recovery are
central to the development of programs, services, and workforce. The principles provide the
clinical framework that influences decision-making on all aspects of care delivery including
program design and implementation, service delivery, training of the workforce, allocation of
resources, and measurement of outcomes.
1. Principle One -Timely Access & Integrated Services
o Individuals and families are connected with services in a manner that is streamlined,
effective, and seamless
o Collaborative care coordination occurs across agencies, plans for care are integrated,
and whole person care considers all life domains such as health, education,
employment, housing, and spirituality
o Barriers to access and treatment are identified and addressed
o Excellent customer service ensures individuals and families are transitioned from one
point of care to another without disruption of care
1
rev 2017 Dec
Exhibit B - Page 2 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
2. Principle Two - Strengths-based
o Positive change occurs within the context of genuine trusting relationships
o Individuals, families, and communities are resourceful and resilient in the way they
solve problems
o Hope and optimism is created through identification of, and focus on, the unique
abilities of individuals and families
3. Principle Three - Person-driven and Family-driven
o Self-determination and self-direction are the foundations for recovery
o Individuals and families optimize their autonomy and independence by leading the
process, including the identification of strengths, needs, and preferences
o Providers contribute clinical expertise, provide options, and support individuals and
families in informed decision making, developing goals and objectives, and identifying
pathways to recovery
o Individuals and families partner with their provider in determining the services and
supports that would be most effective and helpful and they exercise choice in the
services and supports they receive
4. Principle Four- Inclusive of Natural Supports
o The person served identifies and defines family and other natural supports to be
included in care
o Individuals and families speak for themselves
o Natural support systems are vital to successful recovery and the maintaining of
ongoing wellness; these supports include personal associations and relationships
typically developed in the community that enhance a person's quality of life
o Providers assist individuals and families in developing and utilizing natural supports.
5. Principle Five - Clinical Significance and Evidence Based Practices (EBP)
o Services are effective, resulting in a noticeable change in daily life that is measurable.
o Clinical practice is informed by best available research evidence, best clinical
expertise, and client values and preferences
o Other clinically significant interventions such as innovative, promising, and emerging
practices are embraced
2
rev 2017 Dec
Exhibit B - Page 3 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
6. Principle Six- Culturally Responsive
o Values, traditions, and beliefs specific to an individual's or family's culture(s) are
valued and referenced in the path of wellness, resilience, and recovery
o Services are culturally grounded, congruent, and personalized to reflect the unique
cultural experience of each individual and family
o Providers exhibit the highest level of cultural humility and sensitivity to the self-
identified culture(s) of the person or family served in striving to achieve the greatest
competency in care delivery
7. Principle Seven -Trauma-informed and Trauma-responsive
o The widespread impacts of all types of trauma are recognized and the various
potential paths for recovery from trauma are understood
o Signs and symptoms of trauma in individuals, families, staff, and others are recognized
and persons receive trauma-informed responses
o Physical, psychological and emotional safety for individuals, families, and providers is
emphasized
8. Principle Eight - Co-occurring Capable
o Services are reflective of whole-person care; providers understand the influence of
bio-psycho-social factors and the interactions between physical health, mental health,
and substance use disorders
o Treatment of substance use disorders and mental health disorders are integrated; a
provider or team may deliver treatment for mental health and substance use
disorders at the same time
9. Principle Nine - Stages of Change, Motivation, and Harm Reduction
o Interventions are motivation-based and adapted to the client's stage of change
o Progression though stages of change are supported through positive working
relationships and alliances that are motivating
o Providers support individuals and families to develop strategies aimed at reducing
negative outcomes of substance misuse though a harm reduction approach
o Each individual defines their own recovery and recovers at their own pace when
provided with sufficient time and support
3
rev 2017 Dec
Exhibit B - Page 4 of 4
Fresno County Department of Behavioral Health
Guiding Principles of Care Delivery
10. Principle Ten - Continuous Quality Improvement and Outcomes-Driven
o Individual and program outcomes are collected and evaluated for quality and efficacy
o Strategies are implemented to achieve a system of continuous quality improvement
and improved performance outcomes
o Providers participate in ongoing professional development activities needed for
proficiency in practice and implementation of treatment models
11. Principle Eleven - Health and Wellness Promotion, Illness and Harm Prevention, and Stigma
Reduction
o The rights of all people are respected
o Behavioral health is recognized as integral to individual and community well-being
o Promotion of health and wellness is interwoven throughout all aspects of DBH services
o Specific strategies to prevent illness and harm are implemented at the individual,
family, program, and community levels
o Stigma is actively reduced by promoting awareness, accountability, and positive
change in attitudes, beliefs, practices, and policies within all systems
o The vision of health and well-being for our community is continually addressed
through collaborations between providers, individuals, families, and community
members
4
rev 2017 Dec
Exhibit C-Page 1 of 6
EVALUATION FOR CALIFORNIA REDUCING DISPARITIES EVOLUTIONS INNOVATION PROJECT
Iran Barrera
Fiscal Year(FY)2022-23
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
Direct Personnel Admin Salaries Subtotal 0.00 $ $ -
Acct# Program Position FTE Admin Program Total
1116 Program Evaluator 0.11 $ 45,000 $ 45,000
Direct Personnel Program Salaries Subtotal 0.11 $ 45,000 $ 45,000
Admin Program Total
Direct Personnel Salaries Subtotal 0.11 $ $ 45,000 $ 45,000
Direct Employee Benefits
Acct# Description Admin Program Total
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
Direct Payroll Taxes&Expenses Subtotal:
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 45,000 $ 45,000
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
5000: DIRECT SPECIAL EXPENSES
Acct# I Line Item Description Amount
5005 ISurvey Development-Community Stakeholder Meeting and CRDP Programs 20,000
DIRECT SPECIAL EXPENSES TOTAL: $ 20,000
TOTAL PROGRAM EXPENSES $ 65,000
PROGRAM FUNDING SOURCES
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations CRDP Evolutions 65,000
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $ 65,000
TOTAL PROGRAM FUNDING SOURCES: $ 65,000
NET PROGRAM COST: $ -
Exhibit C-Page 2 of 6
EVALUATION FOR CALIFORNIA REDUCING DISPARITIES EVOLUTIONS INNOVATION PROJECT
Iran Barrera
Fiscal Year(FY)2022-23 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 45,000
Administrative Positions -
Program Positions 45,000
1116 Program Evaluator 45,000 Program Evaluator will provide program evaluation for three California Reducing
Disparities Evolutions Innovation projects. Duties may include but are not limited to
support and technical assistance,development of surveys and program evaluation tools,
data gathering and analysis,and overall evaluation of programs. Hourly rates includes
supplies and materials,wages,payroll taxes,and benefits.
225 Hours x$200 Hourly Rate=$45,000
Direct Employee Benefits
Direct Payroll Taxes&Expenses: -
5000:DIRECT SPECIAL EXPENSES 20,000
5005 Survey Development-Community Stakeholder Meeting 20,000 One-time fees to develop community feedback survey,and program surveys and/or
and CRDP Programs evaluation tools. Payment to be made upon completion of approved surveys or
evaluation tools.
Community Stakeholder Feedback Survey-$5000
Sweet Potato Program Evaluation Tool/Survey-$5000
Hmong Helping Hands Program Evaluation Tool/Survey-$5000
Atencion Plena and Platicas Program Evaluation Tool/Survey-$5000
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 65,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 65,000
BUDGET CHECK: -
Exhibit C-Page 3 of 6
EVALUATION FOR CALIFORNIA REDUCING DISPARITIES EVOLUTIONS INNOVATION PROJECT
Iran Barrera
Fiscal Year(FY)2023-24
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
Direct Personnel Admin Salaries Subtotal 0.00 $ $ -
Acct# Program Position FTE Admin Program Total
1116 Program Evaluator 0.22 $ 90,000 $ 90,000
Direct Personnel Program Salaries Subtotal 0.22 $ 90,000 $ 90,000
Admin Program Total
Direct Personnel Salaries Subtotal 0.22 $ $ 90,000 $ 90,000
Direct Employee Benefits
Acct# Description Admin Program Total
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
Direct Payroll Taxes&Expenses Subtotal:
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 90,000 $ 90,000
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
TOTAL PROGRAM EXPENSES $ 90,000
PROGRAM FUNDING SOURCES
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention -
8303 INN-Innovations CRDP Evolutions 90,000
8304 WET-Workforce Education&Training -
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $ 90,000
TOTAL PROGRAM FUNDING SOURCES: $ 90,000
NET PROGRAM COST: $ -
Exhibit C-Page 4 of 6
EVALUATION FOR CALIFORNIA REDUCING DISPARITIES EVOLUTIONS INNOVATION PROJECT
Iran Barrera
Fiscal Year(FY)2023-24 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 90,000
Administrative Positions -
Program Positions 90,000
1116 Program Evaluator 90,000 Program Evaluator will provide program evaluation for three California Reducing
Disparities Evolutions Innovation projects. Duties may include but are not limited to
support and technical assistance,development of surveys and program evaluation tools,
data gathering and analysis,and overall evaluation of programs. Hourly rates includes
supplies and materials,wages,payroll taxes,and benefits.
450 Hours x$200 Hourly Rate=$90,000
Direct Employee Benefits
Direct Payroll Taxes&Expenses: -
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 90,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 90,000
BUDGET CHECK: -
Exhibit C-Page 5 of 6
EVALUATION FOR CALIFORNIA REDUCING DISPARITIES EVOLUTIONS INNOVATION PROJECT
Iran Barrera
Fiscal Year(FY)2024-25
PROGRAM EXPENSES
1000:DIRECT SALARIES&BENEFITS
Direct Employee Salaries
Acct# Administrative Position FTE Admin Program Total
Direct Personnel Admin Salaries Subtotal 0.00 $ $ -
Acct# Program Position FTE Admin Program Total
1116 Program Evaluator 0.11 $ 45,000 $ 45,000
Direct Personnel Program Salaries Subtotal 0.11 $ 45,000 $ 45,000
Admin Program Total
Direct Personnel Salaries Subtotal 0.11 $ $ 45,000 $ 45,000
Direct Employee Benefits
Acct# Description Admin Program Total
Direct Employee Benefits Subtotal: $ $ $
Direct Payroll Taxes&Expenses:
Acct# Description Admin Program Total
Direct Payroll Taxes&Expenses Subtotal:
DIRECT EMPLOYEE SALARIES&BENEFITS TOTAL: Admin Program Total
$ $ 45,000 $ 45,000
DIRECT EMPLOYEE SALARIES&BENEFITS PERCENTAGE: Admin Program
0%1 100%
TOTAL PROGRAM EXPENSES $ 45,000
PROGRAM FUNDING SOURCES
8300-MENTAL HEALTH SERVICE ACT(MHSA)
Acct# MHSA Component MHSA Program Name Amount
8301 CSS-Community Services&Supports $
8302 PEI-Prevention&Early Intervention
8303 INN-Innovations CRDP Evolutions 45,000
8304 WET-Workforce Education&Training
8305 CFTN-Capital Facilities&Technology
MHSA TOTAL $ 45,000
TOTAL PROGRAM FUNDING SOURCES: $ 45,000
NET PROGRAM COST: $ -
Exhibit C-Page 6 of 6
EVALUATION FOR CALIFORNIA REDUCING DISPARITIES EVOLUTIONS INNOVATION PROJECT
Iran Barrera
Fiscal Year(FY)2024-25 Budget Narrative
PROGRAM EXPENSE
ACCT#1 LINE ITEM AMT DETAILED DESCRIPTION OF ITEMS BUDGETED IN EACH ACCOUNT LINE
1000:DIRECT SALARIES&BENEFITS 45,000
Administrative Positions -
Program Positions
1116 Program Evaluator 45,000 Program Evaluator will provide program evaluation for three California Reducing
Disparities Evolutions Innovation projects. Duties may include but are not limited to
support and technical assistance,development of surveys and program evaluation tools,
data gathering and analysis,and overall evaluation of programs. Hourly rates includes
supplies and materials,wages,payroll taxes,and benefits.
225 Hours x$200 Hourly Rate=$45,000
Direct Employee Benefits
Direct Payroll Taxes&Expenses: -
TOTAL PROGRAM EXPENSE FROM BUDGET NARRATIVE: 45,000
TOTAL PROGRAM EXPENSES FROM BUDGET TEMPLATE: 45,000
BUDGET CHECK: -
Exhibit D - Page 1 of 4
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
Dollars ($3,000,000). If this is a claims-made policy, then (1)the retroactive date must
be prior to the date on which services began under this Agreement; (2)the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse/ molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
(G)Cyber Liability. Cyber liability insurance with limits of not less than Two Million Dollars
($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The
cyber liability policy must be endorsed to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited to
information or data) that is in the care, custody, or control of the Contractor.
D-1
Exhibit D - Page 2 of 4
Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
Breach, which may include Disclosure of Personal Information to an Unauthorized Third
Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under [identify
the Article, section, or exhibit containing data security obligations] of this Agreement; (iv)
system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security
Breach; (vii)failure to comply with privacy policy; (viii) payment card liabilities and costs;
(ix) infringement of intellectual property, including but not limited to infringement of
copyright, trademark, and trade dress; (x) invasion of privacy, including release of
private information; (xi) information theft; (xii) damage to or destruction or alteration of
electronic information; (xiii) cyber extortion; (xiv) extortion related to the Contractor's
obligations under this Agreement regarding electronic information, including Personal
Information; (xv) fraudulent instruction; (xvi)funds transfer fraud; (xvii) telephone fraud;
(xviii) network security; (xix) data breach response costs, including Security Breach
response costs; (xx) regulatory fines and penalties related to the Contractor's obligations
under this Agreement regarding electronic information, including Personal Information;
and (xxi) credit monitoring expenses.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th
Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by
mail or email to the person identified to receive notices under this Agreement,
certificates of insurance and endorsements for all of the coverages required under this
Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
D-2
Exhibit D - Page 3 of 4
(iv) The professional liability insurance certificate, if it is a claims-made policy, must
also state the retroactive date of the policy, which must be prior to the date on
which services began under this Agreement.
(v) The cyber liability insurance certificate must also state that it is endorsed, and
include an endorsement, to cover the full replacement value of damage to,
alteration of, loss of, or destruction of intangible property (including but not limited
to information or data) that is in the care, custody, or control of the Contractor.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VI I.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) Waiver of Subrogation. The Contractor waives any right to recover from the County, its
officers, agents, employees, and volunteers any amounts paid under the policy of
worker's compensation insurance required by this Agreement. The Contractor is solely
responsible to obtain any policy endorsement that may be necessary to accomplish that
waiver, but the Contractor's waiver of subrogation under this paragraph is effective
whether or not the Contractor obtains such an endorsement.
(F) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
D-3
Exhibit D - Page 4 of 4
(G)Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
D-4
Exhibit E - Page 1 of 2
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("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 used 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.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
Exhibit E - Page 2 of 2
(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:
Exhibit F - Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 of seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit F - Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990 (a-f)
and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-
free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is prohibited and
specifying actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Exhibit F - Page 3 of 6
Failure to comply with these requirements may result in suspension of payments under
this Agreement or termination of this Agreement or both and CONTRACTOR may be
ineligible for award of any future State agreements if the department determines that any
of the following has occurred: the CONTRACTOR has made false certification, or
violated the certification by failing to carry out the requirements as noted above. (Gov.
Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1)final unappealable finding of contempt of court by a
Federal court has been issued against CONTRACTOR within the immediately preceding
two (2) year period because of CONTRACTOR's failure to comply with an order of a
Federal court, which orders CONTRACTOR to comply with an order of the National
Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will comply with
the requirements of Section 6072 of the Business and Professions Code, effective
January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number of
hours of pro bono legal services during each year of the contract equal to the lessor of
30 multiplied by the number of full time attorneys in the firm's offices in the State, with
the number of hours prorated on an actual day basis for any contract period of less than
a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of equipment,
materials, or supplies, other than procurement related to a public works contract, declare
under penalty of perjury that no apparel, garments or corresponding accessories,
equipment, materials, or supplies furnished to the state pursuant to the contract have
been laundered or produced in whole or in part by sweatshop labor, forced labor, convict
labor, indentured labor under penal sanction, abusive forms of child labor or exploitation
of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor,
convict labor, indentured labor under penal sanction, abusive forms of child labor or
exploitation of children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the
California Department of Industrial Relations website located at www.dir.ca.gov, and
Public Contract Code Section 6108.
Exhibit F - Page 4 of 6
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR's records, documents, agents or employees, or premises if
reasonably required by authorized officials of the contracting agency, the Department of
Industrial Relations, or the Department of Justice to determine the contractor's
compliance with the requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has any
questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code &10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or has a financial
interest and which is sponsored or funded by any state agency, unless the employment,
activity or enterprise is required as a condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code M 0411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he or she
engaged in any of the negotiations, transactions, planning, arrangements or any part of
the decision-making process relevant to the contract while employed in any capacity by
any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a contract with any state
agency if he or she was employed by that state agency in a policy-making position in the
same general subject area as the proposed contract within the twelve (12) month period
prior to his or her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Exhibit F - Page 5 of 6
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against liability for
Worker's Compensation or to undertake self-insurance in accordance with the
provisions, and CONTRACTOR affirms to comply with such provisions before
commencing the performance of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment. Payment of
invoices presented with a new name cannot be paid prior to approval of said
amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently qualified to do
business in California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit. Although there
are some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do business in California.
Agencies will determine whether a corporation is in good standing by calling the Office of
the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local governing
body, which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not subject to
review promulgated by the State Air Resources Board or an air pollution control district;
(2) subject to cease and desist order not subject to review issued pursuant to Section
13301 of the Water Code for violation of waste discharge requirements or discharge
prohibitions; or (3)finally determined to be in violation of provisions of federal law
relating to air or water pollution.
Exhibit F - Page 6 of 6
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General, and their
designees may, at any time, inspect and audit any records or documents of
CONTRACTOR or its subcontractors, and may, at any time, inspect the premises,
physical facilities, and equipment where Medicaid-related activities or work is conducted.
The right to audit under this section exists for ten (10) years from the final date of the
contract period or from the date of completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must confirm the
identity and determine the exclusion status of CONTRACTOR, any subcontractor, as
well as any person with an ownership or control interest, or who is an agent or managing
employee of CONTRACTOR through routine checks of Federal databases. This
includes the Social Security Administration's Death Master File, the National Plan and
Provider Enumeration System (NPPES), the List of Excluded Individuals/Entities (LEIE),
the System for Award Management (SAM), and any other databases as the State or
Secretary may prescribe. These databases must be consulted upon contracting and no
less frequently than monthly thereafter. If the State finds a party that is excluded, it must
promptly notify the CONTRACTOR and take action consistent with § 438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under this
part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or financial
institution located outside of the U.S. are considered in the development of actuarially
sound capitation rates.
Exhibit G - Page 1 of 2
FRESNO COUNTY MENTAL HEALTH PLAN
INCIDENT REPORTING
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes the form, and the supervisor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed for
each client.
Where the forms should be sent—within 24 hours from the time of the incident or first
knowledge of the incident:
• Incident Report should be sent to:
DBHlncidentreporting(a)fresnocountyca.gov and designated Contract Analyst
Exhibit G - Page 2 of 2
Fresno County Department of Behavioral Health-Incident Report
Send completed forms to dbhincidentreporting@fresnocountyca.gov and designated contract analyst within 24 hours of an
incident or knowledge of an incident. DO NOT COPY OR REPRODUCE/NOT part of the medical record.
Client Information
Last Name: Click or tap here to enter text. First Name: Click or tap here to enter text. Middle Initial:Click or tap here to enter text.
Date of Birth:Click or tap here to enter text.Client ID#:Click or tap here to enter text. Gender: ❑ Male ❑ Female
County of Origin:Click or tap here to enter text.
Name of Reporting Party:Click or tap here to enter text. Name of Facility:Click or tap here to enter text.
Facility Address:Click or tap here to enter text. Facility Phone Number:Click or tap here to enter text.
Incident(check all that apply)
❑ Homicide/Homicide Attempt ❑ Attempted Suicide(resulting in serious injury) ❑ Death of Client ❑ Medical Emergency
❑ Injury(self-inflicted or by accident) ❑ Violence/Abuse/Assault(toward others, client and/or property)
❑ Other-Specify(i.e. medication errors, client escaping from locked facility,fire, poisoning,epidemic outbreaks, other
catastrophes/events that jeopardize the welfare and safety of clients,staff and/or members of the community):Click or tap here to
enter text.
Date of Incident: Click or tap here to enter text. Time of Incident: Click or tap here to enter text.❑am ❑pm
Location of Incident:Click or tap here to enter text.
Description of the Incident(Attach additional sheet if needed):Click or tap here to enter text.
Key People Directly Involved in Incident(witnesses,staff): Click or tap here to enter text.
Action Taken (check all that apply)
❑ Consulted with Physician ❑ Called 911/EMS ❑ First Aid/CPR Administered ❑ Law Enforcement Contacted
❑ Client removed from building ❑ Parent/Legal Guardian Contacted ❑Other(Specify): Click or tap here to enter text.
Description of Action Taken: Click or tap here to enter text.
Outcome of Incident(If Known): Click or tap here to enter text.
Form Completed by:
Printed Name Signature Date
Reviewed by Supervisor/Program Manager:
Printed Name Signature Date
For Internal Use only:
❑ Report to Administration ❑ Report to Intensive Analysis Committee for additional review ❑Request Additional Information
❑ No Action ❑ Unusual Occurrence ❑ Other: Click or tap here to enter text.
Revised 08/18
Exhibit H — Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address(number,street) City State ZIP code
CLIA number Taxpayer ID number(EIN) /Telephone number
)
II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and
addresses of individuals or corporations under"Remarks"on page 2. Identify each item number to be continued.
YES NO
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
byTitles XVIII, XIX, or XX?......................................................................................................................... n n
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX?...................................................................................... n n
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution's, organization's, or
agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)........... n n
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under"Remarks."
NAME ADDRESS EIN
B. Type of entity: n Sole proprietorship n Partnership n Corporation
n Unincorporated Associations n Other(specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under"Remarks."
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers........................................................................................................... n n
NAME ADDRESS PROVIDER NUMBER
Exhibit H — Page 2 of 2
YES NO
IV. A. Has there been a change in ownership or control within the last year? ....................................................... o 0
If yes, give date.
B. Do you anticipate any change of ownership or control within the year?....................................................... o 0
If yes, when?
C. Do you anticipate filing for bankruptcy within the year?................................................................................ o 0
If yes, when?
V. Is the facility operated by a management company or leased in whole or part by another organization?.......... o 0
If yes, give date of change in operations.
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?......... o 0
VII. A. Is this facility chain affiliated? ...................................................................................................................... o 0
If yes, list name, address of corporation, and EIN.
Name EIN
Address(number,name) City State ZIP code
B. If the answer to question VII.A. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN.)
Name EIN
Address(number,name) City State ZIP code
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully failing to fully and accurately disclose the
information requested may result in denial of a request to participate or where the entity already participates, a termination of
its agreement or contract with the agency, as appropriate.
Name of authorized representative(typed) Title
Signature Date
Remarks
Exhibit I - Page 1 of 2
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED TRANSACTIONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction. If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4. The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
5. The terms covered transaction, debarred, suspended, ineligible, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause, have the meanings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6. Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and information of a participant is not required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
CERTIFICATION
(1) The prospective primary participant certifies to the best of its knowledge and belief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
Exhibit I - Page 2 of 2
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default.
(2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Signature: Date:
(Printed Name & Title) (Name of Agency or Company)