HomeMy WebLinkAboutMOU-19-6056 A1 FINAL.pdf STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY \
DEPARTMENT OF SOCIAL SERVICES
CDSS 744 P Street• Sacramento, CA 95814 • www.cdss.ca.gov
0--
KIM JOHNSON GAVIN NEWSOM
DIRECTOR GOVERNOR
May 3, 2023
County of Fresno Department of Social Services
2135 Fresno Street, Suite 100
Fresno, CA 93721
SUBJECT: MOU-19-6056 Al
Dear Contractor:
Please complete the following checked item(s) and return to my attention at:
GRANTMOU I NTAKE(aD-dss.ca.gov
Attn: Breanna Chan
Please note in the enclosed Agreement that the General Terms and Conditions are available upon request. If you do
not have Internet capabilities, please call me for a hard copy of the document
Std. 213 with attached Exhibits. Print and sign two copies of the Std. 213. Please use blue ink if available.
Std. CCC, Contractor Certification Clauses. It is available on the above referenced Internet site. Please sign
and return page one. Failure to do so will prohibit the State of California from doing business with your
company. CDSS will be keeping the signed Std. CCC on file for three (3) years.
A copy of your insurance certification, in accordance with Exhibit E, which includes the State of California,
its officers, agents, and employees as additionally insured.
Resolution from the Board of Supervisors (or appropriate governing body) authorizing the designated official
to enter into and sign this Agreement.
The CDSS will request the form be signed and submitted during execution of new, renewal or amendment
agreements.
Std. 204, Payee Data Record. No payment can be made unless this form is completed and returned.
Voluntary Statistical Data Reporting Form. The completion of this form is strictly voluntary.
The enclosed Agreement is signed on behalf of CDSS and is being returned to you for further processing.
Once completed, send to CDSS Contracts and Purchasing Bureau at the above address.
X The enclosed fully executed Agreement is for your records.
This Agreement cannot be considered binding on either party until approved by appropriate authorized State
agencies. No services should be provided prior to approval, as the State is not obligated to make any payments on
any agreement prior to final approval. Expeditious handling of this Agreement is appreciated. No alteration of these
documents will be accepted without prior State approval. If you need further information, please call me at(916)651-
3507.
clta4z'
Breanna Chan, Contracts Analyst
Contracts and Purchasing Bureau
Enclosure(s)
Agreement No. 23-175
MOU-19-6056 Al
CDSS/ County of Fresno
AMENDMENT TO THE Page 1 of 2
PRIVACY AND SECURITY AGREEMENT (Agreement)
BETWEEN
the California Department of Social Services (CDSS) and the
County of Fresno
Department/Agency of Social Services ;
parties to the Agreement #19-428 , effective on September 1, 2019.
This Amendment entered into by between the
County of Fresno
Department/Agency of Social Services
(County Department) and CDSS, extends the termination date of the Agreement to
allow ongoing transmissions of PI while the renewal of the Agreement is negotiated and
finalized between CDSS and the County Departments/Agencies.
AGREEMENTS
CDSS and County Department/Agency mutually agree to modify the following parts of
the Agreement as set forth below:
XVIII. TERMINATION
A. This Agreement shall terminate on either March 1, 2024 or upon execution of a
successor Agreement, whichever occurs sooner. The parties can agree in writing
to extend the term of the Agreement. County Department/Agency requests for an
extension shall be approved by CDSS and limited to no more than a six (6)
month extension.
B. Survival: All provisions of this Agreement that provide restrictions on disclosures
of PII and that provide administrative, technical, and physical safeguards for the
PII in the County Department/Agency's possession shall continue in effect
beyond the termination or expiration of this Agreement, and shall continue until
the PII is destroyed or returned to CDSS.
Except as set forth in this Amendment, the Agreement is unaffected and shall continue
in full force and effect in accordance with its terms. If there is conflict between this
amendment and the Agreement, the terms of this amendment will prevail.
MOU-19-6056 Al
CDSS/ County d KFEMDM5NT TO MEDI-CAL PRIVACY &SECURITY AGREEMENT NO.: 19 - 428
Page 2 of 2
SIGNATORIES
The signatories below warrant and represent that they have the competent authority on
behalf of their respective agencies to enter into the obligations set forth in this
Agreement.
The authorized officials whose signature appears below have committed their
respective agencies to the terms of the Agreement.
For the County of Fresno
Department/Agency of Social Services
6Z3
(S n t e) (Dale)
—10
Sal Quintero Chairman of the Board
(Name) (Title)
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
For the California Department of Social Services, By AJ,)�c. _Deputy
5/1/2023
(Signature) (Date)
Section
Sharon Hoshiyama Chief, Contracts Bureau
(Name) (Title)
2