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HomeMy WebLinkAboutAgreement A-16-413 with CDVAProp63.pdf STATE OF CALIFORNIA EDMUND G.BROWN JR.,Governor DEPARTMENT OF VETERANS AFFAIRS Office of Procurement and Contracting 1227"O"Street,Room 100 Sacramento,CA 95814 Telephone: (916)651-7766 Facsimile: (916)651-9089 May 20, 2016 Charles Hunnicutt, County Veterans Service Officer County of Fresno 1320 E. Shaw Avenue, Suite 105 Fresno, CA 93710 Subject: Contract#16XS0006 Dear Mr. Hunnicutt: This Agreement cannot be considered binding on either party until approved by appropriate authorized State agencies. No services should be provided prior to approval, as the State is not obligated to make any payments on any Agreement prior to final approval. Your expeditious handling of this Agreement is appreciated. For inquiries regarding this Agreement, please contact Terry Larson, Contract Analyst at (916) 651-7766 or by email at terry.larson(a-calvet.ca.gov. Complete the following item(s) and return to the address stated above: ® Std. 213, Standard Agreement- print, sign, and date four (4) originals and return as soon as possible for further processing to address in header, Attn: Terry Larson, an original will be mailed to you. ® Std. 204, Payee Data Record - no payment can be made unless this form is completed and returned. Payment will be made according to Item 2 "Payee's Business Name" as completed on the Std. 204. ® Std. CCC 307 Contractor Certification Clauses - the Contractor Certification package contains clauses and conditions that may apply to your Agreement and to person(s) doing business with the State of California. Please sign and return page one of the Std. CCC 307. Failure to do so will prohibit the State of California from doing business with your company. ® Please send a copy of the resolution, order, motion, or ordinance for signatory authority. Sincerely, Terry Larson Contract Analyst Enclosure(s) HONORING CALIFORNIA'S VETERANS STATE OF CALIFORNIA Agreement No. 16-413 STANDARD AGREEMENT STD 213(Rev 06/03) AGREEMENT NUMBER 16XS0006 REGISTRATION NUMBER 1, This Agreement is entered into between the State Agency and the Contractor named below: STATE AGENCY'S NAME California Department of Veterans Affairs CONTRACTOR'S NAME County of Fresno 2. The term of this July, 1, 2016 through June 30, 2017 Agreement is: Or upon approval whichever is later 3. The maximum amount $45,000.00 of this Agreement is: Forty Five Thousand Dollars and Zero Cents 4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made a part of the Agreement. Exhibit A—Scope of Work 2 page(s) Exhibit A-1 —Program Narrative 5 page(s) Exhibit B—Budget Detail and Payment Provisions 3 page(s) Exhibit B-1 —Budget Form/Narrative 2 page(s) Exhibit C*—General Terms and Conditions GTC 610 Check mark one item below as Exhibit D: eExhibit-D Special Terms and Conditions (Attached hereto as part of this agreement) 6 page(s) Exhibit- D* Special Terms and Conditions Items shown with an Asterisk(*), are hereby incorporated by reference and made part of this agreement as if attached hereto. These documents can be viewed at www.ols.dgs.ca.gov/Standard+Language IN WITNESS WHEREOF,this Agreement has been executed by the parties hereto. CONTRACTOR California Department of General Services Use Only CONTRACTOR'S NAME(if other than an individual,state whether a corporation,partnership,etc.) County of Fresno BY(Authorized Signature) DATE SIGNED(Do not type) ,es ` —._-� LC Odd 9+c► PRINTED NAME AND TITLE OF PERSON SIG TING Ernest Buddy Mendes, Chairman, Fresno County Board of Supervisors ADDRESS 2281 Tulare St., Suite 301 Fresno, CA 93721 STATE OF CALIFORNIA AGENCY NAME California Department of Veterans Affairs BY(Authorized Signature) DATE SIGNED(Oo not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: SCM 1, 4.04A.2 David Gerard,Chief, Facilities and Business Services Division ADDRESS 1227 O Street, Sacramento, CA 95814 ATTEST: BERNICE E. SEIDEL,Clerk Board flSupervisors By N e ty California Department of Veterans Affairs Agreement Number: 16XS0006 Exhibit A - Scope of Work County of Fresno VETERAN MENTAL HEALTH OUTREACH SERVICES 1. INTRODUCTION/SERVICES A. This is an Agreement in which the County of Fresno, hereafter referred to as the Contractor shall provide mental health outreach services, as specified within Exhibit A-1, in accordance with the Mental Health Services Act (Proposition 63), for the California Department of Veterans Affairs, (CalVet). B. Provider must be able to perform the tasks associated with providing services under the scope of their license. Contractor will provide services in accordance with federal and state laws and regulations and CalVet policies. 2. CONTACT INFORMATION A. The project representatives during the term of this agreement will be: 1. CalVet Representative: Phillip Leggett, Mental Health Coordinator 1227 O Street, Room 105 Sacramento, CA 95814 Phone: (916) 503-8327 Email: phillip.legett(cD_calvet.ca.gov 2. Contractor Representative: Charles Hunnicutt, CVSO County of Fresno 1320 E. Shaw Avenue, Suite 105 Fresno, CA 93710 Phone: (559) 221-0331 B. Contract Representatives, addresses, and phone/fax numbers may be changed by issuing a 20-day prior written notification and shall not require a formal amendment to this Agreement. The notifying party shall provide complete contact information for the replacement Contract Representative including, name, title, mailing address, phone/fax numbers, and email address. All other changes require a formal written amendment to this agreement. 3. CONTRACTOR'S RESPONSIBILITIES The Contractor shall provide the following services: A. Expand and/or enhance mental health services to include treatment, and other related recovery programs to veterans currently residing in or returning to the community from their military service as they transition back to civilian life. Rev. 3/18/2016 Page 1 of 2 California Department of Veterans Affairs Agreement Number: 16XS0006 Exhibit A - Scope of Work County of Fresno B. Provide the following performance measures on a periodic and annual basis: 1. Provide four (4) periodic progress reports to include the following: a) Performance table that includes the goal for each performance measure and the source of collecting the performance measure (See Exhibit B — Budget Detail and Payment Provisions for periodic progress report/metric due dates). b) Any narrative related to Performance Assessment and Data. 2. Provide an annual progress report at the end of the funding period. The report must summarize information from the periodic reports, describe the accomplishments of the project, and describe the next steps for implementing any plans for additional work identified during the funding period. 4. INDEPENDENT CONTRACTOR STATUS A. The Contractor/Providers shall be considered "Independent Contractors" in relation to CalVet and the State. Therefore, the Contractor/Providers shall not be considered employee(s) of the CalVet and shall not be entitled to any employee benefits from the CalVet or the State including, but not limited to, the following: 1. Premium Pay, Overtime Pay, or Holiday Pay 2. Medical Insurance 3. Vacation or Sick Leave 4. Worker's Compensation 5. Other employee benefits Rev 10/9/2015 Page 2 of 2 California Department of Veterans Affairs Contract Number: 16XS0006 Program Narrative Exhibit A-1 Appendix A — Program Narrative Fresno County Veterans Service Office Veterans Outreach Proposition 63 Section A: Statement of Need Fresno County covers an area over 6,000 square miles in central California; located near the center of California's San Joaquin Valley. Fresno County is one of the largest, fastest growing, and most diverse counties in the state of California. It is the 10th most populous county with an estimated 972,297 residents, according to the California Department of Finance. Of the nearly one million residents, 41,619 are veterans of the armed forces. Serving these veterans is one of the County's top priorities. In FY 2014-15, the Fresno County Veterans Service Officer (FCVSO) provided assistance to 5,231 veterans. Veteran outreach in Fresno County is designed to enhance access to veteran services with an emphasis on prevention and early intervention mental health services by providing timely and effective referrals to the appropriate service providers. The goal of outreach activities is to ensure that newly discharged soldiers and veterans are educated about the various VA mental health services available to them, including services dealing with Post-Traumatic Stress Disorder (PTSD), Military Sexual Trauma (MST) and Traumatic Brain Injury (TBI). Participants are identified and engaged through the participation of the FCVSO at events such as the Yellow Ribbon, Stand Downs, Job Fairs, Muster Briefing, Armories for National Guard Reserves Events and presentations to incarcerated veterans. The FCVSO participates in the events by conducting presentations and/or managing an information booth. The FCVSO currently represents 5 Central Valley counties (Fresno, Madera, Kings, Kern and Tulare), voicing their concerns related to mental health services. Working closely with the Regional Collaborative Coordinator for the area he has identified several key barriers to accessing Veteran Service programs which include: Stigma- due to concerns about stigma, veterans may not admit that they need care or think that they will get better on their own. Avoidance- many veterans avoid getting treatment because they want to avoid dealing with troubling memories, thoughts, feelings and situations related to the trauma because they are too painful. Concerns about career- some veterans feel that asking for help can be a sign of weakness and hurt their military career. Additionally, there is lack of awareness in regards to resources available for veterans. Public service announcements can be an effective way to reach veterans and their families because they have the potential to reach a large audience. In Fresno County there are currently no advertisements regarding the mental health services available to veterans; most referrals are through word of mouth. 1 California Department of Veterans Affairs Contract Number: 16XS0006 Program Narrative Exhibit A-1 Section B: Proposed Service/Project The purpose of the service is to connect newly discharged soldiers and other veterans with the appropriate mental health and substance use services in order to help mitigate the harmful effects of combat, sexual assault, in-service injury, and readjustment/assimilation to civilian life by providing education, networking, prevention, intervention, and improved access to support services. The Goals/Objectives for the proposal include: • Perform 450 PTSD and MST screenings to identify veterans in need of referrals. • Provide timely and effective referrals to service providers in order to enhance the mental and physical healthcare of veterans with serious mental health issues. Referrals will be tracked through a Referral Screening Tracking sheet which will identify the date, client name, case number, screening for PTSD /MST and TBI and whether and where the client was referred for services. • Assist 150 veterans and their families in application/submittal of Service Related Disability Compensation claims & Non-Service Related Disability Pensions. • Assist 100 incarcerated Veterans; this includes VSO staff visiting and connecting with prisoners still in Prison to process new claims and maintain existing cases as part of case management. • Assist with the verification process of 75 MIL100 forms, for the Fresno County Court System, as well as attend modification meetings to create a better usable updated MIL 100 form. • Comply with CalVet agreement with the VA, working towards a paperless system to submit claims. Thus allowing expedited claim processing and elimination of any backlogs. • When applicable, shift qualifying veterans from Medi-Cal programs to the VA medical system for mental health related care. • Inform CalVet on issues of access to care, customer and clinician satisfaction, efficiency, and delivery of quality healthcare. The FCVSO currently visits outreach events such as Yellow Ribbon Reintegration Program events, Stand Downs, Job Fairs, Muster Briefings, National Guard Reserve Armories and other events throughout Fresno. The FCVSO conducts presentations at these events which consist of sharing real life stories and educating the audience regarding the services available through the Veterans Service Office, VA hospital, Vet Center and local non-profit organizations. The veterans are given an opportunity to share and ask questions; many veterans contact the FCVSO for a one-on-one follow up. There are no formal MOUs with the VA operatives or County Mental Health Department; however there are informal partnerships with the organizations. The FCVSO is a veteran and therefore understands the issues, problems, values, and language associated with serving in the military. Understanding military culture is imperative when talking with veterans that may have PTSD or TBI issues. These veterans often feel isolated and may be reluctant to seek assistance. If a veteran with PTSD or TBI has the additional task of translating military language or explaining military structure to a service provider, he/she may be discouraged to seek help, therefore creating an additional barrier. The FCVSO also contacts the local media to cover veterans outreach events, to insure that veterans are aware of the events. Any interviews made convey what benefits are available and the collaboration with other agencies that provide services to new veterans in the county. 2 California Department of Veterans Affairs Contract Number: 16XS0006 Program Narrative Exhibit A-1 Section C: Proposed Implementation Approach Experience and Anticipated Impact Transitioning from a military to a civilian lifestyle can be tough. Simply reconnecting with family and readjusting to home life can be tough enough to prevent a search for mental health services. Factoring in finding a job or recovering from an injury and the transition can become overwhelming. The FCVSO is a former veteran with eleven years of experience in Fresno. For the last six years, he has also been the Veterans Service Officer for Madera County. Additionally, he is accredited by the California Department of Veterans Affairs. The FCVSO has been conducting mental health outreach and referring veterans needing care for over ten years. Achievement of the outreach goals outlined in Section B have had meaningful and relevant results because more veterans have gotten the help they need, therefore helping veterans avoid homelessness, potentially reducing crime, overcoming barriers to employment and striving toward a healthy lifestyle. By reaching out to veterans early and often at events, the FCVSO is conducting mental health outreach to a veteran audience who otherwise may have never come into the Fresno Veterans Services Office. The outreach efforts are the first step in helping link this population to services to ensure the transition is successful. Additionally assisting veterans and their families in the application/submittal of PTSD claims may help the veteran become more self-reliant and helps inform the CalVet on issues of access to care, customer and clinician satisfaction, efficiency, and delivery of quality healthcare should improve the delivery of services overall. FCVSO uses best practices, as identified within the Substance Abuse and Mental Health Services Administration National Registry of Evidence-based Programs and Practices, to help Veterans assess VA and community resources and identify and/or address mental health/substance use issues. The FCVSO shows Veterans how to effectively develop a plan and prioritize goals to be successful in meeting VA requirements for benefits to achieve rewards once they finish the treatment. As mentioned above, the FCVSO attends various outreach events and as a result of the information provided at these events, veterans will request a follow up meeting. When meeting with veterans one-on-one, the FCVSO asks a brief series of questions to determine whether a veteran may have an issue with PTSD or MST. Typically homeless combat veterans with mental health and substance use issues are referred to the VA hospital for a 120 day treatment plan. Combat vets with mental health issues only are referred to the local Vet Center. The VA hospital also has a mobile clinic for rural areas. Number of Participants Through this program, the Fresno County Veterans Service Office anticipates serving approximately 450 unduplicated clients for mental health services. Approximately 150 of these clients will also have substance use issues. A new population being served in Madera County, which the FCVSO oversees, is with the incarcerated population in Chowchilla State Prison. Current projections for this contract term are about 12 cases per month. With the current success at the Chowchilla Prison there is hope mimic the outreach in Fresno County, by connecting and establishing partnerships with the Fresno County Judicial system by the end of this contract term (June 30, 2017). By the end of this contract term we hope to assist more than 100 incarcerated veterans, between the two counties. 3 California Department of Veterans Affairs Contract Number: 16XS0006 Program Narrative Exhibit A-1 Organization Partnerships The FCVSO refers veterans to the Vet Center, the VA Hospital and San Joaquin Valley Veterans for services. The FCVSO has established a working relationship with the not-for-profit organization, San Joaquin Valley Veterans, a project of WestCare (SJVV). A program of SJVV called "Home Front" offers transitional housing and services for women veterans. Services include; life skills, education, employment readiness, family development and counseling for PTSD and MST. The FCVSO refers women veterans to SJVV and also provides information to the women currently at the facility. SJVV also runs a similar home called the "Veterans Village for males". Another partnership we have created is with Central Valley Veterans organization; this is a non-profit organization that works with homeless veterans. Central Valley Veterans assist with delinquent bills that would cause veterans to be evicted or lose services. They also provide assistance with providing furniture, moving expense, food and clothing. The FCVSO is partnering with the Fresno County Court System starting in June 2016, to sit on a Committee that will identify/verify and support veterans entering and exiting the court system. The committee will include VA Veterans Justice Outreach, CalVet, Fresno County Superior Court and FCVSO. Part of this process is to update and modify the MIL100 form, so that it can be utilized by the VSO to process and verify veterans more clearly. This will allow veterans easier assistance when they are released from Jail/Prison or in some cases allow them to seek VA assistance rather than be incarcerated, to deal with issues that were incurred in military services. The FCVSO also has a partnership with the Chowchilla Men's Maximum Security Prison. Currently processing about 12 claims per month, which includes ongoing case management and new claims. The Veterans office receives about 10 correspondence letters a week from prisoners asking question about claims and claiming process. Currently presentations are done once a month (on site), with about 40 attendees each time (we estimate there are about 325 in the veteran community here; however due to prison guidelines only so many prisoners may be present during this presentation at one time). Due to the successful outreach occurring here, there is discussion for "VET housing" to be established within the prison. The idea is to house veterans who will be nearing parole, so that they can have an easier, assisted transition when released (An action plan will be created for each prisoner that will connect them with housing, employment, aid and health benefits).With the current success at the Chowchilla Prison there is hope to connect and establish partnerships with the Fresno County Judicial system by the end of this contract term (June 30, 2017). Potential Barriers The greatest potential barrier to the success of the proposed project is the lack of awareness. Many veterans do not have knowledge of the available services. In an effort to be proactive, the FCVSO is focusing on attending Blue Ribbon and Muster Briefing Events so that soldiers are educated on resources before deployment rather than upon their return. 4 California Department of Veterans Affairs Contract Number: 16XS0006 Program Narrative Exhibit A-1 Proposition 63 Funding Utilization and Funding per Veteran Prior to Prop 63, the FCVSO assisted 80-90 families in the application/submittal of claims. The Prop 63 funding received by Fresno County in the last few years has enabled the FCVSO to increase Mental Health outreach efforts and attend more outreach events throughout the county. If mental health funding were to end, the FCVSO would continue the outreach on a smaller scale by attending only the larger events, such as stand downs and job fairs. Approximately 25 percent of the FCVSO's total outreach activities are Mental Health specific, Total Proposed Cost of Program- $45,175.00 Total Unduplicated Veterans Served- 550 Cost Per Veteran- $82.14 Section D: Performance Assessment and Data All Veterans served through this program are required to complete a California Action Plan for Reintegration Form. This form has a section listing the benefits an individual may request additional information on including TBI/PTSD. The FCVSO utilizes the responses on this form to help track the number of veterans requesting services. Another tracking method is through the Event Log, which includes event information such as date, location, type of event, number of veterans participating, CVSO staff attending and time spent. A third tracking tool is a Referral Screening document, which tracks each participant, the date, last of digits of SSN, Branch of Service, whether a veteran was screened and referred for PTSD/TBI or MST. A new metrics tracking will occur this contract term, for tracking incarcerated Veterans and tracking MIL100 Forms; each are expecting to utilize the VETPRO system. Travel and material costs are calculated through the use of queries in Fresno's PeopleSoft system. The data gathered is used to manage whether the FCVSO will meet the cost per veteran goal throughout the year. Performance metrics and data source for tracking are as follows: ■ FCVSO will present at 55 outreach events; data source is the Event log. ■ FCVSO will perform 450 PTSD/TBI and MST screenings to identify veterans in need of referrals; data source is the Referral Screening Log. ■ FCVSO will assist 150 veterans and their families in application/submittal of Service Related Disability Compensation claims & Non-Service Related Disability Pensions related to PTSD; data source is an adhoc report from VETPRO indicating the number of PTSD claims filed. ■ FCVSO will assist 100 veterans within the Prison system and will identify these individuals on the Performance metrics, by ensuring staff correctly identify this population identified through VETPRO. ■ FCVSO will assist with verifying 75 MIL 100 forms Each requested period, the FCVSO will report statistical data as identified in Attachment A. 5 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit B - Budget Detail and Payment Provisions County of Fresno I. STANDARD BUDGET DETAIL AND PAYMENT PROVISIONS 1. Invoicing and Payment A. For services satisfactorily rendered, and upon receipt and approval of the invoices, the State agrees to compensate the Contractor for services rendered in accordance with the rates in Exhibit B-1. 1) The first quarterly payment shall be made upon approval of the contract in the amount of$11,250.00. 2) The remaining three payments shall be made upon receipt of quarterly invoices by the CalVet Contract Manager. 3) Quarterly invoices shall be submitted no later than the following dates: July 1, 2016 Contract Begins Term: July 1, 2016—June 30, 2017 October 31, 2016 1st Quarter Invoice/Metrics Due 1st Quarter(07/01/2016—9/30/2016) January 30, 2017 2nd Quarter Invoice/Metrics Due 2nd Quarter(10/01/2016— 12/31/16) April 28, 2017 3rd Quarter Invoice/Metrics Due 3rd Quarter(01/01/2017—03/31/2017) Counties must summarize information from the periodic reports, describe the accomplishments of the project and describe next steps for implementing any July 31, 2017 Annual Progress Reports plans for additional work identified during the funding period. (Annual Progress Reports are due with 4th Quarter invoices and metrics.) 4th Quarter(04/01/17—06/30/17) B. Quarterly payments shall only be approved upon periodic invoices that shall include the Agreement Number, County name, address and telephone number. Quarterly invoices shall also be accompanied by the quarterly reports identified in Exhibit A— Scope of Work, and shall be submitted in duplicate not more frequently than listed above to: Original Invoice Approval Copy Department of Veterans Affairs Department of Veterans Affairs CalVet Accounting Office Veterans Services Division 1227 "O" Street Room 402 1227 O Street, Room 105 Sacramento, CA 95814 Sacramento, CA 95814 Attn: Phillip Leggett Rev 2/26/2016 Page 1 of 3 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit B - Budget Detail and Payment Provisions County of Fresno Budqet Contingency Clause A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further form and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform 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 Contractor to reflect the reduced amount. 2. 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. II. SPECIAL BUDGET DETAIL AND PAYMENT PROVISIONS 1. Submissions of Invoices/Claims A. All invoices/claims must be completed thoroughly and legibly, with all applicable fields completed. Invoices/claims that are submitted to the appropriate location but have been altered, or are inaccurate, or do not provide all necessary information will not be accepted and will be returned to the Contractor for correction. B. Any changes to this provision relating to the invoice/claim submittal process, including but not limited to an address, form, or process change, shall be an administrative change managed through the appropriate designated CalVet office and shall not require a contract amendment. C. Invoices/claims submitted shall include the following information in order to be considered complete and acceptable for processing, or the invoice/claim will be returned: 1) Contractor's Company name 2) Contractor's Company address, phone number and e-mail 3) Date of invoice/claim 4) Invoice/claim number 5) Location where services were performed 6) Agreement Number 7) Contractor Federal Employer Identification Number and National Provider Identifier number 8) Date(s) of Service 9) Total dollar amount being billed 10) First and Last name of Contractor or Provider performing services, if applicable Rev 2/26/2016 Page 2 of 3 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit B - Budget Detail and Payment Provisions County of Fresno 11) Contractor's or Provider's Classification, whichever is applicable 12) Contractors shall include the following information on the invoice/claim submitted for hourly reimbursement: a) Hourly Rate b) Time in and time out c) Total hours worked d) Total number of Residents seen e) Any other medical information or documentation reasonably required to verify and substantiate the provision of services and the charges for such services. Rev 2/26/2016 Page 3 of 3 California Department of Veterans Affairs Agreement Number 16XS0006 Budget Form/Narrative Exhibit B-1 BUDGET FORM/NARRATIVE The Budget Form/Narrative may not represent the actual dollar amount allotted for this Agreement. The Budget Form is the Contractor's response to Program's Request for Application and shall be attached as a reference for Contractor's proposal of how expenses will be addressed as part of this agreement. Appendix B — Budget Form Fresno County Veterans Service Office Veterans Outreach Proposition 63 A. Personnel Hrs./Mos. Mos./Yr. Spent on Position Hourly Wage Spent on Cost Program Program FCVSO 35.625 36 hours/mo. 12 $15,390.00 VSR II 1 26.593 9 hours/mo. 12 $2,872.00 Total $18,262.00 B. Fringe Benefits Component Rate Annual Wage Cost UIB, SDI, WC 7.86% $18,262.00 $1,435.00 Retirement 63.51% $18,262.00 $11,598.00 Health/Life Benefits 8.85% $18,262.00 $1,616.00 Total $14,649.00 C. Travel Location Purpose Rate (Mileage Only) Cost Various Outreach Locations Outreach $0.54 $3,059.00 Various Collaborative Events Collaborative $0.54 $1,529.00 Total $4,588.00 D. Supplies Items Rate (Cost x Months) Cost Printing Cost for Brochures $50 x 12 $600.00 Mailing Costs $25 x 12 $300.00 Promotional Items $77 x 12 $924.00 Total $ 1,824.00 E. Contracting Name Service Rate (Cost/Individual Cost x Individual x Days) Total $0.00 F. Other Item Rate Cost Support Staff Cost $37.51 per hour x 156 hours $5,852.00 Total $5,852.00 Section A: Personnel $18,262.00 Section D: Supplies $1,824.00 Section B: Fringe Benefits $14,649.00 Section E: Contracting $0.00 Section C: Travel $4,588.00 Section F: Other $5,852.00 Total Requesting $45,175.00 Rev. 3-21-2016 Page 1 of 2 California Department of Veterans Affairs Agreement Number 16XS0006 Budget Form/Narrative Exhibit B-1 Appendix C — Budget Narrative Fresno County Veterans Service Office Veterans Outreach Proposition 63 Section A: Personnel FCVSO salary cost for 432 outreach hours which consist of 237 hours of outreach at Yellow Ribbon Reintegration Program events, Stand Downs, Job Fairs, Muster briefings, Incarcerated presentations, National Guard Reserve Armories events/presentations in the area, 140 hours of one-on-one follow up with veterans and 55 hours of preparation and planning. VSR II salary cost is for 108 outreach hours for inmate outreach activities; claims, communication letters, visitations and presentations. Section B: Fringe Benefits FCVSO and VSR II benefit cost for 540 outreach hours. Benefits include Retirement, Unemployment and State Disability Insurance, Workers' Compensation, Life and Health Insurance and Administrative Benefits. Rates used to calculate benefit cost are the Counties projected benefit rates for FY 2016- 17. Section C: Travel Travel is required because the events are held outside of the Veterans Service Office. Travel costs include mileage cost (at the current state rate) for FCVSO to attend approximately 55 outreach events including Yellow Ribbon Reintegration Program events, Stand Downs, Job Fairs, Muster briefings, Incarcerated presentations, National Guard Reserve Armories events/presentations. Section D: Supplies Supply cost for the printing of tri-fold color brochures and business cards to be distributed at the various outreach events. Promotional items costs (pens, pencils, bags, banners, tarps, etc.) to be given away at outreach events to promote the VSO mental health outreach activities. Postage cost for mailing follow up materials, appointment letters and informational flyers. The calculation for these totals were based the average of actuals reported in the 14XS0003 Agreement with the California Department of Veterans Affairs, for Prop. 63 mental health outreach services, with a projected increase for increased outreach and collaborative events. Section E: Contracting NA Section F: Other Average support staff salary and benefit cost for 3 hours of administrative support a week (e.g. phone calls, photocopies, follow-up). Rev. 3-21-2016 Page 2 of 2 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit D —Special Terms and Conditions County of Fresno 1. EXCISE TAX: The State of California is exempt from Federal Excise Taxes, and no payment will be made for any taxes levied on employees' wages. The State will pay for any applicable State of California or local sales or use taxes on the services rendered or equipment or parts supplied pursuant to this Contract. California may pay any applicable sales or use tax imposed by another state. 2. STATUTORY AND REGULATORY PROVISIONS A. This Contract shall be governed and construed in accordance with all applicable statutory and regulatory provisions including, but not limited to: 1) Title XVI II of the Federal Social Security Act 2) Title XIX of the Federal Social Security Act 3) Chapters 7 and 8 (commencing with Section 14000), Part 3, Division 9, Welfare and Institutions Code 4) Division 3, Title 22, California Code of Regulations (CCR) 5) Health and Safety Code Section 1340 et seq. 6) All applicable Federal provisions which regulate the administration of health care programs and budget revisions, as contained in the Code of Federal Regulations (CFR), Title 42, and Title 45, Part 74, Title 42 United States Code, Sections 1395 et seq. and 1396 et seq. 7) Sub-chapter 13 (commencing with Section 6800), Chapter 4, Part 1, Title 17, CCR; and 8) All other applicable laws and regulations. B. Any provision of this Contract in conflict with the applicable laws and regulations is hereby amended to conform to the provisions of those laws and regulations. Such amendment of the Contract shall be effective on the effective date of the statutes or regulations necessitating it, and shall be binding on the parties even though the amendment may not have been reduced to writing and formally agreed upon and executed by the parties. If, due to amendment in laws of regulations, Contractor is unable or unwilling to comply with the provisions of the amendment(s), State or Contractor may terminate this Contract in accordance with the Termination provision of this Contract. 3. EXAMINATION AND AUDIT A. Contractor shall allow the State and its related entities, the Comptroller General of the United States, Department of Justice (DOJ), and the Bureau of Medi-Cal Fraud, or their duly authorized representatives, to inspect or otherwise evaluate the quality, appropriateness, and timeliness of services performed under this Contract, and to inspect, evaluate, and audit any and all books, records, and facilities maintained by the Contractor and Subcontractors pertaining to services under this Contract at any time during normal business hours. B. Contractor shall be subject to the examination and audit of the State Auditor for a period of three (3) years after final payment under this Contract in accordance with Government Code, Section 85467.7. The examination and audit shall be confined to those matters directly connected with the performance of the contract, including, but not limited to, the costs of administering the Contract. C. Books and records include, but are not limited to, all physical records originated or prepared pursuant to the performance under this Contract, including working papers, reports, financial records, and books of account, Medical Records, prescriptions files, Subcontracts, and any other documentation pertaining to medical and non-medical services for residents of the Home. Upon request, at any time during the term of this Contract, the Contractor shall furnish any record or copy. Rev. 2/25/2016 Page 1 of 6 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit D —Special Terms and Conditions County of Fresno 4. RESOLUTION OF DISPUTES: A. The Contractor may dispute and appeal a decision or action by the State arising out of the Interpretation or administration of this Contract. A written dispute notice shall be submitted to the Contract Manager within thirty (30) calendar days from the date the Contractor receives notice of the decision or action in dispute. The Contractor's dispute notice shall state the following, based on the most accurate information available to the Contractor: 1) That it is a dispute pursuant to this Section. 2) The date, nature, and circumstances of the conduct, which is the subject of dispute. 3) The names, telephone numbers, function, and activity of each contractor, subcontractor, State official, or employee involved in or knowledgeable about the conduct. 4) The identification of any documents and the substance of any oral communications involved in the conduct. Copies of all identified documents shall be attached. 5) The reason why the Contractor is disputing the conduct. 6) The cost impact to the Contractor directly attributable to the alleged conduct, if any. 7) The Contractor's desired remedy. B. The State and the Contractor agree to try to resolve all contractual issues by negotiation and mutual agreement at the Contract Manager level. The parties recognize that the implementation of this policy depends on open-mindedness, and the need for both sides to present adequate supporting information on matters in question. The Contract Manager, in a written decision stating the factual basis for the decision, will decide any disputes concerning performance of this Contract. Before issuance of the Contract Manager's decision, informal discussions between the parties by the individuals who have not participated substantially in the matter in dispute will be considered by the parties in efforts to reach mutual agreement. C. The Contract Manager will render a decision or request additional substantiating documentation from the Contractor within thirty(30)days of receipt of the Contractor's appeal. A copy of the decision will be provided to the Contractor. The decision shall be final and conclusive unless, within thirty (30) days from the date of the decision, the Contractor files a written appeal addressed to the Undersecretary, California Department of Veterans Affairs. D. The Undersecretary's decision shall be final and conclusive unless the decision is arbitrary, capricious, grossly erroneous or if any determination of fact is unsupported by substantiating evidence. The Undersecretary's decision will be in writing and may encompass facts, interpretations of the Contract, and determination or application of law. The Contractor may, prior to the Undersecretary's decision, present oral or documentary evidence, and arguments in support of the Contractor's appeal. The decision will either: 1) Find in favor of the Contractor, in which case the Undersecretary may: a) Countermand the earlier conduct which caused the Contractor to file a dispute; or b) Reaffirm the conduct and, if there is a cost impact sufficient to constitute a change in obligations pursuant to the payment provisions, direct the State to comply with that Section. 2) Deny the Contractor's dispute and, where necessary, direct the manner of future performance; or 3) Request additional substantiating documentation in the event the information in the Contractor's dispute or appeal is inadequate to permit a decision to be made under paragraphs (1) or (2) above, advise the Contractor as to what additional information is required, and establish how that information will be furnished. The Contractor shall have thirty (30) days to respond to the Undersecretary's request for further information. Upon receipt of this additional requested information, the Undersecretary will have thirty (30) days to respond with a decision. Failure to Rev. 2/25/2016 Page 2 of 6 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit D —Special Terms and Conditions County of Fresno supply additional information required by the Undersecretary within the time period specified above shall constitute waiver by the Contractor of all claims. E. Attorney's fees and costs for any dispute or subsequent trial shall be borne by the respective parties. Both parties waive trial by jury, and any trial in superior or municipal court shall be by a judge alone. Any litigation arising out of this Contract shall be conducted in a California Court pursuant to California law. F. Contractor shall continue with the responsibilities under this Contract during any dispute. 5. AGENCY LIABILITY(Applies only to Federally Funded Contracts): The Contractor warrants by execution of this Contract, that no person or selling agency has been employed or retained to solicit or secure this Contract upon Contract or understanding for a commission, percentage, brokerage, or contingent fee, excepting bona fide employees or bona fide established commercial or selling agencies maintained by the Contractor for the purpose of securing business. For breach or violation of this warranty, the State shall, in addition to other remedies provided by law, have the right to annul this Contract without liability, paying only for the value of the work actually performed, or otherwise recover the full amount of such commission, percentage, brokerage, or contingent fee. 6. POTENTIAL SUBCONTRACTORS: For all Agreements, with the exception of Interagency Agreements and other governmental entities/auxiliaries exempt from bidding, nothing contained in this Contract or otherwise shall create any contractual relation between the State and any subcontractors, and no subcontract shall relieve the Contractor of Contractor's responsibilities and obligations hereunder. The Contractor agrees to be as fully responsible to the State for the acts and omissions of its subcontractors and of persons either directly or indirectly employed by any of them, as it is for the acts and omissions of persons directly employed by the Contractor. The Contractor's obligation to pay its subcontractors is an independent obligation from the State's obligation to make payments to the Contractor. As a result, the State shall have no obligation to pay or enforce the payment of any moneys to any subcontractor. 7. INSURANCE REQUIREMENTS A. Upon contract award, contractor must furnish to the State an original certificate(s) of insurance stating that the contractor has the following types of coverage, if applicable: 1) Commercial General Liability: Combined Single Limit (CSL) for no less than $1,000,000 per occurrence for bodily injury and property damage. The policy must include coverage for liabilities arising out of premises, operations, independent contractors, products/completed operations, personal & advertising injury, and liability assumed under an insured contract. This insurance shall apply separately to each insured against whom claim is made or suit is brought subject to the contractor's limit of liability. 2) Professional Liability: (Applies to any contract in which the work is of a professional nature such as, but not limited to, physicians, architects, engineers, accountants, or consultants) Covering any damages caused by an error, omission, or any negligent acts. Limits of not less than $1,000,000 per occurrence and $3,000,000 aggregate. 3) Automobile Liability (Applies to any contract in which the contractor will likely use a vehicle to complete the project or drive a vehicle onto State property): Limits of not less than $1,000,000 per accident. Such insurance shall cover liability arising out of an automobile including owned, hired, and non-owned autos. Rev. 2/25/2016 Page 3 of 6 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit D —Special Terms and Conditions County of Fresno a) MCS90 endorsement on the Automobile policy (required whenever contractor will be transporting Hazardous materials i.e. Pest Control and Waste contracts.) 4) Pollution Liability/Environmental Impairment Liability (Applies only to Pollution Contracts — i.e. Pest Control and Waste Contracts): In addition, the certificate evidencing general liability must include evidence of one of the following if applicable to the service: a) Pesticide/Herbicide Endorsement, OR b) An endorsement deleting the general liability pollution exclusion, OR c) A separate environmental/pollution liability policy with limits not less than $1,000,000 covering bodily injury and property damage from pollution and related clean up costs incurred arising out of the work or services to be performed under this contract. 5) Workers' Compensation (Mandatory for all Contractors who have at least one employee): Contractor shall maintain workers' compensation and employer's liability coverage for all its employees who will be engaged in the performance of the contract, including special coverage extensions where applicable. Contractor shall furnish a certificate for Workers' Compensation issued by an insurance carrier licensed to write Workers' Compensation insurance in the State of California, including the name of the carrier and the date of expiration of insurance, or a Certificate of Consent to Self-Insure issued by the Department of Industrial Relations. 6) Fidelity Bond/Crime Insurance: (Applies only to contracts handling State money or securities — i.e. Armored Car Service Contracts) Contractor shall maintain Employee Dishonesty and, when applicable, Inside/Outside Money & Securities coverages for state-owned property in the care, custody and control of the Contractor. Coverage limits shall not be less than the amount scheduled in the contract. The policy shall include as Contractor. Coverage limits shall not be less than the amount scheduled in the contract. The policy shall include as loss payee the California Department of Veterans Affairs 7) The certificate(s) of insurance shall be on an ACORD form, or equivalent, and must show "occurrence" coverage. The certificates of insurance must also contain all of the following provisions: a) Name and address of the insurance company, policy number, and beginning and ending dates of the policy. b) Statement that the insurer will not cancel the insured's coverage without 30 days prior written notice to the State. c) Statement that the State of California, its officers, agents, employees, and servants are included as additional insured on the policy, but only insofar as the operations under this contract. 8) Contractor agrees that any insurance herein provided shall be in full force and effect at all times during the term of the contract. In the event said insurance coverage expires at any time during the term of this contract, Contractor agrees to provide, at least ten (10) days prior to said expiration date, a new certificate of insurance evidencing insurance coverage as provided for herein for not less than the remainder of the term of the contract, or for a period of not less than one (1) year. In the event contractor fails to keep in effect at all times insurance coverage herein provided, State may, in addition to any other remedies it may have, terminate the contract upon the occurrence of such event, subject to the provisions of the contract. 9) Contractor shall notify the State within five (5) days if any insurance coverage identified in the contract is altered in any way. Rev. 2/25/2016 Page 4 of 6 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit D —Special Terms and Conditions County of Fresno 8. RIGHT TO TERMINATE A. The State reserves the right to terminate this Contract subject to thirty (30) days written notice to the Contractor. Contractor may submit a written request to terminate this Contract only if the State should substantially fail to perform its responsibilities as provided herein. However, the Contract can be immediately terminated for cause. The term "for cause" shall mean that the Contractor fails to meet the terms, conditions, and/or responsibilities of the contract. In this instance, the contract termination shall be effective as of the date indicated on the State's notification to the Contractor. B. This Contract may be suspended or cancelled without notice, at the option of the Contractor, if the Contractor or State's premises or equipment are destroyed by fire or other catastrophe, or so substantially damaged that it is impractical to continue service, or in the event the Contractor is unable to render service as a result of any action by any governmental authority. 9. FORCE MAJEURE: Neither party shall be liable to the other for any delay in or failure of performance, nor shall any such delay in or failure of, performance constitute default, if such delay or failure is caused by "Force Majeure." As used in this section, "Force Majeure" is defined as follows: Acts of war and acts of god such as earthquakes, floods, and other natural disasters such that performance is impossible. 10. EVALUATION OF CONTRACTOR: Performance of the Contractor under this Agreement will be evaluated. The evaluation shall be prepared on Contract/Contractor Evaluation Sheet (STD 4), and maintained in the Agreement file. For consultant agreements, a copy of the evaluation will be sent to the Department of General Services, Office of Legal Services, if it is negative and over$5,000. 11. SB/DVBE PARTICIPATION: In accordance with requirements set forth by the State, the CalVet shall enforce all laws, rules, and regulations pertaining to this program. It is the Contractors responsibility to provide CalVet with all required documents as outlined in this agreement. The CalVet reserves the right to contact each SB and DVBE identified by the Contractor to verify compliance. Failure to meet SB/DVBE requirements under Exhibit B, and Exhibit C (GTC 610), paragraphs 19.a and 19.b. may deem the Contractor to be non-responsible and rejected from future bid and contract opportunities with the CalVet. 12. LICENSES AND PERMITS: The Contractor shall be an individual or firm licensed to do business in California and shall obtain at his/her expense all license(s) and permit(s) required by law for accomplishing any work required in connection with this contract. If you are a Contractor located within the State of California, a business license from the city/county in which you are headquartered is necessary; however, if you are a corporation, a copy of your incorporation documents/letter from the Secretary of State's Office can be submitted. If you are a Contractor outside the State of California, you will need to submit to the California Department of Veterans Affairs a copy of your business license or incorporation papers for your respective State showing that your company is in good standing in that state. In the event any license(s) and/or permit(s) expire at any time during the term of this contract, Contractor agrees to provide agency a copy of the renewed license(s) and/or permit(s) within 30 days following the expiration date. In the event the Contractor fails to keep in effect at all times all required license(s) and permit(s), the State may, in addition to any other remedies it may have, terminate this contract upon occurrence of such event. Rev. 2/25/2016 Page 5 of 6 California Department of Veterans Affairs Agreement Number 16XS0006 Exhibit D —Special Terms and Conditions County of Fresno 13. CONSULTANT—STAFF EXPENSES: The Contractor represents that it has or shall secure at its own expense, all staff required to perform the services described in this Agreement. Such personnel shall not be employees of or have any contractual relationship with any governmental entity. 14. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION: For the purpose of this contract, contractor shall comply with the federal Health Insurance Portability and Accountability Act (HIPAA), as well as State and Federal requirements for privacy protection. The definitions and obligations required by the HIPAA Standards for Privacy of Individually Identified Health Information (U.S.C. 1320d et seq.), and implementing regulations including but not limited to 45 Code of Federal Regulations parts 142, 160, 162, and 164, hereinafter referred to as the Privacy Rule, remain enforce and applicable for access to protected health information, including electronic protected health information. 15. LEGAL CONTRACTS (applies only to Legal Services Contracts) In accordance with (Public Contract Code Section (10353.5)The Contractor shall: A. Agree to adhere to legal cost and billing guidelines designated by the State. B. Adhere to litigation plans designated by the state agency. C. Adhere to case phasing of activities designated by the state agency. D. Submit and adhere to legal budgets as designated by the state agency. E. Maintain legal malpractice insurance in an amount not less than the amount designated by the state agency. F. Submit to legal bill audits and law firm audits if requested by the state agency. The audits may be conducted by employees and designees of the state agency or by any legal cost control providers retained by the state agency for purpose. G. Submit to a legal cost and utilization review, as determined by the state agency. Rev. 2/25/2016 Page 6 of 6 ATTEST: BERNICE E.SEIDEL,Clerk Board of Supervisors CCC-307 By —J" a�_ CL"LL CERTIFICATION l'oeputy 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) Printed Name and Title of Person Signing Ernest Buddy Mendes, Chairman,Fresno County Board of Supervisors Date Executed Executed in the County of Lc a` ._ _�.__,_._ 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 8103) (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 over$100,000 executed or amended after January 1, 2007, the contractor certifies that contractor is in compliance with Public Contract Code section 10295.3. 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 STATE OF CALIFORNIA No.: California Department of Veteran Affairs (CDVA) Mental Health Outreach Funding Term: July 1, 2016—June 30,2017 REVIEWED AND RECOMMENDED FOR APPROVAL: DELFINO E.NEIRA, DIRECTOR DEPARTMENT OF SOCIAL SERVICES By: Date: APPROVED AS TO LEGAL FORM: DANIEL C. CEDERBORG, COUNTY COUNSEL By: Date: APPROVED AS TO ACCOUNTING FORM: VICKI CROW, C.P.A.,AUDITOR-CONTROLLER/ TREASURER-TAX COLLECTOR By: I)ate: 6171 Org: 1125 Acct: 3480 Subclass: 17230 Fund: 0065