HomeMy WebLinkAboutSTATE DPH-Immunization Local Assistance Grant_A-23-189.pdf COU County of Fresno Hall of Records, Room 301
2281 Tulare Street
Fresno,California
(60 Board of Supervisors 93721-2198
p 1856 0 Telephone:(559)600-3529
FR�S� Minute Order Toll Free: 1-800-742-1011
www.co.fresno.ca.us
April 25, 2023
Present: 5- Supervisor Steve Brandau,Vice Chairman Nathan Magsig, Supervisor Buddy Mendes,
Supervisor Brian Pacheco, and Chairman Sal Quintero
Agenda No. 35. Public Health File ID:23-0106
Re: Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California
Department of Public Health for the Immunization Local Assistance Grant, effective July 1,2022
through June 30,2027,total not to exceed$9,693,817;approve and authorize the Director of Public
Health, or designee,to execute flu vaccine supplementary agreements for the sharing of flu vaccines
that were provided to the Department by the State with interested medical providers that meet State
and Department guidelines;and,approve and Authorize the Director of the Department of Public
Health to submit any necessary forms for efficient administration of the grant through June 2027,
without change to total award
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero
Agreement No.23-189
County of Fresno Page 36
co
Board Agenda Item 35
p 1s56 p
FRE`'n
DATE: April 25, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with the California Department of Public Health
RECOMMENDED ACTION(S):
1. Approve and authorize the Chairman to execute a retroactive revenue Agreement with the
California Department of Public Health for the Immunization Local Assistance Grant,
effective July 1, 2022 through June 30, 2027, total not to exceed $9,693,817.
2. Approve and authorize the Director of Public Health, or designee,to execute flu vaccine
supplementary agreements for the sharing of flu vaccines that were provided to the
Department by the State with interested medical providers that meet State and Department
guidelines.
3. Approve and Authorize the Director of the Department of Public Health to submit any
necessary forms for efficient administration of the grant through June 2027,without change
to total award.
There is no additional Net County Cost associated with the recommended actions. Approval of the first
recommended action will provide continued non-competitive California Department of Public Health (CDPH)
grant funding to support immunizations, outreach, and educational services through the Department of
Public Health's Immunization Program. The funding provides staffing with related services and supplies. The
agreement maximum for each fiscal year is $450,576, with an additional $7,440,937 in COVID-19
vaccine-related activities funding for FY 2022-23 that may roll over any unspent funds each year until June
30, 2025. The second recommended action will allow the Department's Director, or designee, to execute flu
vaccine supplementary agreements for the sharing of flu vaccines that were provided to the Department by
the State with interested medical providers that meet State and Department guidelines. The third
recommended action will allow the Director to submit any necessary and related forms to the California
Department of Public Health for the efficient administration of the grant. This item is countywide.
ALTERNATIVE ACTION(S):
There is no alternative action. Should your Board not approve the recommended actions, the Department
would be unable to fully fund immunization activities in the County, resulting in increased cost to the County
to cover services and avoid being in violation of the California Health & Safety Code.
RETROACTIVE AGREEMENT:
The recommended retroactive revenue agreement was received from CDPH on January 26, 2023, is
retroactive to July 1, 2022 and is being brought to your Board in accordance with the agenda item
processing timelines.
County of Fresno page 1 File Number.23-0106
File Number.23-0106
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The annual allocation
is $450,576 for FYs 2022-23 through 2026-27, with $7,440,936.74 in COVID-19 related activities funding for
FY 2022-23, and that any unspent funds may be rolled over each year until June 30, 2025. Sufficient
appropriations and estimated revenues are included in the Department's Org 5620 FY 2022-23 Adopted
Budget and will be included in subsequent budget requests.
The agreement includes full reimbursement of direct costs but does not allow for indirect cost recovery.
Health Realignment will cover the current indirect rate of 18.816% percent($78,607)of salaries and benefits
per fiscal year.
DISCUSSION:
Pursuant to California Health and Safety Code, section 120350, County Health Officers are charged with the
organization and maintenance of an immunization program to ensure availability to County residents and the
investigation and outbreak mitigation of vaccine preventable diseases. The recommended agreement will
provide funding to support mandated immunization programs, through health education, outreach, and direct
immunization administration to County residents. Additionally, it will support case management for Hepatitis
B positive mothers and their newborns, serves as a resource for immunization questions from providers
throughout the County, and funds flu clinics during the fall and winter seasons.The annual funds will assist
with vaccine awareness and immunization services, while the COVID-19 funding will help fund COVID-19
vaccine-related activities such as: staffing, vendor contracts to administer COVID-19 vaccine, pop-up
COVID-19 vaccination clinics, community-based organization contracts, and the purchase and maintenance
of vaccine storage equipment.
The Department has received immunization subvention funds for over 30 years and proposes to utilize
these grant funds to fund program personnel costs as well as education and training materials. From
February 11th, 2021 through March 1st, 2022, the Department's Immunization program administered
132,880 doses of COVID-19 vaccines, redistributed 169,389 COVID-19 vaccine doses throughout Fresno
County, and allowed the direct shipping of 553,832 doses to medical providers. To date, in FY 2022-23, over
10,233 vaccines were administered; 2,452 were flu vaccines, and 4,230 were COVID-19 vaccines. The
program shared 5,948 flu vaccine doses with community medical partners, redistributed 91,709 doses of
COVID-19 vaccines, and approved for direct shipping of 203,546 doses of COVID-19 vaccines to other
providers.
The recommended Agreement deviates from the County's standard indemnification language and requires
the County(and the County's contractors receiving this funding)to provide one-way indemnification to the
State in the performance of the Agreement. This language is typically present in State grants therefore, the
Department has determined that its acceptance of the indemnification language is advantageous as the
State-grant is a critical funding source for Immunization related activities. Without this funding the continued
provision of these services would be negatively impacted.
REFERENCE MATERIAL:
BAI #46, February 22, 2022
BAI#34, April 27, 2021
BAI #37, January 21, 2020
BAI #33, December 12, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Agreement with California Department of Public Health
County of Fresno page 2 File Number:23.0106
File Number:23-0106
CAO ANALYST:
Ron Alexander
County of Fresno Page 3 File Number:23-0106
Agreement No. 23-189
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
[CALIFORNIA IMMUNIZATION PROGRAM
Awarded By
THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter"Department"
TO
j Fresno County Department of Public Health, Immunization Program,! hereinafter
"Grantee"
Implementing the project, "To assist local health departments (LHDs) in preventing
and controlling vaccine-preventable diseases (VPDs) in the local health jurisdiction
(LHJ)," hereinafter "Project"
GRANT AGREEMENT NUMBER 1,22-10856
The Department awards this Grant, and the Grantee accepts and agrees to use the Grant
funds as follows:
AUTHORITY: The Department has authority to grant funds for the Project under Health and
Safety Code, Section 120325-120380, which requires immunizations against childhood
diseases prior to school admittance and Federal Grant numbers 5 NH231P922612-04-00, 6
NH231P922612-02-02, 6 NH231P922612-02-03, and 6 NH231P922612-02-04.1
PURPOSE: The Department shall award this Grant Agreement to and for the benefit of
the Grantee; the purpose of the Grant is to assist LHDs in preventing and controlling
VPDs in the LHJ. The Grantee is to implement activities to:
• Assess and improve coverage levels in the jurisdiction of all vaccines
recommended by the Advisory Committee on Immunization Practices (ACIP) to
protect the population.
• Detect, report, and control vaccine-preventable diseases in the jurisdiction. ]
Related Statutes
California Health & Safety Code sections:
• 120130 requires the Local Health Officer to properly report to CDPH those diseases
listed as reportable, which include vaccine-preventable diseases.
• 120175 requires the Local Health Officer to take measures as may be
necessary to prevent the spread or occurrence of additional cases of
reportable diseases (which includes reportable vaccine-preventable
diseases).
• 120350 requires Local Health Officers to organize and maintain a program to
make available the immunizations required for admittance to childcare facilities
and schools.
Page 1 of 4
State of California— Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
GRANT AMOUNT: The maximum amount payable under this Grant Agreement shall not
exceed the amount of[$9,693,816.74. J
TERM OF GRANT AGREEMENT: The term of the Grant shall begin on �f July 1, 2022 and
terminates on !June 30, 20271. No funds may be requested or invoiced for services
performed or costs incurred after June 30, 2027.
PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will
be:
California Department of Public Health Grantee: Fresno County Department of Public
Health, Immunization Program
Name: Noemi Marin Name: Scotti Blanks, MSN, PHN, FNP-BC, RN
Address: 850 Marin Marina Bay Pkwy., Bldg. P, Address: 1221 Fulton Street
2nd FI.
City, ZIP: Richmond, CA 94804 City, ZIP: Fresno, CA 93721
Phone: (510) 620-3737 Phone: (559) 600-3567
E-mail: noemi.marin@cdph.ca.gov E-mail: sblanks@fresnocountyca.gov
Direct all inquiries to the following representatives:
California Department of Public Health, Grantee: (Fresno County Department of Public
Immunization Branch Health, Immunization Program
Attention: Robina EscaladaAttention: Scotti Blanks, MSN, PHN, FNP-BC, RN
Address: 850 Marina Bay Pkwy., Bldg. P, 2nd FI. Address: 1221 Fulton Street
City, Zip: Richmond, CA 94804 City, Zip: Fresno, CA 93721
Phone: (510) 620-3729 Phone: (559) 600-3567
E-mail: robina.escalada@cdph.ca.gov E-mail: sblanks@fresnocountyca.gov
Page 2 of 4
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
All payments from CDPH to the Grantee; shall be sent to the following address:
Remittance Address
Grantee: [Fresno County Department of
Public Health, Immunization Program'
Attention "Cashier": Business Office
Address: P.O. Box 11867
City, Zip: Fresno, CA 93775
Phone: (559) 600-6415
E-mail: dphboap@fresnocountyca.gov
Either party may make changes to the Project Representatives, or remittance address, by
giving a written notice to the other party, said changes shall not require an amendment to
this agreement but must be maintained as supporting documentation. Note: Remittance
address changes will require the Grantee to submit a completed CDPH 9083 Governmental
Entity Taxpayer ID Form or STD 204 Payee Data Record Form and the STD 205 Payee
Data Supplement which can be requested through the CDPH Project Representatives for
processing.
STANDARD GRANT PROVISIONS. The Grantee must adhere to all Exhibits listed
and any subsequent revisions. The following Exhibits are attached hereto or attached by
reference and made a part of this Grant Agreement:
(Exhibit A GRANT APPLICATION
(The Grant Application provides the description of the project and associated
costs)
Note: Once the Grant Agreement has been fully executed, requests for
modifications/changes thereafter to the existing Exhibit A and/or Exhibit A,
Attachment 1, do not require a formal amendment but must be agreed to in
writing by both parties_The CDPH/Grantee Project Representatives are
responsible for keeping records of approved modifications/changes. Such
modifications/changes must be made at least 30 days prior to implementation.
A formal written amendment is required when there is an increase or decrease
in funding or a change in the term of the agreement.
Exhibit B BUDGET DETAIL AND PAYMENT PROVISIONS
The approved budget supersedes the proposed budget in the Grant Application
Exhibit C STANDARD GRANT CONDITIONS
Page 3 of 4
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229 (12/2021)
Exhibit D REQUEST FOR APPLICATION (RFA) #22-10537
Exhibit E ADDITIONAL PROVISIONS
Exhibit F FEDERAL TERMS AND CONDITIONS
I
GRANTEE REPRESENTATIONS: The Grantee(s) accept all terms, provisions, and
conditions of this grant, including those stated in the Exhibits incorporated by reference
above. The Grantee(s) shall fulfill all assurances and commitments made in the application,
declarations, other accompanying documents, and written communications (e.g., e-mail,
correspondence) filed in support of the request for grant funding. The Grantee(s) shall
comply with and require its subgrantee's to comply with all applicable laws, policies, and
regulations.
IN WITNESS THEREOF, the parties have executed this Grant on the dates set forth below.
Executed By:
Date: 7 �i Z 3
( Sal Quintero
Chairman of the Board of Supervisors of the
County of Fresno
Fresno County Department of Public Health,
Immunization Program
2281 Tulare Street, #301 ATTEST:
Fresno, CA 93721 BERNICE E.SEIDEL
[ I Clerk of the Board of Supervisors
I County of Fresno,State of California
_Deputy
Date: 5-30-23
[ ] Ja ler Sandoval, Chief
(Contracts Management Unit ]
California Department of Public Health
1616 Capitol Avenue, Suite 74.262
P.O. Box 997377, MS 1800- 1804
Sacramento, CA 95899-7377
Page 4 of 4
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
Date: 09/15/2022
CDPH Immunization Branch Form 1
Fiscal Year 2022 - 2027
APPLICATION COVER SHEET/CHECKLIST
DATE OF 9/30/22
SUBMISSION
OFFICIAL
ORGANIZATION Fresno County Department of Public Health
NAM E
AGREEMENT (Leave blank. Will be assigned by CDPH/IZ)
NUMBER
Provide the name, phone number, and e-mail address of the person we can contact to confirm the date/time of
the negotiation conference call.
Contact Name: Scotti Blanks Phone Number: (559) 600-3567
E-mail: sblanks@fresnocountyca.gov
Type of Application:
❑ New X❑ Renewal ❑ Continuation ❑ Supplement ❑ Revision
❑❑ Supplement ❑❑ Revision
Budget Period: Total Amount Requested for 5 Years:
From: July 1, 2022 To: June 30, 2027 $ 9,693,816.74
Board of Supervisors/Resolution meeting dates for the upcoming 6 months
10/11/22, 10/25/22, 11/8/22, 11/29/22, 12/13/22
Dates after 12/31/22 are not yet scheduled.
Page 1 of 2
Fresno County Department of Public
Health, Immunization Program
Grant Agreement #: 22-10856
RFA#::22-10537
Exhibit A Date:09/15/2022
Form 1
Federal Compliance Requirements of the
Immunization Grant No. 5 NH231P922612-04-00
COVID-19 R2 Grant No. 6 NH23IP922612-02-02
COVID-19 R3 Grant No. 6 NH231P922612-02-03
COVID-19 R4 Grant No. 6 NH231P922612-02-04
This section requires LHD Grantee signature to acknowledge that the LHD Grantee has reviewed and
understands the Federal Compliance Requirements of all grants listed above. See enclosed copy of the
Award Attachments under which these grants are issued.
fF
� 6 '
Print Name and Title of Person Signing Signature of Person Signing Date �—
APPLICATION CONTENTS:
Application Due by 5:00 p.m., (Pacific Standard Time), September 30, 2022 Please Check
Form 1: Application Cover Sheet/Checklist
Form 2: Grantee Information Form
®\
Form 3: Local Project Synopsis
Form 4: Scope of Work for Local Health Departments/Glossary of
Acronyms and Terms
Form 5: Exhibit B — Budget
Form 6: Government Agency Taxpayer ID Form
NOTE: The above documents must be completed and submitted with this Application Cover Sheet/Checklist
Form. E-mail completed application to 1zb.admin@cdph.ca.gov by the submission deadline.
Page 2 of 2
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Date: 09/15/2022
Exhibit A
Form 2
CDPH Immunization Branch
Grantee Information Form
Date Form Completed: 9/20/2022
This is the information that will appear on your grant agreement cover page.
Federal Tax ID# _ Contract/Grant# (will be assigned by IZ/CDPH)
Data Universal
Number System
(DUNS)# _
Unique Entity
Identifier(UEI)# _
Official
Organization
Name Fresno County Department of Public Health, Immunization Program
Mailing Address P. O. Box 11867, Fresno, CA 93775
= Street Address (If Different) 1221 Fulton Street, Fresno, CA 93721
O
County Fresno
N
'= Phone (559) 600-3567 Fax (559)600-7606
cv www.co.fresno.ca.us/departments/public-
Website Website health
O
The Grant Signatory has authority to sign the grant agreement cover.
Name Sal Quintero
cTitle Chairman of the Board of Supervisors of the County of Fresno
cc
= If address(es) are the same as the organization above,just check this box and go to Phone ❑
rn
T Mailing Address 2281 Tulare Stree,t#01, Fresno, CA 93721
c
L Street Address (If Different)
Phone (559) 600-3529 Fax (559) 600-1508
E-mail Clerk/bos@fresnocountyca.gov
The Project Director is responsible for all of the day-to-day activities of project implementation and for
o seeing that all grant requirements are met. This person will be in contact with State Immunization Branch
0 staff, will receive all programmatic, budgetary, and accounting mail for the project and will be responsible
o for the proper dissemination of program information.
Name Scotti Blanks
0
a. Title Supervising Public Health Nurse
If address(es) are the same as the organization above,just check this box and go to Phone
Page 1 of 2
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Date: 09/15/2022
Mailing Address
Street Address (If Different)
Phone (559) 600-3567 Fax (559) 600-7606
E-mail sblanks@fresnocountyca.gov
All payments are sent to the attention of this person at the designated address.
Name Business Office
m
> Title Public Health Business Office
If address(es) are the same as the organization above,just check this box and go to Phone
.r
m
Mailing Address P. O. Box 11867, Fresno, CA 93775
Street Address (If Different)
a Phone (559) 600-6415 Fax (559) 600-7687
E-mail dphboap@fresnocountyca.gov
The Fiscal Reporter prepares invoices, maintains fiscal documentation and serves as the primary
contact for all related questions.
L Name Jose Rodriguez
d
0
Title Accountant
a
If address(es) are the same as the organization above,just check this box and go to Phone
Mailing Address
i,: Street Address (If Different)
Phone (559)600-6425 Fax (559) 600-7692
E-mail josrodriguez@fresnocountyca.gov
The Fiscal Signatory has signature authority for invoices and all fiscal documentation reports.
Name Business Office
o Title Public Health Business Office
w
rn
If address(es) are the same as the organization above,just check this box and go to Phone
U) Mailing Address
y Street Address(If Different)
U.
Phone (559) 600-6415 Fax (559) 600-7687
E-mail dphboap@fresnocountyca.gov
Page 2 of 2
Fresno County Department of Public
Health, Immunization Program
Exhibit A Grant Agreement#: 22-10856
RFA#: 22-10537
Date: 09/15/2022
CDPH Immunization Branch Form 3
Local Assistance Grant Application
Local Project Synopsis
Name of Grantee: Fresno County Department of Public Health: Immunization Program
1. DESCRIPTION OF SERVICES TO BE PROVIDED:
Narrative
The California State Department of Public Health Immunization Grant funds are directed
towards increasing immunization rates, reducing barriers to immunizations, and reducing
vaccine preventable disease incidence. These tasks are accomplished by (1) Monitoring
and promoting the reporting requirements under the California School Immunization Law
in public and private family day care homes, nursery schools, day nurseries, pre-
kindergarten facilities, and transitional kindgarten through 12th grade; (2) Providing
surveillance and outbreak control of vaccine preventable disease (VPD); (3) Maintaining
the Perinatal Hepatitis B Program; (4) Training agencies, schools, health care providers,
and others on the current immunization guidance; (5) Promoting the utilization of the
California Immunization Registry (CAIR2); (6) Collaborating with local agencies and
providers to support the use of seasonal influenza vaccine throughout Fresno County.
Case management and care coordination for Perinatal Hepatitis B Program clients will
continue in order to reduce the incidence and transmission of Hepatitis B. Outreach and
education activities targeted at providers and local birth hospitals will also continue in
order to promote best practices of both the Universal Birth Dose of Hepatitis B vaccine to
prevent hepatitis and Tdap vaccination for pregnant women to prevent pertussis in
newborns.
2. EVALUATION PLANS:
All grantees participate in process evaluation per their Scope of Work activities.
Grantees must complete a quarterly grant report detailing their activities.
Page 1 of 1
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Date: 09/15/2022
Exhibit A Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Purpose
The purpose of this grant is to assist local health departments (LHDs) in preventing and controlling
vaccine-preventable diseases in the local health jurisdiction (LHJ).
Related Statutes
California Health & Safety Code sections:
• 120130 requires the Local Health Officer to properly report to CDPH those diseases listed
as reportable, which include vaccine-preventable diseases.
• 120175 requires the Local Health Officer to take measures as may be necessary to
prevent the spread or occurrence of additional cases of reportable diseases (which
includes reportable vaccine-preventable diseases).
• 120350 requires Local Health Officers to organize and maintain a program to make
available the immunizations required for admittance to childcare facilities and schools.
Services to be Performed by the Grantee
The Grantee is to implement activities to:
• Assess and improve coverage levels in the jurisdiction of all vaccines recommended by
the Advisory Committee on Immunization Practices (ACIP) to protect the population.
• Detect, report, and control vaccine-preventable diseases in the jurisdiction.
The LHD must agree to the following inclusive objectives and conduct the following activities. Many of
the services to be performed are also conditions for federal funding of the CDPH Immunization
Branch (IZB) and/or statutory requirements of State and LHDs. The level of local assistance grant
funding to be awarded is not represented as sufficient for support of all the required activities; a
significant amount of local support and funding is expected. Local assistance grant funds must not be
used to supplant (i.e., replace) local funds currently being expended for immunization services and
activities.
Grantee agrees to assign the responsibility of monitoring each program component:
1) Vaccine Accountability and Management; 2)Access to and Utilization of Quality Immunization
Services; 3) California Immunization Registry (CAIR); 4) Perinatal Hepatitis B Prevention; 5)
Education, Information, Training, and Partnerships; 6) Prevention, Surveillance and Control of
Vaccine Preventable Disease (VPD); 7) Childcare and School Immunization Entry Requirements; 8)
Influenza; and 9) COVID-19 Vaccination.
Grantee will monitor grant fund expenditures to maximize the utilization of the funding for achieving
the goals and objectives. Grant invoices shall be reviewed and submitted quarterly to the CDPH
Immunization Branch.
The Immunization Coordinator is required to participate in meetings, webinars, and conference
calls as requested by the CDPH Immunization Branch including, but not limited to, the CDPH
Immunization Branch's Immunization Coordinators' Meeting, New Immunization Coordinator
Page 1 1
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Date: 09/15/2022
Exhibit A Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Orientation (offered annually and required for all new Immunization Coordinators), regional
coordinators' meetings, and conference calls related to influenza, outbreak control,
perinatal hepatitis B, changes in policies and procedures, and other important issues.
Page 12
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Exhibit A
Date: 09/15/2022 CDPH Immunization Branch Form 4
Scope of Work for Local Health Departments FY 2022-2023
Area 1. Vaccine Accountability and Management
Goal 1.1: Maintain viability of IZB supplied vaccine to ensure vaccine effectiveness and
reduce vaccine waste.
Required Activities Performance Measures
Goal 1.1 Activity a: Annually, make sure all 1. Updated Vaccine Management Plans for each
relevant staff within LHD-operated clinics LHD facility.
(routine mass vaccination, or special 2. Completed EZIZ Lessons for Key Practice
immunization outreach) are properly trained on Staff.
current policies and procedures for proper 3. Completed training logs (training date, topics,
vaccine storage and handling outlined in each methods, and list of attendees).
participation agreement/addendum for the
receipt of IZB-supplied vaccines (317,
Vaccines for Children [VFC], state general
fund).
Goal 1.1 Activity b: Develop and implement a 1. Training plan developed and implemented.
training plan for provider facilities outside LHDs 2. Number of completed trainings.
receiving IZB supplied doses (state or 317 3. Completed training logs (training date, topics,
Outbreak). Focus the plan on proper vaccine methods, and list of attendees).
management, vaccine storage and handling 4. Training packet completed and available.
requirements, and administration prior to the 5. Number of signed Vaccine Management Plans
distribution of IZB-supplied vaccines. received and reviewed.
Goal 1.1 Activity c: Develop and implement a 1. Developed and implemented Quality
plan to verify that providers administering 317 Assurance Plan.
Outbreak and state general fund immunizations 2. Completion of Mass Vaccination Hourly
outside the LHDs adhere to policies for vaccine Temperature Logs/Electronic Data Files.
management. Conduct Quality Assurance 3. Temperature Documentation on CDPH
verifications (such as random temperature log provided Logs for all IZB-supplied
review, on-site vaccination clinic assessments, vaccines/Electronic Temperature Files.
review of vaccine losses, etc.) at least every 4. Percentage of sites receiving Quality
other year, in a sample of sites receiving Assurance verifications (minimum sample of
vaccines.
10% of sites receiving vaccines).
5. Number of Completed Quality Assurance
verifications.
Goal 1.1 Activity d: Promote and encourage 1. Documentation of storage and handling best
adoption of CDPH and CDC storage and practices promotion efforts.
handling guidelines among all healthcare
providers providing immunization services in
the community.
Page 13
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Exhibit A Date: 09/15/2022
CDPH Immunization Branch Form 4
Scope of Work for Local Health Departments FY 2022-2023
Goal 1.2: Facilitate compliance with current protocols, policies, and procedures for vaccine
accountability for LHD facilities and partners that receive IZB-supplied vaccine.
Activity Performance Measures
Goal 1.2 Activity a: Make sure all relevant 1. Completed annual program recertification
staff involved in vaccine ordering, and corresponding educational lessons for all
management, and accountability activities key practice staff.
within local health department-operated clinics
adhere to all program requirements as outlined
in the VFC/317 Provider Participation
Agreements and Addendums. Complete
annual VFC/317 program recertification.
Goal 1.2 Activity b: Promote adherence to 1. Documentation of provided guidance.
eligibility guidelines corresponding to VFC,
Section 317, and state general fund vaccines.
Upon release of the Immunization Branch's
Vaccine Eligibility Guidelines, IMM-1142,
disseminate guidance to all relevant staff
involved in vaccine ordering, management, and
accountability activities within local health
department operated pediatric and adult
immunization clinics.
Goal 1.2 Activity c: Verify that processes are 1. Updated LHD protocols, inclusive of eligibility
in place such that IZB-supplied (317, VFC, guidelines, for each vaccine funding source.
state) vaccines are administered to eligible
individuals following outlined eligibility
guidelines for each vaccine funding source.
Goal 1.2 Activity d: Comply with federal 1. Documentation of procedures.
policies regarding vaccine distribution. Publicly
funded VFC and 317 vaccines must be
distributed directly to the location at which the
provider will administer the vaccines.
Area 2. Access to and Utilization of Quality Immunization Services
Goal 2.1: Improve access to and receipt of all ACIP-recommended immunizations,
especially for low income and underserved community members.
Required Activities Performance Measures
Goal 2.1 Activity a: Maintain an immunization 1. Referral list completed and updated on an
safety net that includes any LHD resource and annual basis.
referral lists to other programs that connect
patients to services.
Page 14
Fresno County Department of Public
Health, Immunization Program
Exhibit A Grant Agreement#: 22-10856
CDPH Immunization Branch Date: 09/1 RFA#: 22-10537
10537
Scope of Work for Local Health Departments FY 2022-2023 5/2022
Form 4
Goal 2.1 Activity b: Be responsive to 1. Maintain log of access problems resolved at
problems Medi-Cal members report related to local level or reported to CDPH.
access to immunization services.' Work with
the corresponding Medi-Cal Managed Care
Plan (MCP) to resolve problems. After
attempts to work with MCP, if still unable to
resolve, collect details and escalate to Senior
Field Representative or other designated
Immunization Branch staff person.
Goal 2.1 Activity c: For all LHD facilities that 1. Number of LHD clinics with corrective actions
are VFC providers, participate in and support that were all completed within the specified
provider compliance and quality improvement time frame on the VFC Compliance Visit
visits in conjunction with the CDPH Report.
Immunization Branch. Assist with the
implementation of corrective action plans,
strategies to reduce missed opportunities for
vaccination, and linkage/referral to medical
homes.
Area 3. California Immunization Registry (CAIR)2
Goal 3.1 Promote and optimize 3 the use of CAIR in the jurisdiction
Required Activities Performance Measures
Goal 3.1 Activity a: Enter all IZB-supplied 1. Number of LHD clinics participating in CAIR/
vaccine doses administered by LHD or number all LHD clinics.
partners, including influenza doses, into CAIR. 2. Percentage of LHD clinic doses entered into
the registry within 14 days.
3. Number of state flu doses entered by end of
flu season/number state flu doses
administered.
4. CAIR ID list submitted to CDPH.
Goal 3.1 Activity b: For LHDs with primary 1. Inactive patients marked as inactive in CAIR.
care clinics, use manage patient status
functionality to remove inactive patients at
least once a year.
Goal 3.1 Activity c: In LHD primary care 1. Low infant or adolescent CAIR coverage rate
clinics, utilize CAIR data to identify and identified and improved.
1 Requirements for Medi-Cal immunization services are summarized here:http://izcoordinators.org/vaccine-programs/medi-cal-and-
pharmacy-resources/
Z CAIR refers to the statewide system that will connect CAIR2 with the San Diego Immunization Registry and Healthy Futures.
a If have EHR, move from manual data entry to data exchange(upload from EHR)to bidirectional data exchange.See
https://cairweb.org/docs/CAIR2-Communications/IMM-1266.pdf and https://cairweb.org/docs/CAIR2-Communications/IMM-1260.pdf
Page 15
Fresno County Department of Public
Health, Immunization Program Grant
Agreement#: 22-10856 RFA#:
Exhibit A 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
improve low or lagging infant or adolescent
vaccination coverage levels.
Goal 3.1 Activity d: Review monthly CAIR 1. Number of VFC Sites identified for priority
usage reports' to identify priority non- recruitment/retention contact.
participating VFC sites that need to be
recruited/retained. Communicate priority sites
to Local CAIR Re LCR .
Goal 3.1 Activity a (required): Invite CAIR 1. Number of trainings with CAIR
staffs to participate in local provider trainings in participation/number of trainings held.
order to promote CAIR.
Goal 3.2: Connect local Immunization Information Systems (IIS) to CAIR (for San Joaquin
Count only)
Required Activities Performance Measures
Goal 3.2 Activity a: Implement data sharing 1. Full historical data load completed.
with CAIR2, including:
• Attend scheduled planning meetings with
CAIR2 staff.
• Comply with agreed upon timelines.
• Complete data transfer testing, including
both inbound to CAIR2 and outbound back
to local IIS.
• Share bulk historical loads of existing
patients and immunizations to CAIR2 to
initiate data sharing.
Goal 3.2 Activity b: Initiate and maintain 1. Ongoing data sharing continues.
ongoing electronic data sharing with CAIR2.
Area 4. Perinatal Hepatitis B Prevention
Goal 4.1: Reduce the incidence of perinatal hepatitis B virus (HBV) infection in the
jurisdiction.
Note: Coordinate perinatal HBV prevention efforts with your LHD's Maternal Child and Adolescent Health (MCAH)
program, as activities 4.1 a-4.1 c may also help fulfill Title V requirements and MCAH Scope of Work Activities.
Required Activities Performance Measures
Goal 4.1 Activity a: Educate medical 1. Percentage of HBsAg-positive pregnant
providers and hospital staff about the women identified in the reporting period who
screening, care, and reporting of pregnant were enrolled prior to delivery.
women who test positive for hepatitis B and
4 Monthly CAIR usage reports for VFC providers are posted here: http://izcoordinators.org/cair-reports/.
5"CAIR staff" includes CAIR2 and local registry staff.
Page 16
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
their infants according to the guidance outlined 2. Percentage of HBsAg-positive pregnant
below: women identified in the reporting period with
Guidance for Prenatal Providers an HBV DNA test result during pregnancy.
Guidance for Labor and Delivery Hospitals 3. Percentage of PEP errors in the reporting
Guidance for Pediatric Providers period with completed LHJ follow-up.
Goal 4.1 Activity b: Educate identified 1. Number of HBsAg positive pregnant women
HBsAg-positive pregnant women about their identified and contacted.
HBV status and provide the appropriate
information on prevention of perinatal hepatitis
B transmission, based on current ACIP
recommendations and the guidance outlined
below:
Perinatal Hepatitis B Prevention Program
Coordinator Handbook
Note: Even if you had no cases in the previous period
you are still required to complete this activity so that you
are prepared if there is a case in the future.
Goal 4.1 Activity c: Collect and submit 1. Percentage of infants born to HBsAg-positive
requested data to CDPH on HBsAg-positive mothers in the reporting period who received
pregnant women and their infants according to PEP according to ACIP recommendations.
the guidance outlined below: 2. Percentage of infants born to HBsAg-positive
Perinatal Hepatitis B Prevention Program mothers who completed the HBV vaccine
Coordinator Handbook series by 12 months of age.
3. Percentage of infants born to HBsAg-positive
mothers who have completed PVS testing by
24 months of age.
4. Percentage of infants closed to case
management with complete information
within 24 months.
Area 5. Education, Information, Training, and Partnerships
Goal 5.1: Provide and/or promote educational activities and information to health care
providers, schools and childcare centers, and other immunization stakeholders to promote
best practices for immunizations and the im ortance of timely vaccinations.
Required Activities Performance Measures
Goal 5.1 Activity a: Based on local priorities 1. Summary of efforts conducted to distribute
and resources, disseminate print and/or materials in print or electronically to
electronic communications among providers, immunization stakeholders.
school, general public and other immunization 2. Target date for completion of summary.
stakeholders in their jurisdiction.
Note:Depending on funding, CDPH may offer select
hard-copy materials to all VFC Providers through the
Page 17
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
Online VFC store. If the VFC store is available, LHDs
may choose to refer VFC providers in their jurisdiction to
order select materials from the VFC store instead.
CDPH will inform LHDs on centralized communication
activities from the Immunization Branch (e.g., print
materials to VFC providers; electronic communications
and resources to VFC providers, schools, pharmacies,
and community-based organizations/other stakeholders;
and traditional media/social media activities to reach the
general public). LHDs may supplement any gaps in
communication with local efforts. Contact the
Information & Education Section if you would like to
learn more about the Immunization Branch's centralized
communication vehicles and activities.
Goal 5.2: Develop partnerships and collaborative activities in order to expand
immunization services, promote best practices and improve coverage rates among
children, adolescent and adults.
Required Activities Performance Measures
Goal 5.2 Activity a: Engage with at least 3 1. Number of partner types (provider, school,
types of partners in conducting educational social service/other partners) engaged with.
activities or trainings. 2. Summary of activities conducted with each
(votes: partner type.
• Partnership engagement should be based on 3. Summary of activities conducted with new
commitment to perform agreed-upon activities(e.g., partners.
joint training, mass vaccination clinic, collaboration
to include immunization messaging in
communications or event, promotional efforts).
• LHJ will engage with at least one "provider"partner,
one "school"partner and one "social service or
other"partner.
o "Provider partner"may include hospitals,
federally qualified health centers (FQHCs), long
term care facilities, birth facilities, professional
associations (local ACOG chapter), pharmacies,
health plans and community clinics.
o "School partner"may include childcare
providers, school or school district, County
Department of Education, college, school
nurses'association or other school-related
organizations.
o "Social service and other partners"may include
WIC, MCAH, social service agencies, migrant
health, homeless shelters, drug-treatment
centers,jails, faith-based organizations, local
business or community-based organizations
Area 6. Prevention, Surveillance and Control of Vaccine Preventable Disease (VPD)
Page 18
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
Goal 6.1: Conduct surveillance to identify VPD cases and/or outbreaks, and implement
recommended prevention and control activities.
Required Activities Performance Measures
Goal 6.1 Activity a: Ensure that appropriate 1. Percentage of measles PCR positive
clinical specimens are tested, and relevant specimens submitted for molecular
epidemiologic information is collected for VPDs characterization.
requiring immediate public health action. 2. Percentage of Neisseria meningitidis positive
specimens/isolates submitted for molecular
characterization.
Goal 6.1 Activity b: Implement appropriate 1. Quarterly review of Quicksheets with
public health activities for the control and applicable staff completed.
prevention of cases and/or outbreaks of VPDs 2. Percentage of infant pertussis cases <4
that are reportable to CDPH in accordance months of age with documentation of
with CDPH recommendations. mother's prenatal care provider information
(name and city of prenatal care provider).
3. Percentage of infant pertussis cases <4
months of age for whom maternal Tdap
status is known.
4. Percentage of providers reached6 who
provided prenatal care to a woman whose
infant developed pertussis. Reaching the
provider is only required if the woman never
got Tdap during this pregnancy or did not
receive Tdap at 27-36 weeks gestation.'
Goal 6.1 Activity c: Obtain vaccine and 1. Completed outbreak response request$ with
assist with the organization and plan for doses and target population (as
implementation of efforts to vaccinate appropriate).
susceptible individuals, if appropriate, in the
context of a VPD outbreak and exposure.
Goal 6.2: Collect and submit requested data to CDPH on VPD cases and outbreaks.
e Sending a letter re:standard of care is the minimum acceptable communication,with copy to your LHD Maternal Child and Adolescent
Health(MCAH) program.See Template Letter for Prenatal Care Providers with Pregnant Patients that did not Receive Prenatal Tdap
Appropriately and Infants Developed Pertussis
7 Please note: If a practice decides to modify or reduce the number of prenatal care visits due to the COVID-19 pandemic,ACOG
encourages clinicians to include recommended maternal immunizations(influenza and Tdap)during remaining in-person appointments,
even if that means immunizations will be administered outside of the typically recommended weeks of gestation. Please make note of
any clinic modifications in the notes field in the maternal immunizations section in CaIREDIE.
8 The Immunization Branch provides a form for requesting vaccine from CDPH.
Page 19
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
Required Activities Performance Measures
Goal 6.2 Activity a: Report VPDs and other 1. Percentage of measles cases reported
conditions reportable to CDPH Immunization immediately to CDPH.
Branch per CDPH instructions listed here: 2. Percent of meningococcal disease cases in
ReportingGuidanceForLHJs high school and college students reported
immediately to CDPH.
3. Percentage of case reports submitted to
CDPH via an electronic communicable
disease reporting system (CaIREDIE or
other) in the recommended timeframe.
4. Percentage of VPD cases with appropriate
resolution status assigned, as per CSTE
case definition.
5. Percentage of VPD cases with complete
data.
Goal 6.2 Activity b: Collect and submit 1. Percentage of confirmed hepatitis A cases
CDPH-requested VPD case and outbreak for whom hepatitis A risk factors are known.
data. 2. Percentage of meningococcal disease cases
aged 14-24 years for whom high school or
college attendance status is known.
Area 7. Childcare and School Immunization Entry Requirements
Goal 7.1: Decrease the proportion of pupils who are overdue for required immunizations or
admitted conditionally.
Required Activities Performance Measures
Goal 7.1 Activity a: Provide guidance, 1. Percentage of schools with kindergarteners
training, and support for compliance with entry in the jurisdiction that have completed the
immunization requirements by all childcare annual immunization assessment.
centers and schools within the jurisdiction.
Goal 7.1 Activity b: At least annually, visit 1. Percentage of schools that meet the
schools with 10 or more kindergarteners that definition of"targeted schools" 9
reported > 10% were either conditionally Target 2022-2023 School Year: Less than
admitted or overdue for required immunization; 3% of schools have >10% of kindergarteners
provide guidance and support follow-up until either conditional or overdue.
these students are up to date.
Area 8. Influenza
e"Targeted schools are schools with 10 or more kindergarteners that reported greater than 10%of students conditionally admitted
and/or overdue for required immunization.
Page 1 10
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
CDPH Immunization Branch RFA#: 22-10537
Scope of Work for Local Health Departments FY 2022-2023 Date: 09/15/2022
Form 4
Goal 8.1: Strengthen capacity to protect against seasonal influenza and to prepare for a
pandemic.
Required Activities Performance Measures
Goal 8.1 Activity a: To assist your LHD 1. Mass vaccination exercise completed by
emergency preparedness lead in fulfilling its local health department, including
emergency preparedness grant requirements, immunization and preparedness program
utilize IZB-supplied influenza vaccine or other staff.
317-funded1Ovaccines to support at least one
mass immunization exercise/year. Confirm
your LHD emergency preparedness program
has entered all doses into CAIR within 14 days
of administration, as per the emergency
preparedness grant requirement.
Goal 8.1 Activity b: Utilize IZB-supplied 1. Number of doses of influenza vaccine
influenza vaccine to immunize jurisdiction administered.
against influenza; doses may be shared with Target # of doses must be at least 90% of
local partners. previous season's total doses.
Area 9. COVID-19 Vaccination
Goal 9.1: Organize an effective COVID-19 vaccination response at the local level.
Required Activities Performance Measures
Goal 9.1 Activity a: Develop and implement a 1. Percentage of target number of individuals
COVID-19 vaccination plan that ensures vaccinated, or target number of doses
equitable vaccination access and encourages administered, for each focus population, as
widespread vaccine acceptance and uptake. described in your Vaccination Equity
Workplan. (Note: LHDs will not be penalized
for not reaching their targets but will be
required to describe challenges faced in
reaching targets and describe how they will
address these challenges.)
2. Completion of COVID-specific activity
progress report. Template provided by IZB-
CDPH.
3. Participation in periodic meetings with IZB-
CDPH staff.
Goal 9.1 Activity b: Respond to requests 1. Response to requests for information from
from IZB-CDPH for information on local efforts IZB-CDPH as needed.
and plans to address vaccine hesitancy,
improve vaccine access, reach vulnerable
10 If the LHD would like to use Pan Flu Funding or other emergency preparedness funding for vaccine purchase, please reach out to the
Immunization Branch with your request.
Page 1 11
Fresno County Department of Public
Health, Immunization Program
Exhibit A
Grant Agreement#: 22-10856
RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
populations, and vaccinate adolescents and
children 5-11 years of age, during Phase 3 of
the vaccine rollout.
Glossary of Acronyms and Terms
Abbreviation or Definition
317 vaccine Vaccine provided to LHD clinics and partners for uninsured adults and
for outbreak purposes.
ACIP Advisory Committee on Immunization Practices
ACOG American College of Obstetricians and Gynecologists
AFIX Assessment, Feedback, Incentive, eXchange
AFM Acute Flaccid Myelitis
ARNOLD Advanced Results Notification and On-Line Delivery (within CaIREDIE)
CAIR California Immunization Registry
CaIREDIE California Reportable Disease Information Exchange
CDC Centers for Disease Control and Prevention
CDPH California Department of Public Health
COVID-19 Coronavirus Disease 2019
CPSP Comprehensive Perinatal Services Program
CSTE Council of State and Territorial Epidemiologists
DNA Deoxyribonucleic Acid
eCR Electronic Case Reporting
EHR Electronic Health Record
ELR Electronic Laboratory Reporting
EZIZ An Immunization Branch-operated website (eziz.org) with
immunization training and resource materials.
Page 112
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
FQHC Federally Qualified Health Center
HBsAg Hepatitis B Surface Antigen
HBV Hepatitis B Vaccine
HL7 Health Level 7 (standards for data exchange)
HPV Human papillomavirus
IgM Immunoglobulin
IIS Immunization Information System
IQIP Immunization Quality Improvement for Providers
ISI Immunization Skills Institute
IZ Immunization
IZB Immunization Branch (of CDPH)
Vaccine ordered through the CDPH Immunization Branch and supplied
IZB-supplied vaccine to LHD clinics or partners using state or federal (VFC and 317) funding
sources.
LCR Local CAR representative (on CDPH IZB staff)
LHD Local Health Department
Clinic run or housed in LHD that serves as a medical home for its
LHD Primary Care Clinic patients. Includes federally qualified health centers or look-alikes that
are o erated or housed in LHDs
LHJ Local Health Jurisdiction
MA Medical Assistant
MCAH Maternal Child and Adolescent Health
MCP Medi-Cal Managed Care Plan
MDL Microbial Diseases Laboratory
MOU Memorandum of Understanding
NIAM National Immunization Awareness Month
Page 1 13
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Exhibit A RFA#: 22-10537
CDPH Immunization Branch Date: 09/15/2022
Scope of Work for Local Health Departments FY 2022-2023 Form 4
NIVW National Influenza Vaccine Week
OBGYN Obstetrics and Gynecology
PBE Personal Belief Exemption
PCR Polymerase Chain Reaction
PEP Post Exposure Prophylaxis
PHPP Perinatal Hepatitis B Prevention Program
PVS Post-Vaccination Serology
PVW Preteen Vaccine Week
SGF State General Fund
TB Tuberculosis
Tdap Tetanus, Diphtheria, and Pertussis
TK/K Transitional Kindergarten/Kindergarten
VFC Vaccines for Children Program
VPDs Vaccine-Preventable Disease(s)
VRDL Viral and Rickettsial Disease Laboratory (of CDPH)
WIC Women, Infants, and Children
Page 1 14
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
RFA#: 22-10537
Date: 09/15/2022
Exhibit A
Form 5
CDPH Immunization Branch
Local Assistance Grant Funds
Budget Budget Budget Budget Budget
(`Year 1) ("Year 2) (**Year 3) (**Year 4) (**Year 5)
07/01/2022 to 07/01/2023 to 07/01/2024 to 07/01/2025 to 07/01/2026 to
06/30/2023 06/30/2024 06/30/2025 06/30/2026 06/30/2027
I. County of Fresno $ 7,891,512.74 $ 450,576.00 $ 450,576.00 $ 450,576.00 $ 450,576.00
II. (Subgrantee, if any) $ - $ - $ - $ - $ -
Total $ 7,891,512.74 $ 450,576.00 $ 450,576.00 $ 450,576.00 $ 450,576.00
**CDPH Immunization Program will provide funding source information as it becomes available each fiscal year.
Total Funding for 5-Year Term: $ 9,693,816.74
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Exhibit B
Budget Detail and Payment Provisions
1. Invoicing and Payment
A. Upon completion of project activities as provided in Exhibit A Grant
Application/Attachment 1 Grantee Written Modification, and upon receipt and approval
of the invoices, the State agrees to reimburse the Grantee for activities performed and
expenditures incurred in accordance with the total amount of this agreement.
B. Invoices shall include the Grant Number and shall be submitted electronically or in
triplicate not more frequently than monthly in arrears to:
Robina Escalada
California Department of Public Health
Immunization Branch
850 Marina Bay Pkwy., Bldg. P, 2"d Floor
Richmond, CA 94804
C. Invoices shall:
1) Be prepared on Grantee letterhead. If invoices are not on produced letterhead
invoices must be signed by an authorized official, employee or agent certifying that
the expenditures claimed represent activities performed and are in accordance with
Exhibit A Grant Application under this Grant.
2) Bear the Grantee's name as shown on the Grant.
3) Identify the billing and/or performance period covered by the invoice.
4) Itemize costs for the billing period in the same or greater level of detail as indicated
in this Grant. Subject to the terms of this Grant, reimbursement may only be sought
for those costs and/or cost categories expressly identified as allowable and
approved by CDPH.
D. Amount awarded under this Grant is identified in the CDPH 1229 Grant Agreement.
2. Budget Contingency Clause
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent
years covered under this Agreement does not appropriate sufficient funds for the
program, this Agreement shall be of no further force and effect. In this event, the State
shall have no liability to pay any funds whatsoever to Grantee or to furnish any other
considerations under this Agreement and Grantee shall not be obligated to fulfill any
provisions of this Agreement.
B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, the State shall have the option to either cancel this Agreement with no liability
occurring to the State or offer an agreement amendment to Grantee to reflect the
reduced amount.
Page 1 of 2
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Exhibit B
Budget Detail and Payment Provisions
3. Prompt Payment Clause
Payment will be made in accordance with, and within the time specified in, Government
Code Chapter 4.5, commencing with Section 927.
4. Timely Submission of Final Invoice
A. A final undisputed invoice shall be submitted for payment no more than sixty (60
calendar days following the expiration or termination date of this Grant, unless a later or
alternate deadline is agreed to in writing by the program grant manager. Said invoice
should be clearly marked "Final Invoice", indicating that all payment obligations of the
State under this Grant have ceased and that no further payments are due or
outstanding.
B. The State may, at its discretion, choose not to honor any delinquent final invoice if the
Grantee fails to obtain prior written State approval of an alternate final invoice
submission deadline.
5. Travel and Per Diem Reimbursement
Any reimbursement for necessary travel and per diem shall, unless otherwise specified in
this Agreement, be at the rates currently in effect, as established by the California
Department of Human Resources (Cal HR). If the Cal HR rates change during the term of
the Agreement, the new rates shall apply upon their effective date and no amendment to
this Agreement shall be necessary. No travel outside the State of California shall be
reimbursed without prior authorization from the CDPH. Verbal authorization should be
confirmed in writing. Written authorization may be in a form including fax or email
confirmation.
Page 2 of 2
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 1 of 4
EXHIBIT C
STANDARD GRANT CONDITIONS
1. APPROVAL: This Grant is of no force or effect until signed by both parties and approved by
the Department of General Services, if required. The Grantee may not commence
performance until such approval has been obtained
2. AMENDMENT: No amendment or variation of the terms of this Grant shall be valid unless
made in writing, signed by the parties, and approved as required. No oral understanding or
Agreement not incorporated in the Grant is binding on any of the parties. In no case shall
the Department materially alter the scope of the Project set forth in Exhibit A.
3. ASSIGNMENT: This Grant is not assignable by the Grantee, either in whole or in part,
without the written consent of the Grant Manager in the form of a written amendment to the
Grant.
4. AUDIT: Grantee agrees that the Department, the Bureau of State Audits, or their designated
representative shall have the right to review and to copy any records and supporting
documentation pertaining to this Grant. Grantee agrees to maintain such records for a
possible audit for a minimum of three (3)years after final payment or completion of the
project funded with this Grant, unless a longer period of records retention is stipulated.
Grantee agrees to allow the auditor(s) access to such records during normal business hours
and to allow interviews of any employees who might reasonably have information related to
such records. Further, Grantee agrees to include a similar right of the State to audit records
and interview staff in any subcontract related to the project.
5. CONFLICT OF INTEREST: Grantee certifies that it is in compliance with all applicable state
and/or federal conflict of interest laws.
6. INDEMNIFICATION: Grantee agrees to indemnify, defend and save harmless the State, its
officers, agents and employees from any and all claims and losses accruing or resulting to
any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or
corporation furnishing or supplying work services, materials, or supplies in connection with
the project, and from any and all claims and losses accruing or resulting to any person, firm
or corporation who may be injured or damaged by Grantee in the performance of any
activities related to the Project.
7. FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS: Grantee agrees
that, at a minimum, its fiscal control and accounting procedures will be sufficient to permit
tracing of all grant funds to a level of expenditure adequate to establish that such funds have
not been used in violation of any applicable state or federal law, or the provisions of this
Grant. Grantee further agrees that it will maintain separate Project accounts in accordance
with generally accepted accounting principles.
8. GOVERNING LAW: This Grant is governed by and shall be interpreted in accordance with
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 2 of 4
the laws of the State of California.
9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other
amounts (including any interest thereon) accruing to or received by the Grantee under this
Grant shall be paid by the Grantee to the Department, to the extent that they are properly
allocable to costs for which the Grantee has been reimbursed by the Department under this
Grant.
10. INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the
performance of the Project, shall act in an independent capacity and not as officers,
employees or agents of the Department.
11. MEDIA EVENTS: Grantee shall notify the Department's Grant Manager in writing at least
twenty (20) working days before any public or media event publicizing the accomplishments
and/or results of the Project and provide the opportunity for attendance and participation by
Department's representatives.
12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any
rights or remedies for any third- party as a beneficiary of this Grant or the project.
13. NOTICE: Grantee shall promptly notify the Department's Grant Manager in writing of any
events, developments or changes that could affect the completion of the project or the budget
approved for this Grant.
14. PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform
services under this Grant where such services are called for.
15. RECORDS: Grantee certifies that it will maintain Project accounts in accordance with
generally accepted accounting principles. Grantee further certifies that it will comply with the
following conditions for a grant award as set forth in the Request for Applications (Exhibit D)
and the Grant Application (Exhibit A).
A. Establish an official file for the Project which shall adequately document all
significant actions relative to the Project;
B. Establish separate accounts which will adequately and accurately depict all
amounts received and expended on this Project, including all grant funds received
under this Grant;
C. Establish separate accounts which will adequately depict all income received which
is attributable to the Project, especially including any income attributable to grant
funds disbursed under this Grant;
D. Establish an accounting system which will adequately depict final total costs of the
Project, including both direct and indirect costs; and,
E. Establish such accounts and maintain such records as may be necessary for the
state to fulfill federal reporting requirements, including any and all reporting
requirements under federal tax statutes or regulations.
16. RELATED LITIGATION: Under no circumstances may Grantee use funds from any
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 3 of 4
disbursement under this Grant to pay for costs associated with any litigation between the
Grantee and the Department.
17. RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings,
specifications, reports, computer programs, operating manuals, notes, and other written or
graphic work submitted under Exhibit A in the performance of the Project funded by this Grant
shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part,
any final form data and information received, collected, and developed under this Project,
subject to appropriate acknowledgment of credit to the Department for financial support.
Grantee shall not utilize the materials submitted to the Department (except data)for any profit
making venture or sell or grant rights to a third-party who intends to do so. The Department
has the right to use submitted data for all governmental purposes.
18. VENUE: (This provision does not apply to Local Governmental Entities)
The Department and Grantee agree that any action arising out of this Grant shall be filed and
maintained in the Superior Court, California. Grantee waives any existing sovereign immunity
for the purposes of this Grant, if applicable.
19. STATE-FUNDED RESEARCH GRANTS:
A. Grantee shall provide for free public access to any publication of a department-funded
invention or department-funded technology. Grantee further agrees to all terms and
conditions required by the California Taxpayer Access to Publicly Funded Research Act
(Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the
Government Code).
B. As a condition of receiving the research grant, Grantee agrees to the following terms and
conditions which are set forth in Government Code section 13989.6 ("Section 13989.E"):
1) Grantee is responsible for ensuring that any publishing or copyright agreements
concerning submitted manuscripts fully comply with Section 13989.6.
2) Grantees shall report to the Department the final disposition of the research grant,
including, but not limited to, if it was published, when it was published, where it was
published, when the 12-month time period expires, and where the manuscript will be
available for open access.
3) For a manuscript that is accepted for publication in a peer-reviewed journal, the
Grantee shall ensure that an electronic version of the peer-reviewed manuscript is
available to the department and on an appropriate publicly accessible database
approved by the Department, including, but not limited to, the University of California's
eScholarship Repository at the California Digital Library, PubMed Central, or the
California Digital Open Source Library, to be made publicly available not later than 12
months after the official date of publication. Manuscripts submitted to the California
Digital Open Source Library shall be exempt from the requirements in subdivision (b)
of Section 66408 of the Education Code. Grantee shall make reasonable efforts to
comply with this requirement by ensuring that their manuscript is accessible on an
approved publicly accessible database, and notifying the Department that the
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 4 of 4
manuscript is available on a department-approved database. If Grantee is unable to
ensure that their manuscript is accessible on an approved publicly accessible
database, Grantee may comply by providing the manuscript to the Department not
later than 12 months after the official date of publication.
4) For publications other than those described inparagraph B.3 above„ including
meeting abstracts, Grantee shall comply by providing the manuscript to the
Department not later than 12 months after the official date of publication.
5) Grantee is authorized to use grant money for publication costs, including fees charged
by a publisher for color and page charges, or fees for digital distribution.
Fresno County Department of Public
Health, Immunization Program
Grant Agreement#: 22-10856
Total Pages: 65
EXHIBIT
REQUEST FOR
APPLICATION #22 =10537
State of California—Health and Human Services Agency
California Department of Public Health
I)COPH
TOMBS J.ARAG6N,M.D.,Dr.P.H. GAVIN NEWSOM
Director and State Public Health Officer Governor
DATE: September 15, 2022
TO: Local Health Officers
County Health Executives Association of California (CHEAC) Members
Immunization Coordinators
Receiving Immunization Program Local Assistance Grants
FROM: Maria E. Volk, MPA, Assistant Branch Chief N,(a,, _ e ,VI-(_/Z_
Immunization Branch "ll
SUBJECT: Request for Application
Immunization Local Assistance Grant Funds, Fiscal Year 2022-2027
COVID-19 Emergency Grant Funds, Fiscal Year 2022-2024
GRANT AGREEMENT FUNDING ANNOUNCEMENT/RELEASE
The California Department of Public Health (CDPH), Immunization Branch, is pleased to
release the Federal Grant subaward application process to Local Health Department (LHD)
grantees for FY 2022-27. CDPH has authority to grant funds for the Project under Health
and Safety Code, Section 120325-120380, which requires immunizations against childhood
diseases prior to school admittance. The purpose of this grant is to assist LHDs in
preventing and controlling vaccine-preventable diseases in the local health jurisdiction
(LHJ).
RELATED STATUTES
California Health & Safety Code sections:
120130 requires the Local Health Officer to properly report to CDPH those diseases listed
as reportable, which include vaccine-preventable diseases.
• 120175 requires the Local Health Officer to take measures as may be necessary to
prevent the spread or occurrence of additional cases of reportable diseases (which
includes reportable vaccine-preventable diseases).
120350 requires Local Health Officers to organize and maintain a program to make
available the immunizations required for admittance to child care facilities and schools.
SERVICES TO BE PERFORMED BY THE GRANTEE
The Grantee is to implement activities to:
• Assess and improve coverage levels in the jurisdiction of all vaccines recommended by
the Advisory Committee on Immunization Practices (ACIP) to protect the population.
• Detect, report, and control vaccine-preventable diseases in the jurisdiction.
• For detailed scope of work objectives and activities, please refer to the enclosed
revised Scope of Work. The CDPH and award subrecipients will make agreed-
upon changes to the Scope of Work on an as-needed basis. These changes will be
made in writing but will not require a formal amended agreement.
`to Hr,u yr
Immunization Branch /Division of Communicable Disease Control
850 Marina Bay Parkway, Bldg. P, 2"d Floor, Richmond, CA 94804
(510) 620-3737 ♦ FAX(510)620-3774 ♦ Internet Address: www.getimmunizedca.org
Local Health Officers
Immunization Coordinators
Receiving Immunization Program Local Assistance Grants
September 15, 2022
Page 2 of 5
OVERVIEW, GRANT TERMS. AND FUNDING
This letter provides an overview of the allocation of funding application process. The Immunization
Branch has been awarded a Federal Grant through the Centers of Disease Control and Prevention
(CDC). As in past years, your State Immunization Branch Field Representative will discuss the
contractual dollar amount available to your Department for FY 2022-27. In addition, your
representative is available for assistance and consultation regarding any programmatic issues included
in the grant and preparation of your proposed budget. For your reference, a copy of the
Allowable/Non-Allowable Uses of 317 and Vaccines for Children (VFC) Federal Assistance (FA)
Operations Funds are enclosed.
This year CDPH will be initiating local assistance grants with a five-year term. The annual immunization
grant award figure for each fiscal year within the five-year term is the same. The annual award figure
for COVID-19 funds will vary each fiscal year and is dependent on total prior year expenditures and
available carry-over. Similar to prior years, the availability of federal local assistance grant funds is
dependent upon funds received from CDC and, at CDPH's discretion, we may award additional
funding if it becomes available. Should funding be reduced, we will promptly notify you of such
changes, collaborate efforts and revise the budget to match available funds.
IMMUNIZATION FEDERAL AWARD
Federal Grant Award No.: 5 NH231P922612-04-00
Award Issue Date: 07/06/2022
Catalog of Federal Domestic Assistance (CFDA) Title: Immunization Cooperative Agreements
Catalog of Federal Domestic Assistance (CFDA) No.: 93.268
Data Universal Numbering Systems (DUNS) No.: 7991506150000
Unique Entity Identifier(UEI) No.: KD2JSY6LNMW7
Total Federal Award to Date: $45,407,872
Amount Made Available for Local Assistance Subrecipient Awards: $15,176,352
Year 1 Budget, FY 2022-23: 100% Prevention and Public Health Funds (PPHF)
COVID-19 ROUND 2 FEDERAL AWARD
Federal Grant Award No.: 6 NH231P922612-02-02
Award Issue Date: 12/16/2020
Catalog of Federal Domestic Assistance (CFDA) Title: Immunization Cooperative Agreements
Catalog of Federal Domestic Assistance (CFDA) No.: 93.268
Data Universal Numbering Systems (DUNS) No.: 7991506150000
Unique Entity Identifier (UEI) No.: KD2JSY6LNMW7
Total Federal Award to Date: $20,074,619
Amount Made Available for Local Assistance Subrecipient Awards: $10,000,005
Year 3 Budget, FY 2022-23: 100% Coronavirus Aid, Relief, and Economic Security (CARES)
Funds
Immunization Branch/Division of Communicable Disease Control
850 Marina Bay Parkway, Bldg. P, 211 Floor, Richmond, CA 94804
(510)620-3737 ♦ FAX(510) 620-3774 ♦ Internet Address: www.getimmunizedca.orq
Local Health Officers
Immunization Coordinators
Receiving Immunization Program Local Assistance Grants
September 15, 2022
Page 3 of 5
COVID-19 ROUND 3 FEDERAL AWARD
Federal Grant Award No.: 6 NH231P922612-02-03
Award Issue Date: 01/15/2021
Catalog of Federal Domestic Assistance (CFDA) Title: Immunization Cooperative Agreements
Catalog of Federal Domestic Assistance (CFDA) No.: 93.268
Data Universal Numbering Systems (DUNS) No.: 7991506150000
Unique Entity Identifier (UEI) No.: KD2JSY6LNMW7
Total Federal Award to Date: $357,026,635.00
Amount Made Available for Local Assistance Subrecipient Awards: $182,205,207
Year 3 Budget, FY 2022-23: 100% Coronavirus Response and Relief Supplemental
Appropriations (CRRSA) Funds
COVID-19 ROUND 4 FEDERAL AWARD
Federal Grant Award No.: 6 NH231P922612-02-04
Award Issue Date: 03/31/2021
Catalog of Federal Domestic Assistance (CFDA) Title: Immunization Cooperative Agreements
Catalog of Federal Domestic Assistance (CFDA) No.: 93.268
Data Universal Numbering Systems (DUNS) No.: 7991506150000
Unique Entity Identifier(UEI) No.: KD2JSY6LNMW7
Total Federal Award to Date: $357,026,635.00
Amount Made Available for Local Assistance Subrecipient Awards: $178,500,003
Year 3 Budget, FY 2022-23: 100% Coronavirus Response and Relief Supplemental
Appropriations (CRRSA) Funds
ELIGIBLE FOR LOCAL ASSISTANCE:
The Immunization Branch has determined that the following 61 LHDs and three non-
profit organizations are eligible to apply for available funding for their Local
Immunization Program, which supports the State's objectives to control vaccine-
preventable diseases.
County of Alameda County of Madera County of San Luis Obispo
County of Alpine County of Marin County of San Mateo
County of Amador County of Mariposa County of Santa Barbara
City of Berkeley County of Mendocino County of Santa Clara
County of Butte County of Merced County of Santa Cruz
County of Calaveras County of Modoc County of Shasta
County of Colusa County of Mono County of Sierra
County of Contra Costa County of Monterey County of Siskiyou
County of Del Norte County of Napa County of Solano
County of El Dorado County of Nevada County of Sonoma
County of Fresno County of Orange County of Stanislaus
Immunization Branch/Division of Communicable Disease Control
850 Marina Bay Parkway, Bldg. P, 2nd Floor, Richmond, CA 94804
(510) 620-3737 ♦ FAX(510)620-3774 ♦ Internet Address:www.getimmunizedca.orq
Local Health Officers
Immunization Coordinators
Receiving Immunization Program Local Assistance Grants
September 15, 2022
Page 4 of 5
County of Glenn City of Pasadena County of Sutter
County of Humboldt County of Placer County of Tehama
County of Imperial County of Plumas County of Trinity
County of Inyo County of Riverside County of Tulare
County of Kern County of Sacramento County of Tuolumne
County of Kings County of San Benito County of Ventura
County of Lake County of San Bernardino County of Yolo
County of Lassen County of San Diego County of Yuba
City of Long Beach City & County of San Francisco
County of Los Angeles County of San Joaquin
CA Immunization Coalition CA Primary Care Association Redwood Comm. Health Coalition
APPLICATION PROCEDURES AND DEADLINES:
Application must be submitted and received via email by the CDPH Immunization Branch
by 5:00 p.m., (Pacific Standard Time), September 30, 2022. Email your application to:
izb.admin@cdph.ca.gov, telephone number(510) 620-3737. A completed application must
include the following:
Form 1: Application Cover Sheet/Checklist
Form 2: Grantee Information Form
Form 3: Local Project Synopsis
Form 4: Scope of Work for Local Health Departments/Glossary of Acronyms and Terms
Form 5: Exhibit B — Budget
Form 6: Government Agency Taxpayer ID Form
FY 2022-23 Immunization Agreement Invoice Submission Deadlines and Budget
Modification Guidelines
Invoices are due on a quarterly basis. The final invoice for the fiscal year is due no more
than sixty (60) calendar days from June 30.
Budget modification requests are required when shifting/moving funds from one budget
line-item to another. Budget line-item shifts do not require a formal grant agreement
amendment and can be agreed upon between CDPH and the Subgrantee. Budget
Modification Requests must be submitted and approved prior to submitting the
corresponding invoice. (See enclosed Budget Modification Request).
GRANT AWARD APPEALS PROCEDURES
An applicant who has submitted an application and was not funded may file an appeal with
CDPH Immunization Branch. Appeals must state the reason, law, rule, regulation, or
practice that the applicant believes has been improperly applied in regard to the evaluation
Immunization Branch/Division of Communicable Disease Control
850 Marina Bay Parkway, Bldg. P, 2"d Floor, Richmond, CA 94804
(510) 620-3737♦ FAX (510) 620-3774 ♦ Internet Address: www.getimmunizedca.org
Local Health Officers
Immunization Coordinators
Receiving Immunization Program Local Assistance Grants
September 15, 2022
Page 5 of 5
or selection process. There is no dispute process for applications that are submitted late or
are incomplete. Appeals shall be limited to the following grounds:
a.) The CDPH Immunization Branch failed to correctly apply the application review
process, the format requirements or evaluating the applications as specified in the
RFA.
b.) The CDPH Immunization Branch failed to follow the methods for evaluating and
scoring the applications as specified in the RFA.
Appeals must be sent by email to Noemi.Marin(cD.cdph.ca.gov and received within five (5)
business days from the date you received notification that your grant application was
denied. The CDPH Immunization Branch Chief, or her designee, will then come to a
decision based on the written appeal letter. The decision of the CDPH Immunization
Branch Chief, or her designee, shall be the final remedy. Appellants will be notified by
email with 15 days of the consideration of the written appeal letter.
CDPH Immunization Branch reserves the right to award the agreement when it believes all
appeals have been resolved, withdrawn, or responded to the satisfaction of the CDPH
Immunization Branch.
Thank you.
Enclosures: Allowable/Non-Allowable Uses of 317 and Vaccines for Children (VFC) Federal
Assistance (FA) Operations Funds
Federal Compliance Requirements of the Immunization Grant No. 5
N H231 P922612-04-00
Federal Compliance Requirements of the COVID-19 Round 1 Grant No. 6
N H231 P922612-02-02
Federal Compliance Requirements of the COVID-19 Round 1 Grant No. 6
N H231 P922612-02-03
Federal Compliance Requirements of the COVID-19 Round 1 Grant No. 6
N H231 P922612-02-04
cc: Perinatal Hepatitis B Coordinators
State Immunization Branch Field Representatives
Noemi Marin, CDPH, Immunization Branch
Ruby Escalada, CDPH, Immunization Branch
Rossana Ordonez, CDPH, Immunization Branch
Roland Rafol, CDPH, Immunization Branch
Immunization Branch/Division of Communicable Disease Control
850 Marina Bay Parkway, Bldg. P, 2"d Floor, Richmond, CA 94804
(510)620-3737 ♦ FAX(510)620-3774 ♦ Internet Address: www.getimmunizedca.org
RFA: #22-10537
Date: 09/15/2022
CDPH Immunization Branch Form 1
Fiscal Year 2022 - 2027
APPLICATION COVER SHEET/CHECKLIST
DATE OF
SUBMISSION
OFFICIAL
ORGANIZATION (Please indicate the official county/organization name)
NAME
AGREEMENT (Leave blank. Will be assigned by CDPH/IZ)
NUMBER
Provide the name, phone number, and e-mail address of the person we can contact to confirm the date/time of
the negotiation conference call.
Contact Name: Phone Number:
E-mail:
Type of Application:
❑ New X❑ Renewal ❑ Continuation ❑ Supplement ❑ Revision
F-ISupplement El Revision
Budget Period: Total Amount Requested for 5 Years:
From: July 1, 2022 To: June 30, 2027 $
Board of Supervisors/Resolution meeting dates for the upcoming 6 months:
Page 1 of 2
RFA: #22-10537
Date: 09/15/2022
Federal Compliance Requirements of the
Immunization Grant No. 5 NH231P922612-04-00
COVID-19 R2 Grant No. 6 NH231P922612-02-02
COVID-19 R3 Grant No. 6 NH231P922612-02-03
COVID-19 R4 Grant No. 6 NH231P922612-02-04
This section requires LHD Grantee signature to acknowledge that the LHD Grantee has reviewed and
understands the Federal Compliance Requirements of all grants listed above. See enclosed copy of the
Award Attachments under which these grants are issued.
Print Name and Title of Person Signing Signature of Person Signing Date
APPLICATION CONTENTS:
Application Due by 5:00 p.m., (Pacific Standard Time), September 30, 2022 Please Check
Form 1: Application Cover Sheet/Checklist ❑
Form 2: Grantee Information Form ❑
Form 3: Local Project Synopsis ❑
Form 4: Scope of Work for Local Health Departments/Glossary of ❑
Acronyms and Terms
Form 5: Exhibit B — Budget ❑
Form 6: Government Agency Taxpayer ID Form ❑
NOTE: The above documents must be completed and submitted with this Application Cover Sheet/Checklist
Form. E-mail completed application to izb.admin(D_cdph.ca.goy by the submission deadline.
Page 2 of 2
RFA: #22-10537
Date: 09/15/2022
Form 2
CDPH Immunization Branch
Grantee Information Form
Date Form Completed:
This is the information that will appear on your grant agreement cover page.
Federal Tax ID # Contract/Grant# (will be assigned by IZ/CDPH)
Data Universal
Number System
(DUNS)#
Unique Entity
Identifier(UEI)#
Official
Organization
Name
Mailing Address
C
0 Street Address (If Different)
N_
County
.E Phone Fax
cv
LE) Website
O
The Grant Signatory has authority to sign the grant agreement cover.
Name
c Title
r
!4
rn
If address(es) are the same as the organization above,just check this box and go to Phone ❑
Mailing Address
Street Address (If Different)
0
Phone Fax
E-mail
The Project Director is responsible for all of the day-to-day activities of project implementation and for
seeing that all grant requirements are met. This person will be in contact with State Immunization Branch
L staff,will receive all programmatic, budgetary, and accounting mail for the project and will be responsible
0 for the proper dissemination of program information.
m
in Name
r
avi Title
0
a` If address(es) are the same as the organization above,just check this box and go to Phone ❑
Mailing Address
Street Address (If Different)
Page 1 of 2
RFA: #22-10537
Date: 09/15/2022
Phone Fax
E-mail
All payments are sent to the attention of this person at the designated address.
L Name
m
> Title
If address(es) are the same as the organization above,just check this box and go to Phone ❑
= Mailing Address
a>
mStreet Address (If Different)
a Phone Fax
E-mail
The Fiscal Reporter prepares invoices, maintains fiscal documentation and serves as the primary
contact for all related questions.
Name
a�
0
Title
CL
If address(es) are the same as the organization above,just check this box and go to Phone ❑
Mailing Address
ii Street Address (If Different)
Phone Fax
E-mail
The Fiscal Signatory has signature authority for invoices and all fiscal documentation reports.
Name
o Title
�a
= If address(es) are the same as the organization above,just check this box and go to Phone ❑
aM
U) Mailing Address
�o
N Street Address (If Different)
iL
Phone Fax
E-mail
Page 2 of 2
RFA: #22-10537
Date: 09/15/2022
CDPH Immunization Branch Form 3
Local Assistance Grant Application
Local Project Synopsis
Name of Grantee:
1. DESCRIPTION OF SERVICES TO BE PROVIDED:
Narrative
2. EVALUATION PLANS:
All grantees participate in process evaluation per their Scope of Work activities.
Grantees must complete a quarterly grant report detailing their activities.
Page 1 of 1
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Purpose
The purpose of this grant is to assist local health departments (LHDs) in preventing and controlling
vaccine-preventable diseases in the local health jurisdiction (LHJ).
Related Statutes
California Health & Safety Code sections:
• 120130 requires the Local Health Officer to properly report to CDPH those diseases listed
as reportable, which include vaccine-preventable diseases.
• 120175 requires the Local Health Officer to take measures as may be necessary to
prevent the spread or occurrence of additional cases of reportable diseases (which
includes reportable vaccine-preventable diseases).
• 120350 requires Local Health Officers to organize and maintain a program to make
available the immunizations required for admittance to childcare facilities and schools.
Services to be Performed by the Grantee
The Grantee is to implement activities to:
• Assess and improve coverage levels in the jurisdiction of all vaccines recommended by
the Advisory Committee on Immunization Practices (ACIP) to protect the population.
• Detect, report, and control vaccine-preventable diseases in the jurisdiction.
The LHD must agree to the following inclusive objectives and conduct the following activities. Many of
the services to be performed are also conditions for federal funding of the CDPH Immunization
Branch (IZB) and/or statutory requirements of State and LHDs. The level of local assistance grant
funding to be awarded is not represented as sufficient for support of all the required activities; a
significant amount of local support and funding is expected. Local assistance grant funds must not be
used to supplant (i.e., replace) local funds currently being expended for immunization services and
activities.
Grantee agrees to assign the responsibility of monitoring each program component:
1) Vaccine Accountability and Management; 2) Access to and Utilization of Quality Immunization
Services; 3) California Immunization Registry (CAIR); 4) Perinatal Hepatitis B Prevention; 5)
Education, Information, Training, and Partnerships; 6) Prevention, Surveillance and Control of
Vaccine Preventable Disease (VPD); 7) Childcare and School Immunization Entry Requirements; 8)
Influenza; and 9) COVID-19 Vaccination.
Grantee will monitor grant fund expenditures to maximize the utilization of the funding for achieving
the goals and objectives. Grant invoices shall be reviewed and submitted quarterly to the CDPH
Immunization Branch.
The Immunization Coordinator is required to participate in meetings, webinars, and conference
calls as requested by the CDPH Immunization Branch including, but not limited to, the CDPH
Immunization Branch's Immunization Coordinators' Meeting, New Immunization Coordinator
Page i 1
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Orientation (offered annually and required for all new Immunization Coordinators), regional
coordinators' meetings, and conference calls related to influenza, outbreak control, perinatal
hepatitis B, changes in policies and procedures, and other important issues.
Page 12
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Area 1. Vaccine Accountability and Management
Goal 1.1: Maintain viability of IZB supplied vaccine to ensure vaccine effectiveness and
reduce vaccine waste.
Required Activities Performance Measures
Goal 1.1 Activity a: Annually, make sure all 1. Updated Vaccine Management Plans for each
relevant staff within LHD-operated clinics LHD facility.
(routine mass vaccination, or special 2. Completed EZIZ Lessons for Key Practice
immunization outreach) are properly trained on Staff.
current policies and procedures for proper 3. Completed training logs (training date, topics,
vaccine storage and handling outlined in each methods, and list of attendees).
participation agreement/addendum for the
receipt of IZB-supplied vaccines (317,
Vaccines for Children [VFC], state general
fund).
Goal 1.1 Activity b: Develop and implement a 1. Training plan developed and implemented.
training plan for provider facilities outside LHDs 2. Number of completed trainings.
receiving IZB supplied doses (state or 317 3. Completed training logs (training date, topics,
Outbreak). Focus the plan on proper vaccine methods, and list of attendees).
management, vaccine storage and handling 4. Training packet completed and available.
requirements, and administration prior to the 5. Number of signed Vaccine Management Plans
distribution of IZB-supplied vaccines. received and reviewed.
Goal 1.1 Activity c: Develop and implement a 1. Developed and implemented Quality
plan to verify that providers administering 317 Assurance Plan.
Outbreak and state general fund immunizations 2. Completion of Mass Vaccination Hourly
outside the LHDs adhere to policies for vaccine Temperature Logs/Electronic Data Files.
management. Conduct Quality Assurance 3. Temperature Documentation on CDPH
verifications (such as random temperature log provided Logs for all IZB-supplied
review, on-site vaccination clinic assessments, vaccines/Electronic Temperature Files.
review of vaccine losses, etc.) at least every 4. Percentage of sites receiving Quality
other year, in a sample of sites receiving Assurance verifications (minimum sample of
vaccines.
10% of sites receiving vaccines).
5. Number of Completed Quality Assurance
verifications.
Goal 1.1 Activity d: Promote and encourage 1. Documentation of storage and handling best
adoption of CDPH and CDC storage and practices promotion efforts.
handling guidelines among all healthcare
providers providing immunization services in
the community.
Page 13
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Goal 1.2: Facilitate compliance with current protocols, policies, and procedures for vaccine
accountability for LHD facilities and partners that receive IZB-supplied vaccine.
Activity Performance Measures
Goal 1.2 Activity a: Make sure all relevant 1. Completed annual program recertification
staff involved in vaccine ordering, and corresponding educational lessons for all
management, and accountability activities key practice staff.
within local health department-operated clinics
adhere to all program requirements as outlined
in the VFC/317 Provider Participation
Agreements and Addendums. Complete
annual VFC/317 program recertification.
Goal 1.2 Activity b: Promote adherence to 1. Documentation of provided guidance.
eligibility guidelines corresponding to VFC,
Section 317, and state general fund vaccines.
Upon release of the Immunization Branch's
Vaccine Eligibility Guidelines, IMM-1142,
disseminate guidance to all relevant staff
involved in vaccine ordering, management, and
accountability activities within local health
department operated pediatric and adult
immunization clinics.
Goal 1.2 Activity c: Verify that processes are 1. Updated LHD protocols, inclusive of eligibility
in place such that IZB-supplied (317, VFC, guidelines, for each vaccine funding source.
state) vaccines are administered to eligible
individuals following outlined eligibility
guidelines for each vaccine funding source.
Goal 1.2 Activity d: Comply with federal 1. Documentation of procedures.
policies regarding vaccine distribution. Publicly
funded VFC and 317 vaccines must be
distributed directly to the location at which the
provider will administer the vaccines.
Area 2. Access to and Utilization of Quality Immunization Services
Goal 2.1: Improve access to and receipt of all ACIP-recommended immunizations,
especially for low income and underserved community members.
Required Activities Performance Measures
Goal 2.1 Activity a: Maintain an immunization 1. Referral list completed and updated on an
safety net that includes any LHD resource and annual basis.
referral lists to other programs that connect
patients to services.
Page 14
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Goal 2.1 Activity b: Be responsive to 1. Maintain log of access problems resolved at
problems Medi-Cal members report related to local level or reported to CDPH.
access to immunization services.' Work with
the corresponding Medi-Cal Managed Care
Plan (MCP) to resolve problems. After
attempts to work with MCP, if still unable to
resolve, collect details and escalate to Senior
Field Representative or other designated
Immunization Branch staff person.
Goal 2.1 Activity c: For all LHD facilities that 1. Number of LHD clinics with corrective actions
are VFC providers, participate in and support that were all completed within the specified
provider compliance and quality improvement time frame on the VFC Compliance Visit
visits in conjunction with the CDPH Report.
Immunization Branch. Assist with the
implementation of corrective action plans,
strategies to reduce missed opportunities for
vaccination, and linkage/referral to medical
homes.
Area 3. California Immunization Registry (CAIR)2
Goal 3.1 Promote and optimize 3 the use of CAIR in the jurisdiction
Required Activities Performance Measures
Goal 3.1 Activity a: Enter all IZB-supplied 1. Number of LHD clinics participating in CAIR/
vaccine doses administered by LHD or number all LHD clinics.
partners, including influenza doses, into CAIR. 2. Percentage of LHD clinic doses entered into
the registry within 14 days.
3. Number of state flu doses entered by end of
flu season/number state flu doses
administered.
4. CAIR ID list submitted to CDPH.
Goal 3.1 Activity b: For LHDs with primary 1. Inactive patients marked as inactive in CAIR.
care clinics, use manage patient status
functionality to remove inactive patients at
least once a year.
Goal 3.1 Activity c: In LHD primary care 1. Low infant or adolescent CAIR coverage rate
clinics, utilize CAIR data to identify and identified and improved.
1 Requirements for Medi-Cal immunization services are summarized here:http://izcoordinators.org/vaccine-programs/medi-cal-and-
pharmacV-resources/
Z CAIR refers to the statewide system that will connect CAIR2 with the San Diego Immunization Registry and Healthy Futures.
3 If have EHR, move from manual data entry to data exchange(upload from EHR)to bidirectional data exchange.See
https://cairweb.org/docs/CAIR2-Communications/IMM-1266.pdf and https://cairweb.org/docs/CAIR2-Communications/IMM-1260.pdf
Page 15
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
improve low or lagging infant or adolescent
vaccination coverage levels.
Goal 3.1 Activity d: Review monthly CAIR 1. Number of VFC Sites identified for priority
usage reports4 to identify priority non- recruitment/retention contact.
participating VFC sites that need to be
recruited/retained. Communicate priority sites
to Local CAIR Re LCR .
Goal 3.1 Activity a (required): Invite CAIR 1. Number of trainings with CAIR
staffs to participate in local provider trainings in participation/number of trainings held.
order to promote CAIR.
Goal 3.2: Connect local Immunization Information Systems (IIS) to CAIR (for San Joaquin
Count only)
Required Activities Performance Measures
Goal 3.2 Activity a: Implement data sharing 1. Full historical data load completed.
with CAIR2, including:
• Attend scheduled planning meetings with
CAIR2 staff.
• Comply with agreed upon timelines.
• Complete data transfer testing, including
both inbound to CAIR2 and outbound back
to local IIS.
• Share bulk historical loads of existing
patients and immunizations to CAIR2 to
initiate data sharing.
Goal 3.2 Activity b: Initiate and maintain 1. Ongoing data sharing continues.
ongoing electronic data sharing with CAIR2.
Area 4. Perinatal Hepatitis B Prevention
Goal 4.1: Reduce the incidence of perinatal hepatitis B virus (HBV) infection in the
jurisdiction.
Note: Coordinate perinatal HBV prevention efforts with your LHD's Maternal Child and Adolescent Health (MCAH)
program, as activities 4.1 a-4.1 c may also help fulfill Title V requirements and MCAH Scope of Work Activities.
Required Activities Performance Measures
Goal 4.1 Activity a: Educate medical 1. Percentage of HBsAg-positive pregnant
providers and hospital staff about the women identified in the reporting period who
screening, care, and reporting of pregnant were enrolled prior to delivery.
women who test positive for hepatitis B and
a Monthly CAIR usage reports for VFC providers are posted here: http://izcoordinators.org/cair-reports/.
s"CAIR staff"includes CAIR2 and local registry staff.
Page 16
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
their infants according to the guidance outlined 2. Percentage of HBsAg-positive pregnant
below: women identified in the reporting period with
Guidance for Prenatal Providers an HBV DNA test result during pregnancy.
Guidance for Labor and Delivery Hospitals 3. Percentage of PEP errors in the reporting
Guidance for Pediatric Providers period with completed LHJ follow-up.
Goal 4.1 Activity b: Educate identified 1. Number of HBsAg positive pregnant women
HBsAg-positive pregnant women about their identified and contacted.
HBV status and provide the appropriate
information on prevention of perinatal hepatitis
B transmission, based on current ACIP
recommendations and the guidance outlined
below:
Perinatal Hepatitis B Prevention Program
Coordinator Handbook
Note: Even if you had no cases in the previous period
you are still required to complete this activity so that you
are prepared if there is a case in the future.
Goal 4.1 Activity c: Collect and submit 1. Percentage of infants born to HBsAg-positive
requested data to CDPH on HBsAg-positive mothers in the reporting period who received
pregnant women and their infants according to PEP according to ACIP recommendations.
the guidance outlined below: 2. Percentage of infants born to HBsAg-positive
Perinatal Hepatitis B Prevention Program mothers who completed the HBV vaccine
Coordinator Handbook series by 12 months of age.
3. Percentage of infants born to HBsAg-positive
mothers who have completed PVS testing by
24 months of age.
4. Percentage of infants closed to case
management with complete information
within 24 months.
Area 5. Education, Information, Training, and Partnerships
Goal 5.1: Provide and/or promote educational activities and information to health care
providers, schools and childcare centers, and other immunization stakeholders to promote
best practices for immunizations and the im ortance of timely vaccinations.
Required Activities Performance Measures
Goal 5.1 Activity a: Based on local priorities 1. Summary of efforts conducted to distribute
and resources, disseminate print and/or materials in print or electronically to
electronic communications among providers, immunization stakeholders.
school, general public and other immunization 2. Target date for completion of summary.
stakeholders in their jurisdiction.
Note: Depending on funding, CDPH may offer select
hard-copy materials to all VFC Providers through the
Page 17
RFAM 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Online VFC store. If the VFC store is available, LHDs
may choose to refer VFC providers in their jurisdiction to
order select materials from the VFC store instead.
CDPH will inform LHDs on centralized communication
activities from the Immunization Branch (e.g., print
materials to VFC providers;electronic communications
and resources to VFC providers, schools, pharmacies,
and community-based organizations/other stakeholders;
and traditional media/social media activities to reach the
general public). LHDs may supplement any gaps in
communication with local efforts. Contact the
Information & Education Section if you would like to
learn more about the Immunization Branch's centralized
communication vehicles and activities.
Goal 5.2: Develop partnerships and collaborative activities in order to expand
immunization services, promote best practices and improve coverage rates among
children, adolescent and adults.
Required Activities Performance Measures
Goal 5.2 Activity a: Engage with at least 3 1. Number of partner types (provider, school,
types of partners in conducting educational social service/other partners) engaged with.
activities or trainings. 2. Summary of activities conducted with each
Notes: partner type.
• Partnership engagement should be based on 3. Summary of activities conducted with new
commitment to perform agreed-upon activities (e.g., partners.
joint training, mass vaccination clinic, collaboration
to include immunization messaging in
communications or event, promotional efforts).
• LHJ will engage with at least one "provider"partner,
one "school"partner and one "social service or
other"partner:
o "Provider partner"may include hospitals,
federally qualified health centers (FQHCs), long
term care facilities, birth facilities, professional
associations (local ACOG chapter), pharmacies,
health plans and community clinics.
o "School partner"may include childcare
providers, school or school district, County
Department of Education, college, school
nurses'association or other school-related
organizations.
o "Social service and other partners"may include
WIC, MCAH, social service agencies, migrant
health, homeless shelters, drug-treatment
centers,jails, faith-based organizations, local
business or community-based organizations.
Area 6. Prevention, Surveillance and Control of Vaccine Preventable Disease (VPD)
Page 18
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Goal 6.1: Conduct surveillance to identify VPD cases and/or outbreaks, and implement
recommended prevention and control activities.
Required Activities Performance Measures
Goal 6.1 Activity a: Ensure that appropriate 1. Percentage of measles PCR positive
clinical specimens are tested, and relevant specimens submitted for molecular
epidemiologic information is collected for VPDs characterization.
requiring immediate public health action. 2. Percentage of Neisseria meningitidis positive
specimens/isolates submitted for molecular
characterization.
Goal 6.1 Activity b: Implement appropriate 1. Quarterly review of Quicksheets with
public health activities for the control and applicable staff completed.
prevention of cases and/or outbreaks of VPDs 2. Percentage of infant pertussis cases <4
that are reportable to CDPH in accordance months of age with documentation of
with CDPH recommendations. mother's prenatal care provider information
(name and city of prenatal care provider).
3. Percentage of infant pertussis cases <4
months of age for whom maternal Tdap
status is known.
4. Percentage of providers reached6 who
provided prenatal care to a woman whose
infant developed pertussis. Reaching the
provider is only required if the woman never
got Tdap during this pregnancy or did not
receive Tdap at 27-36 weeks gestation.?
Goal 6.1 Activity c: Obtain vaccine and 1. Completed outbreak response request8 with
assist with the organization and plan for doses and target population (as
implementation of efforts to vaccinate appropriate).
susceptible individuals, if appropriate, in the
context of a VPD outbreak and exposure.
Goal 6.2: Collect and submit requested data to CDPH on VPD cases and outbreaks.
e Sending a letter re:standard of care is the minimum acceptable communication,with copy to your LHD Maternal Child and Adolescent
Health (MCAH) program.See Template Letter for Prenatal Care Providers with Pregnant Patients that did not Receive Prenatal Tdap
Appropriately and Infants Developed Pertussis
7 Please note: If a practice decides to modify or reduce the number of prenatal care visits due to the COVID-19 pandemic,ACOG
encourages clinicians to include recommended maternal immunizations(influenza and Tdap)during remaining in-person appointments,
even if that means immunizations will be administered outside of the typically recommended weeks of gestation. Please make note of
any clinic modifications in the notes field in the maternal immunizations section in CaIREDIE.
8 The Immunization Branch provides a form for requesting vaccine from CDPH.
Page 19
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Required Activities Performance Measures
Goal 6.2 Activity a: Report VPDs and other 1. Percentage of measles cases reported
conditions reportable to CDPH Immunization immediately to CDPH.
Branch per CDPH instructions listed here: 2. Percent of meningococcal disease cases in
ReportingGuidanceForLHJs high school and college students reported
immediately to CDPH.
3. Percentage of case reports submitted to
CDPH via an electronic communicable
disease reporting system (CaIREDIE or
other) in the recommended timeframe.
4. Percentage of VPD cases with appropriate
resolution status assigned, as per CSTE
case definition.
5. Percentage of VPD cases with complete
data.
Goal 6.2 Activity b: Collect and submit 1. Percentage of confirmed hepatitis A cases
CDPH-requested VPD case and outbreak for whom hepatitis A risk factors are known.
data. 2. Percentage of meningococcal disease cases
aged 14-24 years for whom high school or
college attendance status is known.
Area 7. Childcare and School Immunization Entry Requirements
Goal 7.1: Decrease the proportion of pupils who are overdue for required immunizations or
admitted conditionally.
Required Activities Performance Measures
Goal 7.1 Activity a: Provide guidance, 1. Percentage of schools with kindergarteners
training, and support for compliance with entry in the jurisdiction that have completed the
immunization requirements by all childcare annual immunization assessment.
centers and schools within the jurisdiction.
Goal 7.1 Activity b: At least annually, visit 1. Percentage of schools that meet the
schools with 10 or more kindergarteners that definition of"targeted schools" 9
reported > 10% were either conditionally Target 2022-2023 School Year: Less than
admitted or overdue for required immunization; 3% of schools have >10% of kindergarteners
provide guidance and support follow-up until either conditional or overdue.
these students are up to date.
Area 8. Influenza
9"Targeted schools are schools with 10 or more kindergarteners that reported greater than 10%of students conditionally admitted
and/or overdue for required immunization.
Page 1 10
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
Goal 8.1: Strengthen capacity to protect against seasonal influenza and to prepare for a
pandemic.
Required Activities Performance Measures
Goal 8.1 Activity a: To assist your LHD 1. Mass vaccination exercise completed by
emergency preparedness lead in fulfilling its local health department, including
emergency preparedness grant requirements, immunization and preparedness program
utilize IZB-supplied influenza vaccine or other staff.
317-funded1Ovaccines to support at least one
mass immunization exercise/year. Confirm
your LHD emergency preparedness program
has entered all doses into CAIR within 14 days
of administration, as per the emergency
preparedness grant requirement.
Goal 8.1 Activity b: Utilize IZB-supplied 1. Number of doses of influenza vaccine
influenza vaccine to immunize jurisdiction administered.
against influenza; doses may be shared with Target# of doses must be at least 90% of
local partners. previous season's total doses.
Area 9. COVID-19 Vaccination
Goal 9.1: Organize an effective COVID-19 vaccination response at the local level.
Required Activities Performance Measures
Goal 9.1 Activity a: Develop and implement a 1. Percentage of target number of individuals
COVID-19 vaccination plan that ensures vaccinated, or target number of doses
equitable vaccination access and encourages administered, for each focus population, as
widespread vaccine acceptance and uptake. described in your Vaccination Equity
Workplan. (Note: LHDs will not be penalized
for not reaching their targets but will be
required to describe challenges faced in
reaching targets and describe how they will
address these challenges.)
2. Completion of COVID-specific activity
progress report. Template provided by IZB-
CDPH.
3. Participation in periodic meetings with IZB-
CDPH staff.
Goal 9.1 Activity b: Respond to requests 1. Response to requests for information from
from IZB-CDPH for information on local efforts IZB-CDPH as needed.
and plans to address vaccine hesitancy,
improve vaccine access, reach vulnerable
10 If the LHD would like to use Pan Flu Funding or other emergency preparedness funding for vaccine purchase, please reach out to the
Immunization Branch with your request.
Page 1 11
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
populations, and vaccinate adolescents and
children 5-11 years of age, during Phase 3 of
the vaccine rollout.
Glossary of Acronyms and Terms- t
317 vaccine Vaccine provided to LHD clinics and partners for uninsured adults and
for outbreak purposes.
ACIP Advisory Committee on Immunization Practices
ACOG American College of Obstetricians and Gynecologists
AFIX Assessment, Feedback, Incentive, eXchange
AFM Acute Flaccid Myelitis
ARNOLD Advanced Results Notification and On-Line Delivery (within CaIREDIE)
CAIR California Immunization Registry
CaIREDIE California Reportable Disease Information Exchange
CDC Centers for Disease Control and Prevention
CDPH California Department of Public Health
COVID-19 Coronavirus Disease 2019
CPSP Comprehensive Perinatal Services Program
CSTE Council of State and Territorial Epidemiologists
DNA Deoxyribonucleic Acid
eCR Electronic Case Reporting
EHR Electronic Health Record
ELR Electronic Laboratory Reporting
EZIZ An Immunization Branch-operated website (eziz.org) with
immunization training and resource materials.
Page 112
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
FQHC Federally Qualified Health Center
HBsAg Hepatitis B Surface Antigen
HBV Hepatitis B Vaccine
HL7 Health Level 7 (standards for data exchange)
HPV Human papillomavirus
IgM Immunoglobulin
IIS Immunization Information System
IQIP Immunization Quality Improvement for Providers
ISI Immunization Skills Institute
IZ Immunization
IZB Immunization Branch (of CDPH)
Vaccine ordered through the CDPH Immunization Branch and supplied
IZB-supplied vaccine to LHD clinics or partners using state or federal (VFC and 317) funding
sources.
LCR Local CAR representative (on CDPH IZB staff)
LHD Local Health Department
Clinic run or housed in LHD that serves as a medical home for its
LHD Primary Care Clinic patients. Includes federally qualified health centers or look-alikes that
are o erated or housed in LHDs
LHJ Local Health Jurisdiction
MA Medical Assistant
MCAH Maternal Child and Adolescent Health
MCP Medi-Cal Managed Care Plan
MDL Microbial Diseases Laboratory
MOU Memorandum of Understanding
NIAM National Immunization Awareness Month
Page 1 13
RFA#: 22-10537
Date: 09/15/2022
Form 4
CDPH Immunization Branch
Scope of Work for Local Health Departments FY 2022-2023
NIVW National Influenza Vaccine Week
OBGYN Obstetrics and Gynecology
PBE Personal Belief Exemption
PCR Polymerase Chain Reaction
PEP Post Exposure Prophylaxis
PHPP Perinatal Hepatitis B Prevention Program
PVS Post-Vaccination Serology
PVW Preteen Vaccine Week
SGF State General Fund
TB Tuberculosis
Tdap Tetanus, Diphtheria, and Pertussis
TK/K Transitional Kindergarten/Kindergarten
VFC Vaccines for Children Program
VPDs Vaccine-Preventable Disease(s)
VRDL Viral and Rickettsial Disease Laboratory (of CDPH)
WIC Women, Infants, and Children
Page 1 14
RFA: #22-10537
Date: 09/15/2022
County of
Grant#
CDPH Immunization Branch Form 5
Local Assistance Grant Funds
Exhibit B - Budget
Budget Budget Budget Budget Budget
(*Year 1) (**Year 2) (**Year 3) (**Year 4) (**Year 5)
07/01/2022 to 07/01/2023 to 07/01/2024 to 07/01/2025 to 07/01/2026 to
06/30/2023 06/30/2024 06/30/2025 06/30/2026 06/30/2027
I. County of $ - $ - $ - $ - $ -
II. (Subgrantee, if any) $ - $ - $ - $ - $ -
Total $ - $ - $ - $ - $ -
**CDPH Immunization Program will provide funding source information as it becomes available each fiscal year.
Total Funding for 5-Year Term: $ -
RFA: #22-10537
Date: 09/15/2022
Allowable Uses of
317 and Vaccines for Children (VFC) Federal Assistance (FA) Operations Funds
POB developed the following table to assist applicants in preparing budgets that are following
federal grants policies and CDC award requirements. The table was developed using a
combination of 2 CFR Part 200, 45 CFR Part 75, HHS Grants Policy Statement, and
NCIRD/ISD-identified program priorities.
Object Class Category/Expenses Allowable
with 317
operations
funds
Personnel
Salary/wages x
Fringe
Compensation/fringe benefits x
Travel
State/Local/Regional conference travel expenses x
Local meetings/conferences (Ad hoc) (excluding meals) x
In-state travel costs x
Out of state travel costs (e.g. NIC, Perinatal Hep B Meeting, Program x
Managers/PHA Meeting, ACIP meetings, VFC trainings, Program Managers
Orientation, and other national or CDC-sponsored immunization program
meetings) *
*Refer to Funding Categories, IPOM Unit I
VFC-only site visits x
QI-only site visits x
Combined (VFC and QI site visits) x
Perinatal hospital record reviews x
Equipment*
Fax machines for vaccine ordering x
Vaccine storage equipment for federally funded vaccine x
Copiers/printers x
*Equipment: an article of tangible nonexpendable personal property having useful
life of more than one year and an acquisition cost of$5.000 or more per unit. If
cost is below this threshold amount, item may be included in supplies.
Page 1 of 4
RFA: #22-10537
Date: 09/15/2022
Allowable Uses of
317 and Vaccines for Children (VFC) Federal Assistance (FA) Operations Funds
Supplies
Vaccine administration and VPD testing supplies (including, but not x
limited to, nasal pharyngeal swabs, syringes for emergency
vaccination clinics)
Office supplies: general office (pens, paper, paper clips, etc.), ink x
cartridges, calculators
Personal computers, Laptops, Tablets x
Pink Books, Red Books, Yellow Books x
Printers x
Laboratory supplies (influenza cultures and PCRs, cultures and x
molecular, lab media serotyping)
Digital data logger with valid certificate of calibration/validation/testing x
report
Vaccine shipping supplies (storage containers, ice packs, bubble wrap, x
etc.)
Contractual
State/local conferences expenses (conference site, materials printing, x
hotel accommodations expenses, speaker fees). Food/meal cost is not
allowable.
Regional/Local meetings x
General contractual services (e.g., local health departments, x
contractual staff, advisory committee media, provider trainings)
CDC-managed contracts for awardee IIS support (GSA, Office of x
Acquisition Services) (DA funding only)
Applicant IIS contractual agreements (support, enhancement, upgrades) x
Financial Assistance (FA)
Non-CDC contract vaccines 317 FA vaccine funds must be requested in
funding application using 317 FA vaccines
Indirect
Indirect costs x
Miscellaneous
Accounting services x
Advertising (restricted to recruitment of staff or trainees, procurement x
of goods and services, disposal of scrap or surplus materials)
Audit Services x
BRFSS Survey x
Committee meetings (room rental, equipment rental, etc.) x
Page 2 of 4
RFA: #22-10537
Date: 09/15/2022
Allowable Uses of
317 and Vaccine for Children (VFC) Federal Assistance (FA) Operations Funds
Communication (electronic/computer transmittal, messenger, postage, x
local and long-distance telephone)
Consumer information activities x
Consumer/provider board participation (travel reimbursement) x
Data processing x
Laboratory services (tests conducted for immunization programsNPD x
surveillance)
Local service delivery activities x
Maintenance operation/repairs x
Malpractice insurance for volunteers x
Memberships/subscriptions x
NIS Oversampling x
Pagers/cell phones x
Printing of vaccine accountability forms x
Professional service costs directly related to immunization activities x
(limited term staff), Attorney General Office services
Public relations x
Publication/printing costs (all other immunization-related publication x
and printing expenses)
Rent (requires explanation of why these costs are not included in the x
indirect cost rate agreement/cost allocation plan)
Shipping materials (other than vaccine) x
Shipping (vaccine) Restricted to programs that receive VFC distribution x
funding
Software license/Renewals (ORACLE, etc.) x
Stipend Reimbursements x
Toll-free phone lines for vaccine ordering x
Training costs—Statewide, staff, providers x
Translations (translating materials) x
Vehicle lease (restricted to awardees with policies that prohibit local x
travel reimbursement)
VFC enrollment materials x
VFC provider feedback surveys x
VIS camera-ready copies x
Page 3 of 4
RFA: #22-10537
Date: 09/15/2022
Non-Allowable Uses of
317 and Vaccines for Children (VFC) Federal Assistance (FA) Operations Funds
Expense NOT allowable with
federal immunization
funds
Advertising costs(e.g., conventions, displays, exhibits, x
meetings, memorabilia, gifts, souvenirs
Alcoholic beverages x
Building purchases, construction, capital improvements x
Clinical care(non-immunization services) x
Entertainment Cost x
Fundraising Cost x
Goods and services for personal use x
Honoraria x
Independent Research x
Land purchases x
Legislative/lobbying activities x
Interest on loans for the acquisition and/or modernization of an x
existing building
Payment of bad debt, collection of improper payments x
Promotional and/or Incentive Materials (e.g., plaques, clothing x
and commemorative items such as pens, mugs/cups,
folders/folios, lanyards, magnets, conference bags)
Purchase of food (unless part of required travel per diem costs) x
Vehicle Purchase x
Other restrictions which must be taken into account while writing the budget:
• Funds are allowable only for activities and personnel costs directly related to the
Immunization and Vaccines for Children Cooperative Agreement. Funding
requests not directly related to immunization activities are outside the scope of this
cooperative agreement and will not be funded.
• Pre-award costs are not allowable, unless specifically identified by the CDC Office
of Financial Resources (OFR).
Page 4 of 4
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
-/ Award# 5 NH23IP922612-04-00
Centers for Disease Control and Prevention
FAIN# NH23IP922612
Federal Award Date: 07/06/2022
Recipient Information Federal Award Information
1. Recipient Name 11.Award Number
California Department of Public Health 5 N14231P922612-04-00
Capitol Ave 1615 Ca 12.Unique Federal Award Identification Number(FAIN)
Capitol NH231P922612
California Department of Public Health 13.Statutory Authority
Sacramento,CA 95814-5015 Sections 317,317(k)(2)of the Public Health Service Act(42 U.S.C.Sections 247b,247b(k)(2)and 247c),as
(916)552-8264 amended.
14.Federal Award Project Title
2. Congressional District of Recipient CDC-RFA-IP 19-1901 Immunization and Vaccines for Children
06
3. Payment System Identifier(ID)
1743204993A I 15.Assistance Listing Number
4. Employer Identification Number(EIN) 93.269
743204993 16.Assistance Listing Program Title
S. Data Universal Numbering System(DUNS) Immunization Cooperative Agreements
799150615
6. Recipient's Unique Entity Identifier(UEI) 17.Award Action Type
KD2JSY61,NMW7 Non-Competing Continuation
7. Project Director or Principal Investigator 18.Is the Award R&D?
No
Ms.Maria Elena Volk
Assistant Branch chief Summary Federal Award Financial Information
MARIA.VOLK(gCDPI-l.CA.GOV 19. Budget Period Start Date 07/01/2022 -End Date 06/30/2023
(510)620-3748
8. Authorized Official 20. Total Amount of Federal Funds Obligated by this Action $40,063,009.00
20a.Direct Cost Amount $45,163,634.00
Dr.Karen388388 Smith 20b.Indirect Cost Amount $743,660.00
N/A
KAREN.SM1Tl-lQ?cdph.ca.gov 21. Authorized Carryover $0.00
916-449-5900 22. Offset $5,844,285.00
23. Total Amount of Federal Funds Obligated this budget period $0.00
Federal Agency Information
24. Total Approved Cost Sharing or Matching,where applicable $0.00
CDC Office of Financial Resources
25. Total Federal and Non-Federal Approved this Budget Period $40,063,009.00
9. Awarding Agency Contact Information 26. Period of Perfomance Start Date 07/01/2019 -End Date 06/30/2024
Sharlene Sanders
GMS 27. Total Amount of the Federal Award including Approved
Cost Sharing or Matching this Period of Performance $965,385,203.00
gx12(Di,cdc.gov
678-475-4650
28.Authorized Treatment of Program Income
10.Program Official Contact Information ADDITIONAL COSTS
Hilary Oliphant 29.Grants Management Officer-Signature
Public Ileallh Advisor
Kathy Raible
hbo 1(a)cdc.gov
770-488-3973
30. Remarks
Paae 1
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
yet
Centers for Disease Control and Prevention Award# 5 NH23IP922612-04-00
FAIN# NH23IP922612
Federal Award Date: 07/06/2022
Recipient Information 33. Approved Budget
(Excludes Direct Assistance)
Recipient Name I. Financial Assistance from the Federal Awarding Agency Only
California Department of Public Health II. Total project costs including grant funds and all other financial participation
1615 Capitol Ave a. Salaries and Wages g $2,429,244.00
California Department of Public Health
b. Fringe Benefits $1,289,056.00
Sacramento,CA 95814-5015
(916)552-8264 c. Total Personnel Costs $3,718,300.00
Congressional District of Recipient d. Equipment $0.00
06 e. Supplies $765,395.00
Payment Account Number and Type f. Travel $86,130.00
1743204993A I
Employer Identification Number(EIN)Data g• Construction $0.00
743204993 h. Other $5,988,801.00
Universal Numbering System(DUNS)
i. Contractual $34,605,008.00
799150615
Recipient's Unique Entity Identifier (UEI) j. TOTAL DIRECT COSTS $45,163,634.00
KD2JSY6LNMW7
k. INDIRECT COSTS $743,660.00
31.Assistance Type 1. TOTAL APPROVED BUDGET $45,907,294.00
Cooperative Agreement
In. Federal Share $45,907,294-00
32.Type of Award
Other n. Non-Federal Share $0.00
L34.Accounting Classification Codes
FY-ACCOUNT NO. DOCUMENT NO. ADMINISTRATIVE CODE OBJECT CLASS CFDA NO. AMT ACTION FINANCIAL ASSISTANCE APPROPRIATION
1-93909KZ 19NH23IP922612 IP 4L51 93.268 $0.00 75-X-0951
1-9390BKG 19NH23IP922612 IP 41.51 93.268 $0.00 75-75-X-0512-009
1-9390BKJ 19NH23IP922612 IP 41.51 93.268 $0.00 75-75-X-0512-009
1-9390BKM 19NH231P922612 IP 41.51 93.268 $0.00 75-75-X-0512-009
1-939ZRWL 19NH23IP922612 IP 41.51 93.268 $0.00 75-21-0951
1-939ZRYH 19NI423IP922612 IP 41.51 93.268 $0.00 75-21-0951
0-9390EWQ 19NH23IP922612C3 IP 41.51 93.268 $0.00 75-2024-0943
1-9390FG3 20NH23IP922612C3 IP 41.51 93.268 $0.00 75-2024-0943
1-9390GKL 20NH23IP922612CS IP 41.51 93.268 $0.00 75-2124-0943
1-9390GUU 20NH231P922612UDSPC5 IP 41.51 93.268 $0.00 75-2124-0943
1-9390GWA 20NH23IP922612C6 IP 41.51 93.268 $0.00 75-X-0943
1-9390GZB 19NH23IP922612VWCC6 IP 41.51 93.268 $0.00 75-X-0943
2-9390BKG 19NH23IP922612 IP 41.51 93.268 $5,547,558.00 75-75-X-0512-009
2-9390BKJ 19NH23IP922612 IP 41.51 93,268 S404,798.00 75-75-X-0512-009
2-9390BKM 19NH23IP922612 IP 41.51 93268 $6,019,800.00 75-75-X-0512-009
2-9390K3F 19NH23IP922612 IP 41.51 93268 S20,640,649.00 75-X-0951
2-9390K3G 19NH23IP922612 IP 41.51 93.268 $2,630,690.00 75-X-0951
2-939ZRWL 19NH23IP922612 IP 41.51 93.268 $1,946,836.00 75-22-0951
2-939ZRYH 19NH23IP922612 1P 41.51 93.268 $2,872,678.00 75-22-0951
Pace 2
J DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
Award# 5 NH23IP922612-04-00
Centers for Disease Control and Prevention
FAIN# NH23IP922612
Federal Award Date: 07/06/2022
Direct Assistance
BUDGET CATEGORIES PREVIOUS AMOUNT(A) AMOUNT THIS ACTION(B) TOTAL(A+B)
Personnel $0.00 $353,776.00 $353,776.00
Fringe Benerits $0.00 $0.00 $0.00
Travel $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00
Supplies $0.00 $0.00 $0.00
Contractual $0.00 $0.00 $0.00
Construction $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00
Total $0.00 $353,776.00 $353,776.00
P�nc Z
AWARD ATTACHMENTS
California Department of Public Health 5 NH231P922612-04-00
1. Terms and Conditions 2612
AWARD INFORMATION
Incorporation: In addition to the federal laws, regulations, policies, and CDC General Terms
and Conditions for Non-research awards at https://www.cdc.gov/qrants/federal-regulations-
policies/index.html, the Centers for Disease Control and Prevention (CDC) hereby incorporates
Notice of Funding Opportunity (NOFO) number IP19-1901, entitled Immunization and Vaccines
for Children, and application dated April 1, 2022, as may be amended, which are hereby made a
part of this Non-research award, hereinafter referred to as the Notice of Award (NoA).
Approved Funding: Funding in the amount of$45,907,294 is approved for the Year 04 budget
period, which is July 1, 2022 through June 30, 2023. This amount includes carryover and or
offset, please see Use of Unobligated Funds below. All future year funding will be based on
satisfactory programmatic progress and the availability of funds.
The federal award amount is subject to adjustment based on total allowable costs incurred
and/or the value of any third party in-kind contribution when applicable.
Note: Refer to the Payment Information section for Payment Management System (PMS)
subaccount information.
Component/Project Funding: The NOFO provides for the funding of multiple components
under this award. The approved component funding levels for this notice of award are:
NOFO Component Amount
CORE $ 45,407,872
AA1 $ 499,422
HHS Non-Discrimination Legal Requirements for Recipients of Federal Financial
Assistance: This is to notify you that the Centers for Disease Control and Prevention (CDC)
incorporated Department of Health and Human Services (HHS) non-discrimination legal
requirements for recipients of federal financial assistance into the CDC General Terms and
Conditions within your Notice of Award. The new requirements are effective immediately. The
requirements are in the General Requirements section of the General Terms and Conditions,
and are also listed below.
You must administer your project in compliance with federal civil rights laws that prohibit
discrimination on the basis of race, color, national origin, disability, age and, in some
circumstances, religion, conscience, and sex (including gender identity, sexual orientation, and
pregnancy). This includes taking reasonable steps to provide meaningful access to persons with
limited English proficiency and providing programs that are accessible to and usable by persons
with disabilities. The HHS Office for Civil Rights provides guidance on complying with civil rights
laws enforced by HHS. See https://www.hhs.gov/civil-rights/for-providers/provider-
obligations/index.html and https://www.hhs.gov/civil-rights/for-
individuals/nondiscrimination/index.html.
• You must take reasonable steps to ensure that your project provides meaningful access
to persons with limited English proficiency. For guidance on meeting your legal
obligation to take reasonable steps to ensure meaningful access to your programs or
activities by limited English proficient individuals, see https://www.hhs.gov/civil-rights/for-
individuals/special-topics/limited-english-proficiency/fact-sheet-guidance/index.html and
https://www.lep.gov/.
• For information on your specific legal obligations for serving qualified individuals with
disabilities, including providing program access, reasonable modifications, and taking
appropriate steps to provide effective communication, see
http://www.hhs.gov/ocr/civilrights/understanding/disability/index.htmi.
• HHS funded health and education programs must be administered in an environment
free of sexual harassment, see https://www.hhs.gov/civil-rights/for-individuals/sex-
discrimination/index.html.
• For guidance on administering your project in compliance with applicable federal
religious nondiscrimination laws and applicable federal conscience protection and
associated anti-discrimination laws, see https://www.hhs.gov/conscience/conscience-
protections/index.html and https://www.hhs.gov/conscience/religious-
freedom/index.html.
Financial Assistance Mechanism: Cooperative Agreement
Substantial Involvement by CDC: This is a cooperative agreement and CDC will have
substantial programmatic involvement after the award is made. Substantial involvement is in
addition to all post-award monitoring, technical assistance, and performance reviews
undertaken in the normal course of stewardship of federal funds.
CDC program staff will assist, coordinate, or participate in carrying out effort under the award,
and recipients agree to the responsibilities therein, as detailed in the NOFO.
• Provide guidance, trainings, tools, and technical assistance to award recipient on
program area components.
• Host conference calls for sharing information from CDC and between award recipient.
• Work with award recipients on planning and implementation of required and proposed
activities.
• Monitor award recipient vaccine spend plan and replenishment providing regular
feedback and working with award recipient to address barriers.
• Analyze and report results of surveys regarding national, state and selected local level
vaccination coverage.
• Analyze and report result of surveys of award recipient plans and activities related to
preparedness.
• Collaboration with external partners to promote IIS in national health IT settings.
• Develop and support improvements in IIS data quality and program measures to
assess IIS performance.
• Use IIS submitted data to develop methods to estimate national vaccination coverage
and calculate vaccination coverage estimates for routinely recommended childhood
vaccines.
• Use IIS submitted data to monitor seasonal or pandemic influenza vaccination among
ages that are available in the IIS data.
• Assist, as needed, in the development of data collection and reporting methods for
school- enterer vaccination coverage surveys.
• Provide VFC policy guidance via the VFC Operations Guide, periodic trainings and
conference calls, including use of the CDC developed quality assurance site visit tools,
to assist award recipient implement their VFC program in accordance with federal
requirements.
• Provide subject matter guidance in all program component areas.
Direct Assistance (DA): DA is awarded in the amount of$353,776 for this budget period.
Use Of Unobligated Funds: This NoA includes use of Year 02 unobligated funds in the amount
of$5,844,285, which has been applied as an offset to the currently approved funding level for
this budget period. The use of unobligated funds is approved based on the Year 02 Federal
Financial Report (FFR) dated November 29, 2021. The amount of this NoA will be subject to
reduction if the final amount of unobligated funds is less than the amount of unobligated funds
reported on the referenced FFR.
Budget Revision Requirement: By September 1, 2022, the recipient must submit a revised
budget with a narrative justification.
A revised budget is needed in the amount of$1,014,104, which is the amount of additional
funds awarded under this Notice of Award. These additional funds were placed in the "Other"
cost category under the CORE award.
Administrative Requirement: The recipient must respond to the OGS Budget Comments in
accordance with the recommendations provided in GrantSolutions as a Grant Note by
September 1, 2022. If the date falls on a weekend or holiday, the submission will be due the
following business day.
• Component AA1, Justification of general expenses (refer to Budget Preparation
Guidelines)
• Component AA1, Identify the 6 elements for contractors: Name of contractor; Method of
Selection; Performance Period; Scope of Work; Method of Accountability and Itemized
Budget and Justification(refer to Budget Preparation Guidelines)
Failure to submit the required information in a timely manner may adversely affect the future
funding of this project. If the information cannot be provided by the due date, you are required
to contact the GMS/GMO identified in the CDC Staff Contacts section of this notice before the
due date.
Program Income: Any program income generated under this grant or cooperative agreement
will be used in accordance with the Addition alternative.
Addition alternative: Under this alternative, program income is added to the funds committed to
the project/program and is used to further eligible project/program objectives.
Note: The disposition of program income must have written prior approval from the GMO.
FUNDING RESTRICTIONS AND LIMITATIONS
Notice of Funding Opportunity (NOFO) Restrictions:
• Recipients may not use funds for research.
• Recipients may not use funds for clinical care except as allowed by law. This restriction
does not prohibit the use of IP19-1901 funding for vaccination activities, including
the direct administration of vaccines.
• Recipients may use funds only for reasonable program purposes, including personnel,
travel, supplies, and services.
• Generally, recipients may not use funds to purchase furniture or equipment. Any such
proposed spending must be clearly identified in the budget.
• Reimbursement of pre-award costs generally is not allowed, unless the CDC provides
written approval to the recipient.
• Other than for normal and recognized executive-legislative relationships, no funds may
be used for:
a. publicity or propaganda purposes, for the preparation, distribution, or use of any
material designed to support or defeat the enactment of legislation before any
legislative body
b. the salary or expenses of any grant or contract recipient, or agent acting for such
recipient, related to any activity designed to influence the enactment of
legislation, appropriations, regulation, administrative action, or Executive order
proposed or pending before any legislative body
c. See Additional Requirement (AR) 12 for detailed guidance on this prohibition and
additional guidance on lobbying for CDC recipients.
• The direct and primary recipient in a cooperative agreement program must perform a
substantial role in carrying out project outcomes and not merely serve as a conduit for
an award to another party or provider who is ineligible.
• In accordance with the United States Protecting Life in Global Health Assistance policy,
all non-governmental organization (NGO) applicants acknowledge that foreign NGOs
that receive funds provided through this award, either as a prime recipient or
subrecipient, are strictly prohibited, regardless of the source of funds, from performing
abortions as a method of family planning or engaging in any activity that promotes
abortion as a method of family planning, or to provide financial support to any other
foreign non-governmental organization that conducts such activities. See Additional
Requirement (AR) 35 for applicability
https://www.cdc.gov/grants/additionalrequirements/ar-35.html
Indirect Costs:
Indirect costs are approved based on the negotiated indirect cost rate agreement dated August
4, 2021, which calculates indirect costs as follows, a Final is approved at a rate of 20.00% of the
base, which includes, total indirect cost divided by total direct salaries and benefits. The
effective dates of this indirect cost rate are from July 1, 2021 to June 30, 2022.
REPORTING REQUIREMENTS
Performance Progress and Monitoring: Performance information collection initiated under
this grant/cooperative agreement has been approved by the Office of Management and Budget
under OMB Number 0920-1132, "Performance Progress and Monitoring Report",
Expiration Date 10131/2022. The components of the PPMR are available for download at:
https://www.cdc.gov/qrants/already-have-grant/Reporting.htmi .
Required Disclosures for Federal Awardee Performance and Integrity Information System
(FAPIIS): Consistent with 45 CFR 75.113, applicants and recipients must disclose in a timely
manner, in writing to the CDC, with a copy to the HHS Office of Inspector General (OIG), all
information related to violations of federal criminal law involving fraud, bribery, or gratuity
violations potentially affecting the federal award. Subrecipients must disclose, in a timely
manner in writing to the prime recipient (pass through entity) and the HHS OIG, all information
related to violations of federal criminal law involving fraud, bribery, or gratuity violations
potentially affecting the federal award. Disclosures must be sent in writing to the CDC and to
the HHS OIG at the following addresses:
CDC, Office of Grants Services
Sharlene Sanders, Grants Management Specialist
Cherokee Nation Operational Solutions (CNOS)
Centers for Disease Control and Prevention
Branch 1
2939 Flowers Road, MS-TV2
Atlanta, GA 30341
Email: qxl2(@cdc.gov (Include"Mandatory Grant Disclosures" in subject line)
AND
U.S. Department of Health and Human Services
Office of the Inspector General
ATTN: Mandatory Grant Disclosures, Intake Coordinator
330 Independence Avenue, SW
Cohen Building, Room 5527
Washington, DC 20201
Fax: (202)-205-0604 (Include "Mandatory Grant Disclosures" in subject line) or
Email: MandatoryGranteeDisclosures(aD_oig.hhs.gov
Recipients must include this mandatory disclosure requirement in all subawards and contracts
under this award.
Failure to make required disclosures can result in any of the remedies described in 45 CFR
75.371. Remedies for noncompliance, including suspension or debarment (See 2 CFR parts
180 and 376, and 31 U.S.C. 3321).
CDC is required to report any termination of a federal award prior to the end of the period of
performance due to material failure to comply with the terms and conditions of this award in the
OMB-designated integrity and performance system accessible through SAM (currently FAPIIS).
(45 CFR 75.372(b)) CDC must also notify the recipient if the federal award is terminated for
failure to comply with the federal statutes, regulations, or terms and conditions of the federal
award. (45 CFR 75.373(b))
PAYMENT INFORMATION
The HHS Office of the Inspector General(OIG) maintains a toll-free number(1-800-HHS-TIPS(1-
800-447-84771) for receiving information concerning fraud, waste, or abuse under grants and
cooperative agreements. Information also may be submitted by e-mail to hhstips(_oig.hhs.gov or
by mail to Office of the Inspector General, Department of Health and Human Services, Attn:
HOTLINE, 330 Independence Ave., SW, Washington DC 20201. Such reports are treated as
sensitive material and submitters may decline to give their names if they choose to remain
anonymous.
Payment Management System Subaccount: Funds awarded in support of approved activities
have been obligated in a subaccount in the PMS, herein identified as the "P Account". Funds
must be used in support of approved activities in the NOFO and the approved application.
The grant document number identified beginning on the bottom of Page 2 of the Notice of Award
must be known in order to draw down funds.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
_ -✓ � Centers for Disease Control and Prevention Award# 6 NH23IP922612-02-02FAIN# NH23IP922612
Federal Award Date: 12/16/2020
Recipient Information Federal Award Information
1. Recipient Name 11.Award Number
6 NH23IP922612-02-02
California Department of Public Health 12.Unique Federal Award Identification Number(FAIN)
1615 Capitol Ave NH231P922612
California Department of Public Health 13.Statutory Authority
Sections 317,317(k)(2)of the Public Health Service Act(42 U.S.C.Sections 247b,247b(k)(2)and 247c),as
Sacramento,CA 95s 14-5015 14.Federal Award Project Title
[NO DATA] CDC-RFA-IP19-1901 lmmunization and Vaccines for Children
2. Congressional District of Recipient
06
3. Payment System Identifier(ID)
1743204993A I IS.Assistance Listing Number
4. Employer Identification Number(EIN) 93.268
743204993 16.Assistance Listing Program Title
S. Data Universal Numbering System(DUNS) Immunization Cooperative Agreements
799150615
6. Recipient's Unique Entity Identifier 17.Award Action Type
Supplement
7. Project Director or Principal Investigator 18.Is the Award R&D?
No
Ms.Maria Elena Volk
Assistant Branch Chief Summary Federal Award Financial Information
MARIA.VOLK@)CDPH.CA.GOV
19. Budget Period Start Date 07/0 t/2020 -End Date 06/30/2021
(510)620-3748
8. Authorized Official 20. Total Amount of Federal Funds Obligated by this Action $20,074,619.00
20a.Direct Cost Amount $20,074,619.00
Dr.Karen Smith
20b.Indirect Cost Amount $0.00
KAREN.SMITIl@cdph.ca.gov
916-449-5900 21. Authorized Carryover $596,980.00
22. Offset $0.00
23. Total Amount of Federal Funds Obligated this budget period $66,643,627.00
Federal Agency Information
24. Total Approved Cost Sharing or Matching,where applicable $0.00
CDC Office of Financial Resources
2S. Total Federal and Non-Federal Approved this Budget Period $86,718,246.00
9. Awarding Agency Contact Information
26.Project Period Start Date 07/0 U2019 -End Date 06/30/2024
Brandy Coffee
Grants Management Specialist 27.Total Amount of the Federal Award including Approved
gpx7@i cdc.gov Cost Sharing or Matching this Project Period $143,666,925.00
(404)493-4143
28.Authorized Treatment of Program Income
10.Program Official Contact Information ADDITIONAL COSTS
Divya Cassity 29.Grants Management Officer-Signature
PBEMB CoAg Specialist
Brownie Anderson-Rana
kyg4(i!cdc.gov
Grants Management Officer
404.718.8962
30.Remarks
Paae 1
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
-✓
Centers for Disease Control and Prevention Award# 6 NH23IP922612-02-02
FAIN# NH23IP922612
Federal Award Date: 12/16/2020
Recipient Information 33. Approved Budget
(Excludes Direct Assistance)
Recipient Name I. Financial Assistance from the Federal Awarding Agency Only
California Department of Public Health II. Total project costs including grant funds and all other financial participation
1615 Capitol Ave a. Salaries and Wages S1,937,182.00
California Department ol'Public Health b. Fringe Benefits
g $1,017,876.00
Sacramento,CA 95814-5015
c. Total Personnel Costs $2,955,058.00
INN DATA1
Congressional District of Recipient d. Equipment $0.00
06 e. Supplies S1,169,849.00
Payment Account Number and Type f. Travel
$84,_45.00
1743204993A1
Employer Identification Number(EIN)Data g Construction $0.00
743204993 h. Other $5,184,426.00
Universal Numbering System(DUNS)
i. Contractual $77,336,521.00
799150615
Recipient's Unique Entity Identifier j. TOTAL DIRECT COSTS $86,730,099.00
Not Available
k. INDIRECT COSTS $585,127,00
31.Assistance Type 1. TOTAL APPROVED BUDGET $87,315,226.00
Cooperative Agreement
In. Federal Share $87,315,z26.00
32.Type of Award
Demonstration n. Non-Federal Share $0.00
L34.Accounting Classification Codes
FY-ACCOUNT NO. DOCUMENT NO. ADMINISTRATIVE CODE OBJECT CLASS AMT ACTION FINANCIAL ASSISTANCE APPROPRIATION
1-9390FG3 20NH23IP922612C3 lP 41.51 $20,074,619.00 75-2024-0943
Paae 2
Ks` DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
Centers for Disease Control and Prevention Award# 6 NH23IP922612-02-02
FAIN# NH231P922612
Federal Award Date: 12/16/2020
Direct Assistance
BUDGET CATEGORIES PREVIOUS AMOUNT(A) AMOUNT THIS ACTION(B) TOTAL(A+B)
Personnel $0.00 $0.00 $0.00
Fringe Benefits $0.00 $0.00 $0.00
Travel $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00
Supplies $0.00 $0.00 $0.00
Contractual $0.00 $0.00 $0.00
Construction $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00
Total $0.00 $0.00 $0.00
P�nc Z
/ DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
J Award# 6 NH23IP922612-02-02
Centers for Disease Control and Prevention
FAIN# NH23IP922612
Federal Award Date: 12/16/2020
35. Terms And Conditions
Federal Financial Report Cycle
Reporting Period Start Date Reporting Period End Date Reporting Type Reporting Period Due Date
07/01/2020 06/30/2021 jAnnual 09/28/2021
P�rrc A
AWARD ATTACHMENTS
California Department of Public Health 6 NH231P922612-02-02
1. T& C COVID SUPPLEMENT 3
AWARD INFORMATION
Incorporation: In addition to the federal laws, regulations, policies, and CDC General Terms and
Conditions for Non-research awards at
https://www.cdc.gov/grants/federalregulationspolicies/index.html, the Centers for Disease Control
and Prevention (CDC) hereby incorporates Notice of Funding Opportunity (NOFO) number IP19-
1901, entitled, Immunization and Vaccines for Children, which are hereby made a part of this
Non-research award, hereinafter referred to as the Notice of Award (NoA).
Supplemental Component Funding: Additional funding in the amount $20,074,619 is
approved for the Year 02 budget period, which is July 1, 2020 through June 30, 2021.
The NOFO provides for the funding of multiple components under this award. The approved
component funding levels for this notice of award are:
NOFO Component Amount
COVID-19 $20,074,619
Recipients have until June 30. 2022 to expend all COVID-19 funds awarded in Year 2
Overtime: Because overtime costs are a very likely and reasonable expense during the
response to COVID-19, CDC will allow recipients to include projected overtime in their
budgets. Recipients should be careful to estimate costs based on current real-time needs and
will still be required to follow federal rules and regulations in accounting for the employees'
time and effort.
Coronavirus Disease 2019 (COVID-19) Funds: A recipient of a grant or cooperative
agreement awarded by the Department of Health and Human Services (HHS) with funds made
available under the Coronavirus Preparedness and Response Supplemental Appropriations
Act, 2020 (P.L. 116-123); the Coronavirus Aid, Relief, and Economic Security Act, 2020 (the
"CARES Act") (P.L. 116-136); and/or the Paycheck Protection Program and Health Care
Enhancement Act (P.L. 116-139) agrees, as applicable to the award, to: 1) comply with existing
and/or future directives and guidance from the Secretary regarding control of the spread of
COVID-19; 2) in consultation and coordination with HHS, provide, commensurate with the
condition of the individual, COVID-19 patient care regardless of the individual's home
jurisdiction and/or appropriate public health measures (e.g., social distancing, home isolation);
and 3) assist the United States Government in the implementation and enforcement of federal
orders related to quarantine and isolation.
In addition, to the extent applicable, Recipient will comply with Section 18115 of the CARES
Act, with respect to the reporting to the HHS Secretary of results of tests intended to detect
SARS— CoV-2 or to diagnose a possible case of COVID-19. Such reporting shall be in
accordance with guidance and direction from HHS and/or CDC. HHS laboratory reporting
guidance is posted at: https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-
reporting-guidance.pdf.
Further, consistent with the full scope of applicable grant regulations (45 C.F.R. 75.322), the
purpose of this award, and the underlying funding, the recipient is expected to provide to CDC
copies of and/or access to COVID-19 data collected with these funds, including but not limited
to data related to COVID-19 testing. CDC will specify in further guidance and directives what
is encompassed by this requirement.
This award is contingent upon agreement by the recipient to comply with existing and
future guidance from the HHS Secretary regarding control of the spread of COVID-19. In
addition, recipient is expected to flow down these terms to any subaward, to the extent
applicable to activities set out in such subaward.
Unallowable Costs:
• Research
• Clinical care
• Publicity and propaganda(lobbying):
o Other than for normal and recognized executive-legislative relationships,
no funds may be used for:
• publicity or propaganda purposes, for the preparation, distribution, or use
of any material designed to support or defeat the enactment of legislation
before any legislative body
• the salary or expenses of any grant or contract recipient, or agent acting
for such recipient, related to any activity designed to influence the
enactment of legislation, appropriations, regulation, administrative
action, or Executive order proposed or pending before any legislative
body
o See Additional Requirement (AR) 12 for detailed guidance on this prohibition
and additional guidance on lobbying for CDC recipients:
https://www.cdc.,qov/g rants/documents/Anti-
Lobbying_Restrictions for CDC_Grantees_July_2012.pdf
• All unallowable costs cited in CDC-RFA-IP19-1901 remain in effect, unless specifically
amended in this guidance, in accordance with 45 CFR Part 75 — Uniform Administrative
Requirements, Cost Principles, And Audit Requirements for HHS Awards.
ADMINISTRATIVE REQUIREMENTS
The recipient must respond to the comments in the technical review and/or OGS Budget
Comments in accordance with the recommendations provided in GrantSolutions as a Grant
Note within 45 days of receipt of the Notice of Award. If the information cannot be provided by
the due date, you are required to contact the GMS/GMO identified in the Awarding Agency
Contact Information section on the first page before the due date.
Required Disclosures for Federal Awardee Performance and Integrity Information
System (FAPIIS): Consistent with 45 CFR 75.113, applicants and recipients must disclose in a
timely manner, in writing to the CDC, with a copy to the HHS Office of Inspector General (OIG),
all information related to violations of federal criminal law involving fraud, bribery, or gratuity
violations potentially affecting the federal award. Subrecipients must disclose, in a timely
manner in writing to the prime recipient (pass through entity) and the HHS OIG, all information
related to violations of federal criminal law involving fraud, bribery, or gratuity violations
potentially affecting the federal award. Disclosures must be sent in writing to the CDC and to
the HHS OIG at the following addresses:
CDC, Office of Grants Services
Wayne Woods, Grants Management Specialist
Centers for Disease Control and Prevention
Branch 1
2920 Flowers Road, M/S E-15
Atlanta, GA 30341
Email: kuvl(c cdc.gov (Include "Mandatory Grant Disclosures" in subject line)
AND
U.S. Department of Health and Human Services
Office of the Inspector General
ATTN: Mandatory Grant Disclosures,
Intake Coordinator
330 Independence Avenue, SW
Cohen Building, Room 5527
Washington, DC 20201
Fax: (202)-205-0604 (Include "Mandatory Grant Disclosures" in subject line)
or Email: MandatorVGranteeDisclosures(a)_oig.hhs.gov
Recipients must include this mandatory disclosure requirement in all subawards and
contracts under this award.
Failure to make required disclosures can result in any of the remedies described in 45 CFR
75.371. Remedies for noncompliance, including suspension or debarment (See 2 CFR parts
180 and 376, and 31 U.S.C. 3321).
CDC is required to report any termination of a federal award prior to the end of the period of
performance due to material failure to comply with the terms and conditions of this award in
the OMB-designated integrity and performance system accessible through SAM (currently
FAPIIS). (45 CFR 75.372(b)) CDC must also notify the recipient if the federal award is
terminated for failure to comply with the federal statutes, regulations, or terms and conditions
of the federal award. (45 CFR 75.373(b))
PAYMENT INFORMATION
The HHS Office of the Inspector General(OIG) maintains a toll-free number(1-800-HHS-TIPS
[1- 800-447-8477]) for receiving information concerning fraud, waste, or abuse under grants
and cooperative agreements. Information also may be submitted by e-mail to
hhstips(a)_oig.hhs.gov or by mail to Office of the Inspector General, Department of Health and
Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington DC 20201. Such
reports are treated as sensitive material and submitters may decline to give their names if they
choose to remain anonymous.
Payment Management System Subaccount: Funds awarded in support of approved
activities have been obligated in a subaccount in the PMS, herein identified as the "P
Account". Funds must be used in support of approved activities in the NOFO and the
approved application.
The grant document number identified on the bottom of Page 1 of the Notice of Award must
be known in order to draw down funds.
Stewardship: The recipient must exercise proper stewardship over Federal funds by
ensuring that all costs charged to your cooperative agreement are allowable, allocable,
and reasonable and that they address the highest priority needs as they relate to this
program.
All the other terms and conditions issued with the original award remain in effect
throughout the budget period unless otherwise changed, in writing, by the Grants
Management Officer.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
-/ Award# 6 NH23IP922612-02-03
Centers for Disease Control and Prevention
FAIN# NH23IP922612
Federal Award Date: 01/15/2021
Recipient Information Federal Award Information
1. Recipient Name 11.Award Number
6 NH2311`922612-02-03
California Department of Public Health 12.Unique Federal Award Identification Number(FAIN)
1615 Capitol Ave NH231P922612
California Deparnncnt of Public Health 13.Statutory Authority
Sacramento,CA 95814-5015 Sections 317,317(k)(2)of the Public Health Service Act(42 U.S.C.Sections 247b,247b(k)(2)and 247c),as
[NO DATA] nmencied
14.Federal Award Project Title
2. Congressional District of Recipient CDC-RFA-111 19-1901 Immunization and Vaccines for Children
06
3. Payment System Identifier(ID)
1743204993A 1 15.Assistance Listing Number
4. Employer Identification Number(EIN) 93.268
743204993 16.Assistance Listing Program Title
5. Data Universal Numbering System(DUNS) Immunization Cooperative Agreements
799150615
6. Recipient's Unique Entity Identifier 17.Award Action Type
supplement
7. Project Director or Principal Investigator 18.Is the Award R&D?
No
Ms.Maria Elena Volk
Assistant Branch Chief Summary Federal Award Financial Information
MARIA.VOLK@CDPI I.CA.GOV
19. Budget Period Start Date 07/01/2020 -End Date 06/30/2021
(510)620-3743
8. Authorized Official 20. Total Amount of Federal Funds Obligated by this Action $357,026,635.00
20a.Direct Cost Amount $357,026,635.00
Dr.Karen Smith 20b.Indirect Cost Amount $0.00
KAREN.SMITII@cdph.ca.gov
916-449-5900 21. Authorized Carryover $596,980.00
22. Offset $0.00
23. Total Amount of Federal Funds Obligated this budget period $86,718,246.00
Federal Agency Information
24. Total Approved Cost Sharing or Matching,where applicable $0.00
CDC Office of Financial Resources
25. Total Federal and Non-Federal Approved this Budget Period $443,744,881.00
9. Awarding Agency Contact Information
26.Project Period Start Date 07/01/2019 -End Date OC,/30/2024
Wayne woods
kuv I @f'cdc.gov 27.Total Amount of the Federal Award including Approved
770-488-2948 Cost Sharing or Matching this Project Period $500,693,560.00
28.Authorized Treatment of Program Income
10.Program Official Contact Information ADDITIONAL COSTS
Divya Cassity 29.Grants Management Officer-Signature
PBEMB CoAg Specialist
Freda Johnson
kyg4 dicdc.gov
404.718.8962
30. Remarks
Paae I
/ DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
Centers for Disease Control and Prevention Award# 6 NH23IP922612-02-03
FAIN# NH23IP922612
Federal Award Date: 01/15/2021
Recipient Information 33. Approved Budget
(Excludes Direct Assistance)
Recipient Name I. Financial Assistance from the Federal Awarding Agency Only
California Department of Public Health II. Total project costs including grant funds and all other financial participation
1615 Capitol Ave a. Salaries and Wages S1,937,182.00
California Department of Public Health b. Fringe Benefits
g $1,017,876.00
Sacramento,CA 95814-5015
c. Total Personnel Costs $2,955,058.00
[NO DATA]
Congressional District of Recipient d. Equipment $0.00
06 e. Supplies $1,169.849.00
Payment Account Number and Type f. Travel
$s4,_as.00
1743204993A1
Employer Identification Number(EIN)Data g• Construction $0.00
743204993 h. Other $362,211,061.00
Universal Numbering System(DUNS)
i. Contractual $77,336,521.00
799150615
Recipient's Unique Entity Identifier j. TOTAL DIRECT COSTS $443,756,734.00
Not Available
k. INDIRECT COSTS $585,127.00
31.Assistance Type 1. TOTAL APPROVED BUDGET $444,341,861 A0
Cooperative Agreement
m. Federal Share $444,341,861.00
32.Type of Award
Demonstration n. Non-Federal Share $0.00
34.Accounting Classification Codes
FY-ACCOUNT NO. DOCUMENT NO. ADMINISTRATIVE CODE OBJECT CLASS AMT ACTION FINANCIAL ASSISTANCE APPROPRIATION
1-9390GKL 20N1-123IP922612C5 1P 41.51 S357,026,635.00 75-2124-0943
Paoe 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
Centers for Disease Control and Prevention Award# 6 NH23IP922612-02-03
FAIN# NH23IP922612
Federal Award Date: 01/15/2021
Direct Assistance
BUDGET CATEGORIES PREVIOUS AMOUNT(A) AMOUNT THIS ACTION(B) TOTAL(A+B)
Personnel $0.00 $0.00 $0.00
Fringe Beneots $0.00 $0.00 $0.00
Travel $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00
Supplies $0.00 $0.00 $0.00
Contractual $0.00 $0.00 $0.00
Construction $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00
Total $0.00 $0.00 $0.00
Pnno Z
AWARD ATTACHMENTS
California Department of Public Health 6 NH231P922612-02-03
1. Terms and Conditions
AWARD INFORMATION
Incorporation: In addition to the federal laws, regulations, policies, and CDC General Terms and
Conditions for Non-research awards at
https://www.cdc.gov/grants/federairegulationspolicies/index.html, the Centers for Disease Control
and Prevention (CDC) hereby incorporates Notice of Funding Opportunity (NOFO) number IP19-
1901, entitled, Immunization and Vaccines for Children, which are hereby made a part of this
Non-research award, hereinafter referred to as the Notice of Award (NoA).
Supplemental Component Funding: Additional funding in the amount $357,026,635 is
approved for the Year 02 budget period, which is July 1, 2020 through June 30, 2021.
The NOFO provides for the funding of multiple components under this award. The approved
component funding levels for this notice of award are:
NOFO Component Amount
COVID-19 $357,026,635
Recipients have until June 30, 2024 to expend all COVID-19 funds herein and previously
funded.
Overtime: Because overtime costs are a very likely and reasonable expense during the
response to COVID-19, CDC will allow recipients to include projected overtime in their
budgets. Recipients should be careful to estimate costs based on current real-time needs and
will still be required to follow federal rules and regulations in accounting for the employees'
time and effort.
Coronavirus Disease 2019 (COVID-19) Funds: A recipient of a grant or cooperative
agreement awarded by the Department of Health and Human Services (HHS) with funds made
available under the Coronavirus Preparedness and Response Supplemental Appropriations Act,
2020 (P.L. 116-123); the Coronavirus Aid, Relief, and Economic Security Act, 2020 (the "CARES
Act") (P.L. 116-136); the Paycheck Protection Program and Health Care Enhancement Act (P.L.
116-139); and/or the Consolidated Appropriations Act, 2021, Division M — Coronavirus
Response and Relief Supplemental Appropriations Act, 2021 (P.L. 116-266), agrees, as
applicable to the award, to: 1) comply with existing and/or future directives and guidance from
the Secretary regarding control of the spread of COVID-19; 2) in consultation and coordination
with HHS, provide, commensurate with the condition of the individual, COVID-19 patient care
regardless of the individual's home jurisdiction and/or appropriate public health measures (e.g.,
social distancing, home isolation); and 3) assist the United States Government in the
implementation and enforcement of federal orders related to quarantine and isolation.
In addition, to the extent applicable, Recipient will comply with Section 18115 of the CARES Act,
with respect to the reporting to the HHS Secretary of results of tests intended to detect SARS—
CoV-2 or to diagnose a possible case of COVID-19. Such reporting shall be in accordance with
guidance and direction from HHS and/or CDC. HHS laboratory reporting guidance is posted at:
https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-reporting-gu idance.pdf.
Further, consistent with the full scope of applicable grant regulations (45 C.F.R. 75.322), the
purpose of this award, and the underlying funding, the recipient is expected to provide to CDC
copies of and/or access to COVID-19 data collected with these funds, including but not limited to
data related to COVID-19 testing. CDC will specify in further guidance and directives what is
encompassed by this requirement.
Unallowable Costs:
• Research
• Clinical care
• Publicity and propaganda(lobbying):
o Other than for normal and recognized executive-legislative relationships, no
funds may be used for:
■ publicity or propaganda purposes, for the preparation, distribution, or use
of any material designed to support or defeat the enactment of legislation
before any legislative body
■ the salary or expenses of any grant or contract recipient, or agent acting
for such recipient, related to any activity designed to influence the
enactment of legislation, appropriations, regulation, administrative action,
or Executive order proposed or pending before any legislative body
o See Additional Requirement (AR) 12 for detailed guidance on this prohibition and
additional guidance on lobbying for CDC recipients:
https://www.cdc.gov/grants/documents/Anti-
Lobbying_Restrictions for CDC_Grantees_July_2012.pdf
• All unallowable costs cited in CDC-RFA-IP19-1901 remain in effect, unless specifically
amended in this guidance, in accordance with 45 CFR Part 75 —Uniform Administrative
Requirements, Cost Principles, And Audit Requirements for HHS Awards.
COVID-19 Funding Budget Revision Reauirement: The recipient must submit a revised
budget with a narrative justification within 45 days of receipt of the Notice of Award. Failure to
submit the required information in a timely manner may adversely affect the future funding of
this project. If the information cannot be provided by the due date, you are required to
contact the GMS/GMO identified in the Awarding Agency Contact Information section on the
first page before the due date.
ADMINISTRATIVE REQUIREMENTS
The recipient must respond to the comments in the technical review and/or OGS Budget
Comments in accordance with the recommendations provided in GrantSolutions as a Grant
Note within 45 days of receipt of the Notice of Award. If the information cannot be provided by
the due date, you are required to contact the GMS/GMO identified in the Awarding Agency
Contact Information section on the first page before the due date.
REPORTING REQUIREMENTS
Required Disclosures for Federal Awardee Performance and Integrity Information
System (FAPIIS): Consistent with 45 CFR 75.113, applicants and recipients must disclose in a
timely manner, in writing to the CDC, with a copy to the HHS Office of Inspector General (OIG),
all information related to violations of federal criminal law involving fraud, bribery, or gratuity
violations potentially affecting the federal award. Subrecipients must disclose, in a timely
manner in writing to the prime recipient (pass through entity) and the HHS OIG, all information
related to violations of federal criminal law involving fraud, bribery, or gratuity violations
potentially affecting the federal award. Disclosures must be sent in writing to the CDC and to
the HHS OIG at the following addresses:
CDC, Office of Grants Services
Wayne Woods, Grants Management Specialist
Centers for Disease Control and Prevention
Branch 1
2939 Flowers Road, MS-TV-2
Atlanta, GA 30341
Email: kuv16a�cdc.gov (Include "Mandatory Grant Disclosures" in subject line)
AND
U.S. Department of Health and Human Services
Office of the Inspector General
ATTN: Mandatory Grant Disclosures,
Intake Coordinator
330 Independence Avenue, SW
Cohen Building, Room 5527
Washington, DC 20201
Fax: (202)-205-0604 (Include "Mandatory Grant Disclosures" in subject line)
or Email: MandatorVGranteeDisclosures(a�oig.hhs.gov
Recipients must include this mandatory disclosure requirement in all subawards and
contracts under this award.
Failure to make required disclosures can result in any of the remedies described in 45 CFR
75.371. Remedies for noncompliance, including suspension or debarment (See 2 CFR parts
180 and 376, and 31 U.S.C. 3321).
CDC is required to report any termination of a federal award prior to the end of the period of
performance due to material failure to comply with the terms and conditions of this award in
the OMB-designated integrity and performance system accessible through SAM (currently
FAPIIS). (45 CFR 75.372(b)) CDC must also notify the recipient if the federal award is
terminated for failure to comply with the federal statutes, regulations, or terms and conditions
of the federal award. (45 CFR 75.373(b))
PAYMENT INFORMATION
The HHS Office of the Inspector General(01G) maintains a toll-free number(1-800-HHS-TIPS
[1- 800-447-84771) for receiving information concerning fraud, waste, or abuse under grants
and cooperative agreements. Information also may be submitted by e-mail to
hhstips(aoig.hhs.gov or by mail to Office of the Inspector General, Department of Health and
Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington DC 20201. Such
reports are treated as sensitive material and submitters may decline to give their names if they
choose to remain anonymous.
Payment Management System Subaccount: Funds awarded in support of approved
activities have been obligated in a subaccount in the PMS, herein identified as the "P
Account". Funds must be used in support of approved activities in the NOFO and the
approved application.
The grant document number identified on the bottom of Page 1 of the Notice of Award must
be known in order to draw down funds.
Stewardship: The recipient must exercise proper stewardship over Federal funds by
ensuring that all costs charged to your cooperative agreement are allowable, allocable,
and reasonable and that they address the highest priority needs as they relate to this
program.
All the other terms and conditions issued with the original award remain in effect
throughout the budget period unless otherwise changed, in writing, by the Grants
Management Officer.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
--� Award# 6 NH23IP922612-02-04
Centers for Disease Control and Prevention FAIN# NH23IP922612
Federal Award Date: 03/31/2021
Recipient Information Federal Award Information
1. Recipient Name 11.Award Number
6 N1-123IP922612-02-04
California Department of Public Health 12.Unique Federal Award Identification Number(FAIN)
1615 Capitol Ave NH23I13922612
California Department of Public Health 13.Statutory Authority
Sacramento,CA 95814-5015 Sections 317,317(k)(2)of the Public Health Seivice Act(42 U.S.C.Sections 247b,247b(k)(2)and 247c),as
[NO DATA] amended.
14.Federal Award Project Title
2. Congressional District of Recipient CDC-RFA-113 19-1901 Immunization and Vaccines for Children
06
3. Payment System Identifier(ID)
1743204993A I 15.Assistance Listing Number
4. Employer Identification Number(EIN) 93.268
743204993 16.Assistance Listing Program Title
S. Data Universal Numbering System(DUNS) Immunization Cooperative Agreements
799150615
6. Recipient's Unique Entity Identifier 17.Award Action Type
supplement
7. Project Director or Principal Investigator 18.Is the Award R&D?
No
Ms.Maria Elena Volk
Assistant Branch Chief Summary Federal Award Financial Information
MARIA.VOLK@CDPII.CA.GOV
19. Budget Period Start Date 07/01/2020 -End Date 06/30/202I
(510)620-3748
B. Authorized Official 20. Total Amount of Federal Funds Obligated by this Action $357,026,635.00
20a.Direct Cost Amount $357,026,635.00
Dr.Karen Smith 20b.Indirect Cost Amount $0.00
KAREN.SM11'14@cdph.ca.gov
916-449-5900 21. Authorized Carryover $596,980.00
22. Offset $0.00
23. Total Amount of Federal Funds Obligated this budget period $443,744,881.00
Federal Agency Information
24. Total Approved Cost Sharing or Matching,where applicable $0.00
CDC 011ice of Financial Resources
25. Total Federal and Non-Federal Approved this Budget Period $800,771,516.00
9. Awarding Agency Contact Information
26.Project Period Start Date 07/01/2019 -End Date 06/30/2024
Sharlene Sanders
GMS 27.Total Amount of the Federal Award including Approved
gxl2Cwcdc.gov Cost Sharing or Matching this Project Period $857,720,195.00
678-475-4650
28.Authorized Treatment of Program Income
10.Program Official Contact Information ADDITIONAL COSTS
Divya Cassity 29.Grants Management Officer-Signature
PBEMB CoAg Spccialisl
Freda Johnson
kyg4@cdc.gov
404.718.8962
30. Remarks
This fimding is related to the activities under COVID-19 Vaccination Supplement 4(April 2021)
Paae 1
DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
--� Centers for Disease Control and Prevention Award# 6 NH23IP922612-02-04
FAIN# NH23IP922612
Federal Award Date: 03/31/2021
Recipient Information 33• Approved Budget
(Excludes Direct Assistance)
Recipient Name I. Financial Assistance from the Federal Awarding Agency Only
California Department of Public Health II. Total project costs including grant funds and all other financial participation
1615 Capitol Ave a. Salaries and Wages $1,937,182.00
California Department ol'Public Health b. Fringe Benefits $1,017,876.00
Sacramento,CA 95814-5015
c. Total Personnel Costs $2,955,058.00
[NO DATA]
Congressional District of Recipient d. Equipment $0.00
06 e. Supplies $1,169,849.00
Payment Account Number and Type f. Travel
$84,_45.00
1743204993A1
Employer Identification Number(EIN)Data g• Construction $0.00
743204993 h. Other $719,237,696.00
Universal Numbering System(DUNS)
i. Contractual $77,336,521.00
799150615
Recipient's Unique Entity Identifier j. TOTAL DIRECT COSTS $800,783,369.00
Not Available k. INDIRECT COSTS $585,127.00
31.Assistance Type 1. TOTAL APPROVED BUDGET $801,368,496.00
Cooperative Agreement
in. Federal Share $801,368,496.00
32.Type of Award
Demonstration n. Non-Federal Share $0.00
34.Accounting Classification Codes
FY-ACCOUNT NO. DOCUMENT NO. ADMINISTRATIVE CODE OBJECT CLASS AMT ACTION FINANCIAL ASSISTANCE APPROPRIATION
1-9390GKL 20NH23IP922612C5 IP 41.51 S153,521,453.00 75-2124-0943
I-9390GWA 20NH23II'922612C6 IP 41.51 S203,5057182.00 75-X-0943
Paae 2
J DEPARTMENT OF HEALTH AND HUMAN SERVICES Notice of Award
S':, Centers for Disease Control and Prevention Award# 6 NH23IP922612-02 04
FAIN# NH23IP922612
Federal Award Date: 03/31/2021
Direct Assistance
BUDGET CATEGORIES PREVIOUS AMOUNT(A) AMOUNT THIS ACTION(B) TOTAL(A+B)
Personnel $0.00 $0.00 $0.00
Fringe Benclits $0.00 $0.00 $0.00
Travel $0.00 $0.00 $0.00
Equipment $0.00 $0.00 $0.00
Supplies $0.00 $0.00 $0.00
Contractual $0.00 $0.00 $0.00
Construction $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00
Total $0.00 $0.00 $0.00
I��nc 4
AWARD ATTACHMENTS
California Department of Public Health 6 NH231P922612-02-04
1. Terms and Conditions
ADDITIONAL TERMS AND CONDITIONS OF AWARD
Incorporation: In addition to the federal laws, regulations, policies, and CDC General Terms
and Conditions for Non-research awards at
httr)s://www.cdc.gov/grants/federairegulationspolicies/index.html, the Centers for Disease
Control and Prevention (CDC) hereby incorporates Notice of Funding Opportunity (NOFO)
number IP19- 1901, entitled, Immunization and Vaccines for Children, which are hereby
made a part of this Non-research award, hereinafter referred to as the Notice of Award
(NoA).
Supplemental Component Funding: Additional funding in the amount $357,026,635 is
approved for the Year 02 budget period, which is July 1, 2020 through June 30, 2021.
Recipients have until June 30. 2024 to expend all COVID-19 funds herein and
previously funded.
Overtime: Because overtime costs are a very likely and reasonable expense during the
response to COVID-19, CDC will allow recipients to include projected overtime in their
budgets. Recipients should be careful to estimate costs based on current real-time needs
and will still be required to follow federal rules and regulations in accounting for the
employees' time and effort.
Coronavirus Disease 2019 (COVID-19) Funds: A recipient of a grant or cooperative
agreement awarded by the Department of Health and Human Services (HHS) with funds
made available under the Coronavirus Preparedness and Response Supplemental
Appropriations Act, 2020 (P.L. 116-123); the Coronavirus Aid, Relief, and Economic Security
Act, 2020 (the"CARES Act") (P.L. 116-136); the Paycheck Protection Program and Health
Care Enhancement Act (P.L. 116-139); and/or the Consolidated Appropriations Act, 2021,
Division M - Coronavirus Response and Relief Supplemental Appropriations Act, 2021 (P.L.
116-260), the American Rescue Plan Act of 2021 (P.L. 117-2) agrees, as applicable to the
award, to: 1) comply with existing and/or future directives and guidance from the Secretary
regarding control of the spread of COVID-19; 2) in consultation and coordination with HHS,
provide, commensurate with the condition of the individual, COVID-19 patient care regardless
of the individual's home jurisdiction and/or appropriate public health measures (e.g., social
distancing, home isolation); and 3) assist the United States Government in the
implementation and enforcement of federal orders related to quarantine and isolation.
In addition, to the extent applicable, Recipient will comply with Section 18115 of the CARES
Act, with respect to the reporting to the HHS Secretary of results of tests intended to detect
SARS- CoV-2 or to diagnose a possible case of COVID-19. Such reporting shall be in
accordance with guidance and direction from HHS and/or CDC. HHS laboratory reporting
guidance is posted at: https://www.hhs.gov/sites/default/files/covid-19-laboratory-data-
reporting-guidance.pdf.
Further, consistent with the full scope of applicable grant regulations (45 C.F.R. 75.322), the
purpose of this award, and the underlying funding, the recipient is expected to provide to
CDC copies of and/or access to COVID-19 data collected with these funds, including but not
limited to data related to COVID-19 testing. CDC will specify in further guidance and
directives what is encompassed by this requirement.
Unallowable Costs:
• Research
• Clinical care
• Publicity and propaganda(lobbying):
o Other than for normal and recognized executive-legislative relationships, no
funds may be used for:
• publicity or propaganda purposes, for the preparation, distribution, or use
of any material designed to support or defeat the enactment of legislation
before any legislative body
• the salary or expenses of any grant or contract recipient, or agent acting
for such recipient, related to any activity designed to influence the
enactment of legislation, appropriations, regulation, administrative
action, or Executive order proposed or pending before any legislative
body
o See Additional Requirement (AR) 12 for detailed guidance on this prohibition
and additional guidance on lobbying for CDC recipients:
https://www.cdc.gov/grants/documents/Anti-
Lobbying_Restrictions for CDC_Grantees_July_2012.pdf
• All unallowable costs cited in CDC-RFA-IP19-1901 remain in effect, unless specifically
amended in this guidance, in accordance with 45 CFR Part 75 - Uniform Administrative
Requirements, Cost Principles, And Audit Requirements for HHS Awards.
COVID-19 Funding Budget Revision Requirement: The recipient must submit a revised
budget with a narrative justification within 60 days of receipt of the Notice of Award. If the
date falls on a weekend or holiday, the submission will be due the following business day.
Failure to submit the required information in a timely manner may adversely affect the future
funding of this project. If the information cannot be provided by the due date, you are
required to contact the GMS/GMO identified in the Awarding Agency Contact Information
section on the first page before the due date.
REPORTING REQUIREMENTS
Required Disclosures for Federal Awardee Performance and Integrity Information
System (FAPIIS): Consistent with 45 CFR 75.113, applicants and recipients must disclose in
a timely manner, in writing to the CDC, with a copy to the HHS Office of Inspector General
(OIG), all information related to violations of federal criminal law involving fraud, bribery, or
gratuity violations potentially affecting the federal award. Subrecipients must disclose, in a
timely manner in writing to the prime recipient (pass through entity) and the HHS OIG, all
information related to violations of federal criminal law involving fraud, bribery, or gratuity
violations potentially affecting the federal award. Disclosures must be sent in writing to the
CDC and to the HHS OIG at the following addresses:
CDC, Office of Grants Services
Wayne Woods, Grants Management Specialist Centers for Disease Control and Prevention
Branch 1
2939 Flowers Road, MS-TV-2 Atlanta, GA 30341
Email: kuv1(cD_cdc.gov (Include "Mandatory Grant Disclosures" in subject line)
AND
U.S. Department of Health and Human Services Office of the Inspector General
ATTN: Mandatory Grant Disclosures, Intake Coordinator 3301 Independence Avenue, SW
Cohen Building, Room 5527 Washington, DC 20201
Fax: (202)-205-0604 (Include "Mandatory Grant Disclosures" in subject line) or Email:
MandatoryGranteeDisclosures(ia,oig.hhs.ciov
Recipients must include this mandatory disclosure requirement in all subawards and
contracts under this award.
Failure to make required disclosures can result in any of the remedies described in 45 CFR
75.371. Remedies for noncompliance, including suspension or debarment (See 2 CFR parts
180 and 376, and 31 U.S.C. 3321).
CDC is required to report any termination of a federal award prior to the end of the period of
performance due to material failure to comply with the terms and conditions of this award in
the OMB-designated integrity and performance system accessible through SAM (currently
FAPIIS). (45 CFR 75.372(b)) CDC must also notify the recipient if the federal award is
terminated for failure to comply with the federal statutes, regulations, or terms and conditions
of the federal award. (45 CFR 75.373(b))
PAYMENT INFORMATION
The HHS Office of the Inspector General(OIG) maintains a toll-free number(1-800-HHS-
TIPS[1- 800-447-8477]) for receiving information concerning fraud, waste, or abuse under
grants and cooperative agreements. Information also may be submitted by e-mail to
hhstips EDoia.hhs.gov or by mail to Office of the Inspector General, Department of Health and
Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington DC 20201.
Such reports are treated as sensitive material and submitters may decline to give their
names if they choose to remain anonymous.
Payment Management System Subaccount: Funds awarded in support of approved
activities have been obligated in a subaccount in the PMS, herein identified as the "P
Account". Funds must be used in support of approved activities in the NOFO and the
approved application.
The grant document number identified on the bottom of Page 2 of the Notice of Award must
be known to draw down funds.
Stewardship: The recipient must exercise proper stewardship over Federal funds by
ensuring that all costs charged to your cooperative agreement are allowable, allocable, and
reasonable and that they address the highest priority needs as they relate to this program.
All the other terms and conditions issued with the original award remain in effect throughout
the budget period unless otherwise changed, in writing, by the Grants Management Officer.
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 1 of 4
Exhibit E
Additional Provisions
1. Cancellation /Termination
A. This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days
advance written notice to the Grantee.
B. CDPH reserves the right to cancel or terminate this Grant immediately for cause. The
Grantee may submit a written request to terminate this Grant only if CDPH substantially fails
to perform its responsibilities as provided herein.
C. The term "for cause" shall mean that the Grantee fails to meet the terms, conditions, and/or
responsibilities of this agreement. Causes for termination include, but are not limited to the
following occurrences:
1) If the Grantee knowingly furnishes any statement, representation, warranty, or
certification in connection with the agreement, which representation is materially false,
deceptive, incorrect, or incomplete.
2) If the Grantee fails to perform any material requirement of this Grant or defaults in
performance of this agreement.
3) If the Grantee files for bankruptcy, or if CDPH determines that the Grantee becomes
financially incapable of completing this agreement.
D. Grant termination or cancellation shall be effective as of the date indicated in CDPH's
notification to the Grantee. The notice shall stipulate any final performance, invoicing or
payment requirements.
E. In the event of early termination or cancellation, the Grantee shall be entitled to
compensation for services performed satisfactorily under this agreement and expenses
incurred up to the date of cancellation and any non-cancelable obligations incurred in
support of this Grant.
F. In the event of termination, and at the request of CDPH, the Grantee shall furnish copies of
all proposals, specifications, designs, procedures, layouts, copy, and other materials related
to the services or deliverables provided under this Grant, whether finished or in progress on
the termination date.
G. The Grantee will not be entitled to reimbursement for any expenses incurred for services
and deliverables pursuant to this agreement after the effective date of termination.
H. Upon receipt of notification of termination of this Grant, and except as otherwise specified by
CDPH, the Grantee shall:
1) Place no further order or subgrants for materials, services, or facilities.
Page 1 of 4
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 2 of 4
Exhibit E
Additional Provisions
2) Settle all outstanding liabilities and all claims arising out of such termination of orders
and subgrants.
3) Upon the effective date of termination of the Grant and the payment by CDPH of all
items properly changeable to CDPH hereunder, Grantee shall transfer, assign and make
available to CDPH all property and materials belonging to CDPH, all rights and claims to
any and all reservations, grants, and arrangements with owners of media/PR materials,
or others, and shall make available to CDPH all written information regarding CDPH's
media/PR materials, and no extra compensation is to be paid to Grantee for its services.
4) Take such action as may be necessary, or as CDPH may specify, to protect and
preserve any property related to this agreement which is in the possession of the
Grantee and in which CDPH has or may acquire an interest.
I. CDPH may, at its discretion, require the Grantee to cease performance of certain
components of the Scope of Work as designated by CDPH and complete performance of
other components prior to the termination date of the Grant.
2. Avoidance of Conflicts of Interest by Grantee
A. CDPH intends to avoid any real or apparent conflict of interest on the part of the Grantee,
subgrants, or employees, officers and directors of the Grantee or subgrants. Thus, CDPH
reserves the right to determine, at its sole discretion, whether any information, assertion or
claim received from any source indicates the existence of a real or apparent conflict of
interest; and, if a conflict is found to exist, to require the Grantee to submit additional
information or a plan for resolving the conflict, subject to CDPH review and prior approval.
B. Conflicts of interest include, but are not limited to:
1) An instance where the Grantee or any of its subgrants, or any employee, officer, or
director of the Grantee or any subgrant or has an interest, financial or otherwise,
whereby the use or disclosure of information obtained while performing services under
the grant would allow for private or personal benefit or for any purpose that is contrary to
the goals and objectives of the grant.
2) An instance where the Grantee's or any subgrant's employees, officers, or directors use
their positions for purposes that are, or give the appearance of being, motivated by a
desire for private gain for themselves or others, such as those with whom they have
family, business or other ties.
C. If CDPH is or becomes aware of a known or suspected conflict of interest, the Grantee will
be given an opportunity to submit additional information or to resolve the conflict. A Grantee
with a suspected conflict of interest will have five (5)working days from the date of
notification of the conflict by CDPH to provide complete information regarding the suspected
conflict. If a conflict of interest is determined to exist by CDPH and cannot be resolved to
the satisfaction of CDPH, the conflict will be grounds for terminating the grant. CDPH may,
Page 2 of 4
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 3 of 4
Exhibit E
Additional Provisions
at its discretion upon receipt of a written request from the Grantee, authorize an extension of
the timeline indicated herein.
3. Dispute Resolution Process
A. A Grantee grievance exists whenever there is a dispute arising from CDPH's action in the
administration of an agreement. If there is a dispute or grievance between the Grantee and
CDPH, the Grantee must seek resolution using the procedure outlined below.
1) The Grantee should first informally discuss the problem with the CDPH Program Grant
Manager. If the problem cannot be resolved informally, the Grantee shall direct its
grievance together with any evidence, in writing, to the program Branch Chief. The
grievance shall state the issues in dispute, the legal authority or other basis for the
Grantee's position and the remedy sought. The Branch Chief shall render a decision
within ten (10) working days after receipt of the written grievance from the Grantee. The
Branch Chief shall respond in writing to the Grantee indicating the decision and reasons
therefore. If the Grantee disagrees with the Branch Chiefs decision, the Grantee may
appeal to the second level.
2) When appealing to the second level, the Grantee must prepare an appeal indicating the
reasons for disagreement with Branch Chiefs decision. The Grantee shall include with
the appeal a copy of the Grantee's original statement of dispute along with any
supporting evidence and a copy of the Branch Chiefs decision. The appeal shall be
addressed to the Deputy Director of the division in which the branch is organized within
ten (10)working days from receipt of the Branch Chiefs decision. The Deputy Director
of the division in which the branch is organized or his/her designee shall meet with the
Grantee to review the issues raised. A written decision signed by the Deputy Director of
the division in which the branch is organized or his/her designee shall be directed to the
Grantee within twenty (20) working days of receipt of the Grantee's second level appeal.
B. If the Grantee wishes to appeal the decision of the Deputy Director of the division in which
the branch is organized or his/her designee, the Grantee shall follow the procedures set
forth in Division 25.1 (commencing with Section 38050) of the Health and Safety Code and
the regulations adopted thereunder. (Title 1, Division 2, Chapter 2, Article 3 (commencing
with Section 1140) of the California Code of Regulations).
C. Disputes arising out of an audit, examination of an agreement or other action not covered by
subdivision (a) of Section 20204, of Chapter 2.1, Title 22, of the California Code of
Regulations, and for which no procedures for appeal are provided in statute, regulation or
the Agreement, shall be handled in accordance with the procedures identified in Sections
51016 through 51047, Title 22, California Code of Regulations.
D. Unless otherwise stipulated in writing by CDPH, all dispute, grievance and/or appeal
correspondence shall be directed to the CDPH Grant Manager.
Page 3 of 4
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-10856
Page 4 of 4
Exhibit E
Additional Provisions
E. There are organizational differences within CDPH's funding programs and the management
levels identified in this dispute resolution provision may not apply in every contractual
situation. When a grievance is received and organizational differences exist, the Grantee
shall be notified in writing by the CDPH Grant Manager of the level, name, and/or title of the
appropriate management official that is responsible for issuing a decision at a given level.
4. Executive Order N-6-22 - Economic Sanctions
On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding
Economic Sanctions against Russia and Russian entities and individuals. "Economic Sanctions"
refers to sanctions imposed by the U.S. government in response to Russia's actions in Ukraine, as
well as any sanctions imposed under state law. The EO directs state agencies to terminate
contracts with, and to refrain from entering any new contracts with, individuals or entities that are
determined to be a target of Economic Sanctions. Accordingly, should the State determine Grantee
is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned
individuals or entities, that shall be grounds for termination of this Agreement. The State shall
provide Grantee advance written notice of such termination, allowing Grantee at least 30 calendar
days to provide a written response. Termination shall be at the sole discretion of the State.
Prior to awarding and executing grant, the State shall conduct its due diligence to determine if the
proposed awardee is a named individual or entity on federal and any state Economic Sanctions
lists. If the proposed awardee is listed, the State shall refrain from entering into the Grant.
Resources for locating names of sanctioned individuals and entities are available on the DGS Office
of Legal Services' webpage: Ukraine-Russia (ca.gov).
If this Agreement is valued at $5 million or more, upon execution the State will send a separate
notification outlining additional requirements specified under the EO. Compliance with this
Economic Sanctions imposed in response to Russia's actions in Ukraine is required, including with
respect to, but not limited to, the federal executive orders identified in the EO and the sanctions
identified on the U.S. Department of the Treasury website (hftps://home.treasury.gov/policy-
issues/financial-sanctions/sanctionsprograms-and-country-information/ukraine-russia-
related-sanctions). Failure to comply may result in the termination of this Agreement.
Page 4 of 4
California Department of Public Health
Fresno County Department of Public Health,
Immunization Program
Grant Agreement#: 22-108561
Exhibit F
Federal Terms and Conditions
(For Federally Funded Grant Agreements)
This exhibit contains provisions that require strict adherence to various contracting laws and
policies.
Index of Special Terms and Conditions
1. Federal Funds
2. Federal Equal Employment Opportunity Requirements
3. Debarment and Suspension Certification
4. Covenant Against Contingent Fees
5. Lobbying Restrictions and Disclosure Certification
6. Additional Restrictions
7. Human Subjects Use Requirments
8. Audit and Record Retention
9. Federal Requirements
CDPH(rev.12-21) Page 1 of 13
California Department of Public Health— Federal Terms and Conditions Exhibit F
1. Federal Funds
(Applicable only to that portion of an agreement funded in part or whole with federal funds.)
a. It is mutually understood between the parties that this Agreement may have been written
before ascertaining the availability of congressional appropriation of funds, for the mutual
benefit of both parties, in order to avoid program and fiscal delays which would occur if
the Agreement were executed after that determination was made.
b. This Agreement is valid and enforceable only if sufficient funds are made available to the
State by the United States Government for the fiscal years covered by the term of this
Agreement. In addition, this Agreement is subject to any additional restrictions,
limitations, or conditions enacted by the Congress or any statute enacted by the Congress
which may affect the provisions, terms or funding of this Agreement in any manner.
c. It is mutually agreed that if the Congress does not appropriate sufficient funds for the
program, this Agreement shall be amended to reflect any reduction in funds.
d. CDPH has the option to invalidate or cancel the Agreement with 30-days advance written
notice or to amend the Agreement to reflect any reduction in funds.
2. Federal Equal Opportunity Requirements
(Applicable to all federally funded grants entered into by the California Department of Public
Health (CDPH) formerly known as California Department of Health Services (CDHS).)
a. The Grantee will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, national origin, physical or mental handicap,
disability, age or status as a disabled veteran or veteran of the Vietnam era. The Grantee
will take affirmative action to ensure that qualified applicants are employed, and that
employees are treated during employment, without regard to their race, color, religion,
sex, national origin, physical or mental handicap, disability,, age or status as a disabled
veteran or veteran of the Vietnam era. Such action shall include, but not be limited to the
following: employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and career
development opportunities and selection for training, including apprenticeship. The
Grantee agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the Federal Government or CDPH, setting forth
the provisions of the Equal Opportunity clause, Section 503 of the Rehabilitation Act of
1973 and the affirmative action clause required by the Vietnam Era Veterans'
Readjustment Assistance Act of 1974 (38 U.S.C. 4212). Such notices shall state the
Grantee's obligation under the law to take affirmative action to employ and advance in
employment qualified applicants without discrimination based on their race, color, religion,
sex, national origin physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era and the rights of applicants and employees.
b. The Grantee will, in all solicitations or advancements for employees placed by or on behalf
of the Grantee, state that all qualified applicants will receive consideration for employment
CDPH(rev. 12-21) Page 2 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
without regard to race, color, religion, sex, national origin physical or mental handicap,
disability, age or status as a disabled veteran or veteran of the Vietnam era.
c. The Grantee will send to each labor union or representative of workers with which it has
a collective bargaining agreement or other contract or understanding a notice, to be
provided by the Federal Government or the State, advising the labor union or workers'
representative of the Grantee's commitments under the provisions herein and shall post
copies of the notice in conspicuous places available to employees and applicants for
employment.
d. The Grantee will comply with all provisions of and furnish all information and reports
required by Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Era
Veterans' Readjustment Assistance Act of 1974 (38 U.S.C. 4212) and of the Federal
Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending
Executive Order 11246 Relating to Equal Employment Opportunity,' and as
supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract
Compliance Programs, Equal Employment Opportunity, Department of Labor," and of the
rules, regulations, and relevant orders of the Secretary of Labor.
e. The Grantee will furnish all information and reports required by Federal Executive Order
No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order
11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation
at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor," and the Rehabilitation Act of 1973, and
by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and
will permit access to its books, records, and accounts by the State and its designated
representatives and the Secretary of Labor for purposes of investigation to ascertain
compliance with such rules, regulations, and orders.
f. In the event of the Grantee's noncompliance with the requirements of the provisions
herein or with any federal rules, regulations, or orders which are referenced herein, this
Agreement may be cancelled, terminated, or suspended in whole or in part and the
Grantee may be declared ineligible for further federal and state contracts in accordance
with procedures authorized in Federal Executive Order No. 11246 as amended and such
other sanctions may be imposed and remedies invoked as provided in Federal Executive
Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive
Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by
regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs,
Equal Employment Opportunity, Department of Labor," or by rule, regulation, or order of
the Secretary of Labor, or as otherwise provided by law.
g. The Grantee will include the provisions of Paragraphs a through g in every subcontract
or purchase order unless exempted by rules, regulations, or orders of the Secretary of
Labor issued pursuant to Federal Executive Order No. 11246 as amended, including by
Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal
Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60, "Office
of the Federal Contract Compliance Programs, Equal Employment Opportunity,
Department of Labor,"or Section 503 of the Rehabilitation Act of 1973 or(38 U.S.C.4212)
of the Vietnam Era Veteran's Readjustment Assistance Act, so that such provisions will
be binding upon each subgrantee or vendor. The Grantee will take such action with
CDPH(rev. 12-21) Page 3 of 13
California Department of Public Health— Federal Terms and Conditions Exhibit F
respect to any subcontract or purchase order as the Director of the Office of Federal
Contract Compliance Programs or CDPH may direct as a means of enforcing such
provisions including sanctions for noncompliance provided, however, that in the event the
Grantee becomes involved in, or is threatened with litigation by a subgrantee or vendor
as a result of such direction by CDPH, the Grantee may request in writing to CDPH, who,
in turn, may request the United States to enter into such litigation to protect the interests
of the State and of the United States.
3. Debarment and Suspension Certification
a. By signing this Grant, the Grantee agrees to comply with applicable federal suspension
and debarment regulations including, but not limited to 7 CFR Part 3017, 45 CFR 76, 40
CFR 32 or 34 CFR 85.
b. By signing this Grant, the Grantee certifies to the best of its knowledge and belief, that it
and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any federal department or agency;
(2) Have not within a three-year period preceding this application/proposal/agreement
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;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State or local) with commission of any of the offenses
enumerated in Paragraph b(2) herein; and
(4) Have not within a three-year period preceding this application/proposal/agreement
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(5) Shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under federal regulations (i.e., 48 CFR part 9, subpart 9.4),
debarred, suspended, declared ineligible, or voluntarily excluded from participation in
such transaction, unless authorized by the State.
(6) Will include a clause entitled, "Debarment and Suspension Certification" that
essentially sets forth the provisions herein, in all lower tier covered transactions and
in all solicitations for lower tier covered transactions.
c. If the Grantee is unable to certify to any of the statements in this certification, the Grantee
shall submit an explanation to the CDPH Program Contract Manager.
d. The terms and definitions herein have the meanings set out in the Definitions and
Coverage sections of the rules implementing Federal Executive Order 12549.
CDPH(rev. 12-21) Page 4 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
e. If the Grantee knowingly violates this certification, in addition to other remedies available
to the Federal Government, the CDPH may terminate this Agreement for cause or default.
4. Covenant Against Contingent Fees
The Grantee warrants that no person or selling agency has been employed or retained to
solicit/secure this Grant upon an agreement of understanding for a commission, percentage,
brokerage, or contingent fee, except bona fide employees or bona fide established
commercial or selling agencies retained by the Grantee for the purpose of securing business.
For breach or violation of this warranty, CDPH shall have the right to annul this Grant without
liability or in its discretion to deduct from the Grant price or consideration, or otherwise
recover, the full amount of such commission, percentage, and brokerage or contingent fee.
5. Lobbying Restrictions and Disclosure Certification
(Applicable to federally funded grants in excess of $100,000 per Section 1352 of the 31,
U.S.C.)
a. Certification and Disclosure Requirements
(1) Each person (or recipient)who requests or receives a grant, subgrant, which is subject
to Section 1352 of the 31, U.S.C., and which exceeds $100,000 at any tier, shall file
a certification (in the form set forth in Attachment 1, consisting of one page, entitled
"Certification Regarding Lobbying")that the recipient has not made, and will not make,
any payment prohibited by Paragraph b of this provision.
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2, entitled
"Standard Form-LLL 'disclosure of Lobbying Activities"') if such recipient has made or
has agreed to make any payment using nonappropriated funds (to include profits from
any covered federal action) in connection with a grant or any extension or amendment
of that grant, which would be prohibited under Paragraph b of this provision if paid for
with appropriated funds.
(3) Each recipient shall file a disclosure form at the end of each calendar quarter in which
there occurs any event that requires disclosure or that materially affect the accuracy
of the information contained in any disclosure form previously filed by such person
under Paragraph a(2) herein. An event that materially affects the accuracy of the
information reported includes:
(a) A cumulative increase of $25,000 or more in the amount paid or expected to be
paid for influencing or attempting to influence a covered federal action;
(b) A change in the person(s) or individuals(s) influencing or attempting to influence a
covered federal action; or
(c) A change in the officer(s), employee(s), or member(s) contacted for the purpose
of influencing or attempting to influence a covered federal action.
(4) Each person (or recipient) who requests or receives from a person referred to in
CDPH(rev. 12-21) Page 5 of 13
California Department of Public Health— Federal Terms and Conditions Exhibit F
Paragraph a(1) of this provision a grant or subgrant exceeding $100,000 at any tier
under a grant shall file a certification, and a disclosure form, if required, to the next tier
above.
(5) All disclosure forms (but not certifications) shall be forwarded from tier to tier until
received by the person referred to in Paragraph a(1) of this provision. That person
shall forward all disclosure forms to CDPH Program Contract Manager.
b. Prohibition
Section 1352 of Title 31, U.S.C., provides in part that no appropriated funds may be
expended by the recipient of a federal contract or agreement, grant, loan, or cooperative
agreement to pay any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with any of the following covered
federal actions: the awarding of any federal contract or agreement, the making of any
federal grant, the making of any federal loan, entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification of any federal
contract or agreement, grant, loan, or cooperative agreement.
6. Additional Restrictions
Grantee shall comply with the restrictions under Division F, Title V, Section 503 of the
Consolidated Appropriations Act, 2012 (H.R. 2055), which provides that:
"SEC. 503.(a) No part of any appropriation contained in this Act or transferred pursuant
to section 4002 of Public Law 111-148 shall be used, other than for normal and
recognized executive-legislative relationships, for publicity or propaganda purposes, for
the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic
communication, radio, television, or video presentation designed to support or defeat the
enactment of legislation before the Congress or any State or local legislature or legislative
body, except in presentation to the Congress or any State or local legislature itself, or
designed to support or defeat any proposed or pending regulation, administrative action,
or order issued by the executive branch of any State or local government, except in
presentation to the executive branch of any State or local government itself.
(b) No part of any appropriation contained in this Act or transferred pursuant to section
4002 of Public Law 111-148 shall be used to pay the salary or expenses of any grant or
contract recipient, or agent acting for such recipient, related to any activity designed to
influence the enactment of legislation, appropriations, regulation, administrative action, or
Executive order proposed or pending before the Congress or any State government,
State legislature or local legislature or legislative body, other than for normal and
recognized executive-legislative relationships or participation by an agency or officer of a
State, local or tribal government in policymaking and administrative processes within the
executive branch of that government.
(c) The prohibitions in subsections (a) and (b) shall include any activity to advocate or
promote any proposed, pending or future Federal, State or local tax increase, or any
proposed, pending, or future requirement or restriction on any legal consumer product,
including its sale or marketing, including but not limited to the advocacy or promotion of
gun control."
CDPH(rev. 12-21) Page 6 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
7. Human Subjects Use Requirements
(Applicable only to federally funded agreements in which performance, directly or through a
subgrantee/subaward, includes any tests or examination of materials derived from the human
body.)
By signing this Agreement, Grantee agrees that if any performance under this Agreement or
any subcontract or subagreement includes any tests or examination of materials derived from
the human body for the purpose of providing information, diagnosis, prevention, treatment or
assessment of disease, impairment, or health of a human being, all locations at which such
examinations are performed shall meet the requirements of 42 U.S.C. Section 263a (CLIA)
and the regulations thereunder.
8. Audit and Record Retention
(Applicable to agreements in excess of $10,000.)
a. The Grantee shall maintain books, records, documents, and other evidence, accounting
procedures and practices, sufficient to properly reflect all direct and indirect costs of
whatever nature claimed to have been incurred in the performance of this Agreement,
including any matching costs and expenses. The foregoing constitutes "records" for the
purpose of this provision.
b. The Grantee's facility or office or such part thereof as may be engaged in the performance
of this Agreement and his/her records shall be subject at all reasonable times to
inspection, audit, and reproduction.
c. Grantee agrees that CDPH, the Bureau of State Audits, or their designated
representatives including the Comptroller General of the United States shall have the right
to review and to copy any records and supporting documentation pertaining to the
performance of this Agreement. Grantee agrees to allow the auditor(s) access to such
records during normal business hours and to allow interviews of any employees who
might reasonably have information related to such records. Further, the Grantee agrees
to include a similar right of the State to audit records and interview staff in any subgrantee
related to performance of this Agreement. (GC 8546.7, CCR Title 2, Section 1896).
d. The Grantee shall preserve and make available his/her records (1) for a period of three
years from the date of final payment under this Agreement, and (2)for such longer period,
if any, as is required by applicable statute, by any other provision of this Agreement, or
by subparagraphs (1) or (2) below.
(1) If this Agreement is completely or partially terminated, the records relating to the work
terminated shall be preserved and made available for a period of three years from the
date of any resulting final settlement.
(2) If any litigation, claim, negotiation, audit, or other action involving the records has been
started before the expiration of the three-year period, the records shall be retained
until completion of the action and resolution of all issues which arise from it, or until
the end of the regular three-year period, whichever is later.
CDPH(rev. 12-21) Page 7 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
f. The Grantee may, at its discretion, following receipt of final payment under this
Agreement, reduce its accounts, books and records related to this Agreement to
electoronic data storage device. Upon request by an authorized representative to inspect,
audit or obtain copies of said records, the Grantee and/or Subgrantee must supply or
make available applicable devices, hardware, and/or software necessary to view, copy
and/or print said records.
9. Federal Requirements
Grantee agrees to comply with and shall require all subgrantee's, if any, to comply with
all applicable Federal requirements including but not limited to the United States Code,
the Code of Federal Regulations, the Funding Opportunity Announcement, the Notice of
Award, the funding agreement, and any memoranda or letter regarding the applicable
Federal requirements.
CDPH(rev. 12-21) Page 8 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
Attachment 1
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
an agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the making, awarding or entering into of this Federal
contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of this Federal contract, grant, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency of the
United States Government, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal contract, grant, or
cooperative agreement, the undersigned shall complete and submit Standard Form LLL,
"Disclosure of Lobbying Activities" in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subGrantees, subgrants, and contracts
under grants and cooperative agreements) of$100,000 or more, and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
County of Fresno Sal Quintero
Name of Grantee Printed Name of Person Signing for Grantee
22-10785
Contract/ Grant Number Sig atu eVfPeson Signing for Grantee
Ch ' ane Board of Supervisors of the
A rip l 25, 2023 County of Fresno
Date Title ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
After execution by or on behalf of Grantee, please return to: County of Fresno,State of California
By ,� J Greer Deputy
CDPH(rev. 12-21) Page 9 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
California Department of Public Health
Immunization Branch
850 Marina Bay Pkwy., Bldg. P
Richmond, CA 94804
CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address.
CDPH(rev. 12-21) Page 10 of 13
California Department of Public Health—Federal Terms and Conditions Exhibit F
Attachment 2
CERTIFICATION REGARDING LOBBYING
Approved by OMB Complete this form to disclose lobbying
activities pursuant to 31 U.S.C. 13520348-0046
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
[ ] a. contract [ ] a. bid/offer/application [ ] a. initial filing
b. grant b. initial award b. material change
c. cooperative c. post-award For Material Change Only:
agreement
d. loan Year quarter
e. loan guarantee date of last report'
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter
Name
and Address of Prime:
❑ Prime ❑ Subawardee
Tier �, if known:
6. Federal Department/Agency! 7. Federal Program Name/Description:
8. Federal Action Number, if known: 9. Award Amount, if known:
10.a. Name and Address of Lobbying b. Individuals Performing Services (including
Registrant address if different from 10a.
(If individual, last name, first name, MI): (Last name, First name, MI):
11.Information requested through this form
is authorized by title 31 U.S.C. section Signature:
1352. This disclosure of lobbying
activities is a material representation of Print Name:
fact upon which reliance was placed by Title:
the tier above when this transaction was Telephone No.: Date:
made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352.
This information will be available for
public inspection. required disclosure
shall be subject to a not more than
$100,000 for each such failure.
Federal Use Only Authorized for Local Reproduction
Standard Form-LLL (Rev. 7-97)
CDPH(rev. 12-21) Page 11 of 13
California Department of Public Health— Federal Terms and Conditions Exhibit F
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal
recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous
filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or
agreement to make payment to any lobbying entity for influencing or attempting to influence an officer
or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with a covered Federal action. Complete all items
that apply for both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured
to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a
material change to the information previously reported, enter the year and quarter in which the
change occurred. Enter the date of the last previously submitted report by this reporting entity
for this covered Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include
Congressional District, if known. Check the appropriate classification of the reporting entity that
designates if it is, or expects to be a prime or subaward recipient. Identify the tier of the
subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are
not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name,
address, city, State and zip code of the prime Federal recipient. Include Congressional District,
if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least
one organizational level below agency name, if known. For example, Department of
Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known,
enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative
agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified
in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant
announcement number; the contract, grant, or loan award number; the application/proposal
control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal
agency, enter the Federal amount of the award/loan commitment for the prime entity identified
in item 4 or 5.
CDPH(rev. 12-21) Page 12 of 13
California Department of Public Health— Federal Terms and Conditions Exhibit F
10.(a) Enter the full name, address, city, State and zip code of the lobbying registrant under the
Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to
influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services and include full address if
different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11.The certifying official shall sign and date the form, print his/her name, title, and telephone
number.
According to the Paperwork Reduction Act,as amended, no persons are required to respond to a collection of information unless it displays a valid
OMB Control Number.The valid OMB control number for this information collection is OMB No.0348-0046.Public reporting burden for this collection
of information is estimated to average 10 minutes per response,including time for reviewing instructions,searching existing data sources,gathering
and maintaining the data needed,and completing and reviewing the collection of information. Send comments regarding the burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project(0348-0046),Washington,DC 20503.
CDPH(rev. 12-21) Page 13 of 13
Contractor Certification Clauses
CCC 04/2017
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am
duly authorized to legally bind the prospective Contractor to the clause(s) listed
below. This certification is made under the laws of the State of California.
Contractor/Bidder Firm Name (Printed) Federal ID Number
County of Fresno 94-6000512
By (Authorized Signature) ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California _
Print ame and Title of Person Signing BY , _6 Deputy
Sal Quintero, Chairman of the Board of Supervisors of the County of Fresno
Date Executed Executed in the County of
April 25, 2023 Fresno
CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the
nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2,
Section 11102) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution,
dispensation, possession or use of a controlled substance is prohibited and specifying
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will:
1) receive a copy of the company's drug-free workplace policy statement; and,
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et
seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that
no more than one (1) final unappealable finding of contempt of court by a Federal court
has been issued against Contractor within the immediately preceding two-year period
because of Contractor's failure to comply with an order of a Federal court, which orders
Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract
Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective January 1,
2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of 30
multiplied by the number of full time attorneys in the firm's offices in the State, with the
number of hours prorated on an actual day basis for any contract period of less than a full
year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel, garments or
corresponding accessories, or the procurement of equipment, materials, or supplies,
other than procurement related to a public works contract, declare under penalty of
perjury that no apparel, garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been laundered or produced
in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under
penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor,
or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under
penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor.
The contractor further declares under penalty of perjury that they adhere to the Sweatfree
Code of Conduct as set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
b. The contractor agrees to cooperate fully in providing reasonable access to the
contractor's records, documents, agents or employees, or premises if reasonably
required by authorized officials of the contracting agency, the Department of Industrial
Relations, or the Department of Justice to determine the contractor's compliance with the
requirements under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code section 10295.3.
8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions
regarding current or former state employees. If Contractor has any questions on the
status of any person rendering services or involved with the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). No officer or employee shall engage in any employment, activity or enterprise from
which the officer or employee receives compensation or has a financial interest and
which is sponsored or funded by any state agency, unless the employment, activity or
enterprise is required as a condition of regular state employment.
2). No officer or employee shall contract on his or her own behalf as an independent
contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
1). For the two-year period from the date he or she left state employment, no former state
officer or employee may enter into a contract in which he or she engaged in any of the
negotiations, transactions, planning, arrangements or any part of the decision-making
process relevant to the contract while employed in any capacity by any state agency.
2). For the twelve-month period from the date he or she left state employment, no former
state officer or employee may enter into a contract with any state agency if he or she was
employed by that state agency in a policy-making position in the same general subject
area as the proposed contract within the 12-month period prior to his or her leaving state
service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission, payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker's
Compensation or to undertake self-insurance in accordance with the provisions, and
Contractor affirms to comply with such provisions before commencing the performance of
the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies
with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on
the basis of disability, as well as all applicable regulations and guidelines issued pursuant
to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifying that the contractor is currently qualified to do business in
California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are
some statutory exceptions to taxation, rarely will a corporate contractor performing within
the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will
determine whether a corporation is in good standing by calling the Office of the Secretary
of State.
6. RESOLUTION: A county, city, district, or other local public body must provide the State
with a copy of a resolution, order, motion, or ordinance of the local governing body which
by law has authority to enter into an agreement, authorizing execution of the agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall
not be: (1) in violation of any order or resolution not subject to review promulgated by the
State Air Resources Board or an air pollution control district; (2) subject to cease and
desist order not subject to review issued pursuant to Section 13301 of the Water Code for
violation of waste discharge requirements or discharge prohibitions; or (3) finally
determined to be in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT OFFICE OF LEGAL SERVICES
DGS OLS 04(Rev.01117)
Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to,or
otherwise proposes to enter into or renew a contract with, a state agency with respect to any
contract in the amount of$100,000 or above shall certify, under penalty of perjury, at the time
the bid or proposal is submitted or the contract is renewed, all of the following:
1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after
January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section
51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the
Government Code); and
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after
January 1, 2017, if a Contractor has an internal policy against a sovereign nation or
peoples recognized by the United States government, the Contractor certifies that such
policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code)
or the Fair Employment and Housing Act (Section 12960 of the Government Code).
CERTIFICATION
I, the official named below, certify under penalty of perjury under the laws of the State of
California that the foregoing is true and correct.
Proposer/Bidder Firm Name(Printed) Federal ID Number
County of Fresno 94-6000512
By (Authorized Signature)
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
Printed Name and Title of Person Signing ` ,
Byu ,n'-0i4.r>� Deputy
Sal Quintero, Chairman of the Board of supervisors of the County of Fresno
Executed in the County of Executed in the State of
Fresno California
Date Executed
April 25, 2023
AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CAIFORNIA
California Department of Public Health
No./Name: State Grant Agreement No. 22-10856 /Assist local health departments in preventing
and controlling vaccine-preventable diseases in the local health jurisdiction.
Term: July 1, 2022—June 30, 2027
Fund/Subclass: 0001/10000
Organization#: 56201657
Revenue Account#: 4380