HomeMy WebLinkAboutAgreement A-19-120 with CDPH.pdf Agreement No. 19-120
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229(12/2017)
NUTRITION EDUCATION AND OBESITY PREVENTION BRANCH
Awarded By
THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter"Department"
TO
County of Fresno, hereinafter "Grantee"
Implementing the project, "State Physical Activity and Nutrition," hereinafter"Project"
GRANT AGREEMENT NUMBER 18-10558
The Department awards this Grant and the Grantee accepts and agrees to use the Grant funds as
follows:
AUTHORITY: The Department has authority to grant funds for the Project under Health and
Safety Code, Section 125280.
PURPOSE: The Department shall provide a grant to and for the benefit of the Grantee;the
purpose of the Grant is to implement the following overarching strategies of the State Physical
Activity and Nutrition (SPAN) grant:1.) Develop a Healthy Meeting policy for local government
agencies, and assist small retail vendors in adopting healthy food service guidelines;2.) Promote
compliance with federal lactation accommodation laws in targeted worksites;3.)Work with Early
Care and Education (ECE) partners to improve physical activity (PA) and nutrition content in
professional development trainings, and work with ECE sites to increase adoption of nutrition and
PA standards; 4.) Increase community PA by supporting the development or implementation of
pedestrian, bicycle, or transportation plans, and supporting Safe Routes to School program
activities that promote family and community PA;and 5.) Collaborate with state-level partners in
transportation and planning to include obesity, chronic disease prevention, and health equity in
transportation policy.
GRANT AMOUNT: The maximum amount payable under this Grant shall not exceed
$450,000.00 dollars (Four Hundred Fifty Thousand Dollars) .
TERM OF GRANT AGREEMENT: The term of the Grant shall begin on September 30, 2o18, and
terminates on September 29, 2023. No funds may be requested or invoiced for services performed
or costs incurred after September 29, 2023.
Page 1 of 3
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229(12/2017)
PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will be:
California Department of Public Health Grantee:County of Fresno
Name: Nathan Magsig, Chairman, Board o
Name:Kimmy Casjens, Grant Manager Supervisors
Address:1616 Capitol Avenue Address:2281 Tulare Street#300
City,ZIP:Sacramento, CA 95814 City,Zip:Fresno, CA, 93721
Phone:g16-449-5456 Phone:559-600-6449
Fax:g16-449-5415 Fax:559-6o0-7689
E-mail:Kimmy.casjens@cdph.ca.gov E-mail:nmagsig@fresnocountyca.gov
Direct all inquiries to:
California Department of Public Health, Grantee: County of Fresno
Nutrition Education and Obesity Preventiuon
Attention:Linda CowlingAttention:Susie A Rico-Vasquez,Project Director
Address:1616 Capitol AvenueAddress:1221 Fulton Street,3'd Floor
City,Zip:Sacramento, CA 95814 City,Zip:Fresno, CA 93721
Phone:g16-445-2973 Phone:559-600-6407
Fax:g16-449-5414 Fax:
E-mail:linda.cowling@cdph.ca.gov E-mail:sricovasquez@fresnocountyca.gov
Either party may change its Project Representative upon written notice to the other party.
All payments from CDPH to the Grantee;shall be sent to the following address:
Grantee:County of Fresno
Attention:Department of Public Health
Address:P.O. Box n867
City,Zip: :Fresno, CA 93775
Phone:559-600-6415
Fax:
E-mail:dphboap@fresnocountyca.gov
Page 2 of 3
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229(12/2017)
STANDARD PROVISIONS. The following exhibits are attached and made a part of this Grant by this
reference:
Exhibit A GRANT APPLICATION
Exhibit B BUDGET DETAIL AND PAYMENT PROVISIONS
Exhibit C STANDARD GRANT CONDITIONS
Exhibit D ADDITIONAL PROVISIONS
Fxhibit F. FEDERAL TERMS AND CONDITIONS
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 Grantec(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 contractors and
subcontractors 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: TolGa.a-, IZt�.I.pl9
Nathan Magsig, Chairman, Board of
ATTEST: Supervisors
BERNICE E,SEIDEL County of Fresno
Clerk of the Board of Supervisors 2281 Tulare Street#300,
County of Fresno,State of California
• � Fresno, CA 93721
By Deputy
Date: I �nd6WOrIA
M shay Greg ry, C ief
tracts Manag t ent Unit
alifornia Department of Public H_e th
1616 Capitol Avenue, Suite 74.262
P.O. Box 997377, MS 1800-18o4
Sacramento, CA 95899-7377
Page 3 of 3
County ofFresno
18-10558
Exhibit A-Grant Application
a. BACKGROUND
California(CA)is home to almost 38 million people and encompasses a broad diversity of cultures,
ethnicities,and ages.The burden of inadequate nutrition,inactivity,obesity and chronic disease in CAis
substantial and disproportionately affects persons of color and those experiencing lower socio-economic
status (SES). The CADepartment ofPublic Health(CDPH)is dedicated to optimizing the health and well
being ofthe people of CA,and through its Nutrition Education and Obesity Prevention Branch MOP%
has substantial expertise and experience in achieving the goals ofthis grant. The CDPHMOPB State
Physical Activity and Nutrition(Cal SPAN)team will leverage the strength of CDPH's local health
department(LHD)system in 60 ofthe 61 CAlocal health jurisdictions. CDPHwill also provide targeted,
intensive support in select counties to test the scalability and effectiveness ofinterventions and to address
health disparities. CDPHwiU activate a strong,statewide network ofvaried partners to increase and extend
the reach and impact of services. CDPH will apply evidence-based nutrition,breastfeeding(BF),and
physical activity(PA)promotion strategies to advance policy, systems,and environmental(PSE)changes.
This work will support improvements in nutrition and safe and accessible PAthat benefits the entire state
and that can be shared with local government entities.
In 2017, approximately 12.3 million individuals, or 33 percent CA's population were living at or below
185 percent the federal poverty level(FPL),winch qualifies them for food assistance programs like the
SupplementalNutrition Assistance Program(SNAP).Astonishingly,this includes almost 1.3 million children
under six years, or 43 percent of CA's population of that age, and over seven million adults ages 18-64
years,almost a third ofthat population. Though it may seem counterintuitive,the literature shows that those
living in poverty are often overweight or obese due to an abundance ofhigh calorie,low nutrient foods in
their diets and environments.An estimated 34.6 percent,or almost 3.5 million, SNAP-Education(SNAP-Ed)
eligible CAadults are obese, compared with only 22.8 percent ofpersons with higher incomes.Additionally,
27.6 percent, or 254,000 of CA's low resource children ages 2-5 years old are overweight for their age.
Disparities in weight status can lead to disparities in associated chronic disease.For example,among
SNAP-Ed eligible adults, 12.9 percent,or almost 1.3 million have been diagnosed with diabetes,compared
with only 7.1 percent ofnon-eligible adults. There is great need across CAfor evidence based interventions
that address diet and activity-related chronic disease.Healthy foods, safe and accessible PA,and BF ofer
solutions to support weight management and improved health.
Though living in the nation's top producing agricultural state,many Californians face difficulty
accessing faits,vegetables,and other healthy foods in low-resource neighborhoods. CAmothers
participating in the SNAP program reported that it was not easy to access healthy foods, like fruits and
vegetables,whole wheat bread,and low-fat mlk in their neighborhoods. Conversely, community members
ofthese neighborhoods often have ready access to alcohol, snack junk,and fast foods. The limitations in
healthy food availability can have an even greater impact on those residing in rural,low-resource,and
communities of color.Increasing access and availability of healthy food items through a healthy retail
recognition program and through healthy checkout aisles has been a successful approach using food
service standards to improve foods ofered in neighborhood grocery stores.
Worksites are an important part ofthe out-of-home food environment.ARA-time employee spends
2,080 hours per year at work,consuming at least one meal there,phis snacks.When surveyed,65.2
percent of Latinos and 54 percent ofAfiican American(AA)adults say that faits and vegetables are difficult
to find at work Furthermore,the work culture often uses food for celebration,motivation,and reward.Food
service guidelines are one way to make wnrksites healthier.Healthy vending is a good place to start. CA
currently has a state law for nutrition standards for vending machines located on state property,but the law
does not address foods or beverages sold in cafes, cafeterias,or served during meetings or events.By
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CDPH NEOPB Proposal CDC-RFA-DP18-1807
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18-10558
adopting healthy meeting policies that include food service standards that promote healthy options and limit
less healthy options,organizations can make the healthier choice the easy choice.Worksite wellness
policies can also establish supports for mothers who have returned to work and wish to express breastuAk
BF has many known health benefits for infants,children,and mothers. One Healthy People 2020
breastfeeding objective has a target of60.6 percent of infants breastfed at 6 months ofage. The Centers
for Disease Control and Prevention(CDC)BF Report Card,2016, shows that 90.2 percent ofCAinfants
start out being breastfed,but only 58.5 percent are stillbreastfed at 6 months ofage. Initiation and
maintenance rates are lower among CAAAand Hispanic mothers and those living in poverty.According to
the 2011 Surgeon General's Call to Action to Support BF,employed women are less likely to initiate BF
and tend to breastfeed for a shorter time.Although CAlawrequires employers to provide a reasonable
amount ofbreaktime to employees desiring to express milk,more must be done to address barriers if
mothers are to breastfeed as long as mutually desired by both mother and infant. CA's large network of
1,562 Federally Qualified Health Centers (FQHC) serve some of CA's most vulnerable population. CA's
over 2.3 million FQHC patients report household'incomes at or belowthe federal poverty level There are
also opportunities to collaborate with State and local governments to enhance BF supports for thousands of
employees statewide. Continued work in FQHCs and government and private worksites will build on BF
support e$brts initiated through the CDC 1305 grant. When newparents return to work and infants enter
care facilities,it is also important to continue healthful nutrition practices when infants transition from BF to
solids.
In CA,almost 1 million children receive care in licensed early care and education(ECE)settings.It is
critical to influence children's food and PA choices while they are young, as healthy habits, formed early,
can make a difference over a lifetime. Parents and caregivers need support in choosing healthy,age-
appropriate meals,drinks and snacks, as well as ideas to keep kids active.The CAHeahhy Beverages in
Child Care Act,which took effect in 2012,requires a licensed child care facility to follow specific
requirements relating to the provision ofhealthy beverages. CAlaw also requires that ECE children have
free access to water during play and mealtimes.Additionally,those that participate in the Child Care Food
Program(CCFP)must follow a meal pattern that is consistent with good health;however,events and
celebrations outside the meals are not regulated for health content.Likewise,CAChild Care Licensing
Laws recommend centers provide a variety of activities,including quiet and active play,but do not provide
specific PArequirements,nor does the law have requirements to support BE Only 33 percent of CA
children aged 2-5 years met the PArecomrriendations and only 16 percent had less that one hour of screen
time per day. Nbre can be done to improve the health of our youngest citizens by expanding healthy
nutrition practices and'integrating BF and PAstandards into ECE services.
Connectedness to parks,worksites,conmarnity services,and retail opportunities can promote PA
among all ages and abilities. Irnproved public transportation,protected bike lanes, smooth walking paths
with benches,and signage noting distances and directions can increase active transportation(AT). In 2016,
only 3.7 percent of CA adults walked or biked to work,and only 5.1 percent took public transportation. In
the same year, 34.7 percent ofCAchildren ages 4-12 years,reported they had walked or rolled to school at
least once in the past week Integrating PAinto daily activities is a sustainable way to increase PA
Unfortunately,CAhas seen a reduction in the number of Active Transportation Program(ATP)awards,
from 207 in 2015 to just 3 in 2017. Improving AT opportunities through improved master plans and land use
interventions would have far-reaching and long-lasting effects not only on physical health,but mental health
as well PAalso provides psychological benefits and is recommended for some fora s ofdepression.
The costs of failing to address obesity and access to healthy food are high,both in terms of quality of
life as well as in dollars.Hospital charges for obesity-related health conditions increased by 39.7 percent in
CAbetween 2005 and 2014. In 2014,CAsawnearly a half-million hospital admissions for obesity-related
conditions, costing more than $36 billion in hospital charges. CA's Medi-Cal systempaid for nearly 8.0
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CDPH NEOPB Proposal CDC-RFA-DP18-1807
County offresno
18-10558
percent ofthose charges, at an estimated $7.8 billion. Systematic approaches to improve CA's health will
not only impact qualify of life,but can also yield significant economic benefits as welt
b. APPROACH
i Purpose:For SPAN CDC-RFADPI8-1807,the Cal SPAN team will build onthe success of CDC
1305 efforts and will continue to use CDC health promotion programs,tools,and resources to activate
partners,develop activities using evidence based interventions,and implement statewide and local level
initiatives to achieve increased supports for healthy nutrition, safe and accessible PA, and BF in CA
coninimities most in need. CDPH will collaborate with partners both within and external to CDPH and
across a variety of sectors (worksites,maternal and child health,ECE,retail,local govemment,planners,
transportation,etc.)to conduct environmental assessments,engage conimunities in nutrition,PA,and BF
education,and action plan for strategies and activities that address health disparities related to inactivity
and nutrition;activities will encompass all levels of the Social Ecological Nbdel and emphasize public
health approaches for long-term,broad-reaching impact. We will leverage CDPH NEOPB's existing LHD
SNAP-Ed program delivery infrastructure to enact food service standards in govemment organizations,and
nutrition and PA standards for ECE's statewide, and BF and land use strategies in selected counties; the
proposed plan will build upon SNAP-Ed interventions,avoiding duplication.
ii Outcomes:Projected outcomes include:increased number ofplaces that implement food service
guidelines,increased consumption ofnutritious food and beverages;increased number ofplaces that
support increased BF initiation,duration,and exclusivity,increased integration of nutrition and PA
standards in ECE systems;increased number of ECEs that implement nutrition and physical activity
standards;increased collaboration with partners to establish improved systems to promote comnninity-
based PAand walLbility,and increased number ofplaces that implement corii unity planning and
transportation interventions that support safe and accessible PA Ultimately,as a result of this project and
the collective statewide efforts, long-term outcomes include:increased purchasing of healthier foods,
increased BF,increased PAwith an emphasis on walking,and increased ECE nutrition and physical
activity standards met,which will collectively support reduced rates of obesity and overweight and
associated chronic disease in CAconim pities.
iii Strategies and Activities:Across each ofthe five strategies,the Cal SPAN team will pursue a
series of activities to lay the foundation for long-term success,these include:forming and activating
partnerships,conducting and/or reviewing existing assessments and comrmuiuty assets,action planning,
educating intermediaries and recipients of services, sharing lessons learned and successes,training,
technical assistance (TA),and evaluating efforts.
Strategy 1: Implement Food Service Guidelines: The Cal SPANteamwill collaborate with the worksite
wellness program Healthier U and the CDPH and Department of Health Care Services (DHCS)leadership
to promote adoption of healthy meeting policy at CDPH and DHCS.Employee assessment results
indicate strong support for such a policy. The potential reach of this effort is significant,with 3,600 CDPH
employees and 2,500 DHCS employees.Additionally,the team will leverage CDPHNEOPB SNAP-Ed LHD
infrastructure and expertise to collect and examine LHDpolicies in support of state-level efforts and to
identify best practices. Staff will provide training and TAto support local-level healthy meeting policy
adoption among 60 of the 61 CALHDs.Leveraging existing partnerships,CDPHwill explore opportunities
to implement food service guidelines in acute care facilities. To further drive increased access to healthy
foods,we will partner with five CDPHNEOPB LHDs to build on the CDC 1305 SHOP Healthy Here (SHED
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CDPH NEOPB Proposal CDC-RFA-DP18-1807
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Program in up to ten nual retail outlets. This program promotes the increased purchase ofhealthier foods
by implementing nutrition standards in aural and low SES conmlunity retail outlets.
Strategy 2: Implement Supportive BF Interventions: The Cal SPAN team will collaborate with two state-
level BF organizations:The CAWomen,Infants and Children Association(CWA)and the CABF Coalition
(CBC),and two CDPHprograms:Nhternal,Child and Adolescent Health(NEAR)and Women,Infants and
Children(WIC)to expand efforts begun under CDC 1305 work to assist conirriunity health clinics (FQHCs),
and local WIC clinics implement strategies supportive of BF. The Cal SPAN team will ensure the proposed
work is not duplicative ofcurrent WIC efforts. The Cal SPAN team will collaborate to identify existing
practices and training and TAneeds,and will provide education and resources accordingly. Staffwill also
collaborate with the above listed organizations to provide CALHDs and NUAH Black Infant Health(BED
and Home Visiting programs resources and tools supportive of BF. Through partnerships with select LHDs
implementing localworksite wEllness initiatives,the Cal SPANteamwill integrate BF support at up to ten
localwo&ites employing low-resource Californians. Collectively,these activities will address disparities in
BF rates among AA,Latino,and low SES CAworldng women.
Strategy 3: Implement and Integrate Nutrition Standards Into Statewide ECE Systems: The Cal SPAN
team will collaborate with the CDPH NEOPB SNAP-Ed,CAECE Partnership,CAECE Roundtable,and the
CAECE Resource and Referral Network(R&RNetwork)to map the policy influences for ECE professional
development standards and training guidance, determine the number ofECE sites in four target counties
that currently have policies in place that address nutrition standards,assess the strength ofthose
standards/policies, and detemvne howbest to assist ECEs without standards and/or policies to develop
and implement them. The team will leverage CDPHNEOPB SNAP-Ed LHD infrastructure and ECE
expertise for this systems based work The policy reviewwill include PAand BF practices to maximize
opportunities to advance healthy change and identify professional development opportunities. Collectively
these efforts will assist in the identification ofrecommendations to inform professional development and an
ECE recognition program proposal inclusive ofnutrition,PA,and BF support standards.
Strategy 4: Implement and Integrate PA Standards Into Statewide ECE Systems: Building on the
assessment and policy review discussed above,we will work with staff from the CDPHNEOPB SNAP-Ed,
the California ECE Partnership,the CAChiki Care Food Program Roundtable (Roundtable),and the
California Child Care Resource and Referral Network to provide professional development training, TA,and
resources to strengthen PApolicies, standards,and practices within ECE state systems and individual ECE
sites. Cal SPAN staffwill also identify and distribute PApromotional materials through ECE systems that
are suitable for use byparents ofpreschool children and support family-based PA Collectively these efforts
will assist in the identification of set of recommendations to inform professional development and an ECE
recognition program proposal inclusive ofnutrition,PA,and BF support standards.
Strategy 5: Collaborate with Partners to Implement Nhster Plans and Land Use Interventions: The
Cal SPANteam will engage with state and local level partners to promote AT and community design,
master planning and land use strategies,increase con>rrr miry PAthrough training and TAto LHDs to
support the development of successful applications for the California Department of Transportation's Active
Transportation Program(ATP),and support Un within selected geographic regions to engage
communities in Safe Routes to School(SRTS)programs and wayfinding interventions to promote walldng.
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CDPH NEOPB Proposal CDC-RFA-DP18-1807
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1. Collaborations
CDC programs and CDC-funded organizations: The Cal SPAN team will collaborate and coordinate with
the following existing and/or future CDC-funded programs:
• Racial and Ethnic Approaches to Community Health(REAM:CDPHNEOPB has an existing
relationship with the Public Health Institute (PHI),a REACHawardee.Ifawarded a SPAN grant,the
Cal SPANteamwill discuss with PHI ways to expand existing interventions in SanJoaquin County.
• Well-integrated Screening and Evaluation for Women Across the Nation Program(WISEWOMAN): The
WISEWOMANprogram is housed in the CDPH Chronic Disease Control Branch(CDCB). The current
CDPHNEOPB CDC 1305 team has collaborated with WISEVYDMAN on nutrition education materials
and messaging. If awarded,the Cal SPAN team will continue to collaborate with WISEWDMANon
ways to assist LITDs to integrate innovative and evidence-based approaches to heart disease and
stroke prevention within their health care systems and throughout the conmmnities they serve, such as
healthy food service guidelines,and PApromotion.
• Early Care and Education Learning Collaborative (ECELC)through Nemours:The current CDPH
NEOPB CDC 1305 team collaborates with Nemours on nutrition and PApolicy implementation for
ECEs in CA If awarded a SPAN grant,the Cal SPAN team 41 continue to collaborate with Nemours
and share nutrition and PAtools and resources to ECE providers,trainers,and LED staffwurking with
ECEs.
• CDC-RFA-DP18-1815PPEF18(Improving the Health of Americans Through Prevention and
Nhnagement of Diabetes and Heart Disease and Stroke). Ifthe CDPH CDCB is awarded a CDC 1815
grant,the Cal SPAN team will collaborate and coordinate with them on ways to expand efforts to
improve nutrition and PAand decrease chronic diseases in target CApopulations.
Non-funded CDC organizations:
CDPHNEOPB has a strategic partnership approach guided by a Partnership Plan. Staff are
connected to partners in a variety of sectors that provide the opportunity to inform,implement,and/or
promote public health approaches to healthy eating and active living in low-resource CAconnnunities.
The CDPHNEOPB Partnership Plan is designed to actively initiate,foster,pursue,and engage
strategic partnerships across multiple sectors to address obesity,especially among low-income and
ethnic coma imities,and is aimed at magnifying resources,influence,brainpowEr and impact The Cal
SPAN team will also collaborate with a diverse group of external partners and chronic disease
programs at CDPIT Essential collaborative activities include communication of health infomnation to the
public and providers,maintaining current partnerships and building new ones, convening partners on
identified strategies,and providing input to the developmient,implementation and evaluation of
interventions.
The Cal SPAN team will collaborate with other CDPH programs and State Departments that
address diet and activity-related chronic disease,and that serve the same target population and/or
settings. To maximize resources,reach,and impact,we will collaborate with organizations including,
but not limited to:CABF Coalition;CADialogue on Cancer,CADepartment of Transportation;CAECE
Partnership,which includes individuals from Licensing and Certification,CADepartment ofEducation
(CDE),CADairy Council,Fast 5 CA;the CAECE Resource and ReferralNetwvrk CALIF;CA
SNAP-Ed providers;CATobacco Control Program(CTCP);Health in All Policies (HAP);NUAH BIH
and Home Visiting programs;Office of Planning and Resources (OPR); SRTS State and National
Offices;University ofCaffirnia wellness coordinators;Strategic Growth Council(SGC)and WIC.
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CDPH NEOPB Proposal CDC-RFA-DP18-1807
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Collaborative partnerships are listed in the work plan.Adescription of collaborative activities can be
found in the letters of support and/or Ntmorandums ofUnderstandmg.
2. Target Populations and Health Disparities
Target Populations: While CA's obesity rates overall meet the Healthy People 2020 national goal,the
State has a long way to go to create a healthy population. As one of the most populous states, CA's
number of individuals affected by obesity and obesity-related health conditions is high and costly.
Despite progress,disparities persist in obesity rates,with higher rates ofobesityamong Californians
with the lowest household incomes and educational attainment,as well as among some racial and
ethnic groups. The focal population is Californians who have incomes at or below 185 percent of the
FPL Although proposed strategies will be directed statewide for the first year ofthe grant,the following
CA SNAP-Ed counties will be targeted: Orange,Contra Costa, Sacramento,Fresno,and Glenn.
Proposed interventions could reach 6,521,000 individuals ofwhich 2,234,000 are low-resource.
• Food Service Guidelines: Small retail markets in Sacramento,Orange, Glenn, and Fresno counties;
CDPR DHCS,and statewide LHD leadership.
• BF Interventions: Community health clinics that participated in CDC 1305 activities located in
Sacramento,Fresno,Bakersfield,Escondido,Exeter,Las Angeles,Pittsburg, Salinas, San Fernando,
Santa Rosa,Torrance,Vallejo,and Watsonville. The Cal SPAN teamwill also workwith staff at LHDs,
local WIC clinics,Home Visiting and BlHprograms throughout the state,as well as worksites in Orange
and Sacramento counties.
• Implement and Integrate Nutrition Standards into ECE Systems:Promotion ofnutrition guidelines and
implementation ofassociated training will focus on ECE sta$'at both the state and county levels who, in
turn,influence local ECE site staff ECE sites in Orange, Sacramento,Fresno and Contra Costa
counties will be targeted.
• Collaborate with Partners to Implement Nbster Plans and Land Use Interventions:The Cal SPAN team
will work with three counties from the followmg listing:Orange,Contra Costa,Glenn,Fresno,and
Sacramento to provide targeted training and TAon master plans and land use interventions to promote
AT.
• Implement and Integrate PA Standards into Statewide ECE Systems:Promotion ofPA standards and
implementation ofPAtraining will focus on ECE partner PAstafi'at both the state and county levels
who, in turn,impact local ECE site staff;ECE sites in Orange, Sacramento,Fresno and Contra Costa
counties will be targeted.
CDPH selected a mix of counties experienced in the focal areas and those where CDPHNEOPB would
Ike to develop capacity to advance these upstream solutions.For those experienced counties,our workwill
assist with the identification of mode I policies and practices for sharing with others in future years.In
summary, Cal SPAN year one activities will be allocated accordingly.
Strategy and Intervention Summary Chart
Location Food Service BF ECE ECE Master Plans
Guidelines Nutrition PA &Land Use
Statewide X X
Contra Costa County X X X X X
Fresno County X X X X X
Glenn County X
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CDPH NEOPB Proposal CDC-RFA-DP18-1807
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18-10558
Orange County X X X X X
Sacramento County X X X X X
CDPH selected Orange Countybecause ofthe opportunity to address large,nm1ticulturalpopulations,
and because of the LHD's successful history of conducting nutrition and PA initiatives through SNAP-Ed.
Additionally,the LHD SNAP-Ed Director also manages WIC. Orange County has strong expertise and
experience in community engagement,worksite wellness,ECE,retail standards,AT, and BF promotion.
Orange County's total population is over three million, with 27 percent, or 825,000 SNAP-Ed eligible
individuals.Orange County has a high rate of obesity among low-resource and communities of color.Fifty-
nine percent,or 389,000 low-resource adults are ovenNeight or obese.Roughly 63 percent,or 519,000 of
their low-resource population is I-Espanic. The CAHealth Interview Survey(CHIS)reports that almost five
percent of children ages 0-5 years are ovenwight for age, and that during the previous day27.5 percent
ate less than two servings of fruit and 17.9 percent drank one or more glasses of soda;and 59.3 percent
were not active for at least one hour daily.
CDPH selected Contra Costa County to reach and address health disparities across the five key
strategies among communities of color. Contra Costa supports a strong,well-connected ECE Roundtable,
they have experience with advancing BF support among low-resource mothers and they have experience
supporting AT. Contra Costa County's total population is 1.1 million individuals with almost 22 percent, or
237,000 SNAP-Ed eligible. In this county, 15 percent ofadults living at or below 185 percent FPLare AA,
40.8 percent are Hispanic,and 15 percent are Asian. Over fifty-seven percent ofthe adults,or 495,000 are
ovemeight or obese.Among children age 0-5 years, 13.1 percent were ovenwight for age;this rises to
18.7 percent of SNAP-Ed eligible children ofthe same age,20.7 percent ofall children ages 0-5 ate less
than two servings of fruit the previous day and 52.3 percent were not active for a least one hour daily.
CDPH selected Sacramento County for their experience in community engagement,BF supports, small
retail interventions, AT, and implementing nutrition standards at worksites. Sacramento County's total
population is 1.4 million individuals,with 34 percent,or 500,000 SNAP-Ed eligible.Eight percent ofthe
population living at or below 185 percent FPLis AA, almost 33 percent I-Espanic,and 14 percent is Asian.
Over sixty-twn percent,or 230,000 ofthe SNAP-Ed adult population is overweight or obese. Over 18
percent of children ages 0-5 years are overweight by age;that number rises to 24.5 percent of SNAP-Ed
eligible children ofthe same age.Among all children age 0-5 years, CI-IS reports that 21.6 percent ate less
than two servings of fruit the previous day and 76.3 percent were not active for at least one hour daily.
CDPH selected Fresno County because oftheir demonstrated need for services,a large population of
core munities of color,and their central valley location. Their total population is ahnost 947,000,with 46
percent or450,000 SNAP-Ed eligible. Sixty-six percent,or 318,000 ofFresno County's low-resource
population is Hispanic.Eighty percent,or 258,000,of low-resource adults are ovemeight or obese.In
Fresno,among children 0-5 years, 18.8 percent were ovenAcight for age, 12.8 percent ate less than two
servings offiuit the previous day, 15.8 percent drank one or more glasses of soda the previous day,and
51.0 percent were not active for at least one hour daily.
CDPH selected Glenn County to identify how approaches may vary in rural communities. Glenn
County's total population is 27,500,with 44 percent,or 12,000 SNAP-Ed eligible. Glenn County has
experience promoting ECE PAand would benefit from capacity building in the areas of BF promotion and
AT. In rural counties,access to healthy foods and retail food service standards have a potential for strong
impact on consumption ofhealthy foods.In the Tri-County Cluster(Glenn,Colusa and Tehanra) 10.8
percent of children ages 0-5 years are overweight for age and that number rises to 14.8 percent among
SNAP-Ed children ofthe same age.In the Tri-County area,among children age 0-5 years, 17.2 percent ate
less than two servings offiuit the previous day,24.7 percent drank one or more glasses of soda the
7
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
previous day,and 35.0 percent were not active for a least one hour daily. Glenn County,as able,will
leverage the resources and expertise of the tri-county SNAP-Ed LHDprograms.
Health Disparities: Low-resource Californians are at greater risk for obesity and obesity-related health
conditions. One in three Californians (33 percent)lives in a low-resource, SNAP-Ed eligible household. The
age group with the largest proportion of SNAP-Ed eligible is children under the age of six(44 percent, 1.3
million).An estimated 34.6 percent(3,465,000)of SNAP-Ed-eligible adults in CAare obese,compared with
23.1 percent of Californians with higher incomes. The obesity rate among Min CArose 16 percent
between 2001 and 2015;and in 2015 the obesity rate for AAwas 29 percent higher than the general
population. In 2015 for Latinos, 35 percent self-reported height and weight indicating obesity and 38
percent overweight. Heart disease and cancer combine to account for nearly haTofthe deaths among AA
in CA Among SNAP-Ed eligible adults, 12.9 percent were diagnosed with diabetes,compared with 7.1
percent ofnon-eligible adults.Prediabetes disproportionately affects the Latino population,with 36 percent
ofyoung adult Latinos estimated to have prediabetes.Among SNAP-Ed-eligible adults, 8.0 percent were
diagnosed with heart disease. This number is 5.3 percent for Californians with higher incomes.At 21
percent,cardiovascular disease is the second leading cause ofdeath among CALatinos,with cancer
leading at 23 percent.For health disparity information related to focal counties,please see the previous
section. The strategies and activities we propose will focus on preventing nutrition and activity-related
chronic diseases among low-resource comnrmnities and others facing health disparities by informing and
educating those most at risk and the organizations providing services to them,and by creating supportive
food and activity environments in collaboration with community partners.
c. Applicant Evaluation and Performance Nbasurement Plan
The Cal SPAN team will include key personnel from the CDPH NEOPB Research and Evaluation
Section(RES).RES staffwill serve as evaluation leads and will ensure that all data collection and reporting
commitments are met in accordance with the CDC Evaluation and Perfon-nance Nbasurement Strategies.
This includes working collaboratively with CDC to develop an evaluation framework and refined data
management plan within six months of award and determining the impact of CDC funding on identified
outcomes of the SPANprogram.Nbreover,RES will participate in national-level evaluation activities and
report progress,outputs,and outcomes as required and as requested by the CDC in a timely and accurate
manner.
CDPH propose to measure a number ofprocess and outcome measures for each strategy
identified in the ,wrkplan. Outcome measures will include all intemiediate outcomes defined in the CDC
SPAN Logic Nbdel Where needed,we will develop new measures and utilize several ongoing state-
specific surveillance and data collection efforts and tools to capture state and sub-state process and
outcome measures. The proposed source or tool for collecting the associated performance measures are
as follows:
Number ofplaces implementing food service guidelines. The adoption ofhealthymeetingpolicies at
CDPH and DHCS will be measured using key-informant interviews of department leadership. Training and
TAparticipation logs combined with surveys will be used to assess the extent to which LHDs have adopted
and implemented healthy meeting policies in the state.The Cal SPAN team will also leverage our existing
CACommxxrmities of Excellence in Nutrition,Phys ical Activity,and Obe s ity Prevention(CV)Survey,retailer
survey,and the SHH Stage Checklist to assess the adoption of food guidelines in targeted rural and low
SES comnxmity retail outlets.
Number of places implementing breastfeeding guidelines.In collaboration with identified partners,the
Cal SPAN team will develop a briefquestionnaire to assess the extent to which the FQHCs and WIC clinics
8
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
have adopted and implemented strategies for supporting the initiation and continuity of BF.Training and TA
participation logs will be used to monitor progress in support of this strategy. Key-informant interviews of
selected LHD staffwill be used to assess the percentage ofwurksites that adopted practices that support
BF practices that are consistent with federal guidelines.
Number of places implementing community planning and transportation interventions to support
SRTS. The Cal SPAN team will capture community planning through the number of submitted and
approved applications for California Department of Transportation's ATP. In addition, the team will track
support to LHDs promoting the SRTS program and measure the number ofnew communities that
participate in the program or adopt new strategies for supporting PAin their comrnnity.
• Number ofECEs implementing nutrition and PA standards.Nkasurement ofECE adoption of
standards will in occur in phases. The first phase will consist ofthe assessment of current standards and/or
policies at ECE systems level and at targeted ECE sites.After identifying opportunities for system change
and sites with opportunities for improvement,the Cal SPAN team will track training efforts and the
development of improved and implemented standards.Perforinance measures will track systems level
policy change,the percentage of sites with existing policies and standards,and the fraction that
successfully implement or adopt improved standards.
Long-term outcomes will be primarily captured through existing data sources. The Cal SPANteamwill
leverage data from the CASNAP-Ed Champions for Healthy Change Survey, CAHealth Interview Survey
(CMS),and CANhtemal and Infant Health Assessment Survey to assess key behavior change measures.
CDPHwill also leverage a number ofexisting national and statewide data sources for the collection of
outcomes.National data,providing key metrics for CA,will be obtained from the CDC BF Report Card,
National Center for SRTS,the National Health and Nutrition Examination Survey,and the National
Imnunization Survey. These tools will assist the Cal SPAN team to monitor and report on food quality,
availability,affordability,BF practices,and matemal and infant health in low SES communities.
Collectively,the identified data sources willpemiit the Cal SPAN team,in collaboration with CDC,to
address each ofthe key evaluation questions focused on community,ECE environments,and the identified
target population oflov-resource individuals.The Cal SPANteamwillassess chronic disease,risk factors,
health disparities,food services guidelines,and ECE nutrition and PApolicies and will use the results to
drive strategies and activities in Year 2.Performance measures will be used to monitor and evaluate the
implementation ofPAactivities and nutrition guidelines in priority settings (e.g.ECEs and wnrksites),and
the effectiveness ofactivities targeting increased PA,consumption ofnutritious food,decreased rates of
overvwight and obesity,and increase in the number of infants who are breastfed at six months of age.
The Cal SPAN team will develop and implement a continuous quality improvement(C%
infrastructure and an Evaluation Plan for ongoing evaluation,surveillance,perfonnance measurement and
management related to the nutrition and PA strategies.The Cal SPAN team will utilize both qualitative and
quantitative methods to assess internal and external resources,and identify strengths,weaknesses,
opportunities and threats to working collaboratively across chronic disease prevention programs and
partners.Results ofthese inquiries will be used to inform management and staffon ways to improve
collaboration and coordination.
The Cal SPAN team wiiH also leverage an established netvviork of iDs,community coalitions,
university collaborators,and state agency wodgpups to implement the proposed data collection and
evaluation activities.Akey partnership regarding data collection will include LHDs,who already participate
in efforts to monitor and assess, for example,food quality, availability,and affordability within CA Our
relationship with the University of California, specifically the Nutrition Policy Institute (NPI),will be central in
the collection of key outcome measures focused on identified nutrition and PA standards and/or policy,and
9
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
health behaviors.Finally,we will collaborate with CDPHNUAH and WIC to assist in the collection and
measurement planning process involving BF.
Quantitative process and outcome measures will be dependent on the granularity and availability of
data from the aforementioned sources. CDPHNEOPBproposes to develop multi-year aggregate data files
in order to continually track trends,and examine pre-and post-implementation changes in process and
outcome measures.All state-specific data collection efforts will proceed according to established practices
for instrument design,sampling and adn iinistration. CDPH NEOPB-led data collection efi'orts will include
training and technical assistance to collaborators in order to ensure fidelity to instrument-specific protocols.
As necessary,limitations involving reliability,validity or generalizability ofthe data will be disclosed in
reports to CDC.
Data Nhnagement Plan: The proposed data sources Mlvary in terms ofpublic availability and access.
Only CDPH NEOPB RES staff will have access to individual-level surveys with personally identifiable data
(PID). Individual-level survey data will only be reported in aggregate state-or county-level reports,and no
identifiable information will be shared with partners without appropriate data security agreements.Where
needed, statistical masking,or limits on small cell sizes maybe used to further protect data from
unintentional identification.All data will be stored on passvodrd-protected secure servers accessible only by
authorized personnel.We will seek a determination of non-research activity from the California.Committee
for the Protection of Human Subjects (ie.IRB)for all relevant projects. The data will be stored on servers
at a secure site,monitored by security and accessble only to authorized personnel. CDPH NEOPB data
access is protected by secure server login.Files containing PID are additionally protected by being stored
within a pennisssion-based file structure,accessible on a password-protected network All CDPHNEOPB
email and file transfer will be secured through automatic encryption or the use of fiilly Federal Information
Processing Standard 140-2 compliant,secure file transfer sites.PID will be stored on the password-
protected network,not on individual workstations. The security controls include,but are not limnited to,the
following:anti-vies so$ware,periodic log reviews ofspecific systems,generation ofaudit trails,automatic
screensaver timeouts,firewalls, intrusion detection and prevention systems, as well as the requirement to
remote-access the environment through Citrix.We will store data for approximately ten years. Ifthe data
are not being used,we willworkwith the information technology team within CDPHto dispose ofthe data.
d. Organizational Capacity of Applicant to Implement the Approach
The work of this grant is aligned with the mission ofCDPHNEOPB and consistent with the
experience and expertise ofthe staff;grantees, and partners engaged in work in state and local
government agencies and community outlets to advance nutrition guidelines,PApromotion and BF
supports. The mission of CDPH NEOPB states: "Through statewide, regional and local partnerships,
programs,and policy initiatives,we promote healthy eating,physical activity,and food security with an
emphasis on communities with the greatest health disparities."The CDPH NEOPB is part of the
organizational structure of the Center for Healthy Communities (Center). The Center includes all of CDPH's
chronic disease and risk factor programs,such as the CDCB and the Safe and Active Community Branch
(SACB). The WIC program also resides in CDPH and is a state-level partner with CDPH NEOPB. The
physical and organizational proxhiity of these programs,as well as long-standing professional
collaborations,facilitate continued opportunities for further synergies and will allow the Cal SPAN team to
draw from the broader expertise and capacity of CDPH staff
CDPHNEOPBmanages the statewide obesity prevention initiative comprised oflocal, state,and
national partners collectively working toward improving the health status of low-resource Californians
through nutrition education and PApromotion inclusive of community engagement and development
strategies all focused on communities experiencing health disparities. SNAP-Ed services target
10
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
Californians of all ages who live in households with incomes at or below 185 percent ofthe FPLin 60 of61
CA local health jurisdictions.
Depending on the type of service provided, CDPH NEOPB's SNAP-Ed program reaches between 1
million and 12 million Californians each year.In FFY 17,LM reached a total of 506 ECE sites with PSE
change strategies reaching over 17,000 children. hi that same year,LHDs provided worksite wellness
strategies in 138 low-,"age wvrksites,inclusive ofnutrition,PA and BF strategies. Thirty-six counties
worked in AT and SRTS across 168 sites,reaching over 90,000 children. These efforts are fiuther
supported by Preventative Health and Health Services Block Grant(PHHSBG)activities that convene and
engage partners to communicate best practices,to highlight model policies, and to advance upstream
solutions to address health disparities.
CDPHNEOPB brings organizations together to address areas where goals,objectives,and activities
intersect. CDPH NEOPB is committed to nurturing partnerships as the cornerstone of its work to initiate,
encourage and support PSE changes that will lead to decreasing and potentially preventing obesity and
chronic disease.CDPHNEOPB has more than 20 years of experience collaborating with state and local
organizations to obtain and deliver on categorical funding from CDC. CDPH NEOPB has also worked for
over 20 years with advocates to improve nutrition and PAenvironments,and to promote healthy policies to
increase access to healthy foods,beverages and PA
In 2008, CDPHNEOPB staff developed the CAObesity Prevention Plan(COPP)that supported
several LM and community organizations to implement activities addressing obesity prevention,including
increasing fiuit and vegetable consumption,decreasing consumption of energy-dense foods, increasing
PA, and increasing BF initiation,duration,and exclusivity. In 2010,CPDHNEOPB staffimplemented a
Sodium Reduction in Con mi ities CDC grant,which was a collaborative project with Shasta County to
promote adoption ofprocurement policies and practices that limit sodium in government purchased food,
worksites, and schools.Activities also increased the availability oflower sodium food options in schools,
restaurants and worksites and educated decision-makers on sodium reduction strategies. In 2012,CDPH
NEOPB implemented the 805 CDC Supplemental BF grant,which wus a collaborative project with the
CDPH NUM CWA,CBC, and 15 corrnnunity health clinics. Through the grant,we supported the
development of staffing and billing systems for lactation services, implementation systems to provide and
bill for professional BF support services and pumps,and developed BF guidelines and criteria., 9-Steps To
Breastfeeding Friendly. Guidelines for Connnmity Health Centers and Outpatient Care Settings
(Guidelines).
For the past 5 years,CDPHNEOPB staff supported LHDs and community organizations to implement
strategies associated with the nutrition,PA,obesity and school health portions ofthe CDC 1305 grant. CDC
1305 funded staffpartnered with two separately funded statewide programs to expand upon the healthy
retail work of CDPR wlhich improved the ability of 29 small retailers to increase the quality of foods and
beverages stocked. Staff successfully supported BikeShare Programs for employees of 14 state agencies,
reaching over 15,000 staff Staffalso collaborated with CDE,LHDs,and community organizations to
implement policies and practices that created supportive nutrition environments and assisted in the
development,implementation,and evaluation ofcomprehensive school PAprograms in ten targeted CA
school districts. Staffpartnered with school-related organizations,school/district stag LHDs,connrnrnity
organizations to improve and expand PAby AT and SRTS. Staff activated existing partnerships with WIC
and CBC to assist the 15 community health clinics to implement the BF Guidelines in as many clinics within
their organizations. Staffensured CDPH stag managers,and supervisors were aware of state and federal
lactation accommodations laws,and improved the lactation rooms of seven programs within CDPH and
DHCS. In summary,these efforts and successes leveraged the capacity and LHDprogrammatic
infrastructure ofCDPHNEOPB and SNAP-Ed,which allowed such an extensive reach of services on a
fairly small budget.
11
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
The Cal SPAN team consists ofan experienced set ofpublic health professionals (see resumes
provided.)For the CDC SPAN 1807 grant,Caroline Kurtz,PhD(Chief CDPHNEOPB)will serve as the
Principal Investigator.Dr.Kurtz has worked in CDPHNEOPB for over 5 years and for over 13 years has
led obesity prevention social marketing interventions in combination with PSE change approaches. She
also lectures at the UniversityofCalifomia Davis on Nutrition Anthropology and a Master's in Public Health
Seminar. Dr. Kurtz will coordinate closely oath Jackie Richardson,Health Program Nhnager Il;who will
serve as Project Nhnager and will oversee staffworking on the CDC 1807 grant.Nfi.Richardson has over
15 years ofexperience implementing obesity prevention programs in low-resource conmiunities;she has
worked as a Registered Dietitian(RD),and has four years of experience managing CDC grant activities,
including the 1305 CDC grant.
The day-to-day leadership and implementation of strategies and activities ofthe grant and grantees will
be shared between the Andrew Nhnthe,Health Education Consultant III,PACoordinator and Linda
Cowling,Public Health Nutrition Consultant III RD and Nutrition Coordinator.Mr.Nhnthe has worked in
public health for over 30 years, and has focused on ECE and school-related PAfor the last ten years.He
currently provides PAleadership for CDC 1305.M. Cowling has over 20 years of experience as an RD
and has provided nutrition and BF expertise on the 805 CDC BF Supplemental grant,the CDC 1305 grant,
and the Sodium Reduction in Communities CDC grant. Together,Mr.Nhnthe and M. Cowling will share
the responsibilities offacilitating teammeetings,monitoring progress, collaborating with evaluators,
preparing reports,and communicating with partners and CDC. They will have biweekly meetings with M.
Richardson to provide updates and issues related to the project. The Cal SPAN team will also consist of
Health Program Specialist 1, Sophia Nbrcado,who will support food service,AT,and community PA
strategies. M.Nhrcado previously led CDC 1305 SRTS efforts. Other team members include Nbnet
Parham-Lee,a Health Education Consultant III olio has provided leadership for ECE activities for over ten
years and Peter Munoz,a Health Promotion Specialist 1,with experience in healthy retail.
The CDPH NEOPB Fiscal Support Services Unit's Associate Governmental Program Analyst(AGPA),
Emma Keaney,will serve as Fiscal Nhnager,providing budget management and administration for
financial procedures,tracking,monitoring and reporting of expenditures for the CDC 1807 grant.Nfi.
Keaney currently provides budgetary oversight on the CDC 1305 grant and has over six years of
experience managing federal grants within CDPH In administration of federally-funded activities,CDPH
maintains records identifying the source and application of funds;compares expenditures with budget
amounts;and follows written procedures for payment requirements, determining cost allowability,and
financial reporting and monitoring. CDPHuses the Financial Information System for California.to accurately
monitor and report budget and expenditure information by program. Since 2013,CDPH has successfully
applied these policies and protocols to support strong fiscal integrity for CDC grants. Two CDPHNEOPB
grants for State Fiscal Year 2017-18 are PfFISBG,with a budget of$300,000;and Prevention First:
Advancing Synergy for Health,with a budget of$932,886.
The CDPHNEOPB Research & Evaluation Section's (RES) Chief(Lauren Whetstone, PhD)and staff,
will provide data management services,assist in the design and evaluation of strategies,and conduct
performance monitoring. RES will work as a part ofthe larger team to ensure successful implementation of
the evaluation plan and to maintain program quality,consistency,and fidelity for the CDC 1807 grant NPI
staffwill contribute to design and evaluation of strategies,inclusive ofdeveloping evaluation plans,
reviewing policies, identifying assessment tools, and assisting with surveys. Dr. Whetstone has five years'
SNAP-Ed evaluation experience and 18 years' experience evaluating community and clinic based obesity
and chronic disease prevention interventions in underserved rural communities. She is an author and editor
ofthe United States Department ofAgricuhure (LJSDA)SNAP-Ed Evaluation Frame,"ork and Interpretive
Guide.Drs. John Pugliese and Ingrid Cordon together have over 25 years ofresearch and evaluation
experience, including more than ten years of work in public health or social service sectors providing
12
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
evaluation,performance monitoring,and surveillance expertise. Nhi ja Strutz will support evaluation leads
with research and data analysis assistance.Nfi. Strutz wlll also provide TAto LHD contractors on
evaluation tool usage.NPI brings nationally recognized obesity prevention and evaluation expertise to the
team. RES staff are members ofmultiple state-level workgroups and v�Drk closely with state partners
including the CDE,California State University Sacramento,and other branches in CDPHtoward evaluating
public health goals.The Cal SPANteam will collaborate with a host ofprograms and organizations to
leverage resources and maximize the reach and impact of activities listed in the work plan. See
Collaboration section for a list ofpartner programs and organizations.
The Cal SPAN team and local counties have experience successfully implementing strategies from
previous CDC and USDAfunded grants related to nutrition,BF,AT,and PA, and,as a result,if awarded
this grant could begin services immediately. The proposed activities build upon strategies and activities the
Cal SPAN team has cultivated during the past 5 years ofthe 1305 grant.We will activate existing
relationships with LEDs,commnuiities,collaboratives,and coalitions to assist in the implementation of
proposed strategies and activities,to the potential benefit ofthe entire state.
Work Plan—Year One
Overarching Strategy 1: lmplement Food Service Guidelines
Outcome Nhasures:
• Healthy Nbeting Policies developed and implemented in up to tvw State Health Departments
and up to 10 Local Health Departments reaching over 5000 employees statewide
• Healthy food service and stocking standards adopted by up to 10 small retailers in targeted
counties
Short-Term Outcome Intermediate Outcome
Demonstrated progress on food service It number ofplaces that implement food
guidelines service guidelines
Strategy 1 Nflestone(s) Responsible Party Completion Date
Develop Healthy Nbeting Healthy Nheting policy PBNC III(Cowling); September 29,
policy for state and local drafted, adopted and HPS I G vbrcado);RS 2019
government agencies implemented IQ(Pugliese);AGPA
(Stiutz);LHDs;NPI
Settings: CDPR CADepartment ofHeakh Care Services (DHCS),LHDs Statewide
Partners: CDPR DHCS,and LHD Leadership,Healthier U Worksite Wellness Program
Activity 1: Review literature to identify evidence based approaches and 10/1/18-12/31/18
recommendations for healthy food service standards and healthy meeting policies
in the vvurkplace.Document findings.
Activity 2: Collect samples of state and local wellness policies addressing food 10/1/18-12/31/18
service guidelines and healthy meetings.Reviewfor best practices.Document
and share findings via newsletters, a webinar,presentation,and/or web posting.
Activity 3: Collaborate with CDPK DHCS,and LED leadership to develop a draft In/19-3/31/19
"Healthy Meeting" policy to develop food service guidelines for meetings,
trainings,and conferences.
Activity 4: Share draft version of policy with CDPK DHCS,and LED leadership. 4/1/19-6/30/19
Revise as needed. Present and propose for adoption.
Activity 5: Communication Activity: Communicate the importance ofthe policy 4/1/19-6/30/19
with staffand managers.Present information on the policy and alignment with
CDPH and DHCS vision with managers and supervisors.Develop template
13
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
communication piece for use locally and for CDPH employees explaining the
purpose and benefits of the Healthy Nbeting policy.Participate in meetings and
trainings,as invited,to discuss the policy.
Activity 6: Communication Activity. Share Healthy 1Vbeting policy with CDPH 7/1/19-9/30/19
Branch Chiefs,IHDleadership,and place on the CDPHwebsite andintranet.
Activity 7: Evaluation Activity.In partnership with evaluation team,design 10/1/18-12/31/18,
evaluation plan for healthy meeting policy to address the extent to which the 7/1/19-9/30/19
meeting environments have chap ed since the implementation ofthe policy.
Strategy 2 Nflestone Responsible Party Completion Date
Assist small retail vendors in Strategies implemented PFNC IQ(Cowling); September 29,
adopting healthy food service to increase access to and UPS I(M.uioz);RS II 2019
guidelines in select counties. availability ofheahhy (Cordon);IHDs;NPI
foods and beverages
Settings: Small Retail Markets in Sacramento,Orange,Fresno,and Glenn Counties
Partners: CTCB staX CDPH NEOPB staff;IHD staff;WIC, CDCB, CADepartment of Social Services,
Center for Science in the Public Interest
Activity 1: Collaborate with state and local partners to expand the SHOP Healthy 10/1/18-6/30/19
Here (SHEI)retail program to promote the adoption of healthy food service
guidelines through improved stocking standards and healthy check-out lanes.
Activity 2: Evaluation Activity:In selected stores,evaluate the store health profile 1o/1/18-12/31/18
baseline using the Conmirnities of Excellence (0X3)Retail scorecard
Activity 3: Collaborate with partners to determine retailer training and TAneeds. 10/v18-3/31/19
Activity 4: Coordinate with partners to educate retailers on the importance of
healthy food access in their communities.Provide ir&rrnation on healthy 1/1/19�/30/19
procurement practices and storage,display and promotional approaches to help
drive demand for healthy foods and beverages.
Activity 5: Evaluation Activity:Conduct a post assessment using the same CM 7/1/19-9/30/19
scorecard and assess the number ofSHHretailers who have increased the
availability of healthy food and beverages through the adoption of healthy food
service guidelines.
Activity 6: Communication Activity:Develop 2-4 case studies addressing the 7/1/19-9/30/19
impact and lessons learned. Share these case studies with CAIHDs and
partners working in small retail to advance food service guidelines.
Overarching Strategy 2: Implement Interventions Supportive of Breastfeeding
Short-Term Outcome Intermediate Outcome
Demonstrated progress on supportive BF Increased number ofplaces that implement
interventions supportive BF interventions
Outcome Nbasures:
• Supportive BF interventions adopted and implemented in up to 20 community and government
sites
• In targeted counties,increase the number ofwirksites in compliance with state and federal
lactation accommodation laws byup to 10 sites
Strategy 1 Mlestone Responsible Party Completion Date
14
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
Collaborate with partners to Number of State PFM III(Cowling); September 29,
assess the number of sites Departments,LHDs,and RS II(Cordon);AGPA 2019
that support BF in select private,%ND&tes that (Strutz);LM;NPI
counties implement BF supports
Settings: CA State Departments;IHDs, 15 Community Clinics
Partners: LHDs,FQHCs,WIC,CWA,CBC,MCAH BIH and Home Visiting
Activity 1: Collaborate with state and localpartners to assess howmany community 10/1/18-3/31/19
health clinics (i.e. FQHC's, WIC) and LHDs have adopted and implemented policies
that protect promote and support BF.
Activity 2: Coordinate efforts with partners to assess the training and TAneeds of 10/1/18-3/31/19
comniunity health clinics and LHDs to iiTlement BF guidelines and policies.
Activity 3: Based on the results ofthe assessment, Aurkwith partners to develop 4/1/19-6/30/19
content for trainings, Aebinars and/or toolldts to assist comnnanity health clinics and
IHD staff in itWlenienting BF guidelines and policies.
Activity 4: Conduct 1 statewide Aebinar and 1 in person training describing BF 4/1/19-9/30/19
guidelines and resources community health clinics and IHDs can utilize.
Activity 5: Coninunication Activity:Collaborate with partners and practitioners to 7/1/19-9/30/19
develop and share best practices, success stories and presentations.
Activity 6: Evaluation Activity:Assess the number ofcommunityhealth clinics and 7/1/19-9/30/19
IHDs that have a thane in knowled e,intent or practices with BF supports.
Strategy 2 Weston Responsible Party Completion Date
Promote compliance Promotion of compliance PHNC III(Cowling);RS If September 29,
with federal lactation with federal lactation (Cordon);AGPA(Strutz) 2019
acconynodation laws in acconynodation laws in LM;NPI
tar eted vvnrksites I tar eted vvorksites
Settings: Orange County IM, Sacramento County LHD
Partners: WIC,CWA, CABF Coalition,CA SNAP-Ed
Activity 1: Collaborate with state and local partners to access howmanylowwage 10/1/18-3/31/1
vwrksites in selected counties have BF policies in place.
Activity 2: Coordinate with partners to assess the training and TAneeds oftargeted 10/1/18-3/31/19
wvrksites to implement BF policies and comply with federal lactation accommodation laws.
Activity 3: Based on the results ofthe assessment,murk with partners to develop trainings, 4/1/19-6/30/19
webinais,newsletter articles and/or toollflts to assist vwrksites in complying with federal
lactation acconmlodation laws.
Activity 4: Work with partners to provide trainings,TA %Nebinars,resources,newsletter 4/1/19-9/30/19
articles and/or toolkits to targeted sites on complying with lactation accommodation laws.
Activity 5: Connmuucation Activity: Collaborate with partners and practitioners to develop 7/1/19-9/30/19
and share best practices, success stories and presentations.
Activity 6: Evaluation Activity.Assess the number ofpartner v�urksites that have improved 7/1/19-9/30/19
knowledge of and compliance with lactation accommodation laws in select counties.
Overarching Strategy 3 (&5 Combined): Implement&Integrate Nutrition&Physical Activity
Standards into Statewide Early Care and Education CE Systems
Short-Term Outcome Intermediate Outcome
Demonstrated progress on ECE nutrition and physical Increased number of ECE state and local
activity standards systems with embedded nutrition and PA
15
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County offresno
18-10558
standards across four counties reaching up to
174,000 children
Outcome Ntasures: Increased number ofECEs that have implemented and integrated nutrition and
physical activity standards into policies and/or professional develo mlent plans.
Strategy 1 Milestone Responsible Parry Completion
Date
Collaborate with partners to Implementation of PFNC III(Cowling); September 29,
assess the number ofECEs that nutrition standards HEC III(Nfanthe, 2019
implement nutrition and PA (inclusive of BF supports) Parham-Lee);RS III
standards in select counties and PAstandards (Pugliese);LHDs;NPI
Settings: LHDs Statewide working in ECE settings
Partners: Orange County,Fresno County,Contra Costa County,and Sacramento County LHDs,Orange
County Early Childhood Workgroup, CDE,CCFP Roundtable,Contra Costa LHD,CA State ECE
Partners hip,Resource&RefenaINetwurk Network
Activity 1: Review literature to identify evidence based approaches and recommendations for 10/1/18-
nutrition(inclusive ofBF supports)and PAstandards in ECE setting.Document findings. 12/31/18
Activity 2: Collect sample policies addressing nutrition and PAstandards in ECEs. 12A1i18
Activity 3: Collaborate with state and local partners to detemrrine the number ofECEs (ie. centers 1/1/19-
and fan*day care homes)in targeted counties that have nutrition and PApolicies in place, and 3/31/19
the strength ofthose polioies.Review and document best practices.
Activity 4: Coordinate with partners to assess the training and TAneeds ofECEs to implement 1/1/19-
nutrition and PAstandards and policies. 3/31/19
Activity 5: Based on the results ofthe assessment, Aurkwith partners to develop trainings, 4/1/19-
wEbinars,and/or identify resources to assist in the implementation ofnutrition and PAstandards in 6/30/19
ECE sites.
Activity 6: Com rn nication Activity:Create and send fact sheet to county 7/1/19-
R&R Networks regarding assessment results. Share best practices frompolicy reviews with LHDs, 9/30/19
R&R Network and other partners working with ECE.
Activity 7: Evaluation Activity.Assess the number ofECEs in select counties that have 7/1/19-
inlplemiented nutrition and PAstandards. 9/30/19
Strategy 2 Nflestone Responsible Parry Completion
Date
Work with the CA Child Care Training interventions PI-INC III(Cowling); September 29,
R8R Network and CCFP provided to county RBRs HEC III Q&nthe, 2019
Roundtable to improve PAand across CAinclude evidence- Parham-Lee);RS
nutrition content in professional based PAand nutrition III(Pugliese);NPI
development trainings content and materials.
Settings: ECE sites,ECE trainings,R&RNetworktraining opportunities;CCFP Roundtable meetings
Partners: CAR8R Netw*CCFP Roundtable member organizations;Orange County and Contra Costa
County u-n
Activity 1:In collaboration with partners,map systems of influence for ECE professional 10/1/18-3/31/19
development standards and trainmg guidance.Use this to inform future activities.
Activity 2: Review the current PAand nutrition content and resources included in Network 10i1/18-12/31/18
and CCFP trainings.
Activity 3: Compare the content and resources with the standards ofthe CACFP 1/1/19-3/31/19
requirements,along with other evidence based publications.
16
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
Activity 4: With partners,assess provider PAand nutrition trainings needs and interests. 1/1/19-3/31/19
Activity 5: Work with CA R&R Netvwrk and CCFP staff to prepare additional training 1/1/19-6/30/19
materials and resources that can be used in at least four trainings for county R&Rs and
that can be integrated into Roundtable training materials.Inclusive ofresources for parents
and children.
Activity 6: Conduct 2-3 county-wide ECE PAand Nutrition trainings. 4/1/19-9/30/19
Activity 7: Communication Activity: Submit article to the Netwurk for dissemination to 1/1/19-3/31/19
county R&Rs describing the enhanced PAand nutrition training content.
Activity 8: Evaluation Activity.Assess changes in knowledge ofand intent to implement 7/1/19-9/30/19
PAand Nutrition policies and practices mong training recipients.
Strategy 3 Milestone Responsible Completion
Party Date
Provide Nutrition and PAtechnical ECE county R&R PI-M M September 29,
assistance (TA)to at least six ECE organizations add nutrition (Cowling);HEC 2019
county R&R organizations,and to at and PAcontent to their IQ(Nhnthe,
least six individual ECE sites to training plans,and Parham-Lee);
increase ECE adoption and practice of individual ECE sites adopt RS III(Pugliese)
PAand nutrition standards at least twD new PA
practices.
Settings: County RM�s;ECE sites in Contra Costa,Fresno, Sacramento and Orange Counties
Partners: CAR&R Netvwrk CUP Roundtable
Activity 1: Survey ECE county R&R sites and ECEs to determine which ones would like to 1/1/19-3/31/19
receive nutrition and PATA er specified topics.Provide requested TA
Activity 2: Provide training and TAper assessment results. CDPHPAstaffand R&R 4/1/19-9/30-19
Netvamrk PAleads will provide PATAto county R&R organizations and to individual ECE
sites. Similarly,CDPH and R&R Netvwrknutrition staff vJI provide nutrition TA
Activity 3: Comminication Activity:Post evidence-based PAand nutrition practices and 4/1/19-6/30/19
standards on the CDPHweb site andpromote these via listservto coup R&Rs.
Activity 4: Evaluation Activity. CDPH PA staff and R&R Netvwrk PA leads will v Drk 7/1/19-9/30/19
together to survey ECEs that receive TAto detemiine their satisfaction.
Overarching Strategy 4: Establish New or Improved Pedestrian,Bicycle,and Transit Transportation
Systems
Outcome Nhasures: Enhanced active transit systems are incorporated in a community's master plan
and/or improved land use planning to promote AT,especially walking.
Short-Term Outcome Intermediate Outcome
Demonstrated progress on community planning and transportation Number ofplaces where new or
interventions that support safe and accessible PAin up to five CA improved systems to promote PA
counties. were implemented.
Strategy 1 Milestone Responsible Party Completion
Date
Increase community PAby supporting LHD LHD invited to HEC III(Nhnthe); September 29,
involvement in the development,revision, or participate in FPS I(Nhrcado); 2019
implementation ofpedestrian,bicycle,or transportation/ RS If(Cordon);
transportation plans and/or updating a city or general plan U-IDs,NPI
county-wide general plan's transportation or update process
17
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
health element or promoting local policy or and/or
infrastructure solutions. conninittee.
Settings: IHD staff in 3 counties drawn from Orange,Contra Costa, Glenn,Fresno,and Sacramento
Partners: LHD staff SGC/H1AP staX SACB,CalTrans
Activity 1: Coordinate efforts with the CDPH SGC HAP team to promote AT and land use 1o/i/18-6/30/19
planning in NEOPB obesity prevention activities and wvrkplans.
Activity 2: Conduct 1 statewide wEbinar and 1 in person training at a CDPHNEOPB 1/1/19-9/30/19
meeting,training or conference describing howIHD8 can impact their local transportation
and land use planning process to increase AT,and,"ukhg specifically,
Activity 3:Provide technical assistance funds and support to 3 U-n to engage in their 10/1/18-9/30/19
local Cahrans district transportation planning process to promote policy,program,and
infrastructure solutions with a Health Equity focus in disadvantaged communities.
Activity 4: Commuunication Activity.Develop 1 -2 Success Stories with input from IIM staff 4/1/19-9/30/19
and HAP staff Disseminate to partners.
Activity 5: Evaluation:In targeted agencies,assess the number of contacts made with 10/1/18-9/30/19
local planning officials,and the number ofrevis ions or additions promoting AT.
Strategy 2 Nfilestone Responsible Party Completion
Date
Increase comniunity PAthrough Collaboration with CDPH HEC III(Nbnthe) September 29,
training and TAto IHDs to support SACB team to expand HPS I(Nbrcado) 2019
the development of successful their outreach for the RS II(Cordon)
applications for the CA Department of ATP, specifically through
Transportation's Active a gap analysis ofATP-
Transportation Program(ATP). funded school districts
Settings: Statewide
Partners: CDPH SACS,Caltrans staff
Activity 1: Expand upon efforts of CDPH's SACB Active Transportation Safety Program 1/1/19-9/30/19
(ATSP)program to enhance communication and outreach to IHDs statewide about the
Cahrans ATP process.
Activity 2: Conduct 1 statewide webinar and 1 in-person presentation at a NEOPB 4/1/19-9/30/19
meeting,training or conference demonstrating the types oftransportation projects and
activities funded through the AIP.
Activity 3: Work with Cahrans AIP staffand CDPHATSP teamto assess gaps in low 10/1/18-9/30/19
resource connnunities awarded ATP funds for SRTS and to increase applications from
those locations.
Activity 4: Comniunication Activity.Create and deliver presentations at 1-3 NEOPB 4/1/19-9/30/19
events;develop an infographic about the ATP process in collaboration with SACB and
Cal cans staffto be disseminated via NEOPB and partner channels.
Activity 5: Evaluation Activity.Assess changes in knowledge and confidence in 10i1/18-9/30/19
participating in planning processes among involved staff and partners.
Strategy 3 Milestone Responsible Party Completion
Date
18
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
Support select LHD8 to conduct SRTS SRTS activities HEC III(Manthe) September 29,
program activities including promotion of implemented by Health Program 2019
Walkuig School Buses,Bicycle Trains, selected LHDs Specialist I
signage and vvayfnding to promote family (1Vhrcado);RS It
and comrixinity PA (Cordon);LM;NPI
Settings: LHD staffin 3 counties drawn from: Orange,Contra Costa,Glenn,Fresno,and Sacramento
Partners: CDPH SACB,National SRTS
Activity 1: Coordinate with CDPH SACB AT'SP program to disseminate Wallmg School 10/1/18-9/30/19
Bus and Bicycle Train Toollflts and infographics to school districts statewide.
Activity 2: Subcontract with the CAoffice ofthe National SRTS Partnership to conduct 1 1/1/19-9/30/19
statewide vwbinar on an emerging SRTS implementation,program or policy strategy.
Activity 3: Provide TA and funding support to 3 LHDs to promote AT in their region through 10/1/18-9/30/19
policy,program,and infrastructure solutions. Include requirement to conduct a comrimnity
participator wallcability audit and subsequent action planning.
Activity 4: Communication Activity:Launch new infographics with presentations at MOPB 1/1/19-9/30/19
conferences and webinars for LHD partners.
Activity 5: Evaluation team will support awarded LHDs to develop an evaluation plan for 10/1/18-9/30/19
their proposed activities.
Strategy Milestone Responsible Party Completion
Date
Collaborate with state-level partners in Participate in Health Program September 29,
transportation and planning to include Cahrans advisory Specialist 1; 2019
obesity,chronic disease prevention, and groups to support AT Ovbrcado);RS 11
health equity in transportation policy and and improved (Cordon)
programming. community design
Settings: Statewide
Partners: CDPH HAP team, Cakrans ATLC group
Activity 1: Represent CDPHat the California Transportation Commission's ATP Advisory 10/1n8-9/30n9
committee meetings to promote public health-bike,pedestrian,and SRTS.
Activity 2: Participate in the CDPH HAP team Active Transportation Action Plan update 10/1/18-9/30/19
process to support SRTS and con nanityPAcontent.
Activity 3: Participate in Caltrans'AT efforts through either their newly created Walk/Bike 10/1/18-9/30/19
Technical Advisory Connrittee or through the existing Active Transportation for Livable
Communities committee (ATLC).
Activity 4: Communication Activity: Share obesity and chronic disease health impact data 1/1/19-9/30/19
for CAcommunities and the benefits ofATwith state-level planning partners. Share
template policy language to improve walkability and AT in Nhster Plans.
Activity 5: Evaluation:With targeted partners,assess process measures including the 10/1/18-9/30/19
number ofrrreetings attended,and the number outcomes including revisions or additions
promoting health and/or health equity in AT.
19
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County ofFresno
18-10558
Work Plan Overview Years Two-Five
Strate�,yy 1:Implement Food Service Guidelines: Building on the findings and success ofyear one activities,
work plans for years two through five will include strategies and activities that extend services to additional
counties, settings (healthcare,food banks/pantries)and small retail markets as possible.Years two and
three will focus on supports for local government agency healthy meeting policy adoption,assisting small
grocers to improve healthy food access,and deepened evaluation efforts. In years three to five,w will
promote newresources statewide and work with partners to develop trainings and TAto help inform and
drive the approaches. The Cal SPAN team will host convenings,webinars,and/or teleconferences to
support con xnities ofpractice.As organizations implement food service guidelines and policies,the team
will develop success stories to highlight achievements,challenges,and lessons learned.
Stratejzy 2:Implement Interventions Supportive ofBF:Building on the findings and success ofyear one
activities,work plans for years two through five will extend services to additional LHDs,FQHCs,and WIC
clinics.Years two and three will focus on existing BF policies in these sites,and assessing training and TA
needs ofthe second wave ofLHDs and clinics as they begin to develop and implement BF supports.In
years three-five, CDPHwillpromote new resources statewide,and work with partners to develop trahhgs
and TAas per the assessment.wE will host convenings, ,wbinars,and/or teleconferences to support
corrnnunities ofpractice.Also in years two-five,as organizations implement policies,the Cal SPAN team
wallworkwith themto measure progress and impact and to develop success stories.
Strategies 3&5:Implement&Integrate Nutrition&PA Standards into Statewide ECE S sue:Building on
successes in year one, we will develop partnerships to assist assessing ECE centers' readiness to
implement nutrition and PAstandards. The responses from county RSdts and individual ECE sites will
inform and drive the approach for statewide ECE systems, including the state's child care licensing agency,
California's quality rating and improvement systems (QRIS), and a proposal for an ECE recognition
program. CDPH will host convenings,vNebinars,and/or teleconferences to support comrmmities ofpractice.
In years four and five, staffwill work with the CAchild care licensing to strengthen its PAand nutrition-
related requirements for certification. This may include increasing requirements for continuing education
credits and optional trainhgs in obesity prevention strategies, including PA,CACFP meal pattern
implementation and nutrition best practices.Also in years four and five, staff will worm with CDE to propose
revisions to the existing ECE learning standards and frameworks to include stronger PAand nutrition
content and on integrating enhanced PAand nutrition criteria.into QRIS for ECE sites to achieve a higher
performance rating.Finally, CDPH will grow evaluation efforts,and comrrnmicate lessons learned and
promising practices.
Strategy 4:Establish Newor Improved Pedestrian,Bicycle,and Transit Transportation Snterns: The Cal
SPAN team will build upon the success ofyear one to include promotion and adoption ofthe CA-based
Healthy Places Index tool (Southern CA Public Health Alliance)and the CDC's Health and Transportation
Tool, and databases into program guidance,tools,and resources. We will promote incorporating health
equity in AT through creation ofinfographics and messaging in collaboration with partners (e.g., Safe
Routes to School Partnership, ChangeLab Solutions,PolicyLink,etc.).We will host convenings,webinars,
and/or teleconferences to support comrrnuuties ofpractice. In years three to five,we will promote new
resources statewide through the SNAP-Ed LHDnetwork. Finally,w will increase our role as a contributor
in the state's AT policy and program work, providing sustainability for these efforts in the future.
20
CDPH NEOPB Proposal CDC-RFA-DP18-1807
County of Fresno
18-10558
Page 1 of 2
Exhibit B
Budget Detail and Payment Provisions
1. Invoicing and Payment
A. Upon completion of project activies as provided in Exhibit A Grant Application, 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 costs specified herein.
B. Invoices shall include the Grant Number and shall be submitted not more frequently than
monthly in arrears to:
Kimmy Casjens, Grant Manager
California Department of Public Health
Nutrition Education and Obesity Prevention Branch
1616 Capitol Ave., MS 7204
Sacramento, CA 95814
NEOPBfiscalrequest@cdph.ca.gov
C. Invoices shall:
1) Be prepared on Grantee letterhead. If invoices are not on produced letterhead invoices
must be signed by an authorized official, employee or agent certifying that the expenditures
claimed represent activities performed and are in accordance with Exhibit A Grant
Application under this Grant.
2) Bear the Grantee's name as shown on the Grant.
3) Identify the billing and/or performance period covered by the invoice.
4) Itemize costs for the billing period in the same or greater level of detail as indicated in this
Grant. Subject to the terms of this Grant, reimbursement may only be sought for those costs
and/or cost categories expressly identified as allowable and approved by CDPH.
2. Budget Contingency Clause
A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years
covered under this Agreement does not appropriate sufficient funds for the program, this
Agreement shall be of no further force and effect. In this event, the State shall have no liability
to pay any funds whatsoever to Grantee or to furnish any other considerations under this
Agreement and Grantee shall not be obligated to fulfill any provisions of this Agreement.
B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this
program, the State shall have the option to either cancel this Agreement with no liability
occurring to the State, or offer an agreement amendment to Grantee to reflect the reduced
amount.
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. Amounts Payable
A. The amounts payable under this Grant shall not exceed: $450,000.
B. Payment allocations shall be made for allowable expenses up to the amount annually
encumbered commensurate with the state fiscal year in which services are fulfilled and/or goods
are received.
County of Fresno
18-10558
Page 2 of 2
Exhibit B
Budget Detail and Payment Provisions
5. Timely Submission of Final Invoice
A. A final undisputed invoice shall be submitted for payment no more than sixty (60) calendar days
following the expiration or termination date of this Grant, unless a later or alternate deadline is
agreed to in writing by the program grant manager. Said invoice should be clearly marked
"Final Invoice", indicating that all payment obligations of the State under this Grant have ceased
and that no further payments are due or outstanding.
B. The State may, at its discretion, choose not to honor any delinquent final invoice if the Grantee
fails to obtain prior written State approval of an alternate final invoice submission deadline.
6. Travel and Per Diem Reimbursement
Any reimbursement for necessary travel and per diem shall be at the rates currently in effect as
established by the California Department of Human Resources (CaIHR).
County of Fresno
Grant# 18-10558
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
Grant# 18-10558
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
Grant# 18-10558
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: 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
Grant# 18-10558
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# 18-10558
Page 1 of 4
Exhibit D
Additional Provisions
1. Additional Incorporated Documents
A. The following documents and any subsequent updates are not attached, but are
incorporated herein and made a part hereof by this reference. CDPH will maintain on file, all
documents referenced herein and any subsequent updates, as required by program
directives. CDPH shall provide the Contractor with copies of said documents and any
periodic updates thereto, under separate cover.
2. 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.
Page 1 of 4
County of Fresno
Grant# 18-10558
Page 2 of 4
Exhibit D
Additional Provisions
G. The Grantee will not be entitled to reimbursement for any expenses incurred for services
and deliverables pursuant to this agreement after the effective date of termination.
H. Upon receipt of notification of termination of this Grant, and except as otherwise specified by
CDPH, the Grantee shall:
1) Place no further order or subgrants for materials, services, or facilities.
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.
3. Avoidance of Conflicts of Interest by Grantee
A. CDPH intends to avoid any real or apparent conflict of interest on the part of the Grantee,
subgrants, or employees, officers and directors of the Grantee or subgrants. Thus, CDPH
reserves the right to determine, at its sole discretion, whether any information, assertion or
claim received from any source indicates the existence of a real or apparent conflict of
interest; and, if a conflict is found to exist, to require the Grantee to submit additional
information or a plan for resolving the conflict, subject to CDPH review and prior approval.
B. Conflicts of interest include, but are not limited to:
1) An instance where the Grantee or any of its subgrants, or any employee, officer, or
director of the Grantee or any subgrant or has an interest, financial or otherwise,
whereby the use or disclosure of information obtained while performing services under
the grant would allow for private or personal benefit or for any purpose that is contrary to
the goals and objectives of the grant.
2) An instance where the Grantee's or any subgrant's employees, officers, or directors use
their positions for purposes that are, or give the appearance of being, motivated by a
desire for private gain for themselves or others, such as those with whom they have
family, business or other ties.
Page 2 of 4
County of Fresno
Grant# 18-10558
Page 3 of 4
Exhibit D
Additional Provisions
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.
4. 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.
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.
Page 3 of 4
County of Fresno
Grant# 18-10558
Page 4 of 4
Exhibit D
Additional Provisions
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.
Page 4 of 4
California Department of Public Health
County of Fresno
18-10558
Exhibit E
Federal Terms and Conditions
(For Federally Funded Grant Agreements)
The use of headings or titles throughout this exhibit is for convenience only and shall not be used to interpret or to
govern the meaning of any specific term or condition.
This exhibit contains provisions that require strict adherence to various contracting laws and policies.
Index of Special Terms and Conditions
1. Federal Funds
2. Federal Equal Employment Opportunity Requirements
3. Debarment and Suspension Certification
4. Covenant Against Contingent Fees
5. Air or Water Pollution Requirements
6. Lobbying Restrictions and Disclosure Certification
7. Additional Restrictions
8. Human Subjects Use Requirments
9. Financial and Compliance Audit Requirements
10. Audit and Record Retention
11. Federal Requirements
CDPH(rev.07/16) Page 1 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
1. Federal Funds
(Applicable only to that portion of an agreement funded in part or whole with federal funds.)
a. It is mutually understood between the parties that this Grant may have been written before ascertaining
the availability of congressional appropriation of funds, for the mutual benefit of both parties, in order to
avoid program and fiscal delays which would occur if the Grant were executed after that determination
was made.
b. This Grant is valid and enforceable only if sufficient funds are made available to the State by the United
States Government for the fiscal years covered by the term of this Grant. In addition, this Grant is subject
to any additional restrictions, limitations, or conditions enacted by the Congress or any statute enacted by
the Congress which may affect the provisions, terms or funding of this Grant in any manner.
c. It is mutually agreed that if the Congress does not appropriate sufficient funds for the program, this Grant
shall be amended to reflect any reduction in funds.
d. CDPH has the option to invalidate or cancel the Grant with 30-days advance written notice or to amend
the Grant to reflect any reduction in funds.
2. Federal Equal Opportunity Requirements
(Applicable to all federally funded grants entered into by the California Department of Public Health (CDPH)
formerly known as California Department of Health Services (CDHS).)
a. The Grantee will not discriminate against any employee or applicant for employment because of race,
color, religion, sex, national origin, physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era. The Grantee will take affirmative action to ensure that qualified
applicants are employed, and that employees are treated during employment, without regard to their race,
color, religion, sex, national origin, physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era. Such action shall include, but not be limited to the following:
employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination;
rates of pay or other forms of compensation; and career development opportunities and selection for
training, including apprenticeship. The Grantee agrees to post in conspicuous places, available to
employees and applicants for employment, notices to be provided by the Federal Government or CDPH,
setting forth the provisions of the Equal Opportunity clause, Section 503 of the Rehabilitation Act of 1973
and the affirmative action clause required by the Vietnam Era Veterans' Readjustment Assistance Act of
1974 (38 U.S.C. 4212). Such notices shall state the Grantee's obligation under the law to take affirmative
action to employ and advance in employment qualified applicants without discrimination based on their
race, color, religion, sex, national origin physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era and the rights of applicants and employees.
b. The Grantee will, in all solicitations or advancements for employees placed by or on behalf of the Grantee,
state that all qualified applicants will receive consideration for employment without regard to race, color,
religion, sex, national origin physical or mental handicap, disability, age or status as a disabled veteran or
veteran of the Vietnam era.
c. The Grantee will send to each labor union or representative of workers with which it has a collective
bargaining agreement or other contract or understanding a notice, to be provided by the Federal
Government or the State, advising the labor union or workers' representative of the Grantee's
commitments under the provisions herein and shall post copies of the notice in conspicuous places
available to employees and applicants for employment.
d. The Grantee will comply with all provisions of and furnish all information and reports required by Section
503 of the Rehabilitation Act of 1973, as amended, the Vietnam Era Veterans' Readjustment Assistance
Act of 1974 (38 U.S.C. 4212) and of the Federal Executive Order No. 11246 as amended, including by
Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal Employment Opportunity,'
and as supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract Compliance
Programs, Equal Employment Opportunity, Department of Labor," and of the rules, regulations, and
relevant orders of the Secretary of Labor.
CDPH(rev.07/16) Page 2 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
e. The Grantee will furnish all information and reports required by Federal Executive Order No. 11246 as
amended, including by Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal
Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60, "Office of the Federal
Contract Compliance Programs, Equal Employment Opportunity, Department of Labor," and the
Rehabilitation Act of 1973, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant
thereto, and will permit access to its books, records, and accounts by the State and its designated
representatives and the Secretary of Labor for purposes of investigation to ascertain compliance with such
rules, regulations, and orders.
f. In the event of the Grantee's noncompliance with the requirements of the provisions herein or with any
federal rules, regulations, or orders which are referenced herein, this Agreement may be cancelled,
terminated, or suspended in whole or in part and the Grantee may be declared ineligible for further federal
and state contracts in accordance with procedures authorized in Federal Executive Order No. 11246 as
amended and such other sanctions may be imposed and remedies invoked as provided in Federal
Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order
11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60,
"Office of the Federal Contract Compliance Programs, Equal Employment Opportunity, Department of
Labor," or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law.
g. The Grantee will include the provisions of Paragraphs a through g in every subcontract or purchase order
unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Federal
Executive Order No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order
11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation at 41 CFR part 60,
"Office of the Federal Contract Compliance Programs, Equal Employment Opportunity, Department of
Labor," or Section 503 of the Rehabilitation Act of 1973 or (38 U.S.C. 4212) of the Vietnam Era Veteran's
Readjustment Assistance Act, so that such provisions will be binding upon each subGrantee or vendor.
The Grantee will take such action with respect to any subcontract or purchase order as the Director of the
Office of Federal Contract Compliance Programs or CDPH may direct as a means of enforcing such
provisions including sanctions for noncompliance provided, however, that in the event the Grantee
becomes involved in, or is threatened with litigation by a subGrantee or vendor as a result of such
direction by CDPH, the Grantee may request in writing to CDPH, who, in turn, may request the United
States to enter into such litigation to protect the interests of the State and of the United States.
3. Debarment and Suspension Certification
a. By signing this Grant, the Grantee agrees to comply with applicable federal suspension and debarment
regulations including, but not limited to 7 CFR Part 3017, 45 CFR 76, 40 CFR 32 or 34 CFR 85.
b. By signing this Grant, the Grantee certifies to the best of its knowledge and belief, that it and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded by any federal department or agency;
(2) Have not within a three-year period preceding this application/proposal/agreement been convicted of
or had a civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State or local)
transaction or contract under a public transaction; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making
false statements, or receiving stolen property;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State or local)with commission of any of the offenses enumerated in Paragraph b(2) herein;
and
(4) Have not within a three-year period preceding this application/proposal/agreement had one or more
public transactions (Federal, State or local)terminated for cause or default.
(5) Shall not knowingly enter into any lower tier covered transaction with a person who is proposed for
debarment under federal regulations (i.e., 48 CFR part 9, subpart 9.4), debarred, suspended, declared
ineligible, or voluntarily excluded from participation in such transaction, unless authorized by the State.
CDPH(rev.07/16) Page 3 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
(6) Will include a clause entitled, "Debarment and Suspension Certification" that essentially sets forth the
provisions herein, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
c. If the Grantee is unable to certify to any of the statements in this certification, the Grantee shall submit an
explanation to the CDPH Program Contract Manager.
d. The terms and definitions herein have the meanings set out in the Definitions and Coverage sections of
the rules implementing Federal Executive Order 12549.
e. If the Grantee knowingly violates this certification, in addition to other remedies available to the Federal
Government, the CDPH may terminate this Agreement for cause or default.
4. Covenant Against Contingent Fees
The Grantee warrants that no person or selling agency has been employed or retained to solicit/secure this
Grant upon an agreement of understanding for a commission, percentage, brokerage, or contingent fee,
except bona fide employees or bona fide established commercial or selling agencies retained by the Grantee
for the purpose of securing business. For breach or violation of this warranty, CDPH shall have the right to
annul this Grant without liability or in its discretion to deduct from the Grant price or consideration, or otherwise
recover, the full amount of such commission, percentage, and brokerage or contingent fee.
5. Air or Water Pollution Requirements
Any federally funded grant and/or subgrants in excess of $100,000 must comply with the following provisions
unless said grant is exempt under 40 CFR 15.5.
a. Government Grantees agree to comply with all applicable standards, orders, or requirements issued
under section 306 of the Clean Air Act [42 U.S.C. 1857(h)], section 508 of the Clean Water Act (33 U.S.C.
1368), Executive Order 11738, and Environmental Protection Agency regulations (40 CFR part 15).
b. Institutions of higher education, hospitals, nonprofit organizations and commercial businesses agree to
comply with all applicable standards, orders, or requirements issued under the Clean Air Act (42 U.S.C.
7401 et seq.), as amended, and the Federal Water Pollution Control Act (33 U.S.C. 1251 et seq.), as
amended.
6. Lobbying Restrictions and Disclosure Certification
(Applicable to federally funded grants in excess of$100,000 per Section 1352 of the 31, U.S.C.)
a. Certification and Disclosure Requirements
(1) Each person (or recipient) who requests or receives a grant, subgrant, which is subject to Section
1352 of the 31, U.S.C., and which exceeds $100,000 at any tier, shall file a certification (in the form
set forth in Attachment 1, consisting of one page, entitled "Certification Regarding Lobbying") that the
recipient has not made, and will not make, any payment prohibited by Paragraph b of this provision.
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2, entitled "Standard Form-
LLL 'disclosure of Lobbying Activities"') if such recipient has made or has agreed to make any
payment using nonappropriated funds (to include profits from any covered federal action) in
connection with a grant or any extension or amendment of that grant, which would be prohibited under
Paragraph b of this provision if paid for with appropriated funds.
(3) Each recipient shall file a disclosure form at the end of each calendar quarter in which there occurs
any event that requires disclosure or that materially affect the accuracy of the information contained in
any disclosure form previously filed by such person under Paragraph a(2) herein. An event that
materially affects the accuracy of the information reported includes:
(a) A cumulative increase of $25,000 or more in the amount paid or expected to be paid for
influencing or attempting to influence a covered federal action;
CDPH(rev.07/16) Page 4 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
(b) A change in the person(s) or individuals(s) influencing or attempting to influence a covered federal
action; or
(c) A change in the officer(s), employee(s), or member(s) contacted for the purpose of influencing or
attempting to influence a covered federal action.
(4) Each person (or recipient) who requests or receives from a person referred to in Paragraph a(1) of
this provision a grant or subgrant exceeding $100,000 at any tier under a grant shall file a certification,
and a disclosure form, if required, to the next tier above.
(5) All disclosure forms (but not certifications) shall be forwarded from tier to tier until received by the
person referred to in Paragraph a(1) of this provision. That person shall forward all disclosure forms
to CDPH Program Contract Manager.
b. Prohibition
Section 1352 of Title 31, U.S.C., provides in part that no appropriated funds may be expended by the
recipient of a federal contract or agreement, grant, loan, or cooperative agreement to pay any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with any of the
following covered federal actions: the awarding of any federal contract or agreement, the making of any
federal grant, the making of any federal loan, entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any federal contract or agreement, grant,
loan, or cooperative agreement.
7. Additional Restrictions
Grantee shall comply with the restrictions under Division F, Title V, Section 503 of the Consolidated
Appropriations Act, 2012 (H.R. 2055), which provides that:
"SEC. 503.(a) No part of any appropriation contained in this Act or transferred pursuant to
section 4002 of Public Law 111-148 shall be used, other than for normal and recognized
executive-legislative relationships, for publicity or propaganda purposes, for the preparation,
distribution, or use of any kit, pamphlet, booklet, publication, electronic communication, radio,
television, or video presentation designed to support or defeat the enactment of legislation
before the Congress or any State or local legislature or legislative body, except in presentation
to the Congress or any State or local legislature itself, or designed to support or defeat any
proposed or pending regulation, administrative action, or order issued by the executive branch
of any State or local government, except in presentation to the executive branch of any State or
local government itself.
(b) No part of any appropriation contained in this Act or transferred pursuant to section
4002 of Public Law 111-148 shall be used to pay the salary or expenses of any grant or
contract recipient, or agent acting for such recipient, related to any activity designed to
influence the enactment of legislation, appropriations, regulation, administrative action, or
Executive order proposed or pending before the Congress or any State government, State
legislature or local legislature or legislative body, other than for normal and recognized
executive-legislative relationships or participation by an agency or officer of a State, local or
tribal government in policymaking and administrative processes within the executive branch of
that government.
(c) The prohibitions in subsections (a) and (b) shall include any activity to advocate or promote any
proposed, pending or future Federal, State or local tax increase, or any proposed, pending, or future
requirement or restriction on any legal consumer product, including its sale or marketing, including but not
limited to the advocacy or promotion of gun control."
8. Human Subjects Use Requirements
CDPH(rev.07/16) Page 5 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
(Applicable only to federally funded agreements in which performance, directly or through a
subcontract/subaward, includes any tests or examination of materials derived from the human body.)
By signing this Agreement, Contractor agrees that if any performance under this Agreement or any
subcontract or subagreement includes any tests or examination of materials derived from the human body for
the purpose of providing information, diagnosis, prevention, treatment or assessment of disease, impairment,
or health of a human being, all locations at which such examinations are performed shall meet the
requirements of 42 U.S.C. Section 263a (CLIA)and the regulations thereunder.
9. Financial and Compliance Audit Requirements
By signing this Agreement, the Contractor/Subcontrac for agrees to abide by all requirements specified in 2
CFR 200, et seq., 2 CFR 400, et seq., and 45 CFR, 75, et seq., as applicable, including but not limited to
obtaining an annual audit, and any subsequent federal regulatory additions or revisions.
a. The definitions used in this provision are contained in Section 38040 of the Health and Safety Code, which
by this reference is made a part hereof.
b. Direct service contract means a contract or agreement for services contained in local assistance or
subvention programs or both (see Health and Safety[H&S] Code section 38020). Direct service contracts
shall not include contracts, agreements, grants, or subventions to other governmental agencies or units of
government nor contracts or agreements with regional centers or area agencies on aging (H&S Code
section 38030).
c. The Contractor, as indicated below, agrees to obtain one of the following audits:
(1) If the Contractor is a nonprofit organization (as defined in H&S Code section 38040) and receives
$25,000 or more from any State agency under a direct service contract or agreement; the Contractor
agrees to obtain an annual single, organization wide, financial and compliance audit. Said audit shall
be conducted according to Generally Accepted Auditing Standards. This audit does not fulfill the audit
requirements of Paragraph c(3) below. The audit shall be completed by the 15th day of the fifth
month following the end of the Contractor's fiscal year, and/or
(2) If the Contractor is a nonprofit organization (as defined in H&S Code section 38040) and receives less
than $25,000 per year from any State agency under a direct service contract or agreement, the
Contractor agrees to obtain a biennial single, organization wide financial and compliance audit, unless
there is evidence of fraud or other violation of state law in connection with this Agreement. This audit
does not fulfill the audit requirements of Paragraph c(3) below. The audit shall be completed by the
15th day of the fifth month following the end of the Contractor's fiscal year, and/or
(3) If the Contractor is a State or Local Government entity or Nonprofit organization (as defined in 2CFR
Part 200) and expends $750,000 or more in Federal awards, the Contractor agrees to obtain an
annual single, organization wide, financial and compliance audit according to the requirements
specified in 2CFR Part 200. An audit conducted pursuant to this provision will fulfill the audit
requirements outlined in Paragraphs c(1) and c(2) above. The audit shall be completed by the end of
the ninth month following the end of the audit period. The requirements of this provision apply if:
(a) The Contractor is a recipient expending Federal awards received directly from Federal awarding
agencies, or
(b) The Contractor is a subrecipient expending Federal awards received from a pass-through entity
such as the State, County or community based organization.
(4) If the Contractor submits to CDPH a report of an audit other than a single audit, the Contractor must
also submit a certification indicating the Contractor has not expended $750,000 or more in federal
funds for the year covered by the audit report.
d. Two copies of the audit report shall be delivered to the CDPH program funding this Agreement. The audit
report must identify the Contractor's legal name and the number assigned to this Agreement. The audit
report shall be due within 30 days after the completion of the audit. Upon receipt of said audit report, the
CDPH(rev.07/16) Page 6 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
CDPH Program Contract Manager shall forward the audit report to CDPH's Audits and Investigations Unit
if the audit report was submitted under Section 16.c(3), unless the audit report is from a City, County, or
Special District within the State of California whereby the report will be retained by the funding program.
e. The cost of the audits described herein may be included in the funding for this Agreement up to the
proportionate amount this Agreement represents of the Contractor's total revenue. The CDPH program
funding this Agreement must provide advance written approval of the specific amount allowed for said
audit expenses.
f. The State or its authorized designee, including the Bureau of State Audits, is responsible for conducting
agreement performance audits which are not financial and compliance audits. Performance audits are
defined by Generally Accepted Government Auditing Standards.
g. Nothing in this Agreement limits the State's responsibility or authority to enforce State law or regulations,
procedures, or reporting requirements arising thereto.
h. Nothing in this provision limits the authority of the State to make audits of this Agreement, provided
however, that if independent audits arranged for by the Contractor meet Generally Accepted
Governmental Auditing Standards, the State shall rely on those audits and any additional audit work and
shall build upon the work already done.
i. The State may, at its option, direct its own auditors to perform either of the audits described above. The
Contractor will be given advance written notification, if the State chooses to exercise its option to perform
said audits.
j. The Contractor shall include a clause in any agreement the Contractor enters into with the audit firm doing
the single organization wide audit to provide access by the State or Federal Government to the working
papers of the independent auditor who prepares the single organization wide audit for the Contractor.
k. Federal or state auditors shall have "expanded scope auditing" authority to conduct specific program
audits during the same period in which a single organization wide audit is being performed, but the audit
report has not been issued. The federal or state auditors shall review and have access to the current audit
work being conducted and will not apply any testing or review procedures which have not been satisfied by
previous audit work that has been completed.
The term "expanded scope auditing" is applied and defined in the U.S. General Accounting Office (GAO)
issued Standards for Audit of Government Organizations, Programs, Activities and Functions, better
known as the "yellow book".
10. Audit and Record Retention
(Applicable to agreements in excess of$10,000.)
a. The Contractor shall maintain books, records, documents, and other evidence, accounting procedures
and practices, sufficient to properly reflect all direct and indirect costs of whatever nature claimed to have
been incurred in the performance of this Agreement, including any matching costs and expenses. The
foregoing constitutes "records"for the purpose of this provision.
b. The Contractor's facility or office or such part thereof as may be engaged in the performance of this
Agreement and his/her records shall be subject at all reasonable times to inspection, audit, and
reproduction.
c. Contractor agrees that CDPH, the Department of General Services, the Bureau of State Audits, or their
designated representatives including the Comptroller General of the United States shall have the right to
review and to copy any records and supporting documentation pertaining to the performance of this
Agreement. Contractor agrees to allow the auditor(s) access to such records during normal business
hours and to allow interviews of any employees who might reasonably have information related to such
records. Further, the Contractor agrees to include a similar right of the State to audit records and
interview staff in any subcontract related to performance of this Agreement. (GC 8546.7, CCR Title 2,
Section 1896).
CDPH(rev.07/16) Page 7 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
d. The Contractor shall preserve and make available his/her records (1) for a period of three years from the
date of final payment under this Agreement, and (2) for such longer period, if any, as is required by
applicable statute, by any other provision of this Agreement, or by subparagraphs (1) or(2) below.
(1) If this Agreement is completely or partially terminated, the records relating to the work terminated shall
be preserved and made available for a period of three years from the date of any resulting final
settlement.
(2) If any litigation, claim, negotiation, audit, or other action involving the records has been started before
the expiration of the three-year period, the records shall be retained until completion of the action and
resolution of all issues which arise from it, or until the end of the regular three-year period, whichever
is later.
e. The Contractor shall comply with the above requirements and be aware of the penalties for violations of
fraud and for obstruction of investigation as set forth in Public Contract Code § 10115.10, if applicable.
f. The Contractor may, at its discretion, following receipt of final payment under this Agreement, reduce its
accounts, books and records related to this Agreement to microfilm, computer disk, CD ROM, or other
data storage medium. Upon request by an authorized representative to inspect, audit or obtain copies of
said records, the Contractor and/or Subcontractor must supply or make available applicable devices,
hardware, and/or software necessary to view, copy and/or print said records. Applicable devices may
include, but are not limited to, microfilm readers and microfilm printers, etc.
g. The Contractor shall, if applicable, comply with the Single Audit Act and the audit reporting requirements
set forth in Title 2 of the Code of Federal Regulations, Part 200 (2CFR Part 200).
11. Federal Requirements
Grantor agrees to comply with and shall require all subgranteers, if any, to comply with all applicable
Federal requirements including but not limited to the United States Code, the Code of Federal
Regulations, the Funding Opportunity Announcement, the Notice of Award, the funding agreement, and
any memoranda or letter regarding the applicable Federal requirements.
CDPH(rev.07/16) Page 8 of 11
California Department of Public Health—Federal Terms and Conditions Exhibit E
Attachment 1
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in connection with the making,
awarding or entering into of this Federal contract, Federal grant, or cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency of the United States Government, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract,grant, or cooperative agreement,the undersigned shall complete and submit
Standard Form LLL, "Disclosure of Lobbying Activities" in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subGrantees, subgrants, and contracts under grants and
cooperative agreements) of$100,000 or more, and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by Section 1352, Title 31, U.S.C., any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
County of Fresno Nathan Magsig
Name of Grantee Printed Name of Person Signing for Grantee
18-10558
Contract/Grant Number Signature of Person Signing for Gr n ee
4LaLD-N I2L 2Z19 Chairman of the Board of Supervisors of the County of Fresno
Date k, Title
ATTEST:
BERNICE E.SEIDEL
After execution by or on behalf of Grantee, please return to: Clerk of the Board of Supervisors
County of Fresno,State of California
California Department of Public Health By.cRb4j Deputy
Nutrition Education and Obesity Prevention Branch
P.O. Box 997377, MS 7204
Sacramento, CA 95899-7377
CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address.
CDPH(rev.07/16) Page 9 of 11
California Department of Public Health— Federal Terms and Conditions Exhibit E
Attachment 2
CERTIFICATION REGARDING LOBBYING Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
[ ] a. contract [ ] a. bid/offer/application [ ] a. initial filing
b. grant b. initial award b. material change
C. cooperative agreement C. post-award For Material Change Only:
d. loan
e. loan guarantee Year quarter
f. loan insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee, Enter Name
and Address of Prime:
❑ Prime ❑ Subawardee
Tier _, if known:
Congressional District If known: Congressional District, If known:
6. Federal Department/Agency 7. Federal Program Name/Description:
CDFA Number, if applicable:
8. Federal Action Number, if known: 9. Award Amount, if known:
10.a. Name and Address of Lobbying Registrant b. Individuals Performing Services(including address if different from
(If individual,last name, first name, MI): 10a.
(Last name, First name, MI):
11. Information requested through this form is authorized by title 31
U.S.C.section 1352.This disclosure of lobbying activities is a material Signature:
representation of fact upon which reliance was placed by the tier
above when this transaction was made or entered into. This Print Name:
disclosure is required pursuant to 31 U.S.C. 1352. This information
will be available for public inspection. required disclosure shall be Title:
subject to a not more than$100,000 for each such failure. Telephone No.: Date:
Federal Use Only Authorized for Local Reproduction
Standard Form-LLL(Rev.7-97)
CDPH(rev.07/16) Page 10 of 11
California Department of Public Health—Federal Terms and Conditions Exhibit E
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity,whether subawardee or prime Federal recipient,at the initiation or receipt of a covered Federal action,or a
material change to a previous filing,pursuant to title 31 U.S.C.section 1352.The filing of a form is required for each payment or agreement to make payment to any lobbying
entity for influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member
of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report.If this is a follow-up report caused by a material change to the information previously reported,enter the year and
quarter in which the change occurred.Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name,address,city,State and zip code of the reporting entity. Include Congressional District,if known. Check the appropriate classification of the
reporting entity that designates if it is,or expects to be a prime or subaward recipient. Identify the tier of the subawardee,e.g.,the first subawardee of the prime is
the 1st tier. Subawards include but are not limited to subcontracts,subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks"Subawardee,"then enter the full name,address,city,State and zip code of the prime Federal recipient.Include
Congressional District,if known.
6. Enter the name of the Federal agency making the award or loan commitment.Include at least one organizational level below agency name,if known.For example,
Department of Transportation,United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action(item 1). If known,enter the full Catalog of Federal Domestic Assistance(CFDA)
number for grants,cooperative agreements,loans,and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1(e.g.,Request for Proposal(RFP)number;Invitation for Bid
(IFB)number;grant announcement number;the contract,grant,or loan award number;the application/proposal control number assigned by the Federal agency).
Include prefixes,e.g.,'RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal amount of the award/loan commitment
for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity
identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s)performing services,and include full address if different from 10(a). Enter Last Name,First Name,and Middle Initial
(MI).
11. The certifying official shall sign and date the form,print his/her name,title,and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to
respond to a collection of information unless it displays a valid OMB Control Number.
The valid OMB control number for this information collection is OMB No. 0348-0046.
CDPH (rev.07/16) Page 11 of 11
California Department of Public Health
Name/No.: State Physical Activity & Nutrition (CDC-SPAN) (State Grant Agreement No.
18-10558)
Fund/Subclass: 0001/10000
Organization #: 56201555
Revenue Account #: 4380