HomeMy WebLinkAboutAgreement A-19-592 with CDPH (2).pdf Agreement No. 19-592
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229(5/2019)
California HIV Surveillance Program
Awarded By
THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (CDPH), hereinafter "Department"
TO
County of Fresno, hereinafter "Grantee"
Implementing the project, HIV Surveillance, hereinafter "Project"
GRANT AGREEMENT NUMBER 19-10415
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 this project under the California
Health and Safety Code (HSC). Legislature authorized in HSC Section 131019 the CDPH,
Office of AIDS (OA) as the lead agency within the State responsible for coordinating state
programs, services and activities related to Human Immunodeficiency Virus (HIV) and Acquired
Immune Deficiency Syndrome (AIDS). HSC 131085 (a) and (b) authorize the Department to
enter into grants to perform public health activities.
PURPOSE: The Department shall provide a grant to and for the benefit of the Grantee. The
Grantee agrees to administer the HIV Surveillance Program (HSP) and to ensure the
implementation of HIV surveillance activities. The Grantee will plan, develop, and implement all
aspects of HIV surveillance in their jurisdiction.
GRANT AMOUNT: The maximum amount payable under this Grant shall not exceed $453,215.
TERM OF GRANT AGREEMENT: The term of the Grant shall begin on July 1, 2019, and
terminates on June 30, 2024. No funds may be requested or invoiced for services performed or
costs incurred after June 30, 2024.
PROJECT REPRESENTATIVES: The Project Representatives during the term of this Grant will
be:
California Department of Public Health County of Fresno
Kimberly Ferreira, Assistant Chief Joe Prado, Community Health Division Manager
1616 Capitol Avenue, Suite 616, MS 7700 1221 Fulton Street
Sacramento, CA, 95814 Fresno, CA 93721
Telephone: (916) 449-5262 Telephone: (559) 600-3007
Email: kimberly.ferreira@cdph.ca.gov Email: jprado@fresnocountyca.gov
Page 1 of 3
State of California—Health and Human Services Agency—California Department of Public Health
CDPH 1229(5/2019)
Direct all inquiries to:
California Department of Public Health County of Fresno
Kimberly Ferreira, Assistant Chief Jena Adams, Supervising Communicable Disease Specialist
1616 Capitol Avenue, Suite 616, MS 7700 1221 Fulton Street
Sacramento, CA, 95814 Fresno, CA 93721
Telephone: (916) 449-5262 Telephone: (559) 600-6404 ex. 3042
Email: kimberly.ferreira@cdph.ca.gov Email: jadams@fresnocountyca.gov
All payments from CDPH to the Grantee; shall be sent to the following address:
Remittance Address
Contractor: County of Fresno
Cashier— Bruna Chavez, Business Manager
P.O. Box 11800
Fresno, CA 93775
Telephone: (559) 600-6438
Email: dphboap@@fresnocountyca.gov
• Either party may make changes to the information above by giving written notice to the
other party. Said changes shall not require an amendment to the agreement, but the
Grantee will be required to submit a new completed CDPH 9083 Governmental Entity
Taxpayer ID Form or STD 204 Payee Data Record form to the Project Representative
for processing.
STANDARD PROVISIONS: The following exhibits are attached and made a part of this Grant
by this reference:
EXHIBIT A LETTER OF AWARD
EXHIBIT Al LIST OF ALLOCATIONS
EXHIBIT A2 FUNDING ALLOCATION PROCESS
EXHIBIT B BUDGET DETAIL AND PAYMENT PROVISIONS
EXHIBIT C STANDARD GRANT CONDITIONS
EXHIBIT D ADDITIONAL PROVISIONS
EXHIBIT E INFORMATION PRIVACY AND SECURITY REQUIREMENTS
GRANTEE REPRESENTATIONS: The Grantee(s) accept all terms, provisions, and conditions
of this grant, including those stated in the Exhibits incorporated by reference above. The
Grantee(s) shall fulfill all assurances and commitments made in the application, declarations,
other accompanying documents, and written communications (e.g., e-mail, correspondence)
filed in support of the request for grant funding. The Grantee(s) shall comply with and require its
contractors and subcontractors to comply with all applicable laws, polices, and regulations.
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State of California-Health and Human Services Agency-California Department of Public Health
CDPH 1229(5/2019)
IN WITNESS THEREOF, the parties have executed this Grant on the dates set forth below.
Executed By:
Date:
Nathan Magsig, Chairman, Board of Supervisors
ATTEST: County of Fresno
BERNICE E.SEIDEL 2281 Tulare Street, #300
Clerk of the Board of Supervisors Fresno, CA 93721
County f Fresno,State of California
By
Deputy
Date:
Joseph Torrez, Chief
Contracts Management Unit
California Department of Public Health
1616 Capitol Avenue, Suite 74.262
P.O. Box 997377, MS 1800-1804
Sacramento, CA 95899-7377
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\• • State of California—Health and Human Services Agency
California Department of Public Health ' `=
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KAREN L.SMITH,MD,MPH Exhibit A GAVIN NEWSOM
State Public Health Officer&Director Letter of Award Govemor
June 15, 2019
TO: CALIFORNIA LOCAL HEALTH JURISDICTIONS
SUBJECT: FY 2019-20 HIV SURVEILLANCE PROGRAM
The California Department of Public Health, Center for Infectious Diseases, Office of
AIDS (OA) is pleased to announce the availability of $6.67 million in State General
Funds in fiscal year (FY) 2019-2020 for local HIV surveillance programs. HIV
surveillance program activities focus on five goals:
1. Maintain infrastructure for HIV surveillance by establishing and maintaining
HIV case surveillance in health, medical, public health, and social service
settings, including laboratories and HIV testing sites such that HIV case reporting
to the local health department occurs in a timely and complete fashion;
2. Collect and submit accurate, complete, and timely HIV surveillance data to
Office of AIDS. Collect HIV surveillance data that meet all data requirements
set forth by the OA and the Centers for Disease Control and Prevention (CDC),
and submit those data to the OA in a timely fashion;
3. Maintain data security and confidentiality. Protect patient privacy and
confidentiality by ensuring that protected health information is stored and
disclosed only in a manner consistent with California and federal laws and
regulations, and OA policies and procedures;
4. Program management and coordination. Conduct HIV surveillance activities in
a manner consistent with administrative, fiscal, budgetary, and program guidance
from CDPH, OA, and CDC that ensure program management and coordination;
5. Collaborate with partners to respond to the HIV epidemic to facilitate sharing
data and resources to support progress toward meeting California's Integrated
Plan goals and objectives.
`+```` 11t Dtpyt
Office of AIDS, MS 7700• P.O. Box 997426 • Sacramento, CA 95899-7426 \I III® .�
(916)449-5900 • (916)449-5909 FAX
Internet Address: www.cdr)h.ca.00v '
These funds will be available to the HIV surveillance program on a yearly basis
from July 1 , 2019 — June 30, 2024. The amount of funding allocated is on an
annual basis through a non-competitive formula. The Surveillance Program
Funding Allocation Process includes the annual allocation amounts for specific
jurisdictions.
The funds must be used to provide allowable HIV surveillance program activities at the
local level. For guidance, please see the HIV Surveillance Program Scope of Work. All
Grantees must adhere to the Scope of Work, and any subsequent revisions, along with
all instructions, policy memorandums, or directives issued by CDPH/OA. CDPH/OA will
make any changes and/or additions to these guidelines in writing and, whenever
possible, notification of such changes shall be made 30 days prior to implementation.
In order to apply for these funds, you must return the required budget documents by
June 30, 2019. The documents should be e-mailed to HIVSurvrfa(a)_cdph.ca.gov.
Please note that no funds are secured until the contract is fully executed.
We look forward to collaborating with you to conduct effective surveillance of the
California HIV epidemic. If you have any questions, please contact Kimberly Ferreira at
(916) 449-5262 or kimberly.ferreiraa-cdph.ca.gov.
Sincerely,
Marisa Ramos, PhD
Chief, Surveillance and Prevention Evaluation and Reporting Branch
Office of AIDS
California Department of Public Health
cc: Kimberly Ferreira
Assistant Branch Chief
Surveillance and Prevention Evaluation and Reporting Branch
Office of AIDS
California Department of Public Health
Frank Dionisio, Contract Monitor
Surveillance Section
Surveillance and Prevention Evaluation and Reporting Branch
Office of AIDS
California Department of Public Health
Exhibit Al
List of Allocation
FINAL FINAL FINAL FINAL FINAL
FY 19/20 FY 20/21 FY 21/22 FY 22/23 FY 23/24 TOTAL
Summary Adjusted Adjusted Adjusted Adjusted Adjusted Five (5)Year
County/City Action Allocation Allocation Allocation Allocation Allocation Allocation
Alameda Formula $ 285,286 $ 285,286 $ 285,286 $ 285,286 $ 285,286 $ 1,426,430
Alpine No Case $ - $ - $ - $ - $ - $ -
Amador Cap $ 6,015 $ 6,015 $ 6,015 $ 6,015 $ 6,015 $ 30,075
Berkeley HH $ 27,342 $ 27,342 $ 27,342 $ 27,342 $ 27,342 $ 136,710
Butte HH $ 25,343 $ 25,343 $ 25,343 $ 25,343 $ 25,343 $ 126,715
Calaveras HH $ 5,334 $ 5,334 $ 5,334 $ 5,334 $ 5,334 $ 26,670
Colusa Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Contra Costa HH $ 172,681 $ 172,681 $ 172,681 $ 172,681 $ 172,681 $ 863,405
Del Norte HH $ 3,334 $ 3,334 $ 3,334 $ 3,334 $ 3,334 $ 16,670
El Dorado Formula $ 12,561 $ 12,561 $ 12,561 $ 12,561 $ 12,561 $ 62,805
Fresno Cap $ 90,643 $ 90,643 $ 90,643 $ 90,643 $ 90,643 $ 453,215
Glenn Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Humboldt HH $ 12,004 $ 12,004 $ 12,004 $ 12,004 $ 12,004 $ 60,020
Imperial Cap $ 19,193 $ 19,193 $ 19,193 $ 19,193 $ 19,193 $ 95,965
Inyo HH $ 4,668 $ 4,668 $ 4,668 $ 4,668 $ 4,668 $ 23,340
Kern Cap $ 122,859 $ 122,859 $ 122,859 $ 122,859 $ 122,859 $ 614,295
Kings HH $ 18,007 $ 18,007 $ 18,007 $ 18,007 $ 18,007 $ 90,035
Lake HH $ 10,003 $ 10,003 $ 10,003 $ 10,003 $ 10,003 $ 50,015
Lassen HH $ 5,334 $ 5,334 $ 5,334 $ 5,334 $ 5,334 $ 26,670
Long Beach HH $ 243,065 $ 243,065 $ 243,065 $ 243,065 $ 243,065 $ 1,215,325
Los Angeles Cap $ 1,972,378 $ 1,972,378 $ 1,972,378 $ 1,972,378 $ 1,972,378 $ 9,861,890
Madera HH $ 16,006 $ 16,006 $ 16,006 $ 16,006 $ 16,006 $ 80,030
Marin HH $ 51,353 $ 51,353 $ 51,353 $ 51,353 $ 51,353 $ 256,765
Mariposa Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Mendocino HH $ 13,337 $ 13,337 $ 13,337 $ 13,337 $ 13,337 $ 66,685
Merced Cap $ 18,049 $ 18,049 $ 18,049 $ 18,049 $ 18,049 $ 90,245
Modoc HH $ 2,820 $ 2,820 $ 2,820 $ 2,820 $ 2,820 $ 14,100
Mono Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Monterey Formula $ 47,999 $ 47,999 $ 47,999 $ 47,999 $ 47,999 $ 239,995
Napa Formula $ 13,251 $ 13,251 $ 13,251 $ 13,251 $ 13,251 $ 66,255
Nevada HH $ 6,669 $ 6,669 $ 6,669 $ 6,669 $ 6,669 $ 33,345
Orange Formula $ 425,502 $ 425,502 $ 425,502 $ 425,502 $ 425,502 $ 2,127,510
Pasadena Cap $ 26,792 $ 26,792 $ 26,792 $ 26,792 $ 26,792 $ 133,960
Placer Cap $ 15,040 $ 15,040 $ 15,040 $ 15,040 $ 15,040 $ 75,200
Plumas Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Riverside Cap $ 293,218 $ 293,218 $ 293,218 $ 293,218 $ 293,218 $ 1,466,090
Sacramento Cap $ 218,266 $ 218,266 $ 218,266 $ 218,266 $ 218,266 $ 1,091,330
San Benito Cap $ 3,180 $ 3,180 $ 3,180 $ 3,180 $ 3,180 $ 15,900
San Bernardino Cap $ 256,250 $ 256,250 $ 256,250 $ 256,250 $ 256,250 $ 1,281,250
San Diego Formula $ 660,768 $ 660,768 $ 660,768 $ 660,768 $ 660,768 $ 3,303,840
San Francisco HH $ 715,084 $ 715,084 $ 715,084 $ 715,084 $ 715,084 $ 3,575,420
San Joaquin Formula $ 83,479 $ 83,479 $ 83,479 $ 83,479 $ 83,479 $ 417,395
San Luis Obispo HH $ 33,345 $ 33,345 $ 33,345 $ 33,345 $ 33,345 $ 166,725
San Mateo HH $ 89,634 $ 89,634 $ 89,634 $ 89,634 $ 89,634 $ 448,170
Santa Barbara HH $ 34,678 $ 34,678 $ 34,678 $ 34,678 $ 34,678 $ 173,390
Santa Clara HH $ 232,038 $ 232,038 $ 232,038 $ 232,038 $ 232,038 $ 1,160,190
Santa Cruz HH $ 28,010 $ 28,010 $ 28,010 $ 28,010 $ 28,010 $ 140,050
Shasta Formula $ 13,985 $ 13,985 $ 13,985 $ 13,985 $ 13,985 $ 69,925
Sierra Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Siskiyou HH $ 4,668 $ 4,668 $ 4,668 $ 4,668 $ 4,668 $ 23,340
Solano HH $ 63,257 $ 63,257 $ 63,257 $ 63,257 $ 63,257 $ 316,285
Sonoma HH $ 74,029 $ 74,029 $ 74,029 $ 74,029 $ 74,029 $ 370,145
Stanislaus Cap $ 45,123 $ 45,123 $ 45,123 $ 45,123 $ 45,123 $ 225,615
Sutter Cap $ 7,520 $ 7,520 $ 7,520 $ 7,520 $ 7,520 $ 37,600
Tehama Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Trinity Minimum $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 3,000 $ 15,000
Tulare Cap $ 30,081 $ 30,081 $ 30,081 $ 30,081 $ 30,081 $ 150,405
Tuolumne HH $ 4,668 $ 4,668 $ 4,668 $ 4,668 $ 4,668 $ 23,340
Ventura Formula $ 65,776 $ 65,776 $ 65,776 $ 65,776 $ 65,776 $ 328,880
Yolo HH $ 14,672 $ 14,672 $ 14,672 $ 14,672 $ 14,672 $ 73,360
Yuba Cap $ 6,015 $ 6,015 $ 6,015 $ 6,015 $ 6,015 $ 30,075
Total $ 6,674,612 1 $ 6,674,612 $ 6,674,612 1 $ 6,674,612 1 $ 6,674,612 1 $ 33,373,060
Exhibit A2
Funding Allocation Process
Fiscal Year 2019-2020 HIV Surveillance Program
The Office of AIDS (OA) will allocate $6.67 million in Fiscal Year (FY) 2019-20 State
General Fund to local health jurisdictions (LHJs) for local HIV Surveillance Programs.
OA will use the FY 2016-17 formula, with updated data, for allocating these funds and
will implement provisions to provide equity and stability of funding across all regions of
California.
The allocation formula is based upon the following factors:
• New HIV/AIDS cases diagnosed 2013 — 2017; and
• Cumulative HIV (non AIDS cases) through December 31, 2017
No Case LHJs:
The following LHJ, with no reported HIV or AIDS cases during the periods indicated
above, will not receive an allocation of HIV Surveillance Program funding: Alpine.
Funding Minimum:
OA will implement a minimum allocation of$3,000 for the rest of the LHJs. The eight
LHJs receiving the minimum allocation: Colusa, Glenn, Mariposa, Mono, Plumas,
Sierra, Tehama, and Trinity.
OA will apply the following stabilization measures:
1. Fundinq Cap (CAP): OA will implement a funding cap, which is a maximum funding
level placed on each LHJ, set at 106 percent of the FY 2016-17 allocation. The
sixteen LHJs impacted by the funding cap: Amador, Fresno, Imperial, Kern, Los
Angeles, Merced, Pasadena, Placer, Riverside, Sacramento, San Benito, San
Bernardino, Stanislaus, Sutter, Tulare and Yuba.
2. Hold Harmless Provision:
OA will distribute funds to other LHJs so that the minimum funding level is 94
percent of the FY 2016-17 allocation. Twenty-seven LHJs are allocated funds due
to the hold harmless provision.
Nine LHJs receive their unadjusted formula amount: Alameda, El Dorado, Monterey,
Napa, Orange, San Diego, San Joaquin, Shasta, and Ventura.
1
FY 2019/20 HIV Surveillance Program Funding Allocation
Unadjusted FINAL FINAL FINAL
FY 19/20 Allocation% FY 19/20 Adjusted Adjusted Allocation
FY 16/17 Unadjusted of FY 16/17 Adjusted Allocation% %of FY 16/17 Summary
County/City County/City Allocation Allocation Allocation Allocation of Unadjusted Allocation Action
Alameda $ 289,225 $ 286,135 98.9% $ 285,286 99.7% 98.6% Formula
Alpine $ - $ - - $ - - - No Case
Amador $ 5,675 $ 6,464 113.9% $ 6,015 93.1% 106.0% Ca
Berkeley $ 29,088 $ 21,468 73.8% $ 27,342 127.4% 94.0% HH
Butte $ 26,961 $ 16,162 59.9% $ 25,343 156.8% 94.0% HH
Calaveras $ 5,675 $ 3,803 67.0% $ 5,334 140.3% 94.0% HH
Colusa $ 3,000 $ 932 31.1% $ 3,000 321.9% 100.0% Minimum
Contra Costa $ 183,704 $ 123,340 67.1% $ 172,681 140.0% 94.0% HH
Del Norte $ 3,547 $ 1,954 55.1% $ 3,334 170.6% 94.0% HH
El Dorado $ 12,416 $ 12,599 101.5% $ 12,561 99.7% 101.2% Formula
Fresno $ 85,513 $ 144,080 168.5% $ 90,643 62.9% 106.0% Cap
Glenn $ 3,000 $ 2,300 76.7% $ 3,000 130.4% 100.0% Minimum
Humboldt $ 12,771 $ 11,200 87.7% $ 12,004 107.2% 94.0% HH
Imperial $ 18,107 $ 25,860 142.8% $ 19,193 74.2% 106.0% Ca
In o $ 4,966 $ 3,353 67.5% $ 4,668 139.2% 94.0% HH
Kern $ 115,905 $ 123,994 107.0% $ 122,859 99.1% 106.0% Ca
Kings $ 19,157 $ 15,892 83.0% $ 18,007 113.3% 94.0% HH
Lake $ 10,642 $ 5,743 54.0% $ 10,003 174.2% 94.0% HH
Lassen $ 5,675 $ 811 14.3% $ 5,334 657.7% 94.0% HH
Long Beach $ 258,580 $ 181,323 70.1% $ 243,065 134.1% 94.0% HH
Los Angeles $1,860,734 $2,217,159 119.2% $ 1,972,378 89.0% 106.0% Cap
Madera $ 17,028 $ 9,742 57.2% $ 16,006 164.3% 94.0% HH
Marin $ 54,631 $ 33,255 60.9% $ 51,353 154.4% 94.0% HH
Mariposa $ 3,000 $ 841 28.0% $ 3,000 356.7% 100.0% Minimum
Mendocino $ 14,189 $ 7,261 51.2% $ 13,337 183.7% 94.0% HH
Merced $ 17,028 $ 22,462 131.9% $ 18,049 80.4% 106.0% Ca
Modoc $ 3,000 $ - 0.0% $ 2,820 - 94.0% HH
Mono $ 3,000 $ 706 23.5% $ 3,000 424.9% 100.0% Minimum
Monterey $ 46,116 $ 48,142 104.4% $ 47,999 99.7% 104.1% Formula
Napa $ 13,203 $ 13,290 100.7% $ 13,251 99.7% 100.4% Formula
Nevada $ 7,095 $ 5,201 73.3% $ 6,669 128.2% 94.0% HH
Orange $ 422,925 $ 426,768 100.9% $ 425,502 99.7% 100.6% Formula
Pasadena $ 25,276 $ 33,557 132.8% $ 26,792 79.8% 106.0% Cap
Placer $ 14,189 $ 19,063 134.4% $ 15,040 78.9% 106.0% Ca
Plumas $ 3,000 $ 496 16.5% $ 3,000 604.8% 100.0% Minimum
Riverside $ 276,621 $ 413,031 149.3% $ 293,218 71.0% 106.0% Ca
Sacramento $ 205,912 $ 227,691 110.6% $ 218,266 95.9% 106.0% Cap
San Benito $ 3,000 $ 4,420 147.3% $ 3,180 71.9% 106.0% Ca
San Bernardino $ 241,746 $ 271,540 112.3% $ 256,250 94.4% 106.0% Cap
San Diego $ 691,677 $ 662,735 95.8% $ 660,768 99.7% 95.5% Formula
San Francisco $ 760,728 $ 499,451 65.7% $ 715,084 143.2% 94.0% HH
San Joaquin $ 80,906 $ 83,728 103.5% $ 83,479 99.7% 103.2% Formula
San Luis Obispo $ 35,474 $ 23,799 67.1% $ 33,345 140.1% 94.0% HH
San Mateo $ 95,356 $ 80,688 84.6% $ 89,634 111.1% 94.0% HH
Santa Barbara $ 36,892 $ 32,023 86.8% $ 34,678 1 108.3% 94.0% HH
Santa Clara $ 246,849 $ 189,557 76.8% $ 232,038 122.4% 94.0% HH
Santa Cruz $ 29,798 $ 22,205 74.5% $ 28,010 126.1% 94.0% HH
Shasta $ 14,189 $ 14,027 98.9% $ 13,985 99.7% 98.6% Formula
Sierra $ 3,000 $ 180 6.0% $ 3,000 1666.7% 100.0% Minimum
Siski ou $ 4,966 $ 4,029 81.1% $ 4,668 115.9% 94.0% HH
Solano $ 67,295 $ 56,814 84.4% $ 63,257 111.3% 94.0% HH
Sonoma $ 78,755 $ 45,536 57.8% $ 74,029 162.6% 94.0% HH
Stanislaus $ 42,569 $ 55,600 130.6% $ 45,123 81.2% 106.0% Cap
Sutter $ 7,095 $ 7,878 111.0% $ 7,520 95.5% 106.0% Ca
Tehama $ 3,000 $ 2,976 99.2% $ 3,000 100.8% 100.0% Minimum
Trinity $ 3,000 $ 405 13.5% $ 3,000 740.7% 100.0% Minimum
Tulare $ 28,379 $ 41,602 146.6% $ 30,081 72.3% 106.0% Cap
Tuolumne $ 4,966 $ 1,698 34.2% $ 4,668 274.9% 94.0% HH
Ventura $ 69,530 $ 65,971 94.9% $ 65,776 99.7% 94.6% Formula
Yolo $ 15,609 $ 11,786 75.5% $ 14,672 124.5% 94.0% HH
Yuba $ 5,675 $ 6,254 110.2% $ 6,015 96.2% 106.0% Cap
Total $6,649,342 $6,650,980 1 1 $ 6,674,612
1 No Case County/City
9 Unadjusted Formula County/City
16 Funding Cap County/City
8 Minimum Allocation County/City
27 Hold Harmless County/City
61 Total Counties/Cities
2
County of Fresno
19-10415
Page 1 of 2
Exhibit B
Budget Detail and Payment Provisions
1. Invoicing and Payment
A. Upon completion of project activities as provided in the 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 in triplicate not more frequently
than monthly in arrears to:
Invoice Desk
California Department of Public Health
Prevention Program
MS 7700
1616 Capitol Avenue, Suite 616
Sacramento, CA 95814
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 the 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:
1) $453,215 for the budget period of 07/01/2019 through 06/30/2024.
County of Fresno
19-10415
Page 2of2
Exhibit B
Budget Detail and Payment Provisions
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.
5. Timely Submission of Final Invoice
A. A final undisputed invoice shall be submitted for payment no more than forty-five (45) calendar
days following the expiration or termination date of this Grant, unless a later or alternate
deadline is agreed to in writing by the program grant manager. Said invoice should be clearly
marked "Final Invoice", indicating that all payment obligations of the State under this Grant have
ceased and that no further payments are due or outstanding.
B. The State may, at its discretion, choose not to honor any delinquent final invoice if the Grantee
fails to obtain prior written State approval of an alternate final invoice submission deadline.
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
19-10415
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.
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 and the
Grant Application.
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.
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.
Page 4 of 4
4) For publications other than those described in paragraph 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
19-10415
Page 1 of 3
Exhibit D
Additional Provisions
1. Cancellation /Termination
A. This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days
advance written notice to the Grantee.
B. CDPH reserves the right to cancel or terminate this Grant immediately for cause. The
Grantee may submit a written request to terminate this Grant only if CDPH substantially fails
to perform its responsibilities as provided herein.
C. The term "for cause" shall mean that the Grantee fails to meet the terms, conditions, and/or
responsibilities of this agreement. Causes for termination include, but are not limited to the
following occurrences:
1) If the Grantee knowingly furnishes any statement, representation, warranty, or
certification in connection with the agreement, which representation is materially false,
deceptive, incorrect, or incomplete.
2) If the Grantee fails to perform any material requirement of this Grant or defaults in
performance of this agreement.
3) If the Grantee files for bankruptcy, or if CDPH determines that the Grantee becomes
financially incapable of completing this agreement.
D. Grant termination or cancellation shall be effective as of the date indicated in CDPH's
notification to the Grantee. The notice shall stipulate any final performance, invoicing or
payment requirements.
E. In the event of early termination or cancellation, the Grantee shall be entitled to
compensation for services performed satisfactorily under this agreement and expenses
incurred up to the date of cancellation and any non-cancelable obligations incurred in
support of this Grant.
F. In the event of termination, and at the request of CDPH, the Grantee shall furnish copies of
all proposals, specifications, designs, procedures, layouts, copy, and other materials related
to the services or deliverables provided under this Grant, whether finished or in progress on
the termination date.
G. The Grantee will not be entitled to reimbursement for any expenses incurred for services
and deliverables pursuant to this agreement after the effective date of termination.
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.
County of Fresno
19-10415
Page 2 of 3
Exhibit D
Additional Provisions
3) Upon the effective date of termination of the Grant and the payment by CDPH of all
items properly changeable to CDPH hereunder, Grantee shall transfer, assign and make
available to CDPH all property and materials belonging to CDPH, all rights and claims to
any and all reservations, grants, and arrangements with owners of media/PR materials,
or others, and shall make available to CDPH all written information regarding CDPH's
media/PR materials, and no extra compensation is to be paid to Grantee for its services.
4) Take such action as may be necessary, or as CDPH may specify, to protect and
preserve any property related to this agreement which is in the possession of the
Grantee and in which CDPH has or may acquire an interest.
I. CDPH may, at its discretion, require the Grantee to cease performance of certain
components of the Scope of Work as designated by CDPH and complete performance of
other components prior to the termination date of the Grant.
2. Avoidance of Conflicts of Interest by Grantee
A. CDPH intends to avoid any real or apparent conflict of interest on the part of the Grantee,
subgrants, or employees, officers and directors of the Grantee or subgrants. Thus, CDPH
reserves the right to determine, at its sole discretion, whether any information, assertion or
claim received from any source indicates the existence of a real or apparent conflict of
interest; and, if a conflict is found to exist, to require the Grantee to submit additional
information or a plan for resolving the conflict, subject to CDPH review and prior approval.
B. Conflicts of interest include, but are not limited to:
1) An instance where the Grantee or any of its subgrants, or any employee, officer, or
director of the Grantee or any subgrant or has an interest, financial or otherwise,
whereby the use or disclosure of information obtained while performing services under
the grant would allow for private or personal benefit or for any purpose that is contrary to
the goals and objectives of the grant.
2) An instance where the Grantee's or any subgrant's employees, officers, or directors use
their positions for purposes that are, or give the appearance of being, motivated by a
desire for private gain for themselves or others, such as those with whom they have
family, business or other ties.
C. If CDPH is or becomes aware of a known or suspected conflict of interest, the Grantee will
be given an opportunity to submit additional information or to resolve the conflict. A Grantee
with a suspected conflict of interest will have five (5) working days from the date of
notification of the conflict by CDPH to provide complete information regarding the suspected
conflict. If a conflict of interest is determined to exist by CDPH and cannot be resolved to
the satisfaction of CDPH, the conflict will be grounds for terminating the grant. CDPH may,
at its discretion upon receipt of a written request from the Grantee, authorize an extension of
the timeline indicated herein.
County of Fresno
19-10415
Page 3 of 3
Exhibit D
Additional Provisions
3. Dispute Resolution Process
A. A Grantee grievance exists whenever there is a dispute arising from CDPH's action in the
administration of an agreement. If there is a dispute or grievance between the Grantee and
CDPH, the Grantee must seek resolution using the procedure outlined below.
1) The Grantee should first informally discuss the problem with the CDPH Program Grant
Manager. If the problem cannot be resolved informally, the Grantee shall direct its
grievance together with any evidence, in writing, to the program Branch Chief. The
grievance shall state the issues in dispute, the legal authority or other basis for the
Grantee's position and the remedy sought. The Branch Chief shall render a decision
within ten (10) working days after receipt of the written grievance from the Grantee. The
Branch Chief shall respond in writing to the Grantee indicating the decision and reasons
therefore. If the Grantee disagrees with the Branch Chief's decision, the Grantee may
appeal to the second level.
2) When appealing to the second level, the Grantee must prepare an appeal indicating the
reasons for disagreement with Branch Chief's decision. The Grantee shall include with
the appeal a copy of the Grantee's original statement of dispute along with any
supporting evidence and a copy of the Branch Chief's decision. The appeal shall be
addressed to the Deputy Director of the division in which the branch is organized within
ten (10) working days from receipt of the Branch Chief's decision. The Deputy Director
of the division in which the branch is organized or his/her designee shall meet with the
Grantee to review the issues raised. A written decision signed by the Deputy Director of
the division in which the branch is organized or his/her designee shall be directed to the
Grantee within twenty (20) working days of receipt of the Grantee's second level appeal.
B. If the Grantee wishes to appeal the decision of the Deputy Director of the division in which
the branch is organized or his/her designee, the Grantee shall follow the procedures set
forth in Division 25.1 (commencing with Section 38050) of the Health and Safety Code and
the regulations adopted thereunder. (Title 1, Division 2, Chapter 2, Article 3 (commencing
with Section 1140) of the California Code of Regulations).
C. Disputes arising out of an audit, examination of an agreement or other action not covered by
subdivision (a) of Section 20204, of Chapter 2.1, Title 22, of the California Code of
Regulations, and for which no procedures for appeal are provided in statute, regulation or
the Agreement, shall be handled in accordance with the procedures identified in Sections
51016 through 51047, Title 22, California Code of Regulations.
D. Unless otherwise stipulated in writing by CDPH, all dispute, grievance and/or appeal
correspondence shall be directed to the CDPH Grant Manager.
E. There are organizational differences within CDPH's funding programs and the management
levels identified in this dispute resolution provision may not apply in every contractual
situation. When a grievance is received and organizational differences exist, the Grantee
shall be notified in writing by the CDPH Grant Manager of the level, name, and/or title of the
appropriate management official that is responsible for issuing a decision at a given level.
County of Fresno
19-10415
Page 1 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
This Information Privacy and Security Requirements Exhibit (For Non-HIPAA/HITECH Act Contracts)
(hereinafter referred to as "this Exhibit") sets forth the information privacy and security requirements
Contractor is obligated to follow with respect to all personal and confidential information (as defined herein)
disclosed to Contractor, or collected, created, maintained, stored, transmitted or used by Contractor for or
on behalf of the California Department of Public Health (hereinafter"CDPH"), pursuant to Contractor's
agreement with CDPH. (Such personal and confidential information is referred to herein collectively as
"CDPH PCI".) CDPH and Contractor desire to protect the privacy and provide for the security of CDPH
PCI pursuant to this Exhibit and in compliance with state and federal laws applicable to the CDPH PCI.
I. Order of Precedence: With respect to information privacy and security requirements for all CDPH PCI,
the terms and conditions of this Exhibit shall take precedence over any conflicting terms or conditions
set forth in any other part of the agreement between Contractor and CDPH, including Exhibit A (Scope
of Work), all other exhibits and any other attachments, and shall prevail over any such conflicting terms
or conditions.
II. Effect on lower tier transactions: The terms of this Exhibit shall apply to all contracts, subcontracts, and
subawards, and the information privacy and security requirements Contractor is obligated to follow with
respect to CDPH PCI disclosed to Contractor, or collected, created, maintained, stored, transmitted or
used by Contractor for or on behalf of CDPH, pursuant to Contractor's agreement with CDPH. When
applicable the Contractor shall incorporate the relevant provisions of this Exhibit into each subcontract
or subaward to its agents, subcontractors, or independent consultants.
III. Definitions: For purposes of the agreement between Contractor and CDPH, including this Exhibit, the
following definitions shall apply:
A. Breach:
"Breach" means:
1. the unauthorized acquisition, access, use, or disclosure of CDPH PCI in a manner which
compromises the security, confidentiality or integrity of the information; or
2. the same as the definition of "breach of the security of the system" set forth in California
Civil Code section 1798.29(f).
B. Confidential Information: "Confidential information" means information that:
1. does not meet the definition of"public records" set forth in California Government Code
section 6252(e), or is exempt from disclosure under any of the provisions of Section 6250,
et seq. of the California Government Code or any other applicable state or federal laws; or
2. is contained in documents, files, folders, books or records that are clearly labeled, marked or
designated with the word "confidential" by CDPH.
C. Disclosure: "Disclosure" means the release, transfer, provision of, access to, or divulging in any
manner of information outside the entity holding the information.
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 2 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
D. PCI: "PCI" means "personal information" and "confidential information" (as these terms are
defined herein:
E. Personal Information: "Personal information" means information, in any medium (paper,
electronic, oral) that:
1. directly or indirectly collectively identifies or uniquely describes an individual; or
2. could be used in combination with other information to indirectly identify or uniquely
describe an individual, or link an individual to the other information; or
3. meets the definition of"personal information" set forth in California Civil Code section
1798.3, subdivision (a) or
4. is one of the data elements set forth in California Civil Code section 1798.29, subdivision
(g)(1) or (g)(2); or
5. meets the definition of"medical information" set forth in either California Civil Code section
1798.29, subdivision (h)(2) or California Civil Code section 56.05, subdivision 0); or
6. meets the definition of"health insurance information" set forth in California Civil Code
section 1798.29, subdivision (h)(3); or
7. is protected from disclosure under applicable state or federal law.
F. Security Incident: "Security Incident" means:
1. an attempted breach; or
2. the attempted or successful unauthorized access or disclosure, modification or destruction
of CDPH PCI, in violation of any state or federal law or in a manner not permitted under the
agreement between Contractor and CDPH, including this Exhibit; or
3. the attempted or successful modification or destruction of, or interference with,
Contractor's system operations in an information technology system, that negatively
impacts the confidentiality, availability or integrity of CDPH PCI; or
4. any event that is reasonably believed to have compromised the confidentiality, integrity, or
availability of an information asset, system, process, data storage, or transmission.
Furthermore, an information security incident may also include an event that constitutes a
violation or imminent threat of violation of information security policies or procedures,
including acceptable use policies.
G. Use: "Use" means the sharing, employment, application, utilization, examination, or analysis of
information.
IV. Disclosure Restrictions: The Contractor and its employees, agents, and subcontractors shall protect
from unauthorized disclosure any CDPH PCI. The Contractor shall not disclose, except as otherwise
specifically permitted by the agreement between Contractor and CDPH (including this Exhibit), any
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 3 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
CDPH PCI to anyone other than CDPH personnel or programs without prior written authorization from
the CDPH Program Contract Manager, except if disclosure is required by State or Federal law.
V. Use Restrictions: The Contractor and its employees, agents, and subcontractors shall not use any
CDPH PCI for any purpose other than performing the Contractor's obligations under its agreement with
CDPH.
VI. Safeguards: The Contractor shall implement administrative, physical, and technical safeguards that
reasonably and appropriately protect the privacy, confidentiality, security, integrity, and availability of
CDPH PCI, including electronic or computerized CDPH PCI. At each location wher CDPH PCI exists
under Contractor's control, the Contractor shall develop and maintain a written information privacy
and security program that includes administrative, technical and physical safeguards appropriate to
the size and complexity of the Contractor's operations and the nature and scope of its activities in
performing its agreement with CDPH, including this Exhibit, and which incorporates the requirements
of Section VII, Security, below. Contractor shall provide CDPH with Contractor's current and updated
policies within five (5) business days of a request by CDPH for the policies.
VI I. Security: The Contractor shall take any and all steps reasonably necessary to ensure the continuous
security of all computerized data systems containing CDPH PCI. These steps shall include, at a
minimum, complying with all of the data system security precautions listed in the Contractor Data
Security Standards set forth in Attachment 1 to this Exhibit.
VIII. Security Officer: At each place where CDPH PCI is located„ the Contractor shall designate a Security
Officer to oversee its compliance with this Exhibit and to communicate with CDPH on matters
concerning this Exhibit.
IX. Training: The Contractor shall provide training on its obligations under this Exhibit, at its own expense,
to all of its employees who assist in the performance of Contractor's obligations under Contractor's
agreement with CDPH, including this Exhibit, or otherwise use or disclose CDPH PCI.
A. The Contractor shall require each employee who receives training to certify, either in hard copy
or electronic form, the date on which the training was completed.
B. The Contractor shall retain each employee's certifications for CDPH inspection for a period of
three years following contract termination or completion.
C. Contractor shall provide CDPH with its employee's certifications within five (5) business days of
a request by CDPH for the employee's certifications.
X. Employee Discipline: Contractor shall impose discipline that it deems appropriate (in its sole
discretion) on such employees and other Contractor workforce members under Contractor's direct
control who intentionally or negligently violate any provisions of this Exhibit.
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 4 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
XI. Breach and Security Incident Responsibilities:
A. Notification to CDPH of Breach or Security Incident: The Contractor shall notify CDPH
immediately by telephone call plus email or fax upon the discovery of a breach (as defined in
this Exhibit), and within twenty-four (24) hours by email or fax of the discovery of any security
incident (as defined in this Exhibit), unless a law enforcement agency determines that the
notification will impede a criminal investigation, in which case the notification required by this
section shall be made to CDPH immediately after the law enforcement agency determines that
such notification will not compromise the investigation. Notification shall be provided to the
CDPH Program Contract Manager, the CDPH Privacy Officer and the CDPH Chief Information
Security Officer, using the contact information listed in Section XI(F), below. If the breach or
security incident is discovered after business hours or on a weekend or holiday and involves
CDPH PCI in electronic or computerized form, notification to CDPH shall be provided by calling
the CDPH Information Security Office at the telephone numberslisted in Section XI(F), below.
For purposes of this Section, breaches and security incidents shall be treated as discovered by
Contractor as of the first day on which such breach or security incident is known to the
Contractor, or, by exercising reasonable diligence would have been known to the Contractor.
Contractor shall be deemed to have knowledge of a breach if such breach is known, or by
exercising reasonable diligence would have been known, to any person, other than the person
committing the breach, who is a employee or agent of the Contractor.
Contractor shall take:
1. prompt corrective action to mitigate any risks or damages involved with the breach or
security incident and to protect the operating environment; and
2. any action pertaining to a breach required by applicable federal and state laws, including,
specifically, California Civil Code section 1798.29.
B. Investigation of Breach and Security Incidents: The Contractor shall immediately investigate such
breach or security incident. As soon as the information is known and subject to the legitimate
needs of law enforcement, Contractor shall inform the CDPH Program Contract Manager, the
CDPH Privacy Officer, and the CDPH Chief Information Security Officer of:
1. what data elements were involved and the extent of the data disclosure or access involved in
the breach, including, specifically, the number of individuals whose personal information was
breached; and
2. a description of the unauthorized persons known or reasonably believed to have improperly
used the CDPH PCI and/or a description of the unauthorized persons known or reasonably
believed to have improperly accessed or acquired the CDPH PCI, or to whom it is known or
reasonably believed to have had the CDPH PCI improperly disclosed to them; and
3. a description of where the CDPH PCI is believed to have been improperly used or disclosed;
and
4. a description of the probable and proximate causes of the breach or security incident; and
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 5 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
5. whether Civil Code section 1798.29 or any other federal or state laws requiring individual
notifications of breaches have been triggered.
C. Written Report: The Contractor shall provide a written report of the investigation to the CDPH
Program Contract Manager, the CDPH Privacy Officer, and the CDPH Chief Information Security
Officer as soon as practicable after the discovery of the breach or security incident. The report
shall include, but not be limited to, the information specified above, as well as a complete, detailed
corrective action plan, including information on measures that were taken to halt and/or contain
the breach or security incident, and measures to be taken to prevent the recurrence or further
disclosure of data regarding such breach or security incident.
D. Notification to Individuals: If notification to individuals whose information was breached is required
under state or federal law, and regardless of whether Contractor is considered only a custodian
and/or non-owner of the CDPH PCI, Contractor shall, at its sole expense, and at the sole election
of CDPH, either:
1. make notification to the individuals affected by the breach (including substitute notification),
pursuant to the content and timeliness provisions of such applicable state or federal breach
notice laws. Contractor shall inform the CDPH Privacy Officer of the time, manner and
content of any such notifications, prior to the transmission of such notifications to the
individuals; or
2. cooperate with and assist CDPH in its notification (including substitute notification) to the
individuals affected by the breach.
E. Submission of Sample Notification to Attorney General: If notification to more than 500
individuals is required pursuant to California Civil Code section 1798.29, and regardless of
whether Contractor is considered only a custodian and/or non-owner of the CDPH PCI,
Contractor shall, at its sole expense, and at the sole election of CDPH, either:
1. electronically submit a single sample copy of the security breach notification, excluding any
personally identifiable information, to the Attorney General pursuant to the format. content
and timeliness provisions of Section 1798.29, subdivision (e). Contractor shall inform the
CDPH Privacy Officer of the time, manner and content of any such submissions, prior to the
transmission of such submissions to the Attorney General; or
2. cooperate with and assist CDPH in its submission of a sample copy of the notification to the
Attorney General.
F. CDPH Contact Information: To direct communications to the above referenced CDPH staff, the
Contractor shall initiate contact as indicated herein. CDPH reserves the right to make changes
to the contact information below by verbal or written notice to the Contractor. Said changes
shall not require an amendment to this Exhibit or the agreement to which it is incorporated.
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 6 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
CDPH Program CDPH Privacy Officer CDPH Chief Information
Contract Security Officer
Manager
See the Scope of Privacy Officer Chief Information Security Officer
Work exhibit for Privacy Office Information Security Office
Program Contract Office of Legal Services California Dept. of Public Health
Manager California Dept. of Public Health P.O. Box 997377
1415 L Street, 511 Floor MS6302
Sacramento, CA 95814 Sacramento, CA 95899-7413
Email: privacyCa)cdph.ca.gov Email: cdphiso(c)-cdph.ca.gov
Telephone: (877) 421-9634 Telephone: (855) 500-0016
XII. Documentation of Disclosures for Requests for Accounting: Contractor shall document and make
available to CDPH or (at the direction of CDPH) to an Individual such disclosures of CDPH PCI, and
information related to such disclosures, necessary to respond to a proper request by the subject
Individual for an accounting of disclosures of personal information as required by Civil Code section
1798.25, or any applicable state or federal law.
XIII. Requests for CDPH PCI by Third Parties: The Contractor and its employees, agents, or
subcontractors shall promptly transmit to the CDPH Program Contract Manager all requests for
disclosure of any CDPH PCI requested by third parties to the agreement between Contractor and
CDPH (except from an Individual for an accounting of disclosures of the individual's personal
information pursuant to applicable state or federal law), unless prohibited from doing so by applicable
state or federal law.
XIV. Audits, Inspection and EnforcementCDPH may inspect the facilities, systems, books and records of
Contractor to monitor compliance with this Exhibit. Contractor shall promptly remedy any violation of
any provision of this Exhibit and shall certify the same to the CDPH Program Contract Manager in
writing.
XV. Return or Destruction of CDPH PCI on Expiration or Termination: Upon expiration or termination of
the agreement between Contractor and CDPH for any reason, Contractor shall securely return or
destroy the CDPH PCI. If return or destruction is not feasible, Contractor shall provide a written
explanation to the CDPH Program Contract Manager, the CDPH Privacy Officer and the CDPH Chief
Information Security Officer, using the contact information listed in Section XI(F), above.
A. Retention Required by Law: If required by state or federal law, Contractor may retain, after
expiration or termination, CDPH PCI for the time specified as necessary to comply with the law.
B. Obligations Continue Until Return or Destruction: Contractor's obligations under this Exhibit
shall continue until Contractor returns or destroys the CDPH PCI or returns the CDPH PCI to
CDPH; provided however, that on expiration or termination of the agreement between
Contractor and CDPH, Contractor shall not further use or disclose the CDPH PCI except as
required by state or federal law.
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 7 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
C. Notification of Election to Destroy CDPH PCI: If Contractor elects to destroy the CDPH PCI,
Contractor shall certify in writing, to the CDPH Program Contract Manager, the CDPH Privacy
Officer and the CDPH Chief Information Security Officer, using the contact information listed in
Section XI(F), above, that the CDPH PCI has been securely destroyed. The notice shall include
the date and type of destruction method used.
XVI. Amendment: The parties acknowledge that federal and state laws regarding information security and
privacy rapidly evolves and that amendment of this Exhibit may be required to provide for procedures
to ensure compliance with such laws. The parties specifically agree to take such action as is
necessary to implement new standards and requirements imposed by regulations and other
applicable laws relating to the security or privacy of CDPH PCI.The parties agree to promptly enter
into negotiations concerning an amendment to this Exhibit consistent with new standards and
requirements imposed by applicable laws and regulations.
XVII. Assistance in Litigation or Administrative Proceedings: Contractor shall make itself and any
subcontractors, workforce employees or agents assisting Contractor in the performance of its
obligations under the agreement between Contractor and CDPH, available to CDPH at no cost to
CDPH to testify as witnesses, in the event of litigation or administrative proceedings being
commenced against CDPH, its director, officers or employees based upon claimed violation of laws
relating to security and privacy, which involves inactions or actions by the Contractor, except where
Contractor or its subcontractor, workforce employee or agent is a named adverse party.
XVIII. No Third-Party Beneficiaries: Nothing express or implied in the terms and conditions of this Exhibit is
intended to confer, nor shall anything herein confer, upon any person other than CDPH or Contractor
and their respective successors or assignees, any rights, remedies, obligations or liabilities
whatsoever.
XIX. Interpretation: The terms and conditions in this Exhibit shall be interpreted as broadly as necessary to
implement and comply with regulations and applicable State laws. The parties agree that any
ambiguity in the terms and conditions of this Exhibit shall be resolved in favor of a meaning that
complies and is consistent with federal and state laws and regulations.
XX. Survival: If Contractor does not return or destroy the CDPH PCI upon the completion or termination of
the Agreement, the respective rights and obligations of Contractor under Sections VI, VII and XI of
this Exhibit shall survive the completion or termination of the agreement between Contractor and
CDPH.
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 8 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
Attachment 1
Contractor Data Security Standards
1. General Security Controls
A. Confidentiality Statement. All persons that will be working with CDPH PCI must sign a
confidentiality statement. The statement must include at a minimum, General Use, Security
and Privacy safeguards, Unacceptable Use, and Enforcement Policies. The statement must
be signed by the workforce member prior to access to CDPH PCI. The statement must be
renewed annually. The Contractor shall retain each person's written confidentiality statement
for CDPH inspection for a period of three (3) years following contract termination.
B. Background check. Before a member of the Contractor's workforce may access CDPH PCI,
Contractor must conduct a thorough background check of that worker and evaluate the
results to assure that there is no indication that the worker may present a risk for theft of
confidential data. The Contractor shall retain each workforce member's background check
documentation for a period of three (3) years following contract termination.
C. Workstation/Laptop encryption. All workstations and laptops that process and/or store
CDPH PCI must be encrypted using a FIPS 140-2 certified algorithm, such as Advanced
Encryption Standard (AES), with a 128bit key or higher. The encryption solution must be full
disk unless approved by the CDPH Information Security Office.
D. Server Security. Servers containing unencrypted CDPH PCI must have sufficient
administrative, physical, and technical controls in place to protect that data, based upon a risk
assessment/system security review.
E. Minimum Necessary. Only the minimum necessary amount of CDPH PCI required to
perform necessary business functions may be copied, downloaded, or exported.
F. Removable media devices. All electronic files that contain CDPH PCI data must be
encrypted when stored on any removable media or portable device (i.e. USB thumb drives,
floppies, CD/DVD, smart devices tapes etc.). PCI must be encrypted using a FIPS 140-2
certified algorithm, such as Advanced Encryption Standard (AES), with a 128bit key or higher
G. Antivirus software. All workstations, laptops and other systems that process and/or store
CDPH PCI must install and actively use a comprehensive anti-virus software solution with
automatic updates scheduled at least daily.
H. Patch Management. All workstations, laptops and other systems that process and/or store
CDPH PCI must have operating system and application security patches applied, with system
reboot if necessary. There must be a documented patch management process which
determines installation timeframe based on risk assessment and vendor recommendations.
At a maximum, all applicable patches must be installed within 30 days of vendor release.
I. User IDs and Password Controls. All users must be issued a unique user name for
accessing CDPH PCI. Username must be promptly disabled, deleted, or the password
changed upon the transfer or termination of an employee with knowledge of the password.
Passwords are not to be shared. Must be at least eight characters. Must be a non-dictionary
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 9 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
word. Must not be stored in readable format on the computer. Must be changed every 60
days. Must be changed if revealed or compromised. Must be composed of characters from
at least three of the following four groups from the standard keyboard:
• Upper case letters (A-Z)
• Lower case letters (a-z)
• Arabic numerals (0-9)
• Non-alphanumeric characters (punctuation symbols)
J. Data Sanitization. All CDPH PCI must be sanitized using NIST Special Publication 800-88
standard methods for data sanitization when the CDPH PCI is no longer needed.
2. System Security Controls
A. System Timeout. The system must provide an automatic timeout, requiring
reauthentication of the user session after no more than 20 minutes of inactivity.
B. Warning Banners. All systems containing CDPH PCI must display a warning banner each
time a user attempts access, stating that data is confidential, systems are logged, and
system use is for business purposes only. User must be directed to log off the system if they
do not agree with these requirements.
C. System Logging. The system must maintain an automated audit trail which can identify the
user or system process which initiates a request for CDPH PCI, or which alters CDPH PCI.
The audit trail must be date and time stamped, must log both successful and failed
accesses, must be read only, and must be restricted to authorized users This logging must
be included for all user privilege levels including, but not limited to, systems administrators.
If CDPH PCI is stored in a database, database logging functionality must be enabled. Audit
trail data must be archived for at least 3 years after occurrence.
D. Access Controls. The system must use role based access controls for all user
authentications, enforcing the principle of least privilege.
E. Transmission encryption. All data transmissions of CDPH PCI outside the contractor's
secure internal network must be encrypted using a FIPS 140-2 certified algorithm, such as
Advanced Encryption Standard (AES), with a 128bit key or higher. Encryption can be end to
end at the network level, or the data files containing CDPH PCI can be encrypted. This
requirement pertains to any type of CDPH PCI in motion such as website access, file
transfer, and E-Mail.
F. Intrusion Detection. All systems involved in accessing, holding, transporting, and
protecting CDPH PCI that are accessible via the Internet must be protected by a
comprehensive intrusion detection and prevention solution.
3. Audit Controls
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 10 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
A. System Security Review. All systems processing and/or storing CDPH PCI must have at
least an annual system risk assessment/security review which provides assurance that
administrative, physical, and technical controls are functioning effectively and providing
adequate levels of protection. Reviews shall include vulnerability scanning tools.
B. Log Reviews. All systems processing and/or storing CDPH PCI must have a routine
procedure in place to review system logs for unauthorized access.
C. Change Control. All systems processing and/or storing CDPH PCI must have a
documented change control procedure that ensures separation of duties and protects the
confidentiality, integrity and availability of data.
4. Business Continuity/ Disaster Recovery Controls
A. Disaster Recovery. Contractor must establish a documented plan to enable continuation of
critical business processes and protection of the security of electronic CDPH PCI in the
event of an emergency. Emergency means any circumstance or situation that causes
normal computer operations to become unavailable for use in performing the work required
under this agreement for more than 24 hours.
B. Data Backup Plan. Contractor must have established documented procedures to securely
backup CDPH PCI to maintain retrievable exact copies of CDPH PCI. The backups shall be
encrypted.The plan must include a regular schedule for making backups, storing backups
offsite, an inventory of backup media, and the amount of time to restore CDPH PCI should it
be lost. At a minimum, the schedule must be a weekly full backup and monthly offsite
storage of CDPH data.
5. Paper Document Controls
A. Supervision of Data. CDPH PCI in paper form shall not be left unattended at any time,
unless it is locked in a file cabinet, file room, desk or office. Unattended means that
information is not being observed by an employee authorized to access the information.
CDPH PCI in paper form shall not be left unattended at any time in vehicles or planes and
shall not be checked in baggage on commercial airplanes.
B. Escorting Visitors. Visitors to areas where CDPH PCI is contained shall be escorted and
CDPH PHI shall be kept out of sight while visitors are in the area.
C. Confidential Destruction. CDPH PCI must be disposed of through confidential means,
using NIST Special Publication 800-88 standard methods for data sanitization when the
CDPH PSCI is no longer needed.
D. Removal of Data. CDPH PCI must not be removed from the premises of the Contractor
except with express written permission of CDPH.
E. Faxing. Faxes containing CDPH PCI shall not be left unattended and fax machines shall be
in secure areas. Faxes shall contain a confidentiality statement notifying persons receiving
CDPH IPSR(6-16)
County of Fresno
19-10415
Page 11 of 11
Exhibit E
Information Privacy and Security Requirements
(For Non-HIPAA/HITECH Act Contracts)
faxes in error to destroy them. Fax numbers shall be verified with the intended recipient
before sending.
F. Mailing. CDPH PCI shall only be mailed using secure methods. Large volume mailings of
CDPH PHI shall be by a secure, bonded courier with signature required on receipt. Disks
and other transportable media sent through the mail must be encrypted with a CDPH
approved solution, such as a solution using a vendor product specified on the CALIFORNIA
STRATEGIC SOURCING INITIATIVE.
CDPH IPSR(6-16)
CCC 04/2017
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly
authorized to legally bind the prospective Contractor to the clause(s) listed below. This
certification is made under the laws of the State of California.
/Bidder Firm Name (Printed) ! g4 6000 D Number i Contractor �-
i County of Fresno
I
By (Authorized Signaturell
i
}
f Printed Name and Title of Person Signing
Nathan Magsig, Chairman of the Board of Supervisors of the County of Fresno
±Date Executed j Executed in the County of ATTEST:
BERNICE E.SEIDEL
11 I Fresno Clerk of the Board of Supervisors
i
County off resno,State of California
By
CONTRACTOR CERTIFICATION CLAUSES Deputy
1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with
the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2,
Section l 1102) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the
requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free
workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture, distribution,
dispensation, possession or use of controlled substance is prohibited and specifying
actions to be taken against employees for violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free workplace;
3) any available counseling, rehabilitation and employee assistance programs; and,
4) penalties that may be imposed upon employees for drug abuse violations.
c. Every employee who works on the proposed Agreement will:
1) receive a copy of the company's drug-free workplace policy statement; and,
2) agree to abide by the terms of the company's statement as a condition of employment
on the Agreement.
Failure to comply with these requirements may result in suspension of payments under
the Agreement or termination of the Agreement or both and Contractor may be ineligible
for award of any future State agreements if the department determines that any of the
following has occurred: the Contractor has made false certification, or violated the
certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et
seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies
that no more than one (1) final unappealable finding of contempt of court by a Federal
court has been issued against Contractor within the immediately preceding two-year
period because of Contractor's failure to comply with an order of a Federal court, which
orders Contractor to comply with an order of the National Labor Relations Board. (Pub.
Contract Code §10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE-PRO BONO
REQUIREMENT: Contractor hereby certifies that Contractor will comply with the
requirements of Section 6072 of the Business and Professions Code, effective January 1,
2003.
Contractor agrees to make a good faith effort to provide a minimum number of hours of
pro bono legal services during each year of the contract equal to the lessor of 30
multiplied by the number of full time attorneys in the firm's offices in the State, with the
number of hours prorated on an actual day basis for any contract period of less than a full
year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state contract for
legal services, and may be taken into account when determining the award of future
contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an
expatriate corporation or subsidiary of an expatriate corporation within the meaning of
Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the
State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All Contractors contracting for the procurement or laundering of apparel, garments or
corresponding accessories, or the procurement of equipment, materials, or supplies, other
than procurement related to a public works contract, declare under penalty of perjury that
no apparel, garments or corresponding accessories, equipment, materials, or supplies
furnished to the state pursuant to the contract have been laundered or produced in whole
or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal
sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or
with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under
penal sanction, abusive forms of child labor or exploitation of children in sweatshop
labor. The contractor further declares under penalty of perjury that they adhere to the
Sweatfree Code of Conduct as set forth on the California Department of Industrial
Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108.
b. The contractor agrees to cooperate fully in providing reasonable access to the
contractor's records, documents, agents or employees, or premises if reasonably required
by authorized officials of the contracting agency, the Department of Industrial Relations,
or the Department of Justice to determine the contractor's compliance with the
requirements under paragraph(a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, Contractor certifies
that Contractor is in compliance with Public Contract Code section 10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, Contractor certifies that
Contractor is in compliance with Public Contract Code section 10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions
regarding current or former state employees. If Contractor has any questions on the
status of any person rendering services or involved with the Agreement, the awarding
agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
1). No officer or employee shall engage in any employment, activity or enterprise from
which the officer or employee receives compensation or has a financial interest and
which is sponsored or funded by any state agency,unless the employment, activity or
enterprise is required as a condition of regular state employment.
2). No officer or employee shall contract on his or her own behalf as an independent
contractor with any state agency to provide goods or services.
Former State Employees (Pub. Contract Code §10411):
1). For the two-year period from the date he or she left state employment, no former state
officer or employee may enter into a contract in which he or she engaged in any of the
negotiations, transactions, planning, arrangements or any part of the decision-making
process relevant to the contract while employed in any capacity by any state agency.
2). For the twelve-month period from the date he or she left state employment, no former
state officer or employee may enter into a contract with any state agency if he or she was
employed by that state agency in a policy-making position in the same general subject
area as the proposed contract within the 12-month period prior to his or her leaving state
service.
If Contractor violates any provisions of above paragraphs, such action by Contractor shall
render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not receive
payment other than payment of each meeting of the board or commission,payment for
preparatory time and payment for per diem. (Pub. Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the
provisions which require every employer to be insured against liability for Worker's
Compensation or to undertake self-insurance in accordance with the provisions, and
Contractor affirms to comply with such provisions before commencing the performance
of the work of this Agreement. (Labor Code Section 3700)
3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it
complies with the Americans with Disabilities Act(ADA) of 1990, which prohibits
discrimination on the basis of disability, as well as all applicable regulations and
guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
Contractor's name as listed on this Agreement. Upon receipt of legal documentation of
the name change the State will process the amendment. Payment of invoices presented
with a new name cannot be paid prior to approval of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the contracting
agencies will be verifying that the contractor is currently qualified to do business in
California in order to ensure that all obligations due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any
transaction for the purpose of financial or pecuniary gain or profit. Although there are
some statutory exceptions to taxation, rarely will a corporate contractor performing
within the state not be subject to the franchise tax.
c. Both domestic and foreign corporations (those incorporated outside of California) must
be in good standing in order to be qualified to do business in California. Agencies will
determine whether a corporation is in good standing by calling the Office of the Secretary
of State.
6. RESOLUTION: A county, city, district, or other local public body must provide the
State with a copy of a resolution, order, motion, or ordinance of the local governing body
which by law has authority to enter into an agreement, authorizing execution of the
agreement.
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor
shall not be: (1) in violation of any order or resolution not subject to review promulgated
by the State Air Resources Board or an air pollution control district; (2) subject to cease
and desist order not subject to review issued pursuant to Section 13301 of the Water
Code for violation of waste discharge requirements or discharge prohibitions; or(3)
finally determined to be in violation of provisions of federal law relating to air or water
pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
State of California--Health and Human Sendces Agency California Department of Public Health
Contracts and Purchasing Services Section
Darfur Contracting Act
Pursuant to Public Contract Code(PCC) sections 10475-10481, the Darfur Contracting Act's intent is to
preclude State agencies from contracting with scrutinized companies that do business in the African nation of
Sudan. A scrutinized company is a company doing specified types of business in Sudan as defined in PCC
section 10476. Scrutinized companies are ineligible to, and cannot, contract with a State agency for goods or
services (PCC section 10477(a)) unless obtaining permission from the Department of General Services
according to the criteria set forth in PCC section 10477(b).
Therefore, to be eligible to contract with the California Department of Public Health, please initial one of the
following three paragraphs and complete the certification below:
1. NM We do not currently have, or we have not had within the previous
Initials three years, business activities or other operations outside of the United States.
OR
2. We are a scrutinized company as defined in Public Contract Code
Initials section 10476, but we have received written permission from the Department of General
Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section
10477(b) or submit a contract/purchase order. A copy of the written permission from
DGS is included with our bid, proposal or contract/purchase order.
OR
3. We currently have, or we have had within the previous three years,
Initials business activities or other operations outside of the United States,
but we certify below that we are not a scrutinized company
as defined in Public Contract Code section 10476.
CERTIFICATION
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this
company to the clause listed above. This certification is made under the laws of the State of California.
:'Company Name (Printed) Federal ID Number
County of Fresno 94-6000-512
i t
By(Authorized Signature)
i
Printed Name and Title of Person Signing
Ij Nathan Magsig, Chairman of the Board of Supervisors of the County of Fresno ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
Date Executed : Executed in the County and State of Count pf Fresno, tate of Califomia
Fresno, California By
Deputy
CDPH 9067(7/17)
STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES
CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT OFFICE OF LEGAL SERVICES
DGS OLS 04(Rev.01/17)
Pursuant to Public Contract Code section 2010, a person that submits a bid or proposal to, or
otherwise proposes to enter into or renew a contract with, a state agency with respect to any
contract in the amount of$100,000 or above shall certify, under penalty perjury, at the time the
bid or proposal is submitted or the contract is renewed, all of the following:
1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after January 1,
2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil
Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code);
and
2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after
January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples
recognized by the United States government, the Contractor certifies that such policies are not
used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair
Employment and Housing Act (Section 12960 of the Government Code).
CERTIFICATION
r------------------------------ ---r-----------------------1
I, the official named below, certify under-----penalty------of---per--j-ury---und---er I Federal ID Number
the laws of the State of California that the foregoing is true and
correct.
Proposer/Bidder Firm Name (Printed) ; 94-6000-512
County of Fresno
'---------------------------------------------------------L----------------------�
By(Authorized Signature)
F-------------------------------------------------------------------------------�
Printed Name and Title of Person Signing
Nathan Magsig, Chairman of the Board of Supervisors of the County of Fresno
Date Executed rExecuted in the County and State of -i
Fresno, California ATTEST:
L------- `�kckl'---0\ ------------i----------------------
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County f Fresno,State of California
By
Deputy
California Department of Public Health
Name/No.: HIV Surveillance Program Grant (State Grant Agreement No. 19-10415)
Fund/Subclass: 0001/10000
Organization #: 56201644
Revenue Account #: 3525