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STATE DPH-Syphilis Outbreak Strategy_A-23-224.pdf
cot, County of Fresno Hall of Records, Room 301 2281 Tulare Street o Fresno,California ' Board of Supervisors 93721-2198 O Telephone:(559)600-3529 FRESH Minute Order Toll Free: 1-800-742-1011 www.co.fresno.ca.us May 23, 2023 Present: 5- Supervisor Steve Brandau,Vice Chairman Nathan Magsig, Supervisor Buddy Mendes, Supervisor Brian Pacheco, and Chairman Sal Quintero Agenda No. 38. Public Health File ID:23-0222 Re: Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California Department of Public Health to implement the Syphilis Outbreak Strategy, effective July 1,2022 through June 30,2027,total not to exceed$1,751,673 APPROVED AS RECOMMENDED Ayes: 5- Brandau, Magsig, Mendes, Pacheco, and Quintero Agreement No. 23-224 County of Fresno Page 38 co Board Agenda Item 38 s� g O 1856 O FRE`� DATE: May 23, 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): Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California Department of Public Health to implement the Syphilis Outbreak Strategy, effective July 1, 2022 through June 30, 2027,total not to exceed $1,751,673. There is no additional Net County Cost associated with the recommended action. Approval of the recommended action will provide funding from the California Department of Public Health (CDPH)to enhance Department of Public Health (Department)syphilis and congenital syphilis (CS) prevention activities to address the rise of cases within the County, with a focus on disproportionately impacted populations. This item is countywide. ALTERNATIVE ACTION(S): Should your Board not approve the recommended action, the Department would not be able to enhance strategies and activities aimed at reducing the rise of syphilis cases in the County utilizing dedicated CDPH funding. RETROACTIVE AGREEMENT: The recommended retroactive revenue agreement was received from CDPH on November 14, 2022, with a final approved version from CDPH on April 28, 2023. The agreement is retroactive to July 1, 2022; however, the Department has not conducted any activities through this agreement because of contract negotiations with CDPH. It is anticipated the Department will fully utilize the funding through this agreement by the end of the term to meet expected goals. FISCAL IMPACT: There is no increase in Net County Cost associated with the recommended action. The recommended revenue agreement will provide a maximum of$1,751,673 to offset costs associated with providing syphilis and CS services from July 1, 2022 through June 30, 2027. The agreement allows full indirect cost recovery, currently at 18.82% of salaries and benefits. Sufficient appropriations and estimated revenues are included in the Department's Org 5620 FY 2022-23 Adopted Budget and will be included in subsequent budget requests. DISCUSSION: Due to the high rates of early syphilis or CS, Fresno County is one of eight local health jurisdictions within County of Fresno Page 1 File Number:23-0222 File Number:23-0222 California to be allocated funding by CDPH from the one-time appropriation in the 2022 California Budget Act. Through the recommended agreement, the Department will receive funding from CDPH to support innovative and impactful syphilis and CS prevention and control activities, with a focus on disproportionately impacted populations as determined by the Department's Epidemiology, STD, and CS Case Management programs. The Department will seek to partner with local clinics, increase the County's Bicillin program where the local providers are given doses of the antibiotic treatment for syphilis, and create a DoxyPEP program which will provide education on the syphilis preventing medication to increase screening, treatment, and prevention of syphilis and CS. Since 2016 Fresno County has been struggling with high rates of both syphilis and CS cases, experiencing an average of 1,300 syphilis cases and 40 CS cases per year from 2017 to 2022. After seeing a decline in cases in 2018 from the 2017-high case rates of 1,542 syphilis and 64 CS, the County began to experience an increase in its number of cases by roughly 15% per year since 2020. The current 2022 case numbers are comparable to (or exceed)the 2017 high case rates, creating an urgent need to address this issue for Fresno County. The recommended agreement also deviates from the County's standard indemnification language and requires the County(and any County contractor 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. The Department has determined that acceptance of the indemnification language is advantageous to the County, as the grant award will be an essential funding source for syphilis and congenital syphilis prevention and control activities, without which the continued provision of these services would be negatively impacted. ATTACHMENTS INCLUDED AND/OR ON FILE: On file with Clerk-Agreement with the California Department of Public Health CAO ANALYST: Ron Alexander County of Fresno Page 2 File Number.23-0222 Agreement No. 23-224 State of California— Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) CALIFORNIA SEXUALLY TRANSMITTED DISEASES BRANCH STD Program Management Awarded By THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter "Department" TO County of Fresno, hereinafter "Grantee" Implementing the "Syphilis Outbreak Strategy," hereinafter "Project" GRANT AGREEMENT NUMBER 22-10883 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 Health and Safety Code, Section 131085(a). PURPOSE: The Department shall award this Grant Agreement to and for the benefit of the Grantee; the purpose of the grant is to support innovative and impactful syphilis and congenital syphilis (CS) prevention and control activities, with a focus on disproportionately impacted populations as determined by local or regional syphilis and CS epidemiology, which may include, but are not limited to, African American/Black people, Latinx people, American Indians/Alaska Native people, trans women, pregnant people experiencing homelessness or who use drugs, (e.g., people who exchange sex for money, drugs, or a place to stay), and gay, bisexual, and other men who have sex with men (MSM). Funds shall be used to supplement, but not supplant, existing financial and resource commitments of the local health jurisdiction for sexually transmitted disease prevention and control activities. Funds shall be used to supplement, but not supplant, existing financial and resource commitments of the local health jurisdiction for sexually transmitted disease prevention and control activities. GRANT AMOUNT: The maximum amount payable under this Grant Agreement shall not exceed the amount of$1,751,673.00. TERM OF GRANT AGREEMENT: The term of the Grant shall begin July 1, 2022 and terminates on June 30, 2027. No funds may be requested or invoiced for services performed or costs incurred after June 30, 2027. Page 1 of 4 State of California—Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will be: California Department of Public Health Grantee: County of Fresno Name: Alexia McGonagle, Section Chief Name: Jena Adams STD Control Branch Supervising CDC Specialist Address: P.O. Box 997377, MS 7320Address: P.O. Box 11867 City, ZIP: Sacramento, CA 95899-7377 City, ZIP: Fresno, CA 93775 Phone: (916) 628-5222 Phone: (559) 600-3042 E-mail: Alexia.McGonagle(E�cdph.ca.gov E-mail: iadamsQ-fresnocountyca.gov Direct all inquiries to the following representatives: California Department of Public Health, Grantee: County of Fresno STD Control Branch Attention: Adriana Cervantes, Grant ManagerAttention: Jena Adams Address: P.O. Box 997377, MS 7320Address: P.O. Box 11867 City, Zip: Sacramento, CA 95899-7377 City, Zip: Fresno, CA 93775 Phone: (279) 667-1464 Phone: (559) 600-3042 E-mail: Adriana.Cervantes(a-).cdph.ca.gov E-mail: jadams(a-)fresnocountyca.gov All payments from CDPH to the Grantee; shall be sent to the following address: Remittance Address Grantee: County of Fresno Attention: "Cashier": DPH Business Office Address: P.O. Box 11867 City, Zip: Fresno, CA 93775 Phone: (559) 600-6415 E-mail: dphboap6a fresnocountyca.gov Page 2 of 4 State of California—Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) 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 AWARD LETTER, FUNDING ALLOCATIONS/ALLOCATION PROCESS Exhibit A ATTACHMENT 1 — GRANT ACTIVITIES, this document is the final Grant Activities and shall be incorporated by reference or attached hereto. 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 Exhibit C STANDARD GRANT CONDITIONS Exhibit D ADDITIONAL PROVISIONS Exhibit E STD LOCAL ASSISTANCE FUNDS — STANDARDS AND PROCEDURES Exhibit F INFORMATION PRIVACY AND SECURITY REQUIREMENTS Page 3 of 4 State of California—Health and Human Services Agency—California Department of Public Health CDPH 1229 (12/2021) 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: S�3-a J Sal ui t ro, (Chairman of the Board of arrEsr: Supervisors the County of Fresno BERNICE E.SEIDEL Clerk of the Board of Supervisors 2281 Tulare Street County of Fresno,state of California Fresno, CA 93721 By Deputy Date: 6-13-23 Ja er 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 9589977377 Page 4 of 4 State of California—Health and Human Services Agency I J California Department of Public HealthzWe = _ I)CPIPH . TOMAS J.ARAGON,MD,DrPH GAVIN NEWSOM Director and State Public Health Officer Governor Letter of Award DATE: NOVEMBER 14, 2022 TO: CALIFORNIA LOCAL HEALTH JURISDICTIONS SUBJECT: SYPHILIS OUTBREAK STRATEGY GRANT FUNDING The California Department of Public Health (CDPH), Sexually Transmitted Disease Control Branch (STDCB) is pleased to announce the intent to award State local assistance funds through the Syphilis Outbreak Strategy (SOS) Grant, a one-time appropriation in the 2022 California Budget Act for spend down from July 1, 2022 through June 30, 2027. The new (SOS) funds shall be allocated to eight local health jurisdictions (LHJs) with high rates of early syphilis or CS and to support innovative and impactful syphilis and CS prevention and control activities, with a focus on disproportionately impacted populations as determined by local or regional syphilis and CS epidemiology, which may include, but are not limited to, African American/Black people, Latinx people, American Indians/Alaska Native people, trans women, pregnant people experiencing homelessness or who use drugs, (e.g., people who exchange sex for money, drugs, or a place to stay), and gay, bisexual, and other men who have sex with men (MSM). The amount of annual funding was determined by a non-competitive formula set forth in the 2022 California Budget Act, allocating 40% of funds based on congenital syphilis and 60% of funds based on early syphilis cases. The below chart is a summary of the SOS funding allocation for the eight identified LHJs. SOS FUNDING ALLOCATION PENDING GENERAL FUND APPROPRIATION Local Health Jurisdiction FY 2022-23 FY 2023-24 FY 2024-25 Total Allocation Fresno $583,891 $583,891 $583,891 $1,751,673 Kern $581,707 $581,707 $581,707 $1,745,121 Los Angeles HD' $3,957,227 $3,957,227 $3,957,227 $11,871,681 Orange $477,520 $477,520 $477,520 $1,432,560 San Bernardino $1,069,175 $1,069,175 $1,069,175 $3,207,525 San Diego $761,915 $761,915 $761,915 $2,285,745 San FranCiscoz $889,417 $889,417 $889,417 $2,668,251 San Joaquin $679,148 $679,148 $679,148 $2,037,444 TOTAL $9,000,000 $9,000,000 $9,000,000 $27,000,000 1 -Los Angeles excludes Cities of Long Beach&Pasadena 2-San Francisco excludes City of Berkeley CDPH STD Control Branch, MS 7320 • P.O. Box 997377 • Sacramento, CA 95899-7377 (916)445-9860 • Internet Address: www.cdph.ca.gov m° In FY 2022-23, the SOS funds were appropriated at nine million for expenditure until June 30, 2027. Subsequent allocation of nine million each for FY 2023-24 and FY 2024-25 will be made available if funds are appropriated through the California state budget. In addition to the availability of appropriated funds, Grantees will need to demonstrate satisfactory performance in previous years to receive funding for subsequent years. Funds shall be used to supplement, but not supplant, existing financial and resource commitments of the LHJs for sexually transmitted disease prevention and control activities. Grant Activities Grantees will be responsible for all grant objectives in Exhibit A—Attachment 1 — Grant Activities unless they are marked as "Optional." Grantees are encouraged to consider innovative approaches to addressing early syphilis and congenital syphilis prevention and control that may not be specifically listed in the grant activities. Innovative approaches must be described in the narrative portion of each part. The grant activities are enclosed (Exhibit A—Attachment 1 — Grant Activities) for your information and focused on the following key strategic targets: • Part I: Health Access for All: Syphilis Testing, Treatment, and Other Health Care focuses on syphilis testing, treatment, and prophylaxis (e.g., DoxyPEP) to interrupt ongoing syphilis transmission and prevent adverse outcomes. Linkages to prenatal, preconception or family planning care are also included to prevent unintended pregnancies in people who do not want to become pregnant, and to prevent adverse outcomes for pregnant people, including congenital syphilis. • Part II: Supportive Services: Housing, Mental Health, and Substance Use focuses on wrap-around services identified as priorities for syphilis and congenital syphilis prevention. Grantees must identify at least one activity from Part II. • Part III: Core Surveillance and Disease Intervention focuses on core public health functions that may not be met by existing local, state, or federal funding and is considered an optional use of these funds. All Grantees must adhere to the grant activities and STDCB Terms and Conditions, and any subsequent revisions, along with all instructions, policy memorandums, or directives issued by CDPH/STDCB. CDPH/STDCB will make any changes and/or additions to these guidelines in writing and, whenever possible, notification of such changes shall be made 30 days prior to implementation. Travel Costs in Budget The grant budget may include funds for staff to attend meetings, statewide conferences, and trainings related to addressing early syphilis and congenital syphilis prevention and control. The budget may also include travel expenditures for case investigations or outbreak response. The amount of funds allocated for travel may be adjusted or redirected to another line item on a later date to accurately reflect actual planned trips. For additional information about travel reimbursement, please refer to Exhibit B, section 5. Indirect Costs Beginning with FY 2014/2015, the CDPH negotiated the Indirect Cost Rate (ICR) with each LHJ to standardize the rate. This rate is applied to all contracts and grants that CDPH has with your agency. Please see the attached FY 2022-23 ICR for your use in completing your budgets. Please note that most of the LHJs apply the ICR to the total personnel costs only. However, there are a few that apply the rate to the total direct costs (this includes personnel, benefits, operating expenses, travel, and subcontracts line items). Your ICR cannot exceed the negotiated amount, nor can the application of the ICR be changed. However, you may elect to reduce the published Indirect Cost Rate percentage or not include Indirect Costs in the budget Board of Resolution or Minute Order Requirements All agreements with LHJs must have a current Board of Resolution or Minute Order. If the grant is amended during the term of the agreement, a new Board of Resolution or Minute Order must be obtained unless the original resolution clearly states the allowance for amendments, extensions, and renewals to be approved without going through the Board of Supervisors. Terms and Conditions and HIV Confidentiality Documents To enhance coordination across CDPH programs and compliance with CDPH regulations and policies, the STD Control Branch developed guidance documents associated with local assistance funding. Please see the attached STD Terms and Conditions and Exhibit B, Budget Detail and Payment Provision. Additionally, LHJ staff who work with client-level data will be required to sign confidentiality agreements to ensure appropriate handling and data security of STD/HIV data. The grant agreement documents have been prepared by the STD Control Branch, Business Operation Support Section (BOSS) and approved by CDPH — Contracts Management Unit. In an effort to expedite this grant agreement through the approval process, we request that the following items be returned no later than 12/12/2022 via email at STDLHJContracts(d)cdph.ca.gov with a cc to Adriana.Cervantes(a)cdph.ca.gov. 1. Exhibit A—Attachment 1 —Grant Activities o Fill out Parts I through III 2. Original copies of the Grant Agreement (CDPH 1229A) Signature page only (page five of the grant agreement) must bear original or digital signatures. o Due to the continued presence of COVID-19, CDPH is accepting digitally signed grant agreements and electronic submittals. Therefore, until further notice, any documents received electronically will be considered original copies. o When submitting the grant documents electronically, ensure electronic submittals are "clean and legible," preferably scanned in color with minimum 300x300 resolution. 3. One copy of the Board Resolution/Order/Motion, ordinance, or other similar document authorizing execution of the grant agreement. LHJs may exercise their delegated authority to accept and implement this grant agreement and future amendments. o If your next board meeting is scheduled after 12/12/2022, please submit a Letter of Intent to add this grant agreement to your next board meeting. o When you have the documents authorizing the execution of the grant agreement, please send us a copy of the Board Resolution/Order/Motion or ordinance. 4. Contractor Certification Clause (CCC 042017) 5. Budget for Fiscal Years (FY) 2022-2023 thru 2024-2025 6. Budget Justification for FYs 2022-2023 thru 2024-2025 Upon final approval of the grant agreement documents, you will receive an executed copy. If you have any questions, please feel free to contact Adriana Cervantes by email at Adriana.Cervantes(a_cdph.ca.gov or Jasmin Delgado Jasmin.Delgado(cDcdph.ca.gov. Sincerely, Rachel Piper, Chief Contracts and Purchasing Unit Business Operations Support Section STD Control Branch Enclosures cc: Kathleen Jacobson, MD, Chief, STD Control Branch Jessica Frasure-Williams, Chief, Program Development Section, STD Control Branch Jasmin Delgado,Local Capacity Building Unit Chief and Acting Northern California Regional Capacity Building Coordinator, STD Control Branch Danelle Del Rincon, Southern California Regional Capacity Building Coordinator, STD Control Branch Cary Escovedo, Bay Area Regional Capacity Building Coordinator, STD Control Branch Sophie Lyons, Central Inland Regional Capacity Building Coordinator, STD Control Branch Exhibit A—Attachment 1 Syphilis and Congenital Syphilis Outbreak Strategy Grant Activities 1. Service Overview The California Department of Public Health (CDPH), Sexually Transmitted Disease Branch (STDCB) shall provide a grant to and for the benefit of the Grantee. Funded by the 2022 California State Budget Act, nine million dollars for FY 2022-2023 has been appropriated for the Syphilis and Congenital Syphilis (CS) Outbreak Strategy (SOS) for eight local health jurisdictions (Grantee). Subsequent allocation of$9 million each for FY 2023-24 and FY 2024-25 will be made available if funds are appropriated through the California state budget and available for spend down from July 1, 2022 through June 30, 2027. The Grantee will use this funding to expand existing syphilis and congenital syphilis activities. Funding is intended to support innovative and impactful syphilis and congenital syphilis prevention and control activities, with a focus on disproportionately impacted populations as determined by local or regional syphilis and congenital syphilis epidemiology, which may include, but are not limited to, African American/Black people, Latinx people, American Indians/Alaska Native people, trans women, pregnant people experiencing homelessness or who use drugs, (e.g., people who exchange sex for money, drugs, or a place to stay), and gay, bisexual, and other men who have sex with men (MSM). Grantees will be expected to describe how they have centered priority populations based on local epidemiology. Funds shall be used to supplement, but not supplant, existing financial and resource commitments of the local health jurisdiction for sexually transmitted disease prevention and control activities. All Grantees must adhere to the Grant Activities and STDCB Terms and Conditions, and any subsequent revisions, along with all instructions, policy memorandums, or directives issued by CDPH/STDCB. CDPH/STDCB will make any changes and/or additions to these guidelines in writing and, whenever possible, notification of such changes shall be made 30 days prior to implementation. 2. Service Location The services shall be performed at applicable facilities within the Grantee's jurisdiction. 3. Service Hours The services shall be primarily provided Monday through Friday, from 8:00 a.m. to 5:00 p.m. and include evenings, weekends, and holidays as needed. 4. Project Representatives The project representative for the Syphilis and Congenital Syphilis Outbreak Strategy grants at CDPH/STDCB is Adriana Cervantes at Adriana.Cervantes(o)_cdph.ca.gov. 5. Services to be Performed See the attached Grant Activities as follows for a description of the services to be performed. 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C g co = 0 � m y k / 00 c m 2 g \ ± c k (60 - F co _ o e _0 2 a o � £ ? 2 0 ■ c E E a)U a \ E 2 04 mn po c £ w ¥ E \ ■ N q N q N q N N q q o f 00 00 00 oc oo 0) cc ■ (N � CN N 04 CN � 04 04 q E � co— _ . 2 \ 0) \ } CD CD 30 30 00 0 % ■ a CO $ _ 04 C*4 04 CN C14 m ■ 04 N 04 CN CN � k / f § ? R R R q } \ 0 c (D + ƒ ƒ / _ CL ■ I , I C.0 u 2 k C) 0 C) C) 0 q \ \ a - N N C\l C14 04 q 2 5 3 3 0 3 3 ® ® _ \ m o C) 0 o 0 ¥ n r 0 \ \ n = Icu ( \ / ■ EE E E \ LL ƒ k O - 0 County of Fresno 22-10883 Exhibit B Budget Detail and Payment Provisions 1. Invoicing and Payment A. Upon completion of project activities as provided in Exhibit A—Attachment 1, 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 quarterly in arrears to: Adriana Cervantes California Department of Public Health STD Control Branch MS 7320 P.O. Box 997377-7377 Sacramento, CA 95899-7377 Electronic invoice submissions can be transmitted via email to STDLHJlnvoices(@cdph.ca.gov. C. Invoices shall: 1) Be prepared using the electronic invoice template provided by your CDPH Grant Manager. 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 —Attachment 1 under this Grant. 2) Be submitted electronically. Mailed hard copies are not required. 3) Bear the Grantee's name as shown on the Grant. 4) Identify the billing and/or performance period covered by the invoice. 5) 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. Invoices must be submitted no more than forty-five (45) calendar days after the end of each quarter unless a later or alternate deadline is agreed to in writing by the program Grant Manager. E. Amount awarded under this Grant is identified in the CDPH 1229 Grant Agreement. Page 1 of 6 County of Fresno 22-10883 Exhibit B Budget Detail and Payment Provisions 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, or if the appropriated funds have been expended prior to the Agreement expiration date, 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. 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 forty-five (45) 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 A. 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 6 County of Fresno 22-10883 Exhibit B Budget Detail and Payment Provisions B. In accordance with California Assembly Bill 1887 (Chapter 687, Statues of 2016), and Government Code Section 11139.8, travel is prohibited to states that, enact the following after June 26, 2015: a. A law that voids or repeals, or has the effect of voiding or repealing, existing state or local protections against discrimination on the basis of sexual orientation, gender identity, or gender expression. b. A law that authorizes or requires discrimination against same-sex couples or their families or on the basis of sexual orientation, gender identity, or gender expression. c. A law that creates an exemption to antidiscrimination laws in order to permit discrimination against same-sex couples or their families or on the basis of sexual orientation, gender identity, or gender expression. The California Attorney General's webpage lists the states to where travel is prohibited. C. The total budget amount for out-of-state travel shall not exceed five (5) percent of the total annual budget of this grant agreement. 6. Use of Funds/Supplanting These funds shall be used to support innovative and impactful syphilis and congenital syphilis prevention and control activities, with a focus on disproportionately impacted populations as determined by local or regional syphilis and congenital syphilis epidemiology, which may include, but are not limited to, African American/Black people, Latinx people, American Indians/Alaska Native people, trans women, pregnant people experiencing homelessness or who use drugs, (e.g., people who exchange money for sex, drugs, or a place to stay), and gay, bisexual and other men who have sex with men (MSM). Funds shall be used to supplement, but not supplant, existing financial and resource commitments of the LHJs for sexually transmitted disease (STD) prevention and control activities. Supplanting of funds is defined (for the purposes of this agreement) as using local assistance award monies to "replace" or "take the place of" existing local funding. For example, reductions in local funds cannot be offset by the use of any dollars for the same purpose. Page 3 of 6 County of Fresno 22-10883 Exhibit B Budget Detail and Payment Provisions 7. Proper Use of Funds A. The funds for this grant agreement may be used for: 1. Local health jurisdiction staff to support innovative and impactful syphilis and congenital syphilis prevention and control activities. 2. Out-of-state travel to conferences and meetings, except to prohibited states as provided in 5.13. above. Travel costs may include travel and per diem for local leadership and other relevant staff (listed in the budget as in-kind support) to attend the Annual California STD HIV Controllers Association Membership Meeting, Annual STDCB Statewide Meeting (e.g., Congenital Syphilis Prevention Forum), National STD Prevention Conference, or other national forums as relevant. Prior written approval for out-of-state travel approval must be obtained from STDCB and shall not exceed five (5) percent of the total annual budget of this grant agreement. 3. In-state travel to support local capacity building, except to prohibited states as provided in 5.13. above. This includes training course fees, travel, and per diem to support enhancement of knowledge, skills, and abilities of Disease Intervention Workforce (e.g., Principles, Practices, and Pathways to Disease Intervention (3PD1), Phlebotomy, Cultural Humility), or other staff essential to syphilis and congenital syphilis prevention and control. 4. Costs associated with syphilis testing, such as syphilis test kits, laboratory reagents, and other testing supplies. 5. Syphilis treatment (i.e., Benzathine penicillin G, Doxycycline) and prophylaxis (i.e., DoxyPEP). 6. Condoms. 7. Pregnancy tests. 8. Emergency contraception pills. 9. Provider education materials. 10.Client education materials. 11.The purchase, lease, or other support of mobile testing units. a. The Grantee shall only use said vehicles for the performance under the terms of this Agreement. b. The Grantee agrees that all operators of motor vehicles, reimbursed by CDPH under the terms of this Agreement, shall hold a valid State of California driver's license. In the event that ten or more passengers are to be transported in any one vehicle, the operator shall also hold a State of California Class B driver's license. c. If any motor vehicle is reimbursed by CDPH under the terms of this Agreement, the Grantee, as applicable, shall provide, maintain, and certify that, at a minimum, the following type and amount of automobile liability insurance is in effect during the term of this Agreement or any extension period during which any vehicle remains in the Grantee's possession: i. The Grantee, by signing this Agreement, hereby certifies that it possesses or will obtain automobile liability insurance in the amount of$1,000,000 per occurrence for bodily injury and property damage combined. Said insurance must be obtained and made effective upon the delivery date of any motor Page 4 of 6 County of Fresno 22-10883 Exhibit B Budget Detail and Payment Provisions vehicle reimbursed with agreement funds by CDPH under the terms of this Agreement to the Grantee. ii. The Grantee shall, as soon as practical, furnish a copy of the certificate of insurance to the CDPH Program Grant Manager. iii. The Grantee agrees that bodily injury and property damage liability insurance, as required herein, shall remain in effect at all times during the term of this Agreement. iv. The Grantee agrees to provide at least thirty (30) days prior to the expiration date of said insurance coverage a copy of a new certificate of insurance evidencing continued coverage, as indicated herein for not less than the remainder of the term of this Agreement, the term of any extension or continuation thereof, or for a period of not less than one (1) year. v. In the event the Grantee fails to keep insurance coverage as required herein in effect at all times during vehicle possession, CDPH may, in addition to any other remedies it may have, terminate this Agreement upon the occurrence of such event." B. The funds for this grant agreement may be used for the following items, with supportive justification, tracking, and reporting of outcomes: 1. Incentives such as low value gift cards (e.g., WalMart, Safeway, transportation vouchers), hygiene kits, and/or other syphilis or congenital syphilis related incentives. a. Client incentives, such as low value gift cards, may be approved as Behavioral Modification Materials (BMM). The value of the incentive is limited to $50.00 of merchandise per person per intervention (e.g. client attendance for syphilis treatment at $25.00 for each Bicillin injection). b. Current CDPH approvals require the BMM to be justified with scientific proof of behavior change, and be accompanied by a targeted distribution plan, incentive tracking log, and reporting of incentive distribution and client outcomes. c. Incentives cannot be used for the purchase of alcohol, tobacco, firearms, lottery tickets or cannabis. d. There is no prepayment for incentives. The LHJ will only be reimbursed for the amount of incentives distributed during each quarter. 2. Hotel/motel stays for people who are unstably housed during course of late syphilis treatment. 3. Transportation rides/vouchers/tokens for testing and/or treatment. 4. Material support items, including, but not limited to, sleeping bags, tarps, shelter, clothing items, and hygiene kits, to people living with, or at risk for, syphilis. 5. All items under this section are provided to program participants to motivate and/or reinforce positive behavior and/or involvement in syphilis and congenital syphilis control and prevention activities. Receipt of these items requires action on the part of the recipient. The Grantee is responsible for the possession, security (e.g., will keep the BMMs and/or material support items and/or transportation rides/vouchers/tokens in a secure location), and accountability of all these items. The Grantee will prepare a log sheet that will track and identify each of these items, value, transfer date, and recipient. Page 5 of 6 County of Fresno 22-10883 Exhibit B Budget Detail and Payment Provisions 6. All items under this section must also comply with the provisions in Exhibit E, STD Local Assistance Funds — Standards and Procedures. C. The funds for this grant agreement cannot be used for: 1. Stuff We All Get (SWAG) - The purchase of free promotional items for health promotion events such as pens, mugs, t-shirts, posters, key chains, or bumper stickers. This provision is in accordance with the California State Constitution, Article 16, section 6, which prohibits any gifting of public funds. 2. Individual prizes or high value incentives (e.g., Pads, Phones). 3. Cash incentives paid to an individual. 4. Scholarships paid to an individual or a school on behalf of an individual. 5. Food (e.g., sponsored lunch or dinner at provider education sessions, brown bag lunches, buffets at screening events). 6. Construction, renovation, improvement, or repair of property. 7. The purchase of alcohol, tobacco, firearms, lottery tickets or cannabis. Page 6 of 6 County of Fresno 22-10883 Page 1 of 4 EXHIBIT C STANDARD GRANT CONDITIONS 1. APPROVAL: This Grant is of no force or effect until signed by both parties and approved by the Department of General Services, if required. The Grantee may not commence performance until such approval has been obtained 2. AMENDMENT: No amendment or variation of the terms of this Grant shall be valid unless made in writing, signed by the parties, and approved as required. No oral understanding or Agreement not incorporated in the Grant is binding on any of the parties. In no case shall the Department materially alter the scope of the Project set forth in Exhibit A. 3. ASSIGNMENT: This Grant is not assignable by the Grantee, either in whole or in part, without the written consent of the Grant Manager in the form of a written amendment to the Grant. 4. AUDIT: Grantee agrees that the Department, the Bureau of State Audits, or their designated representative shall have the right to review and to copy any records and supporting documentation pertaining to this Grant. Grantee agrees to maintain such records for a possible audit for a minimum of three (3) years after final payment or completion of the project funded with this Grant, unless a longer period of records retention is stipulated. Grantee agrees to allow the auditor(s) access to such records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Grantee agrees to include a similar right of the State to audit records and interview staff in any subcontract related to the project. 5. CONFLICT OF INTEREST: Grantee certifies that it is in compliance with all applicable state and/or federal conflict of interest laws. 6. INDEMNIFICATION: Grantee agrees to indemnify, defend and save harmless the State, its officers, agents and employees from any and all claims and losses accruing or resulting to any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or corporation furnishing or supplying work services, materials, or supplies in connection with the project, and from any and all claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged by Grantee in the performance of any activities related to the Project. 7. FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS: Grantee agrees that, at a minimum, its fiscal control and accounting procedures will be sufficient to permit tracing of all grant funds to a level of expenditure adequate to establish that such funds have not been used in violation of any applicable state or federal law, or the provisions of this Grant. Grantee further agrees that it will maintain separate Project accounts in accordance with generally accepted accounting principles. 8. GOVERNING LAW: This Grant is governed by and shall be interpreted in accordance with the laws of the State of California. County of Fresno 22-10883 Page 2 of 4 9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other amounts (including any interest thereon) accruing to or received by the Grantee under this Grant shall be paid by the Grantee to the Department, to the extent that they are properly allocable to costs for which the Grantee has been reimbursed by the Department under this Grant. 10. INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the performance of the Project, shall act in an independent capacity and not as officers, employees or agents of the Department. 11. MEDIA EVENTS: Grantee shall notify the Department's Grant Manager in writing at least twenty (20)working days before any public or media event publicizing the accomplishments and/or results of the Project and provide the opportunity for attendance and participation by Department's representatives. 12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any rights or remedies for any third- party as a beneficiary of this Grant or the project. 13. NOTICE: Grantee shall promptly notify the Department's Grant Manager in writing of any events, developments or changes that could affect the completion of the project or the budget approved for this Grant. 14. PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform services under this Grant where such services are called for. 15. RECORDS: Grantee certifies that it will maintain Project accounts in accordance with generally accepted accounting principles. Grantee further certifies that it will comply with the following conditions for a grant award as set forth in the Request for Applications (Exhibit D) and the Grant Application (Exhibit A). A. Establish an official file for the Project which shall adequately document all significant actions relative to the Project; B. Establish separate accounts which will adequately and accurately depict all amounts received and expended on this Project, including all grant funds received under this Grant; C. Establish separate accounts which will adequately depict all income received which is attributable to the Project, especially including any income attributable to grant funds disbursed under this Grant; D. Establish an accounting system which will adequately depict final total costs of the Project, including both direct and indirect costs; and, E. Establish such accounts and maintain such records as may be necessary for the state to fulfill federal reporting requirements, including any and all reporting requirements under federal tax statutes or regulations. 16. RELATED LITIGATION: Under no circumstances may Grantee use funds from any disbursement under this Grant to pay for costs associated with any litigation between the Grantee and the Department. County of Fresno 22-10883 Page 3 of 4 17. RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings, specifications, reports, computer programs, operating manuals, notes, and other written or graphic work submitted under Exhibit A in the performance of the Project funded by this Grant shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part, any final form data and information received, collected, and developed under this Project, subject to appropriate acknowledgment of credit to the Department for financial support. Grantee shall not utilize the materials submitted to the Department (except data)for any profit making venture or sell or grant rights to a third-party who intends to do so. The Department has the right to use submitted data for all governmental purposes. 18. VENUE: (This provision does not apply to Local Governmental Entities) The Department and Grantee agree that any action arising out of this Grant shall be filed and maintained in the Superior Court, California. Grantee waives any existing sovereign immunity for the purposes of this Grant, if applicable. 19. STATE-FUNDED RESEARCH GRANTS: A. Grantee shall provide for free public access to any publication of a department-funded invention or department-funded technology. Grantee further agrees to all terms and conditions required by the California Taxpayer Access to Publicly Funded Research Act (Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the Government Code). B. As a condition of receiving the research grant, Grantee agrees to the following terms and conditions which are set forth in Government Code section 13989.6 ("Section 13989.E"): 1) Grantee is responsible for ensuring that any publishing or copyright agreements concerning submitted manuscripts fully comply with Section 13989.6. 2) Grantees shall report to the Department the final disposition of the research grant, including, but not limited to, if it was published, when it was published, where it was published, when the 12-month time period expires, and where the manuscript will be available for open access. 3) For a manuscript that is accepted for publication in a peer-reviewed journal, the Grantee shall ensure that an electronic version of the peer-reviewed manuscript is available to the department and on an appropriate publicly accessible database approved by the Department, including, but not limited to, the University of California's eScholarship Repository at the California Digital Library, PubMed Central, or the California Digital Open Source Library, to be made publicly available not later than 12 months after the official date of publication. Manuscripts submitted to the California Digital Open Source Library shall be exempt from the requirements in subdivision (b) of Section 66408 of the Education Code. Grantee shall make reasonable efforts to comply with this requirement by ensuring that their manuscript is accessible on an approved publicly accessible database, and notifying the Department that the manuscript is available on a department-approved database. If Grantee is unable to ensure that their manuscript is accessible on an approved publicly accessible database, Grantee may comply by providing the manuscript to the Department not later than 12 months after the official date of publication. County of Fresno 22-10883 Page 4 of 4 4) For publications other than those described inparagraph B.3 above„ including meeting abstracts, Grantee shall comply by providing the manuscript to the Department not later than 12 months after the official date of publication. 5) Grantee is authorized to use grant money for publication costs, including fees charged by a publisher for color and page charges, or fees for digital distribution. County of Fresno Grant 22-10883 Page 1 of 5 Exhibit D 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. County of Fresno Grant 22-10883 Page 2 of 5 Exhibit D Additional Provisions H. Upon receipt of notification of termination of this Grant, and except as otherwise specified by CDPH, the Grantee shall: 1) Place no further order or subgrants for materials, services, or facilities. 2) Settle all outstanding liabilities and all claims arising out of such termination of orders and subgrants. 3) Upon the effective date of termination of the Grant and the payment by CDPH of all items properly changeable to CDPH hereunder, Grantee shall transfer, assign and make available to CDPH all property and materials belonging to CDPH, all rights and claims to any and all reservations, grants, and arrangements with owners of media/PR materials, or others, and shall make available to CDPH all written information regarding CDPH's media/PR materials, and no extra compensation is to be paid to Grantee for its services. 4) Take such action as may be necessary, or as CDPH may specify, to protect and preserve any property related to this agreement which is in the possession of the Grantee and in which CDPH has or may acquire an interest. I. CDPH may, at its discretion, require the Grantee to cease performance of certain components of the Scope of Work as designated by CDPH and complete performance of other components prior to the termination date of the Grant. 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. County of Fresno Grant 22-10883 Page 3 of 5 Exhibit D Additional Provisions 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, 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 Chief's decision, the Grantee may appeal to the second level. 2) When appealing to the second level, the Grantee must prepare an appeal indicating the reasons for disagreement with Branch Chief's decision. The Grantee shall include with the appeal a copy of the Grantee's original statement of dispute along with any supporting evidence and a copy of the Branch Chief's decision. The appeal shall be addressed to the Deputy Director of the division in which the branch is organized within ten (10) working days from receipt of the Branch Chief's decision. The Deputy Director of the division in which the branch is organized or his/her designee shall meet with the Grantee to review the issues raised. A written decision signed by the Deputy Director of the division in which the branch is organized or his/her designee shall be directed to the Grantee within twenty (20) working days of receipt of the Grantee's second level appeal. County of Fresno Grant 22-10883 Page 4 of 5 Exhibit D Additional Provisions 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. 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. County of Fresno Grant 22-10883 Page 5 of 5 Exhibit D Additional Provisions 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 (https://home.treasury.aov/policy-issues/financial-sanctions/sanctionsprograms-and- country-information/ukraine-russia-related-sanctions). Failure to comply may result in the termination of this Agreement. County of Fresno Grant 22-10883 Exhibit E STD Local Assistance Funds — Standards and Procedures 1. Overview The California Department of Public Health (CDPH) STD Control Branch (STDCB) sets forth the following standards and procedures. These standards and procedures specify the conditions for receipt of CDPH STDCB local assistance funds. This funding is intended to support innovative and impactful syphilis and congenital syphilis (CS) prevention and control activities, with a focus on disproportionately impacted populations as determined by local or regional syphilis and CS epidemiology, which may include, but are not limited to, African American/Black people, Latinx people, American Indians/Alaska Native people, trans women, pregnant people experiencing homelessness or who use drugs, (e.g., people who exchange money for sex, drugs, or a place to stay), and gay, bisexual, and other men who have sex with men (MSM). All Grantees must adhere to these standards and procedures, and any subsequent revisions, along with all instructions, policy memorandums, or directives issued by CDPH STDCB. CDPH STDCB will make any changes and/or additions to these provisions in writing and, whenever possible, notification of such changes shall be made 30 days prior to implementation. The local health department has the authority for STD Prevention and Control as outlined in the Summary of Regulations Related to STD Prevention and Control Efforts in California. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STD- ForLocalHealthJurisdictions.aspx 2. Grantee's Responsibilities The Grantee agrees to: A. Direct activities toward achieving the program objectives set forth by the CDPH STDCB. B. Use these funds in accordance with any additional guidance set forth by the CDPH STDCB regarding the granting, use and reimbursement of the STDCB local assistance funds. Additional consideration should be given to other guidance from the CDPH and Centers for Disease Control and Prevention (CDC) intended to highlight successful sexually transmitted disease (STD) prevention and control strategies or outline California specific initiatives, policies and procedures. Please find relevant programmatic guidance documents on the CDPH STDCB website: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STD.aspx Page 1 of 6 County of Fresno Grant 22-10883 Exhibit E STD Local Assistance Funds — Standards and Procedures C. Funds shall be used to supplement, but not supplant, existing financial and resource commitments of the LHJs for sexually transmitted disease (STD) prevention and control activities. Supplanting of funds is defined (for the purposes of this agreement) as using local assistance award monies to "replace" or "take the place of existing local funding. For example, reductions in local funds cannot be offset by the use of any dollars for the same purpose. D. Abide by the most recent standards of care for syphilis and CS screening, treatment, control and prevention as promulgated by: 1. California Department of Public Health https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STDs- ClinicalGuidelines.aspx 2. Centers for Disease Control and Prevention https://www.cdc.gov/std/ E. Share health advisories, health education materials, outreach, testing and linkage to care and care coordination protocols, and other products created to enhance syphilis and CS awareness, prevention, testing, linkage to care, and care coordination funded with these dollars with CDPH and other LHJs and community-based organizations (CBOs) in California. The intent of this is to allow duplication (where possible) and cross jurisdictional reach of successful syphilis and CS interventions and activities aimed at the priority populations, clinical providers, and community partners. Source documents should be submitted to CDPH STDCB upon completion and with the annual progress report, and upon request from CDPH, as relevant. F. Submit information and reports as requested by the CDPH STDCB. G. Ensure the use of a competitive bid process in the selection of all sub grantees. If the sub grantee is one where the LHJ has a current agreement with, indicate the date the agreement was effective. If the CBO is a non-profit agency as defined by Internal Revenue Code 501(c), ensure the LHJ has a current letter on file from the Internal Revenue Service for the CBO. Page 2 of 6 County of Fresno Grant 22-10883 Exhibit E STD Local Assistance Funds — Standards and Procedures 3. Reporting Requirements A. Case Report, Laboratory, and Interview Record All Grantees shall comply with morbidity reporting requirements for reportable STDs identified in Title 17, California Code of Regulations (CCR) §2500, §2593, §2641.5-2643.20, and §2800 — 20182 Reportable Diseases and Conditions. https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%2ODocument%20L ibrary/Reportable Diseases.pdf All Grantees, excluding Los Angeles and San Francisco, must enter syphilis and CS case reports, laboratory results, and interview data for their jurisdiction directly into the California Reportable Disease Information Exchange (CaIREDIE) system, the CDPH web-based reporting software for notifiable diseases. Data must be entered into the appropriate tabs and forms in CaIREDIE. Submission of hard copy forms for data entry into CaIREDIE by CDPH or scanning of case reports, laboratory results, or interview records into the electronic filing cabinet (EFC), sans data entry, will not be accepted. Specific case investigation and report requirements are as follows: 1. Syphilis laboratory tests and confidential morbidity reports should be processed and assigned for investigation according to the California Syphilis Reactor Alert System (SRAS). Some health jurisdictions may have a more nuanced local system for prioritizing reported reactive syphilis tests. https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%2ODocume nt%20Library/SyphiIisReactorSRASChartAlgorithm.pdf 2. Syphilis cases and CS case investigations are to be reported according to updated CDPH STDCB protocols on the appropriate case report forms (Syphilis Interview Record or California Congenital Syphilis-CS Case Investigation and Report) found in CaIREDIE; samples of these forms can be viewed at https://www.cdph.ca.gov/Programs/PSB/Pages/CommunicableDise aseControl.aspx. Grantees will complete and close investigations in CaIREDIE within 45 days of initial report to local health department. 3. Grantees will participate in syphilis and CS-specific CaIREDIE trainings and conduct quality control procedures, including review of cases to ensure appropriate surveillance case definition and reconciliation of case counts. Page 3 of 6 County of Fresno Grant 22-10883 Exhibit E STD Local Assistance Funds — Standards and Procedures For additional STD-related CaIREDIE help, please email STDCal RED IE(a cdph.ca.gov. For STD case definitions, please visit https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STDCaseDefinitions. aspx For frequently asked questions, manuals/guidelines, and forms/instructions. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STD-CaIREDIE- Resources.aspx Los Angeles and San Francisco grantees must report the data outlined above to CDPH STD Control Branch via a secure file transfer protocol (FTP) on a weekly basis. Data will be transmitted using the following formats: • Case report data to be submitted using the National Electronic Telecommunications System for Surveillance (NETSS) or Message Mapping Guides (MMG) standards. • Interview record data to be submitted in a format that conforms to the corresponding CaIREDIE data elements. B. Performance Measurement and Program Evaluation Grantees will submit performance indicators specified in the Grant Activities, including for subcontracted activities . Project specific data reporting requirements and performance indicators will be determined in collaboration with CDPH within the first three months of the project period. C. Data Security and Confidentiality Grantees shall comply with recommendations set forth in CDC's "Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs." http://www.cdc.gov/nchhstp/programintegration/docs/PCSiDataSecurityGu idelines.pdf. Grantees shall have staff complete CDPH required confidentiality and data security training, and maintain on file associated confidentiality agreements for each staff person with access to STD data. Page 4of6 County of Fresno Grant 22-10883 Exhibit E STD Local Assistance Funds — Standards and Procedures D. Outbreak Reporting The California Code of Regulations (Title 17, Section 2502[c]) directs local health officers to immediately report unusual disease occurrences or outbreaks to CDPH. Reports should be conveyed by calling the CDPH STDCB Office at (510) 620-3400. E. Financial Expenditures and Reporting Grantees must maintain records reflecting actual expenditures. The CDPH STDCB reserves the right to question and re-negotiate reimbursement for any expenditure that may appear to exceed a reasonable cost for the service. Financial expenditures/reporting are required and must be submitted within 45 calendar days after the end of each quarter. Annual financial expenditures and reporting should be submitted no later than 45 days after the end of the budget period. Invoices should be sent to STDLHJInvoices(cD.cdph.ca.gov. F. Performance Progress Reporting The Midyear Progress Report is due no later than 30 days after the midpoint of the budget period. The Annual Performance Progress Report is due no later than 30 days after the end of the budget period (e.g., July 31, 2020). All publications and manuscripts published as a result of the work supported in part or whole by the cooperative grant must be submitted with the performance progress reports. Additionally, health advisories, health education materials, and other products should be submitted. Midyear and Annual Performance Progress Reports should be submitted to STDLHJContracts(cD-cdph.ca.gov. G. Reporting Use of Incentives, Hotel/Motel Stays, Transportation Rides/Vouchers/Tokens and Material Support 1. All proposals for incentives, hotel/motel stays, transportation rides/vouchers/tokens and material support items must be submitted to CDPH STDCB for review prior to purchase and project implementation, accompanying documents must contain justification for use as behavior modification materials, and accompanied by a targeted distribution plan and tracking/reporting/outcome log. Page 5 of 6 County of Fresno Grant 22-10883 Exhibit E STD Local Assistance Funds — Standards and Procedures 2. When using incentives, hotel/motel stays, transpostation rides/vouchers/tokens and material support items to achieve the goals and objectives outlined in the Grant Activities, the Grantee must adhere to the following requirements: a. Complete a Subject Reimbursement Log that is kept within a secure study file. This log will contain the item brand, item number, denomination, date purchased, reason for disbursement, the recipient of the item, and the issue date (see attached log). b. Each participant receiving one of these items must complete a Subject Payment Receipt at the time the item is issued. The Subject Payment Receipt must be kept in a secure location. c. Participation incentives cannot be used for the purchase of alcohol, tobacco, firearms, lottery tickets or cannabis. d. A copy of the Subject Reimbursement Log must be submitted with the quarterly invoice. e. The Subject Payment Receipt must be kept for a minimum of five (5) years after the termination of the grant. 4. Rights of California Department of Public Health, Sexually Transmitted Disease Control Branch A. The CDPH STDCB reserves the right to modify the terms and conditions of all awards. Additional information and documentation may be required. B. The CDPH STDCB reserves the right to use and reproduce all reports and data produced and delivered pursuant to the local assistance awards and reserves the right to authorize others to use or reproduce such materials, provided that the confidentiality of patient information and records is protected pursuant to California State laws and regulations. Page 6 of 6 County of Fresno 22-10883 Page 1 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPAMITECH Act Contracts) This Information Privacy and Security Requirements Exhibit (Exhibit) sets forth the information privacy and security requirements Contractor is obligated to follow with respect to all personal and confidential information (as defined herein) disclosed to Contractor, or collected, created, maintained, stored, transmitted or used by Contractor for or on behalf of the California Department of Public Health ( CDPH), pursuant to Contractor's agreement with CDPH. (Such personal and confidential information is referred to herein collectively as CDPH PCI.) CDPH and Contractor desire to protect the privacy and provide for the security of CDPH PCI pursuant to this Exhibit and in compliance with state and federal laws applicable to the CDPH PCI. I. Order of Precedence: With respect to information privacy and security requirements for all CDPH PCI, the terms and conditions of this Exhibit shall take precedence over any conflicting terms or conditions set forth in any other part of the agreement between Contractor and CDPH, including Exhibit A (Scope of Work), all other exhibits and any other attachments, and shall prevail over any such conflicting terms or conditions. II. Effect on lower tier transactions: The terms of this Exhibit shall apply to all contracts, subcontracts, and subawards, and the information privacy and security requirements Contractor is obligated to follow with respect to CDPH PCI disclosed to Contractor, or collected, created, maintained, stored, transmitted or used by Contractor for or on behalf of CDPH, pursuant to Contractor's agreement with CDPH. When applicable the Contractor shall incorporate the relevant provisions of this Exhibit into each subcontract or subaward to its agents, subcontractors, or independent consultants. III. Definitions: For purposes of the agreement between Contractor and CDPH, including this Exhibit, the following definitions shall apply: A. Breach: "Breach" means: 1. the unauthorized acquisition, access, use, or disclosure of CDPH PCI in a manner which compromises the security, confidentiality, or integrity of the information; or 2. the same as the definition of"breach of the security of the system" set forth in California Civil Code section 1798.29(f). B. Confidential Information: "Confidential information" means information that: 1. does not meet the definition of"public records" set forth in California Government Code section 6252(e), or is exempt from disclosure under any of the provisions of Section 6250, et seq. of the California Government Code or any other applicable state or federal laws; or 2. is contained in documents, files, folders, books, or records that are clearly labeled, marked or designated with the word "confidential" by CDPH. C. Disclosure: "Disclosure" means the release, transfer, provision of, access to, or divulging in any manner of information outside the entity holding the information. CDPH IPSR 9-22 County of Fresno 22-10883 Page 2 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts D. PCI: "PCI" means "personal information" and "confidential information" (as these terms are defined herein: E. Personal Information: "Personal information" means information, in any medium (paper, electronic, oral) that: 1. directly or indirectly collectively identifies or uniquely describes an individual; or 2. could be used in combination with other information to indirectly identify or uniquely describe an individual, or link an individual to the other information; or 3. meets the definition of"personal information" set forth in California Civil Code section 1798.3, subdivision (a) or 4. is one of the data elements set forth in California Civil Code section 1798.29, subdivision (g)(1) or (g)(2); or 5. meets the definition of"medical information" set forth in either California Civil Code section 1798.29, subdivision (h)(2) or California Civil Code section 56.05, subdivision 0); or 6. meets the definition of"health insurance information" set forth in California Civil Code section 1798.29, subdivision (h)(3); or 7. is protected from disclosure under applicable state or federal law. F. Security Incident: "Security Incident" means: 1. an attempted breach; or 2. the attempted or successful unauthorized access or disclosure, modification, or destruction of CDPH PCI, in violation of any state or federal law or in a manner not permitted under the agreement between Contractor and CDPH, including this Exhibit; or 3. the attempted or successful modification or destruction of, or interference with, Contractor's system operations in an information technology system, that negatively impacts the confidentiality, availability, or integrity of CDPH PCI; or 4. any event that is reasonably believed to have compromised the confidentiality, integrity, or availability of an information asset, system, process, data storage, or transmission. Furthermore, an information security incident may also include an event that constitutes a violation or imminent threat of violation of information security policies or procedures, including acceptable use policies. G. Use: "Use" means the sharing, employment, application, utilization, examination, or analysis of information. CDPH IPSR 9-22 County of Fresno 22-10883 Page 3 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts IV. Disclosure Restrictions: The Contractor and its employees, agents, and subcontractors shall protect from unauthorized disclosure any CDPH PCI. The Contractor shall not disclose, except as otherwise specifically permitted by the agreement between Contractor and CDPH (including this Exhibit), any CDPH PCI to anyone other than CDPH personnel or programs without prior written authorization from the CDPH Program Contract Manager, except if disclosure is required by State or Federal law. V. Use Restrictions: The Contractor and its employees, agents, and subcontractors shall not use any CDPH PCI for any purpose other than performing the Contractor's obligations under its agreement with CDPH. VI. Safeguards: The Contractor shall implement administrative, physical, and technical safeguards that reasonably and appropriately protect the privacy, confidentiality, security, integrity, and availability of CDPH PCI, including electronic or computerized CDPH PCI. At each location where CDPH PCI exists under Contractor's control, the Contractor shall develop and maintain a written information privacy and security program that includes administrative, technical and physical safeguards appropriate to the size and complexity of the Contractor's operations and the nature and scope of its activities in performing its agreement with CDPH, including this Exhibit, and which incorporates the requirements of Section VI I, Security, below. Contractor shall provide CDPH with Contractor's current and updated policies within five (5) business days of a request by CDPH for the policies. VI I. Security: The Contractor shall take any and all steps reasonably necessary to ensure the continuous security of all computerized data systems containing CDPH PCI. These steps shall include, at a minimum, complying with all of the data system security precautions listed in the Contractor Data Security Standards set forth in Attachment 1 to this Exhibit. Vill. Security Officer: At each place where CDPH PCI is located, the Contractor shall designate a Security Officer to oversee its compliance with this Exhibit and to communicate with CDPH on matters concerning this Exhibit. IX. Training: The Contractor shall provide training on its obligations under this Exhibit, at its own expense, to all of its employees who assist in the performance of Contractor's obligations under Contractor's agreement with CDPH, including this Exhibit, or otherwise use or disclose CDPH PCI. A. The Contractor shall require each employee who receives training to certify, either in hard copy or electronic form, the date on which the training was completed. B. The Contractor shall retain each employee's certifications for CDPH inspection for a period of three years following contract termination or completion. C. Contractor shall provide CDPH with its employee's certifications within five (5) business days of a request by CDPH for the employee's certifications. X. Employee Discipline: Contractor shall impose discipline that it deems appropriate (in its sole discretion) on such employees and other Contractor workforce members under Contractor's direct control who intentionally or negligently violate any provisions of this Exhibit. CDPH IPSR 9-22 County of Fresno 22-10883 Page 4 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts XI. Breach and Security Incident Responsibilities: A. Notification to CDPH of Breach or Security Incident: The Contractor shall notify CDPH immediately by telephone and email upon the discovery of a breach (as defined in this Exhibit), and within twenty-four (24) hours by email of the discovery of any security incident (as defined in this Exhibit), unless a law enforcement agency determines that the notification will impede a criminal investigation, in which case the notification required by this section shall be made to CDPH immediately after the law enforcement agency determines that such notification will not compromise the investigation. Notification shall be provided to the CDPH Program Contract Manager, the CDPH Privacy Officer and the CDPH Chief Information Security Officer, using the contact information listed in Section XI (F), below. If the breach or security incident is discovered after business hours or on a weekend or holiday and involves CDPH PCI in electronic or computerized form, notification to CDPH shall be provided by calling the CDPH Information Security Office at the telephone numbers listed in Section XI(F), below. For purposes of this Section, breaches and security incidents shall be treated as discovered by Contractor as of the first day on which such breach or security incident is known to the Contractor, or, by exercising reasonable diligence would have been known to the Contractor. Contractor shall be deemed to have knowledge of a breach if such breach is known, or by exercising reasonable diligence would have been known, to any person, other than the person committing the breach, who is an employee or agent of the Contractor. Contractor shall take: 1. prompt corrective action to mitigate any risks or damages involved with the breach or security incident and to protect the operating environment; and 2. any action pertaining to a breach required by applicable federal and state laws, including, specifically, California Civil Code section 1798.29. B. Investigation of Breach and Security Incidents: The Contractor shall immediately investigate such breach or security incident. As soon as the information is known and subject to the legitimate needs of law enforcement, Contractor shall inform the CDPH Program Contract Manager, the CDPH Privacy Officer, and the CDPH Chief Information Security Officer of: 1. what data elements were involved and the extent of the data disclosure or access involved in the breach, including, specifically, the number of individuals whose personal information was breached; 2. a description of the unauthorized persons known or reasonably believed to have improperly used the CDPH PCI and/or a description of the unauthorized persons known or reasonably believed to have improperly accessed or acquired the CDPH PCI, or to whom it is known or reasonably believed to have had the CDPH PCI improperly disclosed to them; 3. a description of where the CDPH PCI is believed to have been improperly used or disclosed; 4. a description of the probable and proximate causes of the breach or security incident; and CDPH IPSR 9-22 County of Fresno 22-10883 Page 5 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts 5. whether Civil Code section 1798.29 or any other federal or state laws requiring individual notifications of breaches have been triggered. C. Written Report: The Contractor shall provide a written report of the investigation to the CDPH Program Contract Manager, the CDPH Privacy Officer, and the CDPH Chief Information Security Officer as soon as practicable after the discovery of the breach or security incident. The report shall include, but not be limited to, the information specified above, as well as a complete, detailed corrective action plan, including information on measures that were taken to halt and/or contain the breach or security incident, and measures to be taken to prevent the recurrence or further disclosure of data regarding such breach or security incident. D. Notification to Individuals: If notification to individuals whose information was breached is required under state or federal law, and regardless of whether Contractor is considered only a custodian and/or non-owner of the CDPH PCI, Contractor shall, at its sole expense, and at the sole election of CDPH, either: 1. make notification to the individuals affected by the breach (including substitute notification), pursuant to the content and timeliness provisions of such applicable state or federal breach notice laws. Contractor shall inform the CDPH Privacy Officer of the time, manner and content of any such notifications, prior to the transmission of such notifications to the individuals; or 2. cooperate with and assist CDPH in its notification (including substitute notification) to the individuals affected by the breach. E. Submission of Sample Notification to Attorney General: If notification to more than 500 individuals is required pursuant to California Civil Code section 1798.29, and regardless of whether Contractor is considered only a custodian and/or non-owner of the CDPH PCI, Contractor shall, at its sole expense, and at the sole election of CDPH, either: 1. electronically submit a single sample copy of the security breach notification, excluding any personally identifiable information, to the Attorney General pursuant to the format, content and timeliness provisions of Section 1798.29, subdivision (e). Contractor shall inform the CDPH Privacy Officer of the time, manner and content of any such submissions, prior to the transmission of such submissions to the Attorney General; or 2. cooperate with and assist CDPH in its submission of a sample copy of the notification to the Attorney General. F. CDPH Contact Information: To direct communications to the above referenced CDPH staff, the Contractor shall initiate contact as indicated herein. CDPH reserves the right to make changes to the contact information below by verbal or written notice to the Contractor. Said changes shall not require an amendment to this Exhibit or the agreement to which it is incorporated. CDPH IPSR 9-22 County of Fresno 22-10883 Page 6 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts CDPH Program CDPH Privacy Officer CDPH Chief Information Security Contract Manager Officer See the Scope of Work Privacy Officer Chief Information Security Officer exhibit for Program Privacy Office Information Security Office Contract Manager c/o Office of Legal Services California Dept. of Public Health California Dept. of Public Health P.O. Box 997413, MS 6302 P.O. Box 997377, MS 0506 Sacramento, CA 95899-7413 Sacramento, CA 95899-7377 Email: Email: privacyCa�cdph.ca.gov CDPH.InfoSecurityOffice(a)cdph.ca.gov Telephone: (877) 421-9634 Telephone: (855) 500-0016 XI I. Documentation of Disclosures for Requests for Accounting: Contractor shall document and make available to CDPH or (at the direction of CDPH)to an Individual such disclosures of CDPH PCI, and information related to such disclosures, necessary to respond to a proper request by the subject Individual for an accounting of disclosures of personal information as required by Civil Code section 1798.25, or any applicable state or federal law. XIII. Requests for CDPH PCI by Third Parties: The Contractor and its employees, agents, or subcontractors shall promptly transmit to the CDPH Program Contract Manager all requests for disclosure of any CDPH PCI requested by third parties to the agreement between Contractor and CDPH (except from an Individual for an accounting of disclosures of the individual's personal information pursuant to applicable state or federal law), unless prohibited from doing so by applicable state or federal law. XIV. Audits. Inspection and Enforcement: CDPH may inspect the facilities, systems, books and records of Contractor to monitor compliance with this Exhibit. Contractor shall promptly remedy any violation of any provision of this Exhibit and shall certify the same to the CDPH Program Contract Manager in writing. XV. Return or Destruction of CDPH PCI on Expiration or Termination: Upon expiration or termination of the agreement between Contractor and CDPH for any reason, Contractor shall securely return or destroy the CDPH PCI. If return or destruction is not feasible, Contractor shall provide a written explanation to the CDPH Program Contract Manager, the CDPH Privacy Officer and the CDPH Chief Information Security Officer, using the contact information listed in Section XI (F), above. A. Retention Required by Law: If required by state or federal law, Contractor may retain, after expiration or termination, CDPH PCI for the time specified as necessary to comply with the law. B. Obligations Continue Until Return or Destruction: Contractor's obligations under this Exhibit shall continue until Contractor returns or destroys the CDPH PCI or returns the CDPH PCI to CDPH; provided however, that on expiration or termination of the agreement between Contractor and CDPH, Contractor shall not further use or disclose the CDPH PCI except as required by state or federal law. CDPH IPSR 9-22 County of Fresno 22-10883 Page 7 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts C. Notification of Election to Destroy CDPH PCI: If Contractor elects to destroy the CDPH PCI, Contractor shall certify in writing, to the CDPH Program Contract Manager, the CDPH Privacy Officer and the CDPH Chief Information Security Officer, using the contact information listed in Section XI (F), above, that the CDPH PCI has been securely destroyed. The notice shall include the date and type of destruction method used. XVI. Amendment: The parties acknowledge that federal and state laws regarding information security and privacy rapidly evolves and that amendment of this Exhibit may be required to provide for procedures to ensure compliance with such laws. The parties specifically agree to take such action as is necessary to implement new standards and requirements imposed by regulations and other applicable laws relating to the security or privacy of CDPH PCI. The parties agree to promptly enter into negotiations concerning an amendment to this Exhibit consistent with new standards and requirements imposed by applicable laws and regulations. XVII. Assistance in Litigation or Administrative Proceedings: Contractor shall make itself and any subcontractors, workforce employees or agents assisting Contractor in the performance of its obligations under the agreement between Contractor and CDPH, available to CDPH at no cost to CDPH to testify as witnesses, in the event of litigation or administrative proceedings being commenced against CDPH, its director, officers or employees based upon claimed violation of laws relating to security and privacy, which involves inactions or actions by the Contractor, except where Contractor or its subcontractor, workforce employee or agent is a named adverse party. XVIII. No Third-Party Beneficiaries: Nothing express or implied in the terms and conditions of this Exhibit is intended to confer, nor shall anything herein confer, upon any person other than CDPH or Contractor and their respective successors or assignees, any rights, remedies, obligations, or liabilities whatsoever. XIX. Interpretation: The terms and conditions in this Exhibit shall be interpreted as broadly as necessary to implement and comply with regulations and applicable State laws. The parties agree that any ambiguity in the terms and conditions of this Exhibit shall be resolved in favor of a meaning that complies and is consistent with federal and state laws and regulations. XX. Survival: If Contractor does not return or destroy the CDPH PCI upon the completion or termination of the Agreement, the respective rights and obligations of Contractor under Sections VI, VII and XI of this Exhibit shall survive the completion or termination of the agreement between Contractor and CDPH. CDPH IPSR 9-22 County of Fresno 22-10883 Page 8 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts Attachment 1 Contractor Data Security Standards I. Personnel Controls A. Workforce Members Training and Confidentiality. Before being allowed access to CDPH PCI, all Contractor's workforce members who will be granted access to CDPH PCI must be trained in their security and privacy roles and responsibilities at Contractor's expense and must sign a confidentiality and acceptable CDPH PCI use statement. Training must be on an annual basis. Acknowledgments of completed training and confidentiality statements, which have been signed and dated by workforce members must be retained by the Contractor for a period of three (3) years following contract termination. Contractor shall provide the acknowledgements within five (5) business days to CDPH if so requested. B. Workforce Members Discipline. Appropriate sanctions, including termination of employment where appropriate, must be applied against workforce members who fail to comply with privacy policies and procedures, acceptable use agreements, or any other provisions of these requirements. C. Workforce Member Assessment. Before being permitted access to CDPH PCI, Contractor must assure there is no indication its workforce member may present a risk to the security or integrity of CDPH PCI. Contractor shall retain the workforce member's assessment documentation for a period of three (3) years following contract termination. II. Technical Security Controls A. Encryption. All desktop computers, mobile computing devices, and portable electronic storage media that processes or stores CDPH PCI must be encrypted using a FIPS 140-2 certified 128 bit or higher algorithm. The encryption solution must be full disk unless approved by the CDPH Information Security Office (ISO) and Privacy Office (PO). FIPS 140-2 certified 128 bit or higher algorithm end-to-end, individual file encryption, or ISO approved compensating security controls, shall be used to protect CDPH PCI transmitted or accessed outside the Contractor's secure internal network (e.g., email, remote access, file transfer, internet/website communication tools). B. Server Security. Servers containing unencrypted CDPH PCI must have sufficient local and network perimeter administrative, physical, and technical controls in place to protect the CDPH information asset, based upon a current risk assess ment/system security review. C. Minimum Necessary. Only the minimum amount of CDPH PCI required to complete an authorized task or workflow may be copied, downloaded, or exported to any individual device. D. Antivirus software. Contractor shall employ automatically updated malicious code protection mechanisms (anti-malware programs or other physical or software-based solutions) at its network perimeter and at workstations, servers, or mobile computing devices to continuously monitor and take action against system or device attacks, anomalies, and suspicious or inappropriate activities. E. Patch Management. All devices that process or store CDPH PCI must have a documented patch management process. Vulnerability patching for Common Vulnerability Scoring System (CVSS) CDPH IPSR 9-22 County of Fresno 22-10883 Page 9 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts "Critical" severity ratings (CVSS 9.0 — 10.0) shall be completed within forty-eight (48) hours of publication or availability of vendor supplied patch; "High" severity rated (CVSS 7.0- 8.9) shall be completed within seven (7) calendar days of publication or availability of vendor supplied patch; all other vulnerability ratings (CVSS 0.1 — 6.9) shall be completed within thirty (30) days of publication or availability of vendor supplied patch, unless prior ISO and PO variance approval is granted. F. User Identification andAccess Control. All Contractor workforce members must have a unique local and/or network user identification (ID) to access CDPH PCI. The unique ID may be passwords, physical authenticators, or biometrics, or in the case of multi-factor authentication, some combination thereof. Should a workforce member no longer be authorized to access CDPH PCI, or an ID has been compromised, that ID shall be promptly disabled or deleted. User ID's must integrate with user role-based access controls to ensure that individual access to CDPH PCI is commensurate with job-related responsibilities. G. CDPH PCI Destruction. When no longer required for business needs or legal retention periods, all electronic and physical media holding CDPH PCI must be purged from Contractor's systems and facilities using the appropriate guidelines for each media type as described in the prevailing "National Institute of Standards and Technology — Special Publication 800-88" — "Media Sanitization Decision Matrix." H. System Inactivity Timeout. Contractor's computing devices holding, or processing CDPH PCI must be configured to automatically log-off an authenticated user or lock the device in a manner where the user must reauthenticate the user session after no more than twenty (20) minutes of user inactivity. I. Warning Banners. During a user log-on process, all systems providing access to CDPH PCI, must display a warning banner stating that the CDPH PCI is confidential, system and user activities are logged, and system and CDPH PCI use is for authorized business purposes only. User must be directed to log-off the system if they do not agree with these conditions. J. System Logging. Contractor shall ensure its information systems and devices that hold or process CDPH PCI are capable of being audited and the events necessary to reconstruct transactions and support after-the-fact investigations are maintained. This includes the auditing necessary to cover related events, such as the various steps in distributed, transaction-based processes and actions in service-oriented architectures. Audit trail information with CDPH PCI must be stored with read-only permissions and be archived for three (3) years after event occurrence. There must also be a documented and routine procedure in place to review system logs for unauthorized access. K. Intrusion Detection. All Contractor systems and devices holding, processing, or transporting CDPH PCI that interact with untrusted devices or systems via the Contractor intranet and/or the internet must be protected by a monitored comprehensive intrusion detection system and/or intrusion prevention system. III. Audit Controls CDPH IPSR 9-22 County of Fresno 22-10883 Page 10 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPA/HITECH Act Contracts A. System Security Review. Contractor, to assure that administrative, physical, and technical controls are functioning effectively and providing adequate levels of protection for CDPH PCI, shall conduct at least, an annual administrative assessment of risk, including the likelihood and magnitude of harm from the unauthorized access, use, disclosure, disruption, modification, or destruction of an information system or device holding processing, or transporting CDPH PCI, along with periodic technical security reviews using vulnerability scanning tools and other appropriate technical assessments. B. Change Control. All Contractor systems and devices holding, processing, or transporting CDPH PCI shall have a documented change control process for hardware, firmware, and software to protect the systems and assets against improper modification before, during, and after system implementation. IV. Business Continuity/ Disaster Recovery Controls A. Emergency Mode Operation Plan. Contractor shall develop and maintain technical recovery and business continuity plans for systems holding, processing, or transporting CDPH PCI to ensure the continuation of critical business processes and the confidentiality, integrity, and availability of CDPH PCI following an interruption or disaster event lasting more than twenty-four (24) hours. B. CDPH PCI Backup Plan. Contractor shall have a documented, tested, accurate, and regularly scheduled full backup process for systems and devices holding CDPH PCI. V. Paper Document Controls A. Supervision of CDPH PCI. CDPH PCI in any physical format shall not be left unattended at any time. When not under the direct observation of an authorized Contractor workforce member, the CDPH PCI must be stored in a locked file cabinet,desk, or room. It also shall not be left unattended at any time in private vehicles or common carrier transportation, and it shall not be placed in checked baggage on common carrier transportation. B. Escorting Visitors. Visitors who are not authorized to see CDPH PCI must be escorted by authorized workforce members when in areas where CDPH PCI is present, and CDPH PCI shall be kept out of sight of visitors. C. Removal of CDPH PCI. CDPH PCI in any format must not be removed from the secure computing environment or secure physical storage of the Contractor, except with express written permission of the CDPH PCI owner. D. Faxing and Printing. Contractor shall control access to information system output devices, such as printers and facsimile devices, to prevent unauthorized individuals from obtaining any output containing CDPH PCI. Fax numbers shall be verified with the intended recipient before transmittal. E. Mailing. Mailings of CDPH PCI shall be sealed and secured from damage or inappropriate viewing to the extent possible. Mailings which include five hundred (500) or more individually identifiable records of CDPH PCI in a single package shall be sent using a tracked mailing method which CDPH IPSR 9-22 County of Fresno 22-10883 Page 11 of 11 Exhibit F Information Privacy and Security Requirements (For Non-HIPPAMITECH Act Contracts includes verification of delivery and receipt, unless the prior written permission of CDPH to use another method is obtained. CDPH IPSR 9-22 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 P me am and Title of Person Signing By Deputy Sal Quintero, Chairman of the Board of Supervisors of the County of Fresno Date Executed Executed in the County of 5 -02 3 - a 3 Fresno CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public entities.) 2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug-Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: 1) receive a copy of the company's drug-free workplace policy statement; and, 2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement. Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003. Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm's offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108. b. The contractor agrees to cooperate fully in providing reasonable access to the contractor's records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor's compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3. 8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35. DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California. 1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code §10410): 1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code §10411): 1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service. If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e)) 2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement. 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. Agreement Between the County of Fresno and the California Department of Public Health Name: Syphilis Outbreak Strategy Grant Agreement No. 22-10883 Fund/Subclass: 0001/10000 Organization: 56201661 Revenue Account #: 3530