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Home My WebLink AboutAgreement A-13-561-1 Nurse Liaison.pdfCounty of Fresno, Department of Public Health Nurse Liaison 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: 2014-0950 Amendment 1 Contract Number: 2014-0950 Recitals A. Commission and Contractor are parties to that certain Program Services Agreement (the "Agreement"), dated October 7, 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 Nurse Liaison 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 four hundred fourteen thousand nine hundred seventy-six, $414,976 (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. /// 163596 4V1 / 1645 3.0 001 County of Fresno, Department of Public Health Nurse Liaison Signatures APPROVED AS TO LEGAL FORM: DANIEL C . CEDERBORG, COUNTY COUNSEL APPROVED AS TO ACCO UNTING FORM: V ICK I CROW, C.P.A., AUDITOR-CONTROLLER/ TREASURER-TAX COLLECTOR REVIEWED AND RECOMMENDED FOR APPROVAL: By D~~tt Department of Pub lic Hea lth Fund/Subclass : Organization : Account#: 0001/1000 56201615 3530 County of Fresno, Department of Public Health Nurse Liaison 1635964v1 / 16453.0001 A-1 EXHIBIT A Scope of Work (2015-16 Fiscal Year) County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 1 of 9 Agency Name: County of Fresno, Department of Public Health Project Name: Nurse Liaison Contract Number: 2014-0950 Project ID Number: 0950-14 GL: 10-8518-00 Agency Address: 1221 Fulton Mall, Fresno CA 93721 Start date/End date: 07/01/15-06/30/16 Term from/to: 07/01/15-06/30/16 Contract amount: $414,976 FY 14-15: N/A FY 15-16: $414,976 Other Project Funding: $521,771 126 % BOS District: 3 Agency phone #: 559-600-3330 Mailing address if different than above: P.O. Box 11867 Fresno, CA 93775 Agency fax #: 559-600-7729 Website: www.fcdph.org Focus area: Strong Families F5FC Contract Manager: Kristina Hernandez F5FC Finance Manager: Erlan Zuniga Program Contact (Person who runs day to day operations/supervisor/coordinator/manager) Name: Margaret Morris Title: Supervising Public Health Nurse E-mail: mamorris@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Prefix: Mrs. 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: Margaret Morris Title: Supervising Public Health Nurse E-mail: mamorris@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Prefix: Mrs. 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, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 2 of 9 Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY (Person responsible for entering client level and/or aggregate data and funded through this contract) Name: Pon Chin Title: Public Health Nurse II E-mail: chinp@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Training: Access and No Training Required Prefix: Ms. Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY (Person responsible for entering client level and/or aggregate data and funded through this contract) Name: Barbara Besmer Title: Public Health Nurse II E-mail: bbesmer@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Training: Access and No Training Required Prefix: Ms. Persimmony Contact (s) Program Module – PROGRAM DATA ENTRY (Person responsible for entering client level and/or aggregate data and funded through this contract) Name: Margaret Morris Title: Supervising Public Health Nurse E-mail: mamorris@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Training: Access and No Training Required Prefix: Mrs. 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: Margaret Morris Title: Supervising Public Health Nurse E-mail: mamorris@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Training: Access and No Training Required Prefix: Mrs. Persimmony Contact (s) Financial Module – FINANCIAL APPROVAL (Person responsible for approving financial information) Name: Aphivanh Xayavath Title: Staff Analyst E-mail: axayavath@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Training: Access and No Training Required Prefix: Ms. Program Services Face Sheet & Scope of Work County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 3 of 9 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. 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 primary goal of the Nurse Liaison program is to prevent child maltreatment by improving health outcomes for vulnerable children and decreasing potential re-hospitalization rates for at-risk infants. The Nurse Liaison program provides public health nurse liaison services to Community Regional Medical Center and Valley Children's Hospital to support infants from the Neonatal Intensive Care Unit and their families through the transition to community care as well as high risk infants and children under six years of age living in Fresno County who because of organic or environmental factors may be at risk for growth and developmental delays and who may face serious health problems. In addition, the program serves children with developmental or behavior challenges identified through their child care provider and pregnant or parenting teens referred from the CalLearn program. Nurse Liaisons provide assessment, consultation, technical assistance, referral and linkage to a variety of community programs via a home visitation venue. Persimmony Monitoring Module – ANNUAL CONTRACT REVIEW (ACR) ACCESS (Person responsible for responding to administrative and programmatic components of ACR) Name: Margaret Morris Title: Supervising Public Health Nurse E-mail: mamorris@co.fresno.ca.us Phone #: 559-600-3330 Fax #: 559-600-7729 Prefix: Ms. Persimmony Monitoring Module – ANNUAL CONTRACT REVIEW (ACR) ACCESS (Person responsible for responding to the financial component of ACR) Name: Michael Chu Title: Accountant E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426 Fax #: 559-600-7692 Prefix: Mr. Location(s) District(s) Location 1: 1221 Fulton Mall, Fresno CA 93721 District 3 Program Services Face Sheet & Scope of Work County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 4 of 9 Primary Strategy per F5FC Strategic Plan: State Reporting Result Area & Service Area: Refer to the Annual Report & School Readiness Appendices Fiscal Year Is this an evidence based or research based program? (Please check one) Evidence Based Research Based N/A F5FC Strategy Percent of Funding Dollar Amount SD1 Multi-disciplinary research-based Home Visit. 100 $414,976 State Result Area/Outcome State Service Area Percent of Clients (%) Percent of Funding (%) Improved Child Health Maternal and Child Health Care 25 20 Improved Child Health Comprehensive Screening and Assessements 75 10 Improved Child Health Primary Specialty Medical Services 75 70 Program Services Face Sheet & Scope of Work County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 5 of 9 Types of Clients Served and Projected Numbers: Please note that these fields reflect the client type options in Persimmony and not family relationships. Type of Client Total # of Clients FY1516 Child 0<3 125 Child 3-5 50 Parent 0 Prenatal 50 Other 0 TOTAL: 225 Types of Providers/Professionals Served and Projected Numbers Provider Category Total # of Clients in Project FY 1516 Internal Program Staff 5 TOTAL: 5 Projected Numbers Served in Each Geographic Region: Geographical Location of Clients to be Served Total # of Clients Percent Urban (%) Percent Rural (%) Countywide 230 90 10 B. Demographic and Geographic Client Served Details Program Services Face Sheet & Scope of Work County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 6 of 9 The information in the table below will remain the same for the full contract term (from one fiscal year to the next) unless otherwise specified or modified through a contract amendment request. Data due Quarterly. Not Applicable - If your program does not provide aggregate services, please check this box. Service Type F5FC Strategy F5FC Indicators Core Client Type Core Client Target # (Expected # of clients receiving service) Frequency Verification Method FY1415 Case management session- Parenting Teen1 SD1 Multi-disciplinary research-based Home Visit. Increase their protective factors (resiliency) Parent 50 Q1: 10 Q2: 15 Q3: 10 Q4: 15 3 sessions2 Service log Case management session3 SD1 Multi-disciplinary research-based Home Visit. Increase their protective factors (resiliency) Child 175 Q1: 43 Q2: 43 Q3: 43 Q4: 46 3 sessions4 Service log ASQ SDX5 Developmental Screenings and Assessments Children screened, referred, txed for dev. beha Child 85 Q1: 20 Q2: 21 Q3: 22 Q4: 22 Annually and as needed ASQ/ASQ:SE ASQ:SE SDX5 Developmental Screenings and Assessments Children screened, referred, txed for dev. beha Child 35 Q1: 8 Q2: 8 Q3: 9 Q4: 10 Annually and as needed ASQ/ASQ:SE Developmental referral SCX3 Connecting Families with Resources Parents who are know about able to access serv. Child 95 Q1: 22 Q2: 22 Q3: 25 Q4: 26 Annually and as needed Service log Other referral SCX3 Connecting Families with Resources Parents who are know about able to access serv. Child5 95 Q1: 22 Q2: 22 Q3: 25 Q4: 26 Annually and as needed Service log Reflective practice session SCX4 Prof. Dev. Opport. for Early Childhood Pract. Prof. who are adequately trained to meet needs Provider 5 Q1: 5 Q2: 5 Q3: 5 Q4: 5 Once a month6 Attendance Records/Sign-in sheets All services listed in section C are required to be entered in Persimmony on a monthly basis, refer to the Service Provider Manual for details. All clients served by F5FC funds must meet age and residency requirements. Service Provider is required to maintain back-up documentation. The information in the table below will remain the same for the full contract term (from one fiscal year to the next) unless otherwise specified or modified through a contract amendment request. C. Outputs: Services and Contacts D. Aggregate Services and Narrative Program Services Face Sheet & Scope of Work County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 7 of 9 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. Program Services Face Sheet & Scope of Work County of Fresno, Department of Public Health, Nurse Liaison, #2014-0950 0715(1&2) Page 9 of 9 1 Case Management – Parenting Teen: Case Management sessions include PHN visits at the client’s home or field visits as an alternative to the home (examples: school, restaurant, park, etc.). Case management will be provided primarily to pregnant and/or parenting teens. Referrals come from the CalLearn program. Case management sessions may also include a telephone call no less than 10 minutes in length for services such as follow-up with the referral source, consultation with medical providers, child care providers, social workers, parents, and representatives of agencies involved with the client’s follow-up services. These case management sessions will be recorded in the nursing documentation notes 2 Case Management (Parenting Teen) – Frequency: It is expected that there will be an average of three service contacts per client, however it may range from one to as many as needed for case management services based on each client’s needs and availability. 3 Case Management (Child): Case Management sessions include PHN visits at the client’s home, field or site visits. Field visits are defined as visits with the PHN at alternative sites such as a public park, library or a restaurant. Site visits are defined as visits with the PHN at child care homes or centers. Case management sessions may also include a telephone call no less than 10 minutes in length for services such as follow-up with the referral source, consultation with medical providers, child care providers, social workers, parents, and representatives of agencies involved with the client’s follow-up services. These case management sessions will be recorded in the nursing documentation notes. Primary referral sources are Valley Children’s Hospital and Community Regional Medical Center with additional referrals being received from CPS, medical clinics, private doctors, community members, etc. Referral sources also include child care centers, child care homes, preschools, CSN etc. 4 Case Management (Child) – Frequency: It is expected there will be an average of three service contacts per client, however it may range from one to as many as needed for case management services based on each client’s needs and availability. 5 Other Referral (Child): Though typically attached to parent clients, Nurse Liaison will attach other referrals to the child. These other referrals are to improve the environment and decrease stressors on the child. 6 Reflective Practice – Frequency: Staff will participate in a group Reflective Practice (RP) and one-on-one sessions with the SPHN. The average RFP service per staff member is once a month. The focus of these meetings will be to provide an opportunity to explore experiences, feelings and challenges encountered with clients or with the challenges of the role of home visiting itself. County of Fresno, Department of Public Health Nurse Liaison 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 13 197,520 0 197,520 14 134,683 0 134,683 15 15,110 0 15,110 16 347,313 0 347,313 17 18 4,796 0 4,796 19 9,319 0 9,319 20 5,823 0 5,823 21 0 0 0 22 19,938 0 19,938 23 24 4,000 0 4,000 25 4,000 0 4,000 26 6,000 0 6,000 27 0 0 0 28 37,725 0 37,725 29 30 414,976 0 414,976 31 32 33 A.Leveraged 521,771 34 B.Other Funding Source:0 35 C.Other Funding Source:0 36 521,771 03/20/15 Appy Xayavath 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 Title: Prepared by: Date of Submission: Revised Budget: FIRST 5 FRESNO COUNTY Category Agency Name: Project Name: Contract Term: Contract Number: Direct Service Budget 2014-0950 7/1/15-6/30/16 Nurse Liaison County of Fresno Department of Public Health No Yes Children Families Commission of Fresno County Service Provider Budget 7/30/2015 1 of 1 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 Supervising Public Health Nurse 0.32 33,584 Supervising Public Health Nurse 0.57 59,563 - 9 Public Health Nurse I 0.55 31,508 Public Health Nurse I 0.45 25,780 10 Public Health Nurse II 0.45 37,470 Public Health Nurse II 0.55 46,173 11 Public Health Nurse II 0.42 30,367 Public Health Nurse II 0.58 41,348 12 Public Health Nurse II 0.32 26,709 Public Health Nurse II 0.68 56,934 13 Public Health Nurse I 0.30 17,329 Public Health Nurse I 0.25 14,179 14 Office Assistant III 0.59 20,553 Office Assistant III 0.41 14,334 15 2.95 197,520 3.49 258,311 - - 16 B. Benefits 68.187% 17 C. Taxes 7.650% 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 County of Fresno Department of Public Health 7/1/15-6/30/16 Nurse Liaison 2014-0950 A B C D Fiscal Period 1 (Insert Date Range) 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 (07/01/15-06/30/16)Fiscal Period 1 (07/01/15-06/30/16) Personnel Subtotal 347,313 454,206 - 134,683 176,134 - 15,110 19,761 - A. Facilities Costs 4,796 5,565 - II. Operating Expenses Salaries and benefits reflect rates for FY 2015-16. Estimated benefits rates reflect Unemployment Insurance (.00122), Retirement (.4901- .6245), OASDI (.0765), Health Insurance ($6945 per FTE per year) and Benefits Administration ($144 per FTE per year). B. Operational/Supplies 9,319 7,809 - 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 Address: Fresno County Department of Public Health, 1221 Fulton Mall, 4th floor, Fresno, CA 93721. Costs cover the facilities, charges are determined by square footage allocation to the program. The details are: telephone/communication ($1,161), facility services rent which includes household & building maintenance services ($4,244), utilities ($3,802), and security/alarm ($1,154). These are all ISF (internal service funds) charges. General Services Administration provides the base amount for the department. Linkages staff use 950 sq ft. C. Training/Travel 5,823 6,757 - 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 General office supplies such as paper, pencils, envelopes, and filing supplies ($6,040), postage ($500), printing ($8,000), and medical supplies such as stethescopes, baby scales, etc. ($2,588) for the nurses to conduct assessments. 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 Local meetings, conferences, and training ($2,000). Private auto mileage reimbursement at a rate of $0.575 per mile ($2,000). County vehicle garage/maintenance/usage costs ($8,580), based on estimated Internal Service Fund allocation. ISF estimated allocation adjusted slightly for anticipated use. First 5 is billed actuals. Operating Expenses Subtotal 19,938 20,131 - 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 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 4,000 - - 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 Subtotal 4,000 - - Forms, pamphlets, developmental and educational materials needed to evaluate, educate and foster physical/mental/social growth in Nurse Liaison clients. 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 6,000 - - 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 $5,000 per unit or aggregation of same units) Estimated costs for interpreters/translators who provide services for various languages through a Countywide contract. VI. Indirect (= Program Totals - Equipment x Percentage of Indirect) Instructional Information In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined. 37,725 47,434 - Narrative/Justification – Narrative/Justification – Narrative/Justification – 377,251 474,337 - Narrative/Justification – 414,976 521,771 - The actual County indirect cost rate is 14.676%, however, indirect costs were calculated at the allowable rate of 10% of program costs. County of Fresno, Department of Public Health Nurse Liaison 1635964v1 / 16453.0001 C-1 EXHIBIT C Signature Authorization County of Fresno, Department of Public Health Nurse Liaison Children and Families Commission of Fresno County Exhibit C-Signatory Authorization 1 CERTIFY THAT Deborah A. Poochigian, Chairman, Board of Supervisors (name & title) IS AUTHORIZED TO SIGN FOR, AND BY VIRTUE OF HIS/HER SIGNATURE, BIND Countv of Fresno Signature of Governing Body Official & ~a.~ 'if/J.1/J5" Date Signed: Typed Name: Deborah A. Poochigian (: - Title: Chairman, Board of Supervisors Signature of Official Authorized Above & ~Q Rw~ ~/l7/J) Date Signed: # Typed Name: Deborah A. Poochigian () ..., Title: Chairman, Board of Supervisors Note: Should circumstances require a change in the above, a new signatory authorization must be completed and forwarded to Commission. 1635964v1/16453.0001 C-1 ATTEST: BERNICE E. SEIDEL, Clerk Boa~ervi~ors. By~$-L;tt D ty