HomeMy WebLinkAboutAgreement A-13-562-1 Smart Model of Care.pdfCounty of Fresno, Department of Public Health
SMART Model of Care
1635964v1 / 16453.0001 1
First Amendment to
Program Services Agreement
FY 2015/2016
Parties
Commission: Children and Families Commission of Fresno County, California
Contractor: County of Fresno, Department of Public Health, 1221 Fulton Mall, 4th
Floor, Fresno, CA 93721
Administrative
Original Contract Number: 2014-0989
Amendment 1 Contract Number: 2014-0989
Recitals
A. Commission and Contractor are parties to that certain Program Services
Agreement (the "Agreement"), dated October 3, 2013, the Term of which is from July 1, 2013 to
June 30, 2015 (the "Original Term").
B. The Parties now desire to amend the Agreement to provide for an
extension of the Term and to modify the Services and Project Budget all as defined in the
Agreement.
C. All capitalized terms used in this First Amendment to Program Services
Agreement (this "First Amendment") shall have the meanings provided for in the Agreement
unless otherwise specified in this First Amendment.
Therefore, in consideration of the above recitals, which are incorporated into this
First Amendment by reference, the Parties agree as follows:
1. Term. This First Amendment is made effective as of July 1, 2015 (the
“Effective Date”). The Term of the Agreement is extended until June 30, 2016, unless
terminated earlier under the Agreement (the “Term”) or as specified in this Amendment to the
contrary.
2. Amendment to Section 2.1. Effective as of July 1, 2015, Exhibit A will be
replaced with the Exhibit A, “Scope of Work (2015-16 Fiscal Year)” attached to this First
Amendment and incorporated herein by this reference. As of July 1, 2015, except as needed to
interpret and enforce Contractor’s responsibilities and obligations under the original Term of the
Agreement, the original Exhibit A attached to the Agreement will have no further force and
effect.
3. Amendment to Section 4.1. Section 4.1 of the Agreement is deleted in its
entirety and replaced with the following:
County of Fresno, Department of Public Health
SMART Model of Care
1635964v1 / 16453.0001 2
4.1 Project Budget. Compensation for the Services provided from July 1, 2015 to
June 30, 2016 is based upon actual costs as described in Exhibit B.
Compensation for the Services will in no event exceed the total amount of six
hundred one thousand fifty-six, $601,056 (the “Contract Amount”). The Contract
Amount excludes Compensation for Services remaining under the Original Term
of the Agreement. Rather, Compensation for Services provided prior to July 1,
2015 shall be in accordance with the original Agreement and not this
Amendment.
4. Amendment to Section 4.2. The first sentence in Section 4.2 of the
Agreement is deleted in its entirely and replaced with the following (the remainder of Section 4.2
is unaffected):
Commission will reimburse Contractor for all necessary, reasonable, and
justifiable expenses, as determined by Commission, incurred in accordance with
the Project Budget for providing the Services on behalf of Commission in an
amount not to exceed the Contract Amount.
5. Controlling Document; No Other Amendment. In the event of any conflict
between the terms of this First Amendment and the Agreement, the terms of this First
Amendment shall control. Except as amended by this First Amendment, all terms of the
Agreement shall remain in full force and effect, including, without limitation, all monitoring,
evaluation, data collection, contract review, auditing, inspection, and record retention obligations
set forth in Article 9 of the Agreement.
6. Binding Effect. The Agreement, as amended by this First Amendment, is
binding upon, and inures to the benefit of, the respective heirs, executors, administrators,
successors, and assigns of the Parties.
7. Headings and Construction. The subject headings of the sections and
paragraphs of this Amendment are included for purposes of convenience only and do not affect
the construction or interpretation of any of its provisions. All words used in this Amendment
include the plural as well as the singular number, and vice versa; words used in this
Amendment in the present tense include the future as well as the present; and words used in
this Amendment in the masculine gender include the feminine and neuter genders, whenever
the context so requires. No provision of this Amendment will be interpreted for or against a
Party because that Party or its legal representative drafted the provision, and this Amendment
will be construed as if jointly prepared by the Parties.
8. Counterparts. This Amendment may be signed by the Parties in different
counterparts and the signature pages combined to create one document binding on all Parties.
9. Signature Authority. Each Party represents that it has capacity, full
power, and authority to enter into this Amendment and perform under modified terms of the
Agreement, and the person signing this Agreement on behalf of each Party has been properly
authorized and empowered to enter into this Amendment. Contractor must sign the signatory
authorization, attached as Exhibit C and incorporated into this Amendment. Contractor must
complete and forward to Commission a new signatory authorization each time any name, title,
or other information in the existing authorization is no longer current.
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1635964v1116453.0001
County of Fresno , Department of Public Health
SMART Model of Care
Signatures
APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY
COUNSEL
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
REVIEWED AND RECOMMEN ~ED FOR APPROVAL:
By @&rf:
David Pomaville , Director
Department of Public Health
Fund/Subcl ass:
Organiz ation:
Account#:
0001/1000
56201706
3530
County of Fresno, Department of Public Health
SMART Model of Care
1635964v1 / 16453.0001 A-1
EXHIBIT A
Scope of Work (2015-16 Fiscal Year)
R0715 (1&2)
Agency Name: County of Fresno, Department
of Public Health
Project Name: SMART Model of Care
Contract Number: 2014-0989
Project ID Number: 0989-14
GL: 10-8503-00
Agency Address: 1221 Fulton Mall Fresno, CA
93721
Start date/End date: 7/1/15-6/30/2016
Term from/to: 7/1/15-6/30/2016
Contract amount:
$601,056
FY 15-16: $601,056
Other Project Funding:
$323,644
54 %
BOS District: 3 Agency phone #: 559-600-3330
Mailing address if different than above: Agency fax #: 559-600-7729
Website: www.fcdph.org Focus area: Health Promotion
F5FC Contract Manager: Kristina Hernandez
F5FC Finance Manager: Erlan Zuniga
Program Contact
(Person who runs day to day operations/supervisor/coordinator/manager)
Name: Rose Mary Garrone Title: Division Manager, MCAH Director,
Director of Nurses
E-mail: rgarrone@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Prefix: Ms.
Finance Contact
(Person responsible for submitting budgets, financial reports and/or invoices)
Name: Michael Chu Title: Accountant
E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426
Fax #: 559-600-7692 Prefix: Mr.
Notice Contact
(Person who has legal authority to sign contract)
Name: Dave Pomaville Title: Director
E-mail: dpomaville@co.fresno.ca.us Phone #: 559-600-3200
Fax #: 559-600-7687 Prefix: Mr.
Public Contact
(Person responsible for general public calls requesting program information, how to access services, media, etc.)
Name: Rose Mary Garrone Title: Division Manager, MCAH Director,
Director of Nurses
E-mail: rgarrone@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Prefix: Ms.
Program Services Face Sheet & Scope of Work
This document will be completed with First 5 Fresno County (F5FC) staff
and Service Provider during a development meeting.
A. Face Sheet
Program Services Face Sheet & Scope of Work
County of Fresno, SMART Model of Care, #2014-0989
R0715 (1&2) Page 2 of 5
Agency Service Locations:
List all physical addresses where F5FC services take place. If more than three sites, please include in
this document by adding another row. Refer to the Fresno County website to find the correct County
District for each service location.
Persimmony Contact (s) Financial Module – FINANCIAL DATA ENTRY
(Person responsible for entering financial information)
Name: Michael Chu Title: Accountant
E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426
Fax #: 559-600-7692 Training: Access and No Training Required
Prefix: Mr.
Persimmony Contact (s) Financial Module – FINANCIAL APPROVAL
(Person responsible for approving financial information)
Name: Rose Mary Garrone Title: Division Manager, MCAH Director,
Director of Nurses
E-mail: rgarrone@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Training: Access and No Training Required
Prefix: Ms.
Persimmony Monitoring Module – ANNUAL CONTRACT REVIEW (ACR) ACCESS
(Person responsible for responding to administrative and programmatic components of ACR)
Name: Rose Mary Garrone Title: Division Manager, MCAH Director,
Director of Nurses
E-mail: rgarrone@co.fresno.ca.us Phone #: 559-600-3330
Fax #: 559-600-7729 Prefix: Ms.
Location(s) District(s)
Location 1: 1221 Fulton Mall, Brix Building-4th Floor, Fresno, CA
93721
District 3
Program Services Face Sheet & Scope of Work
County of Fresno, SMART Model of Care, #2014-0989
R0715 (1&2) Page 3 of 5
Project Description:
Briefly address what F5FC is funding and why. If applicable, describe the goals/outcomes.
This will be placed on the F5FC website.
The Fresno County Public Health Department will pass-through funding under this contract to assist
Exceptional Parents Unlimited (EPU) in continuing operations of the Assessment Center for Children
under the SMART Model of Care Program. This contract does not have any services attached based on
this integrated system of health and behavioral health, which ensures access to appropriate early
intervention services for children, birth through 5 years, in Fresno County. The three over-arching
strategies of community based identification, center based assessment, and accessible treatment
services, are led by five core functions: screening, decision-making, assessment, referral, and treatment.
Primary Strategy per F5FC Strategic Plan:
State Reporting Result Area & Service Area:
Refer to the Annual Report & School Readiness Appendices Fiscal Year
F5FC Strategy Percent of
Funding
Dollar Amount
HDX3 Developmental Screenings and Assessments
100 $601,056
State Result
Area/Outcome State Service Area
Percent of
Clients
(%)
Percent of
Funding
(%)
Improved Child Health Quality Health Systems Improvement 0 100
Program Services Face Sheet & Scope of Work
County of Fresno, SMART Model of Care, #2014-0989
R0715 (1&2) Page 4 of 5
Service Provider Staff Confidentiality Agreement & Request for Persimmony User Logon
All staff members of F5FC funded programs and projects (Service Providers) who are responsible for gathering or
maintaining confidential information and records must adhere to this agreement.
Responsibilities
During the performance of Service Provider assigned duties related to the F5FC project, Service Provider might
have access to confidential client information and records required for effective coordination and delivery of
services to children and their families. All confidential discussions, deliberations, records, and information
generated or maintained in connection with these activities shall be disclosed only to persons who have the need to
know and authority to access confidential consumer information or records. This includes information obtained and
conveyed through all media including the Persimmony database. Service Provider must not disclose any
confidential client information to any third party without the written authorization from the client or legally
authorized representative.
Legal Liabilities
Service Provider must adhere to the following:
• Notice: All applicable employees, agents, and subcontractors shall be notified of state requirements for
confidentiality and also notified that any person knowingly or intentionally violating the provisions of the state
law is guilty of a misdemeanor.
• Records pertaining to any individual recipient of F5FC will be confidential and will not be open to examination
for any purpose not directly connected with the administration of local evaluation.
• No person will publish, disclose, use, or permit the use of, or cause to be published, disclosed or used, any
confidential information pertaining to any individual recipient of F5FC services.
Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality
Agreement
This notice accompanies a disclosure of confidential information concerning a consumer of services funded by the
F5FC. The above referenced agency is prohibited from making any further disclosure of this confidential
information unless further disclosure is expressly permitted by the written authorization to release the information of
the person to whom it pertains or as otherwise permitted by these regulations. A general authorization for the
release of confidential information is NOT sufficient for this purpose.
Acknowledgement of Confidentiality and Prohibition of Re-Disclosing Confidential Client
Information Employment Confidentiality Agreement
The Agency acknowledges responsibility not to divulge any confidential information or records concerning clients of
F5FC funded services without proper written authorization. By signing the Program Services Agreement, the
Agency accepts confidentiality and prohibition of re-disclosing confidential funding requirements.
County of Fresno, Department of Public Health
SMART Model of Care
1635964v1 / 16453.0001 B-1
EXHIBIT B
Project Budget (2015-16 Fiscal Year)
1
2
3
4
5
6
7
8
9
Year 3 Revised Budget
Year 3
10 7/1/15-6/30/16 7/1/15-6/30/16
11
12
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17
18 0 0 0
19 0 0 0
20 0 0 0
21 0 0 0
22 0 0 0
23
24 0 0 0
25 0 0 0
26 546,415 0 546,415
27 0 0 0
28 54,641 0 54,641
29
30 601,056 0 601,056
31
32
33 A.Leveraged 323,644
34 B.Other Funding Source:0
35 C.Other Funding Source:0
36 323,644
Title:
Prepared by:
Date of Submission:
Revised Budget:
2014-0989
04/21/15
Xyavath Appy
Staff Analyst
Total Program
Amount
Total Other Funding
IV. Professional Services
V. Equipment
VI. Indirect Costs
VII. Other Funding
I. Personnel
A. Salaries
B. Benefits
C. Taxes
Total Personnel
II. Operating Expenses
A. Facilities Costs
B. Operational/Supplies
Total Program
C. Training/Travel
D. Misc. Charges
Total Operating Expenses
III. Program Expenses
A. Materials and Supplies
Total Program Expenses
FIRST 5 FRESNO COUNTY
Category
Agency Name:
Project Name:
Contract Term:
Contract Number:
Direct Service Budget
7/1/18-6/30/16
PHN Passthough to EPU SMART Model of Care
County of Fresno Department of Public Health
No Yes
Children Families Commission of Fresno County
Service Provider Budget
5/16/2015 2 of 2
1 Agency Name:Contract Term:
2 Project Name:Contract Number:3
4
5
6
7 Title FTE Amount Title FTE Amount Title FTE Amount
8 - - -
9
10
11
12
13
14
15 - - - - - -
16 B. Benefits 0%
17 C. Taxes 0%
18
19
Justification of Benefits and
Taxes:
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
43
44
45
46
48
49
50 Program Totals
51
52
53 A. Program Total @ %10.00%
54
55 Total Proposed Budget
Narrative/Justification –
601,056 323,644 -
The actual County indirect cost rate is 14.676%, however, indirect costs were calculated at the allowable rate of 10% of program costs.
VI. Indirect (= Program Totals - Equipment x Percentage of Indirect)
Instructional Information In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined.
54,641 29,422 -
Narrative/Justification – Narrative/Justification – Narrative/Justification –
546,415 294,222 -
Instructional Information In the Narrative/Justification box delineate and explain these costs and how they will support/benefit the program. Also, include the calculations where applicable.
Equipment will be allowed on a case by case basis by the First 5 Contract Manager and Finance Staff. Please give name of employee receiving equipment and cost.
Subtotal - - -
Narrative/Justification –
V. Equipment (Tangible assets that do not exceed $5,000 per unit or aggregation of same units)
Pass-through funds to EPU for the Assessment Center for Children. Includes funds for personnel, operating expenses, professional services, and
insurance/audit costs. Please see Assessment Center for Children Model of Care budget for justification of costs.
IV. Professional Services (Contracts, MOU's, Sub agreements, etc.)
Instructional Information In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or
staff (include calculations where applicable). Any services exceeding $5,000 must have attached a narrative delineating services.
Subtotal 546,415 294,222 -
Narrative/Justification – Provide the number of participants, cost per item, a description of the item, and justification for all expenses that support the clients of the program.
Narrative/Justification for Materials and Supplies Narrative/Justification for Materials and Supplies Narrative/Justification for Materials and Supplies
Subtotal - - -
III. Program Expenses
Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program
participants (include calculations where applicable).
A. Materials and Supplies - - -
Operating Expenses Subtotal - - -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation
D. Misc Charges - - -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (name of local conferences & trainings) for these costs and provide the calculation
C. Training/Travel - - -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (materials, services, leases) for these costs and provide the calculation
B. Operational/Supplies - - -
Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation
A. Facilities Costs - - -
II. Operating Expenses
Personnel Subtotal - - -
- - -
- - -
I. Personnel
The "Amount" should be: Annual
Salary X the FTE whenever
possible
A. Total Salaries & FTE
First 5 Amounts Leveraged Select Other Funding Source:
Fiscal Period 1 (7/1/15-6/30/16)Fiscal Period 1 (7/1/15-6/30/16)
County of Fresno Department of Public Health 7/1/18-6/30/16
PHN Passthough to EPU SMART Model of Care 2014-0989
A B C D
Fiscal Period 1 (Insert Date Range)
County of Fresno, Department of Public Health
SMART Model of Care
1635964v1 / 16453.0001 C-1
EXHIBIT C
Signature Authorization
County of Fresno, Department of Public Health
SMART Model of Care
Children and Families Commission of Fresno County
Exhibit C-Signatory Authorization
1 CERTIFY THAT Deborah A. Poochigian, Chairman, Board of Supervisors
(name & title)
IS AUTHORIZED TO SIGN FOR, AND BY VIRTUE OF HIS/HER SIGNATURE, BIND
County of Fresno
Signature of Governing Body Official &
Date Signed:
Typed Name:
Title:
Signature of Official Authorized Above &
Date Signed:
Typed Name:
Title:
Chairman, Board of Supervisors
Chairman, Board of Supervisors
Note: Should circumstances require a change in the above, a new signatory authorization
must be com leted and forwarded to Commission.
1635964v1/16453.0001 C-1
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
By~k~~
eputy