HomeMy WebLinkAboutAgreement A-23-539 with FCSS.pdf Agreement No. 23-539
1 SERVICE AGREEMENT
2 This Service Agreement ("Agreement") is dated October 10, 2023 and is between
3 Fresno County Superintendent of Schools, a California Educational Organization, whose
4 address is 1111 Van Ness Avenue, Fresno, California, 93721, (hereinafter "CONTRACTOR"),
5 and the County of Fresno, a political subdivision of the State of California ("County").
6 Recitals
7 A. The County, through its Department of Public Health (Department), is in need of a
8 contractor to implement evidence-based nutrition and physical activity (PA) direct education into
9 before and after school program settings, to increase access to nutritious foods and daily quality
10 PA opportunities; implement policy system and environmental (PSE) change policies in food
11 waste prevention strategies and school wellness policies; provide training and technical
12 assistance in Before and After School program settings, in Parlier, Sanger, Kings Canyon
13 (Reedley and Orange Cove), and Kerman Unified School Districts, under the Department's
14 Nutrition Education and Obesity Prevention (NEOP) CalFresh Healthy Living grant program.
15 B. The Contractor is qualified and willing to provide services as identified in Exhibit A to this
16 Agreement, titled "Scope of Services."
17 C. The County and Contractor are in mutual agreement to the conditions and covenants
18 outlined in this Agreement.
19 The parties therefore agree as follows:
20 Article 1
21 Contractor's Services
22 1.1 Scope of Services. The Contractor shall perform all of the services provided in
23 Exhibit A to this Agreement, titled "Scope of Services."
24 1.2 Representation. The Contractor represents that it is qualified, ready, willing, and
25 able to perform all of the services provided in this Agreement.
26 1.3 Compliance with Laws. The Contractor shall, at its own cost, comply with all
27 applicable federal, state, and local laws and regulations in the performance of its obligations
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1
1 under this Agreement, including but not limited to workers compensation, labor, and
2 confidentiality laws and regulations.
3 Article 2
4 Compensation, Invoices, and Payments
5 2.1 The County agrees to pay, and the Contractor agrees to receive, compensation for
6 the performance of its services under this Agreement as described in Exhibit B to this
7 Agreement, titled "Compensation."
8 2.2 Maximum Compensation. The maximum monetary compensation payable under the
9 Agreement shall not exceed One Million Nine Hundred Ninety-One Thousand Seven Hundred
10 Fifty and 00/100 Dollars ($1,991,750.00), for the full five-year term. The maximum
11 compensation payable to the Contractor under this Agreement is Three Hundred Ninety-Eight
12 Thousand Three Hundred Fifty and 00/100 Dollars ($398,350.00) for the period of October 10,
13 2023 through September 30, 2024. Three Hundred Ninety-Eight Thousand Three Hundred Fifty
14 and 00/100 Dollars ($398,350.00)for the period of October 1, 2024 through September 30,
15 2025. Three Hundred Ninety-Eight Thousand Three Hundred Fifty and 00/100 Dollars
16 ($398,350.00) for the period of October 1, 2025 through September 30, 2026. If the Agreement
17 is extended as described in Section 3.2, the maximum compensation payable to the Contractor
18 under this Agreement is Three Hundred Ninety-Eight Thousand Three Hundred Fifty and 00/100
19 Dollars ($398,350.00)for the period of October 1, 2026 through September 30, 2027. If the
20 Agreement is extended as described in Section 3.2, the maximum compensation payable to the
21 Contractor under this Agreement is Three Hundred Ninety-Eight Thousand Three Hundred Fifty
22 and 00/100 Dollars ($398,350.00)for the period of October 1, 2027 through September 30,
23 2028. The Contractor acknowledges that the County is a local government entity and does so
24 with notice that the County's powers are limited by the California Constitution and by State law,
25 and with notice that the Contractor may receive compensation under this Agreement only for
26 services performed according to the terms of this Agreement and while this Agreement is in
27 effect, and subject to the maximum amount payable under this section. The Contractor further
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2
1 acknowledges that County employees have no authority to pay the Contractor except as
2 expressly provided in this Agreement.
3 ///
4 2.3 Invoices. The Contractor shall submit monthly invoices and timesheets to the
5 County of Fresno, Department of Public Health, HPW-CalFresh Healthy Living Program,
6 Attention: HPW-CalFresh Healthy Living Program Staff Analyst at
7 DPHBOAP@fresnocountyca.gov or addressed to the County of Fresno, Department of Public
8 Health, HPW-CalFresh Healthy Living Program, P.O. Box 11867, Fresno, CA 93775, Attention:
9 HPW-CalFresh Healthy Living Program Staff Analyst. The Contractor shall submit each invoice
10 by the 15t" day of each month in which the Contractor performs services for the prior month's
11 expenditures and in any case within 30 days after the end of the term or termination of this
12 Agreement. Invoices shall detail line items as specified in Exhibit B, including original budget
13 amount(s), current month's expenses, year to date expenses, and budget balances. Invoices
14 shall include relevant supporting documentation including but not limited to general ledgers,
15 copies of original statements, program expense records, payroll records, and mileage claims.
16 2.4 Payment. The County shall pay each correctly completed and timely submitted
17 invoice within 45 days after receipt.
18 2.5 Incidental Expenses. The Contractor is solely responsible for all of its costs and
19 expenses that are not specified as payable by the County under this Agreement.
20 Article 3
21 Term of Agreement
22 3.1 Term. This Agreement is effective upon execution, and terminates on September 30,
23 2026, except as provided in section 3.2, "Extension," or Article 5, "Termination and Suspension,"
24 below.
25 3.2 Extension. The term of this Agreement may be extended for no more than two, one-
26 year periods only upon written approval of both parties no later than the last day of the current
27 term. The Director or his or her designee is authorized to sign the written approval on behalf of
28 the County based on the Contractor's satisfactory performance. The extension of this
3
1 Agreement by the County is not a waiver or compromise of any default or breach of this
2 Agreement by the Contractor existing at the time of the extension whether known to the County.
3 Article 4
4 Notices
5 4.1 Contact Information. The persons and their addresses having authority to give and
6 receive notices provided for or permitted under this Agreement include the following:
7
For the County:
8 Director, Department of Public Health
County of Fresno
9 P.O. Box 11867
Fresno, CA 93775
10
For the Contractor:
11 Fresno County Superintendent of Schools
1100 Van Ness Avenue
12 Fresno, CA 93721
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4.2 Change of Contact Information. Either party may change the information in section
14
4.1 by giving notice as provided in section 4.3.
15
4.3 Method of Delivery. Each notice between the County and the Contractor provided
16
for or permitted under this Agreement must be in writing, state that it is a notice provided under
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this Agreement, and be delivered either by personal service, by first-class United States mail, by
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an overnight commercial courier service, by telephonic facsimile transmission, or by Portable
19
Document Format (PDF) document attached to an email.
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(A) A notice delivered by personal service is effective upon service to the recipient.
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(B) A notice delivered by first-class United States mail is effective three County
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business days after deposit in the United States mail, postage prepaid, addressed to the
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recipient.
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(C)A notice delivered by an overnight commercial courier service is effective one
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County business day after deposit with the overnight commercial courier service,
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delivery fees prepaid, with delivery instructions given for next day delivery, addressed to
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the recipient.
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1 4.4 Claims Presentation. For all claims arising from or related to this Agreement,
2 nothing in this Agreement establishes, waives, or modifies any claims presentation
3 requirements or procedures provided by law, including the Government Claims Act (Division 3.6
4 of Title 1 of the Government Code, beginning with section 810).
5 Article 5
6 Termination and Suspension
7 5.1 Termination for Non-Allocation of Funds. The terms of this Agreement are
8 contingent on the approval of funds by the appropriating government agency. If sufficient funds
9 are not allocated, then the County, upon at least 30 days' advance written notice to the
10 Contractor, may:
11 (A) Modify the services provided by the Contractor under this Agreement; or
12 (B) Terminate this Agreement.
13 5.2 Termination for Breach.
14 (A) Upon determining that a breach (as defined in paragraph (C) below) has
15 occurred, the County may give written notice of the breach to the Contractor. The written notice
16 may suspend performance under this Agreement and must provide at least 30 days for the
17 Contractor to cure the breach.
18 (B) If the Contractor fails to cure the breach to the County's satisfaction within the
19 time stated in the written notice, the County may terminate this Agreement immediately.
20 (C) For purposes of this section, a breach occurs when, in the determination of the
21 County, the Contractor has:
22 (1) Obtained or used funds illegally or improperly;
23 (2) Failed to comply with any part of this Agreement;
24 (3) Submitted a substantially incorrect or incomplete report to the County; or
25 (4) Improperly performed any of its obligations under this Agreement.
26 5.3 Termination without Cause. In circumstances other than those set forth above, the
27 County may terminate this Agreement by giving at least 30 days advance written notice to the
28 Contractor.
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1 5.4 No Penalty or Further Obligation. Any termination of this Agreement by the County
2 under this Article 5 is without penalty to or further obligation of the County.
3 5.5 County's Rights upon Termination. Upon termination for breach under this Article
4 5, the County may demand repayment by the Contractor of any monies disbursed to the
5 Contractor under this Agreement that, in the County's sole judgment, were not expended in
6 compliance with this Agreement. The Contractor shall promptly refund all such monies upon
7 demand. This section survives the termination of this Agreement.
8 Article 6
9 Funding Source
10 6.1 Services Funding Source. Funding for these services is provided by United States
11 Department of Agriculture (USDA)-funded Supplemental Nutrition Assistance Program-
12 Education (SNAP-Ed). Guidance via the State of California, Health and Human Services
13 Agency, California Department of Public Health, Nutrition Education and Obesity Prevention
14 Branch grant agreement number 23-10314.
15 Article 7
16 Confidentiality
17 7.1 Confidentiality. All services performed by the Contractor under this Agreement
18 shall be in strict conformance with all applicable Federal, State of California and/or local laws
19 and regulations relating to confidentiality.
20 Article 8
21 Independent Contractor
22 8.1 Status. In performing under this Agreement, the Contractor, including its officers,
23 agents, employees, and volunteers, is at all times acting and performing as an independent
24 contractor, in an independent capacity, and not as an officer, agent, servant, employee, joint
25 venturer, partner, or associate of the County.
26 8.2 Verifying Performance. The County has no right to control, supervise, or direct the
27 manner or method of the Contractor's performance under this Agreement, but the County may
28 verify that the Contractor is performing according to the terms of this Agreement.
6
1 8.3 Benefits. Because of its status as an independent contractor, the Contractor has no
2 right to employment rights or benefits available to County employees. The Contractor is solely
3 responsible for providing to its own employees all employee benefits required by law. The
4 Contractor shall save the County harmless from all matters relating to the payment of
5 Contractor's employees, including compliance with Social Security withholding and all related
6 regulations.
7 8.4 Services to Others. The parties acknowledge that, during the term of this
8 Agreement, the Contractor may provide services to others unrelated to the County.
9 Article 9
10 Indemnity and Defense
11 9.1 Indemnity. The Contractor shall indemnify and hold harmless and defend the
12 County (including its officers, agents, employees, and volunteers) against all claims, demands,
13 injuries, damages, costs, expenses (including attorney fees and costs), fines, penalties, and
14 liabilities of any kind to the County, the Contractor, or any third party that arise from or relate to
15 the performance or failure to perform by the Contractor (or any of its officers, agents,
16 subcontractors, or employees) under this Agreement. The County may conduct or participate in
17 its own defense without affecting the Contractor's obligation to indemnify and hold harmless or
18 defend the County.
19 9.2 Survival. This Article 9 survives the termination of this Agreement.
20 Article 10
21 Insurance
22 10.1 The Contractor shall comply with all the insurance requirements in Exhibit C to this
23 Agreement.
24 Article 11
25 Inspections, Audits, and Public Records
26 11.1 Inspection of Documents. The Contractor shall make available to the County, and
27 the County may examine at any time during business hours and as often as the County deems
28 necessary, all of the Contractor's records and data with respect to the matters covered by this
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1 Agreement, excluding attorney-client privileged communications. The Contractor shall, upon
2 request by the County, permit the County to audit and inspect all of such records and data to
3 ensure the Contractor's compliance with the terms of this Agreement.
4 11.2 State Audit Requirements. If the compensation to be paid by the County under this
5 Agreement exceeds $10,000, the Contractor is subject to the examination and audit of the
6 California State Auditor, as provided in Government Code section 8546.7, for a period of three
7 years after final payment under this Agreement. This section survives the termination of this
8 Agreement. Additional Federal audit requirements may apply if any portion of the compensation
9 to be paid by the County under this Agreement is also provided by Federal funding.
10 11.3 Public Records. The County is not limited in any manner with respect to its public
11 disclosure of this Agreement or any record or data that the Contractor may provide to the
12 County. The County's public disclosure of this Agreement or any record or data that the
13 Contractor may provide to the County may include but is not limited to the following:
14 (A) The County may voluntarily, or upon request by any member of the public or
15 governmental agency, disclose this Agreement to the public or such governmental
16 agency.
17 (B) The County may voluntarily, or upon request by any member of the public or
18 governmental agency, disclose to the public or such governmental agency any record or
19 data that the Contractor may provide to the County, unless such disclosure is prohibited
20 by court order.
21 (C)This Agreement, and any record or data that the Contractor may provide to the
22 County, is subject to public disclosure under the Ralph M. Brown Act (California
23 Government Code, Title 5, Division 2, Part 1, Chapter 9, beginning with section 54950).
24 (D)This Agreement, and any record or data that the Contractor may provide to the
25 County, is subject to public disclosure as a public record under the California Public
26 Records Act (California Government Code, Title 1, Division 7, Chapter 3.5, beginning
27 with section 6250) ("CPRA").
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1 (E) This Agreement, and any record or data that the Contractor may provide to the
2 County, is subject to public disclosure as information concerning the conduct of the
3 people's business of the State of California under California Constitution, Article 1,
4 section 3, subdivision (b).
5 (F) Any marking of confidentiality or restricted access upon or otherwise made with
6 respect to any record or data that the Contractor may provide to the County shall be
7 disregarded and have no effect on the County's right or duty to disclose to the public or
8 governmental agency any such record or data.
9 11.4 Public Records Act Requests. If the County receives a written or oral request
10 under the CPRA to publicly disclose any record that is in the Contractor's possession or control,
11 and which the County has a right, under any provision of this Agreement or applicable law, to
12 possess or control, then the County may demand, in writing, that the Contractor deliver to the
13 County, for purposes of public disclosure, the requested records that may be in the possession
14 or control of the Contractor. Within five business days after the County's demand, the
15 Contractor shall (a) deliver to the County all of the requested records that are in the Contractor's
16 possession or control, together with a written statement that the Contractor, after conducting a
17 diligent search, has produced all requested records that are in the Contractor's possession or
18 control, or (b) provide to the County a written statement that the Contractor, after conducting a
19 diligent search, does not possess or control any of the requested records. The Contractor shall
20 cooperate with the County with respect to any County demand for such records. If the
21 Contractor wishes to assert that any specific record or data is exempt from disclosure under the
22 CPRA or other applicable law, it must deliver the record or data to the County and assert the
23 exemption by citation to specific legal authority within the written statement that it provides to
24 the County under this section. The Contractor's assertion of any exemption from disclosure is
25 not binding on the County, but the County will give at least 10 days' advance written notice to
26 the Contractor before disclosing any record subject to the Contractor's assertion of exemption
27 from disclosure. The Contractor shall indemnify the County for any court-ordered award of costs
28 or attorney's fees under the CPRA that results from the Contractor's delay, claim of exemption,
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1 failure to produce any such records, or failure to cooperate with the County with respect to any
2 County demand for any such records.
3 Article 12
4 Disclosure of Self-Dealing Transactions
5 12.1 Applicability. This Article 12 applies if the Contractor is operating as a corporation
6 or changes its status to operate as a corporation.
7 12.2 Duty to Disclose. If any member of the Contractor's board of directors is party to a
8 self-dealing transaction, he or she shall disclose the transaction by completing and signing a
9 "Self-Dealing Transaction Disclosure Form" (Exhibit D to this Agreement) and submitting it to
10 the County before commencing the transaction or immediately after.
11 12.3 Definition. "Self-dealing transaction" means a transaction to which the Contractor is
12 a party and in which one or more of its directors, as an individual, has a material financial
13 interest.
14 Article 13
15 General Terms
16 13.1 Modification. Except as provided in Article 5, "Termination and Suspension," this
17 Agreement may not be modified, and no waiver is effective, except by written agreement signed
18 by both parties. Notwithstanding the above, changes to object levels in the budget, attached
19 hereto as Exhibit B, that do not exceed ten percent (10%) of the maximum compensation
20 payable to the Contractor, may be made with the written approval of the County's Department of
21 Public Health Director, or designee. Said budget object level changes shall not result in any
22 change to the maximum compensation amount payable to Contractor, nor shall it reduce the
23 delivery of services originally provided for under this Agreement, as stated herein. The
24 Contractor acknowledges that County employees have no authority to modify this Agreement
25 except as expressly provided in this Agreement.
26 13.2 Non-Assignment. Neither party may assign its rights or delegate its obligations
27 under this Agreement without the prior written consent of the other party.
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1 13.3 Governing Law. The laws of the State of California govern all matters arising from
2 or related to this Agreement.
3 13.4 Jurisdiction and Venue. This Agreement is signed and performed in Fresno County,
4 California. Contractor consents to California jurisdiction for actions arising from or related to this
5 Agreement, and, subject to the Government Claims Act, all such actions must be brought and
6 maintained in Fresno County.
7 13.5 Construction. The final form of this Agreement is the result of the parties' combined
8 efforts. If anything in this Agreement is found by a court of competent jurisdiction to be
9 ambiguous, that ambiguity shall not be resolved by construing the terms of this Agreement
10 against either party.
11 13.6 Days. Unless otherwise specified, "days" means calendar days.
12 13.7 Headings. The headings and section titles in this Agreement are for convenience
13 only and are not part of this Agreement.
14 13.8 Severability. If anything in this Agreement is found by a court of competent
15 jurisdiction to be unlawful or otherwise unenforceable, the balance of this Agreement remains in
16 effect, and the parties shall make best efforts to replace the unlawful or unenforceable part of
17 this Agreement with lawful and enforceable terms intended to accomplish the parties' original
18 intent.
19 13.9 Nondiscrimination. During the performance of this Agreement, the Contractor shall
20 not unlawfully discriminate against any employee or applicant for employment, or recipient of
21 services, because of race, religious creed, color, national origin, ancestry, physical disability,
22 mental disability, medical condition, genetic information, marital status, sex, gender, gender
23 identity, gender expression, age, sexual orientation, military status or veteran status pursuant to
24 all applicable State of California and federal statutes and regulation.
25 13.10 No Waiver. Payment, waiver, or discharge by the County of any liability or obligation
26 of the Contractor under this Agreement on any one or more occasions is not a waiver of
27 performance of any continuing or other obligation of the Contractor and does not prohibit
28 enforcement by the County of any obligation on any other occasion.
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1 13.11 Entire Agreement. This Agreement, including its exhibits, is the entire agreement
2 between the Contractor and the County with respect to the subject matter of this Agreement,
3 and it supersedes all previous negotiations, proposals, commitments, writings, advertisements,
4 publications, and understandings of any nature unless those things are expressly included in
5 this Agreement. If there is any inconsistency between the terms of this Agreement without its
6 exhibits and the terms of the exhibits, then the inconsistency will be resolved by giving
7 precedence first to the terms of this Agreement without its exhibits, and then to the terms of the
8 exhibits.
9 13.12 No Third-Party Beneficiaries. This Agreement does not and is not intended to
10 create any rights or obligations for any person or entity except for the parties.
11 13.13 Authorized Signature. The Contractor represents and warrants to the County that:
12 (A) The Contractor is duly authorized and empowered to sign and perform its
13 obligations under this Agreement.
14 (B) The individual signing this Agreement on behalf of the Contractor is duly
15 authorized to do so and his or her signature on this Agreement legally binds the
16 Contractor to the terms of this Agreement.
17 13.14 Electronic Signatures. The parties agree that this Agreement may be executed by
18 electronic signature as provided in this section.
19 (A) An "electronic signature" means any symbol or process intended by an individual
20 signing this Agreement to represent their signature, including but not limited to (1) a
21 digital signature; (2) a faxed version of an original handwritten signature; or (3) an
22 electronically scanned and transmitted (for example by PDF document) version of an
23 original handwritten signature.
24 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed
25 equivalent to a valid original handwritten signature of the person signing this Agreement
26 for all purposes, including but not limited to evidentiary proof in any administrative or
27 judicial proceeding, and (2) has the same force and effect as the valid original
28 handwritten signature of that person.
12
1 (C)The provisions of this section satisfy the requirements of Civil Code section
2 1633.5, subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3,
3 Part 2, Title 2.5, beginning with section 1633.1).
4 (D) Each party using a digital signature represents that it has undertaken and
5 satisfied the requirements of Government Code section 16.5, subdivision (a),
6 paragraphs (1) through (5), and agrees that each other party may rely upon that
7 representation.
8 (E) This Agreement is not conditioned upon the parties conducting the transactions
9 under it by electronic means and either party may sign this Agreement with an original
10 handwritten signature.
11 13.15 Counterparts. This Agreement may be signed in counterparts, each of which is an
12 original, and all of which together constitute this Agreement.
13 Article 14
14 Compliance with State Regulations
15 14.1 Compliance with State Requirements. CONTRACTOR recognizes that COUNTY
16 operates is CalFresh Healthy Living Program with the use of state funds, and that the use of these
17 funds imposes certain requirements on the COUNTY and its subcontractors. CONTRACTOR shall
18 adhere to all State requirements, including those identified in Exhibit E attached hereto and by this
19 reference incorporated herein and made part of this Agreement. It is understood that Exhibit E also
20 grants the COUNTY certain rights, which are reserved to the State; such rights are fully described
21 therein.
22 Article 15
23 Federal Funding Terms and Conditions
24 15.1 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
25 Exclusion-Lower Tier Covered Transactions.
26 (A) County and Contractor recognize that Contractor is a recipient of Federal funds
27 under the terms of this Agreement. By signing this Agreement, Contractor agrees to comply
28 with applicable Federal suspension and debarment regulations, including but not limited to: 7
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1 CFR 3016.35, 29 CFR 97.35, 45 CFR 92.35, and Executive Order 12549. By signing this
2 Agreement, Contractor attests to the best of its knowledge and belief, that it and its principals:
3 (1) Are not presently debarred, suspended, proposed for debarment, declared
4 ineligible, or voluntarily excluded by any Federal department or agency; and
5 (2) Shall not knowingly enter into any covered transaction with an entity or
6 person who is proposed for debarment under Federal regulations, debarred,
7 suspended, declared ineligible, or voluntarily excluded from participation in
8 such transaction.
9 (B) Contractor shall provide immediate written notice to County if at during any time
10 during the term of this Agreement Contractor learns that the representations it makes
11 above were erroneous when made or have become erroneous by reason of changed
12 circumstances.
13 (C) Contractor shall include a clause titled, "Certification Regarding Debarment,
14 Suspension, Ineligibility, and Voluntary Exclusion — Lower Tier Covered Transactions"
15 and similar in nature to this paragraph in all lower tier covered transactions and it all
16 solicitations for lower tier covered transactions.
17 (D) Contractor shall, prior to soliciting or purchasing goods and services in excess of
18 $25,000 funded by this Agreement, review and retain the proposed vendor's suspension
19 and debarment status at https://sam.gov/SAM/.
20 15.2 Property of County. Contractor agrees to take reasonable and prudent steps to
21 ensure the security of any and all said hardware and software provided to it by County under
22 this Agreement, to maintain replacement-value insurance coverages on said hardware and
23 software of like kind and quality approved by County.
24 All purchases over Five Thousand Dollars ($5,000) made during the life of this Agreement
25 that will outlive the life of this Agreement shall be identified as fixed assets with an assigned
26 Fresno County Department of Public Health (DPH) Accounting Inventory Number. These fixed
27 assets shall be retained by County, as County property, in the event this Agreement is
28 terminated or upon expiration of this Agreement. Contractor agrees to participate in an annual
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1 inventory of all County fixed assets and shall be physically present when fixed assets are
2 returned to County possession at the termination or expiration of this Agreement. Contractor is
3 responsible for returning to County all County owned fixed assets upon the expiration or
4 termination of this Agreement.
5 15.3 Prohibition on Publicity. None of the funds, materials, property or services
6 provided directly or indirectly under this Agreement shall be used for Contractor's advertising,
7 fundraising, or publicity (i.e., purchasing of tickets/tables, silent auction donations, etc.)for the
8 purpose of self-promotion. Notwithstanding the above, publicity of the services described in
9 Paragraph One (1) of this Agreement shall be allowed as necessary to raise public awareness
10 about the availability of such specific services when approved in advance by the County's DPH
11 Director or designee for such items as written/printed materials, the use of media (i.e., radio,
12 television, newspapers) and any other related expense(s).
13 15.4 Conflict of Interest. No officer, employee or agent of the County who exercises any
14 function or responsibility for planning and carrying out of the services provided under this
15 Agreement shall have any direct or indirect personal financial interest in this Agreement. In
16 addition, no employee of the County shall be employed by the Contractor under this Agreement
17 to fulfill any contractual obligations with the County. Contractor shall comply with all Federal,
18 State of California and local conflict of interest laws, statutes and regulations, which shall be
19 applicable to all parties and beneficiaries under this Agreement and any officer, employee or
20 agent of the County.
21 15.5 Change of Leadership/Management. In the event of any change in the status of
22 Contractor's leadership or management, Contractor shall provide written notice to County within
23 thirty (30) days from the date of change. Such notification shall include any new leader or
24 manager's name, address and qualifications. "Leadership or management" shall include any
25 employee, member, or owner of Contractor who either a) directs individuals providing services
26 pursuant to this Agreement, b) exercises control over the manner in which services are provided,
27 or c) has authority over Contractor's finances.
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1 15.6 Lobbying Activity. None of the funds provided under this Agreement shall be used
2 for publicity, lobbying or propaganda purposes designed to support or defeat legislation pending
3 in the Congress of the United States of America or the Legislature of the State of California.
4 15.7 State Energy Conservation. Contractor must comply with the mandatory standards
5 and policies relating to energy efficiency, which are contained in the State Energy Conservation
6 Plan issued in compliance with 42 United States (US) Code sections 6321, et. seq.
7 15.8 Clean Air and Water. In the event the funding under this Agreement exceeds One
8 Hundred Fifty Thousand and No/100 Dollars ($150,000), Contractor shall comply with all
9 applicable standards, orders or requirements issued under the Clean Air Act contained in 42
10 U.S. Code 7601 et seq; the Clean Water Act contained in U.S. Code 1368 et seq.; and any
11 standards, laws and regulations, promulgated thereunder. Under these laws and regulations,
12 CONTRACTOR shall assure:
13 (A) No facility shall be utilized in the performance of the Agreement that has been
14 listed on the Environmental Protection Agency (EPA) list of Violating Facilities;
15 (B) County shall be notified prior to execution of this Agreement of the receipt of any
16 communication from the Director, Office of Federal Activities, U.S. EPA indicating that a
17 facility to be utilized in the performance of this Agreement is under consideration to be
18 listed on the EPA list of Violating Facilities;
19 (C) County and U.S. EPA shall be notified about any known violation of the above
20 laws and regulations; and,
21 (D)This assurance shall be included in every nonexempt subgrant, contract, or
22 subcontract.
23 15.9 Audits and Inspections. The Contractor shall at any time during business hours,
24 and as often as the County may deem necessary, make available to the County for examination
25 all of its records and data with respect to the matters covered by this Agreement. The
26 Contractor shall, upon request by the County, permit the County to audit and inspect all of such
27 records and data necessary to ensure Contractor's compliance with the terms of this Agreement.
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1 If this Agreement exceeds ten thousand dollars ($10,000.00), Contractor shall be subject to
2 the examination and audit of the California State Auditor for a period of three (3) years after final
3 payment under contract (Government Code Section 8546.7).
4 In addition, Contractor shall cooperate and participate with County's fiscal review process
5 and comply with all final determinations rendered by the County's fiscal review process. If
6 County reaches an adverse decision regarding Contractor's services to consumers, it may result
7 in the disallowance of payment for services rendered; or in additional controls to the delivery of
8 services, or in the termination of this Agreement, at the discretion of County's DPH Director or
9 designee. If as a result of County's fiscal review process a disallowance is discovered due to
10 Contractor's deficiency, Contractor shall be financially liable for the amount previously paid by
11 County to Contractor and this disallowance will be adjusted from Contractor's future payments,
12 at the discretion of County's DPH Director or designee. In addition, County shall have the sole
13 discretion in the determination of fiscal review outcomes, decisions and actions.
14 15.10 Single Audit Clause.
15 (A) If Contractor expends Seven Hundred Fifty Thousand Dollars ($750,000) or more
16 Federal and Federal flow-through monies, Contractor agrees to conduct an annual audit
17 in accordance with the requirements of the Single Audit Standards as set forth in Office
18 of Management and Budget (OMB) Title 2 of the Code of Federal Regulations, Chapter
19 II, Part 200. Contractor shall submit said audit and management letter to County. The
20 audit must include a statement of findings or a statement that there were no findings. If
21 there were negative findings, Contractor must include a corrective action plan signed by
22 an authorized individual. Contractor agrees to take action to correct any material non-
23 compliance or weakness found as a result of such audit. Such audit shall be delivered
24 to County's DPH Administration for review within nine (9) months of the end of any fiscal
25 year in which funds were expended and/or received for the program. Failure to perform
26 the requisite audit functions as required by this Agreement may result in County
27 performing the necessary audit tasks, or at the County's option, contracting with a public
28
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1 accountant to perform said audit, or, may result in the inability of County to enter into
2 future agreements with the Contractor.
3 (B) A single audit report is not applicable if all Contractor's Federal contracts do not
4 exceed the Seven Hundred Fifty Thousand Dollars ($750,000) requirement or
5 Contractor's federal funding is through Drug Medi-Cal.
6 15.11 Compliance with Federal Requirements. The Contractor recognizes that County
7 operates its NEOP Program with the use of Federal funds, and that the use of these funds
8 imposes certain requirements on the County and its subcontractors. The Contractor shall
9 adhere to all Federal requirements, including those identified in Exhibit F attached hereto and
10 by this reference incorporated herein.
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2 The parties are signing this Agreement on the date stated in the introductory clause.
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FRESNO COUNTY SUPERINTENDENT OF COUNTY OF FRESNO
5 SCHOOLS
6 '-A ct"
7 Dr. Michele an ell-Copher, Superintendent of Sp avirteroVhairman of the Board of
Schools S4wvis the County of Fresno
8
Attest:
9 1100 Van Ness Avenue Bernice E. Seidel
Fresno, California 93721 Clerk of the Board of Supervisors
10 County of Fresno, State of Califomia
11
By: _
12 Deputy
13 For accounting use only:
14 Org No.: 56201662
Account No.: 7295
15 Fund No.: 0001
Subclass No.:10000
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19 /SMA
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SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
� . . �
• • � • •
• FCSS will recruit staff to achieve deliverables Fresno County Due 1-3 months after contract execution:
Recruitment and within contracted period to address the cultural, Superintendent . Onboard program staff.
Hiring of linguistic and literacy needs of the identified of Schools
Program Staff target population within each after school (FCSS) • List of staff recruited, indicate bilingual status.
program site and family-oriented outreach
events in Fresno County. • Submit staff lead contact list and provide updated
list as needed.
Partner • FCSS will meet regularly and work with FCDPH, FCSS Due Monthly:
Collaboration funded partners to enhance or support program Fresno County Meet at least monthly with FCDPH.
and Meetings related activities through collaborative efforts. Department of
Public Health
o FCSS lead and FCDPH lead. (FCDPH) Due Quarterly:
o CFHL leadership meeting (funded January 15, April 15, July 15, and September 15:
partners). • List of meetings, agenda, and FCSS attendees
o All funded agency, partners and staff quarterly with Quarterly Program tracking report.
meeting.
• Meet with other funded subcontracted agency
leads, including FCDPH.
• Meet at least twice a year for an all-funded
agency partner and staff meeting.
• Provide a list of specific target school district FCSS Due 1 month after contract execution, annually
Outreach Plan and school sites (complete address) within the thereafter:
targeted areas for after school program Submit a list of target schools' sites and districts
intervention. list with contact information and update the list as
needed.
• Sites will be verified on the Nutrition Education
and Obesity Prevention Branch (NEOPB) GIS
Mapping tool and add sites to our Fresno
County NEOPB approved Site List.
• Each school site or district must be approved in
the CFHL GIS Map tool prior to providing
services.
Page 1 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
• Provide staff with required onboarding required • FCSS Due Quarterly:
Trainings training, specific to CFHL needs including but 0FCDPH
not limited to PEARS, Food Smarts and Waste January 15, April 15, July 15, and September 15:
Reduction, Civil Rights, Trauma Resilience and Submit team updated training log with Quarterly
Nourishment, CalFresh Healthy Living Building Program tracking report.
Blocks for Success, Taste of Success Food
Tasting and Recipe Demonstrations, Due 1-2 months after contract execution & staff
Breakthrough Messaging in six Steps, and onboarding:
HIPAAtraining. • Staff set up user accounts with CDPH Sharing
Space and Communication Resource Library.
• Program staff to complete other appropriate
trainings identified by FCDPH. Required training • Staff set up user accounts with CFHL Statewide
includes: Training Platform hosted by Leah's Pantry.
o ServSafe
o Program Tools/Assessments Due 1-3 months after contract execution:
o Data Management System • FCSS program staff attend the FCDPH Health
o Health Equity Equity Training.
o CATCH and SPARK
o Other trainings as identified by FCDPH
or CFHL
• Submit monthly invoices with back-up • FCSS Due 30 days after the end of each month:
Monthly Invoices documentation for all expenditures. Monthly billing, back-up documentation for all
expenditures, and invoice.
• Include Invoice Summary Spreadsheets
• Enter program activity data into PEARS • FCSS Due Quarterly:
Program database. • FCDPH
Evaluation and • Program January 15, April 15, July 15, and September 15:
Reporting • Enter program activity, demographic data card Evaluator 9 PEARS Data Entry and reporting.
9•
System (PEARS) (visual accounting), adult surveys/pre and post
Data and (4+ class series), Single session data entry, and • Submit social media and website analytics report,
Reporting indirect activity. lifetime post total impressions, and summary with
the quarterly program tracking report.
• Enter partners (non-funded) information -
documenting Key Informant Surveys, meetings, Due Annually:
and meeting outcomes.
July 1:
Page 2 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
• Enter coalitions information - long term group of Input success story in PEARS and submit final draft
organizations or individuals working on adopting to FCDPH.
practices, supports or standards.
Keep on file:
• Enter policy systems, and environmental project • Data cards for adults served.
changes to document progress, assessments at
sites. • Visual Estimate Data Cards for Youth served.
• Mark PEARS entries complete quarterly, with • Meeting, training, or event sign-in sheets.
exception of PSE entries. Mark PEARS-PSE
entries complete in the 4t" quarter. . Participant and volunteer registration for special
events or trainings.
• Collaborate with FCDPH evaluator and FCDPH
staff(local reviewer) and State reviewers to edit . Program Indirect Activity.
or revise data within a designated timeframe
and add collaborators in any programmatic • Pre and Post tests.
entries in PEARS as needed.
• Success story.
• Develop and submit a success story on a policy,
system, or environmental change project in the • Press releases, photo release, consent forms,
afterschool setting. and photos.
• Enter social media analytics and website
analytics for Safe and Healthy Kids - CFHL,
FCSS website Safe and Healthy Kids social
media reporting analytics: Facebook, Instagram,
Snap Chat, YouTube.
• Conduct IOE pre and post surveys or tests (3+ • FCSS Due Annually:
Impact Outcome class series). • FCDPH-
Evaluation (IOE) • Program October 15:
Evaluator
• Conduct IOE with the 8-10 age group in at least • Nutrition Policy IOE Survey pretests.
4 school sites with at least 30 youths. Institute
Evaluation team June 15:
• Conduct IOE with the 11-13 age group in at • IOE Survey posttest and planning worksheet.
least 4 school sites with at least 30 youth.
• Other IOE required documentation.
Page 3 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
• A total of 300 youth (ages 14-17) at 9 sites will
participate in nutrition and physical activity
education, series and single session direct
education.
Include the following items in the Quarterly Tracking • FCSS Due Quarterly:
Report: 0FCDPH
Quarterly January 15, April 15, July 15, and September 15:
CalFresh Health • Updated numbers for deliverables and activities. • Submit Quarterly CalFresh Healthy Living
Living Tracking Program Tracking report.
Report • Current Year— District and school site Wellness,
nutrition, and Physical activity policy. • List of curriculum and resources used each FFY.
• Current list of curriculum and supplemental
resources used.
• Submit equipment log, theft sensitive purchase FCSS Due Biannual:
Biannual Reports log biannually.
April 1 Mid-Year Report
• NEOPB Semi-Annual Progress Report and work (October 1 - March 31):
with FCDPH staff to provide response to state • Submit annual employee certification forms,
on reporting requests. equipment, and theft sensitive logs.
• Semi-Annual Full time Employee Forms. • Submit biannual report.
October 1 Year End Report
(April 1 - September 30):
• Submit annual employee certification forms,
equipment, and theft sensitive logs.
• Submit biannual report.
• Key Informant Interview Surveys FCSS Due February 2024 after contract execution:
Other FCDPH Key Informant Surveys.
Assessments . WeIISAT 3.0 Program
and Surveys Evaluator Due February Year 1 and Year 3:
Page 4 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
• WeIISTAT 3.0 Assessments for each School
District.
• Conduct annual site assessment and evaluation FCSS Due Annually:
Site Level scores (SLAQ/LAC and respective action plan FCDPH
Assessment objectives). Program December 1:
Questionnaire Evaluator
Submit completed SLAQ.
(SLAQ), Site • Submit SLAQ's online, use links to complete an
Action Plans, and online SLAQ survey live or to submit responses March 1:
Local Health that have been pre-recorded on a printable form. Submit completed Site Action Plans.
Department
Activity Check • Submit Online LHD Activity Checklist (LAC), use August 1:
List (LAC) links to complete an online LHD Activity • Submit completed LAC.
Checklist survey live or to submit responses that
have been pre-recorded on a printable form.
� .
LEARN Before and After-School Programs in the following 7 Daily Quality • Physical Activity in Schools (Non-PE), Children
school districts in Fresno County: Physical aged 5-17.
Activity
• Access to
• Parlier Unified. Healthy Food • Site or Organizational Wellness Policy.
• Sanger Unified.
• Kings Canyon Unified (Reedley & Orange • Food Waste Prevention, Recovery, and
Cove). Redistribution.
• Kerman Unified.
ACTIVITY DESCRIPTIO RESPONSIBLE PARTY DELIVERABLEs, D•
1-DE. Provide approved evidence-based nutrition FOSS Document Monthly:
Direct Education and physical activity education to youth directly or
& Reach (DE) through train the trainer models in at least 20 school Due the 30th:
sites reaching 8,000 youth annually in Parlier, Direct Education (series and single sessions), sign
Sanger, Kings Canyon (Reedley and Orange Cove), in sheets, pictures, data cards, curriculum pre and
and Kerman Unified School Districts in Fresno posttests.
County.
Page 5 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
Due Quarterly:
2-DE. Compliment nutrition education with taste
testing of fruits and vegetables served & structured January 15, April 15, July 15, and September 15:
physical activity opportunities, gardens, and food PEARS Data Entry and reporting.
waste prevention.
Reach: Youth Age Group Documentation Yearly:
• 2,700 — 5 to 7 Site or District SLAQ Action Plan.
• 3,000 — 8 toll Number of events and outcomes to be included in
• 2,000 — 11 to 13 monthly progress report.
• 300 — 14 to17
Total Annual Reach: 8,000 Youth • Outcomes to be reported using the data
management system as appropriate (PEARS).
3-DE. Conduct IOE nutrition education with the 8-10
age group in at least 4 school sites with at least 30 • Eating and Activity Tool for Youths (EATS).
youths.
• CATCH Lesson Observation and evaluation tools.
4-DE. Conduct IOE nutrition education with the 11-
13 age group in at least 4 school sites with at least • Food Smart for Kids evaluation tools.
30 youth.
• Impact Outcome Evaluation Behavior Survey
5-DE. A total of 300 youth (ages 14-17) at 9 sites Tools, pre & post test results, report, and annual
will participate in nutrition and physical activity planning documents.
education, series and single session direct
education.
6-DE. Collaborate & align outreach and educational
activities with other FCDPH identified efforts such
as local Active Transportation events, Community
Parks and Physical Activity Programing, Food
Waste and Prevention Recovery and Distribution
efforts, Access to Healthy Foods, and Improving
Access and Utilization of Farmers Markets.
7-DE. Program staff will use culturally and
linguistically appropriate approved health education
materials during outreach and educational events.
Page 6 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
8-DE. Track the direct/indirect education, training,
and event outcomes in a designated tracking tool
and/or FCDPH identified data management system
(PEARS, Formative and Impact Outcome
Evaluation).
9-DE. Provide information and/or linkages during
these events on:
o COVID-19 related resources
o Oral health, tobacco, and other chronic
disease prevention & support
ACTIVITY DESCRIPTION RESPONSIBLE DELIVERABLEs, D.
PARTY
1-CE. Identify and engage at least 6 local site FCSS Due Quarterly:
Community leadership and staff within the participating school
Engagement (CE) districts annually. PEARS Reporting
January 15, April 15, July 15, and September 15:
2-CE. Identify and engage 10 afterschool . Local school district and school site wellness
coordinators annually in the afterschool programs in policies.
the participating school districts.
• Food Waste Prevention and Recovery resources
3-CE. Engage 25 teachers, parents and/or youth and best practices in a school setting.
champions within the participating school districts
annually. . Site Level Assessment Questionnaires (SLAQ) and
LHD Activity Checklist (LAC) scores and outcome
4-CE. Engage at least 10 afterschool program goals.
leads and staff within the participating school district
annually. • Food waste and recovery materials disseminated.
5-CE. Present assessment results and/or educate
on the benefits and impact of school wellness CFHL Program Tracking Report
policy, structured physical activity, and food waste January 15, April 15, July 15, September 15
prevention and recovery. Track identified and engaged leadership, school
district staff, afterschool program coordinators,
6-CE. Leverage relationships with influencers to teachers, parents, youth champions, and
generate support for new and existing interventions afterschool program leads identified and engaged.
among afterschool community members.
Page 7 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
7-CE. Assessment readiness, strengths and gaps, Keep on file:
physical environment, and infrastructure and . Agenda and sign-in sheets.
organizational capacity.
• SLAQ's and LAC's, Action Plans.
8-CE. Engage local influencers consistently
throughout planning, implementation, and . Key Informant Surveys.
maintenance of interventions.
• Other resources and feedback collected:
9-CE. Engage teachers, parents, and youth in o Physical activity, food waste prevention and
assessments and gather feedback related to recovery, school wellness policy
assessments and barriers. opportunities in afterschool programs.
10-CE. Gather parent and youth feedback of the
needs and desires of physical activity, food waste
prevention and recovery, school wellness policy
opportunities in afterschool programs.
ACTIVITY DESCRIPTION RESPONSIBLE
D.
PARTY DELIVERABLEs,
1-IEP. Promote, support, and reinforce messages FOSS Due Quarterly:
Indirect Education consistent with direct education and other activities
and Promotion within sites to include but not limited to physical PEARS Reporting
(IEP) activity, gardens, and food waste prevention and January 15, April 15, July 15, and September 15:
recovery, active transportation. Report indirect education disseminated,
newsletters, site-based events participated, flyers,
2-IEP. Communicate through various appropriate posters, and promotion of messages and other
channels such as newsletters, site-based events, activities such physical activity, gardens, and food
flyers, posters, website, and social media to engage waste prevention and recovery, active
students and parents to implement interventions in transportation.
after school programs.
CFHL Program Tracking Report
3-IEP. Promote and collaborate with local sites, January 15, April 15, July 15, September 15:
partners, and FCDPH staff for Rethink Your Drink . Report site-based event reach, website, and social
Day, Healthy Snack Day. media posts and reach to engage students and
parents to implement interventions in after school
4-IEP. Promote CFHL approved Healthy Snack programs.
Day Activities and Materials.
Keep on file:
Page 8 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
5-IEP. Promote CATCH; Just a minute Jam School . Visual estimates, reach, event flyers, materials
Program; Fuel up to play 60; Parents in Action! A disseminated' and sign-up sheets.
Guide to Engaging Parents in Local School
Wellness Policy— CA Project Lean. . Participant registration for special events.
6-IEP. Track Rethink Your Drink Day Activities, and
Materials; HOTM Family, and Community
Newsletters; Recipe Cards; Cookbooks,
disseminated materials.
7-IEP. Track and promote food waste prevention
education, Farmers Market Initiative resources and
recovery materials.
8-IEP. Reach 16,000 individuals annually within the
5 participating school districts.
ACTIVITY DESCRIPTION RESPONSIBLE DELIVERABLEs, D.
I PARTY
1-TTA. Provide training and technical assistance to FCss Due Quarterly:
Training and after-school key stakeholders such as after-school
Technical leads and staff, in afterschool program sites with the PEARS Reporting
Assistance (TTA) technical assistance and resources. January 15, April 15, July 15, and September 15:
• Report training and technical assistance to after-
2-TTA. Provide training and technical assistance to school key stakeholders such as after-school leads
each school site in support and advance new and/or and staff, in afterschool program sites.
improved physical activity, food waste prevention
and recovery, and school wellness policies. . Report training and technical assistance to each
school site in support and advance new and/or
3-TTA. Provide training and technical assistance to improved physical activity, food waste prevention
20 afterschool leads and staff of participating school and recovery, and school wellness policies, active
districts (4) annually (CATCH, SPARK, Active transportation demonstration, walk or ride to school
Transportation demonstrations, walk or ride to events, bike rodeo, and other Safe Routes to
school events, Bike Rodeo, Safe Routes to School School event planning or programs.
event planning and programs).
CFHL Program Tracking Report
January 15, April 15, July 15, September 15:
Page 9 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
• Report training and technical assistance to after-
school key stakeholders such as after-school leads
and staff, in afterschool program sites.
Keep on file:
• Training Agenda, materials disseminated, sign-up
sheets, participant registration and volunteers for
special events, photos, and photo consent forms.
• •Y: COLLABORATIO
DESCRIPTIONACTIVITY •• DocuMENTATION,
1-E. FCSS will work with the FCDPH and program FOSS Due Quarterly:
Evaluation (E) evaluator to implement evaluation metrics, 0FCDPH
benchmarks, and practices to evaluate the 0Program CFHL Program Tracking Report
effectiveness and impact of the program. These Evaluator January 15, April 15, July 15, September 15:
activities include: Report program collaboration and program
• Work with FCDPH Equity Officer in completing a progress and other evaluation needs as identified.
health equity assessment.
Due Once during the grant cycle:
• Collaborate with FCDPH Equity Officer in Health equity assessment, and health equity plan.
completing a health equity plan based on
assessment findings.
• Contribute to the effectiveness of the CFHL
program evaluation through collaboration and
feedback of program progress and other evaluation
needs as identified.
1-PCC. Attend at least 2 school district wellness policy FCSS Due Quarterly:
Partners, meetings and/or planning work groups annually. FCDPH
Coalitions and Program Tracking Report
Collaboration 2-PCC. Support and attend at least two local school January 15, April 15, July 15, and September 15:
(PCC) wellness policy meetings and planning work groups to Update the number of partnerships, meetings, and
assist with policy, structured physical activity, wellness policy supported.
development and implementation planning and youth
engagement. PEARS Reporting
January 15, April 15, July 15, and September 15:
Page 10 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
3-PCC. Assist and support at least 2 wellness policy . Document partnerships and coalitions in PEARS.
development of nutrition, physical activity, and equity . List of new and expanded partnerships to be
language, implementation and maintenance of school reported in the quarterly program report and
wellness policy, structured physical activity, and youth PEARS.
interventions. . Meetings, agendas & participants, or attendees to
be reported in the quarterly program report and
4-PCC. Contractor will work with FCDPH, funded and PEARS.
non-funded partners to enhance or support program
related activities through partnerships and
collaborative efforts.
5-PCC. Expanded and track partnerships.
6-PCC. Participate in FCHIP workgroups as
appropriate to communicate, cross-promote, facilitate
a coordinated approach to enhance the consistency of
nutrition messaging and integrate activities with
contractors and community partners to improve access
to healthy foods and physical activity.
7-PCC. Participate in the Fresno Food Policy Council
and food waste prevention partner meetings in target
communities.
1-MBC. Contractor will work with FCDPH to FCss Due Quarterly:
Media, collaborate on media and/or communication needs to • FCDPH
Branding, & assure it aligns with programmatic requirements. Program Tracking Report
Communication January 15, April 15, July 15, and September 15:
(MBC) 2-MBC. Materials used and/or developed will be . List and calendar of CFHL focused social media
culturally and linguistically appropriate health posts or videos and CFHL state and created
education materials that align with the target communication tools created to be included in the
population. program tracking report.
3-MBC. Any developed media, event flyers, direct . Advance email approval for purchase, design or
education flyer or indirect education promotional items creative for promotional items.
needs to be submitted at least a 4-week advance of
the event for local and state review and approval . Advance request and notice via email approval for
process. use of Fresno County Department of Public
Page 11 of 12
SCOPE OF SERVICES
FRESNO COUNTY SUPERINTENDENT OF SCHOOLS
BEFORE AND AFTER-SCHOOL PROGRAM EXHIBIT A
Health Logo, Healthy Fresno County Logo and
4-MBC. Use current approved CFHL Branding CFHL logo.
Guidelines, CalFresh Healthy Living Toolkit(s),
resources, and marketing materials for partners that
will assist with implementing the new brand guidance
locally.
5-MBC. Any promotional items and design or creative
supportive of nutrition education, physical activity, food
waste, farmers market initiatives, or other CFHL
initiatives are to be approved in advance and allowable
for purchase by CDSS, State and/or local CFHL
guideline.
6-MBC. FCSS will attend branding and customizing
material training and webinars for CalFresh Healthy
Living Statewide Training and Resources.
Page 12 of 12
CalFresh Healthy Living EXHIBIT B
Fresno County Superintendent of Schools
YEAR 1 BUDGET
(October 10, 2023- September 30, 2024)
PERSONNEL
Position Title and Name Annual Salary % FTE Benefit Rate Benefit Cost
Program Coordinator, Cyndi Dean $ 103,622 70% 28.57% $ 20,723
Project Specialist, Charles Clancy $ 74,834 100% 20% $ 14,967
Project Specialist, Jason Wara $ 73,701 100% 20% $ 14,740
Sub-Total $ 252,157 2.7 $ 50,430
Total Personnel $ 302,588
NON-CAPITAL SUPPLIES
Office Supplies $ 2,430 Notes: Total Budget is$398,350
Printing/Copying annually
Other, Storage Bins $ 1,206
Total Supplies $ 3,636
MATERIALS
Venue Event Materials $ 13,822
Food Prep Materials $ 16,750
PSE Afterschool Projects $ 8,000
Education Curriculum&Materials $ 6,000
Small Kitchen Appliances $ 7,500
Total Materials $ 52,072
Notes: Travel out of
TRAVEL town:
Per diem- per staff
CFHL Forum in Garden Grove, CA $ 1,488 $46.00
Mileage @ .655 per mile $ 648
Trainings Lodging per FTE-
Total Travel $ 2,136 CFHL Forum=$141 per,
night; Trainings=$110 per
Maintenance
IT Support-Computer/Phone system/Internet
maintenance of CFHL Staff
Total Maintenance $ -
Total Direct Costs $ 360,432
Administrative (Indirect) Costs at
10.52% $ 37,918
TOTAL BUDGET $ 398,350
1
Budget Narrative Year 1 Exhibit B
Fresno County of Superintendent Schools
CalFresh Healthy Living
Contractor Name: Fresno County Superintendent of Schools
Contractor Address: 1111 Van Ness Ave.,Fresno,CA 93721
Contractor Phone Number. (559)265-3000
Contractor Contact Person Dr.Michele Cantwell-Copher,Superintendent of Schools
Budget Term: 10/10/2023-9/30/2024
EXPENDITURES JUSTIFICATIONS
Personnel Amount FTE Justification
Requested
Program Coordinator C ndi Des$ 103,622.00 70% Manage staff,grant,and oversight of CFHL five communities.
Project Specialist,Charles Clanc$ 74.834.00 100% Responsible for program activities for Kerman,Mendota,&Sanger.
Pro ect Specialist,Jason Ware $ 73,701.00 100% Responsible for program activities in Parlier&Reedley.
Fringe benefits $ 50.431.00
TOTAL Personnel Expenses $ 302,588.00
11
Non-Capital Supplies Amount unit
Requested Cost CITY FTE Justification
Office Supplies $ 2,430.00 $9.72 250 1 Misc-paper,pens,ink,envelopes,folders,etc.
fLL!ing/Copying
$ 645.00 129 5 1 Additional bins for storing and transporting supplies-
Other,Storage Bins 8 Pack/10 gal stackable @$129.00 x 5=$645.00
$ 561.00 93.5 6 1 Additional bins for storing and transporting supplies-
Other,Storage Bins 4 Pack/27 gal stackable @$93.50 x 6=$561.00
AL Non-Capital Supplies Expenses $ 3,636.00
Materials Amount Unit
Requested Cost CITY
Justification
Venue Event Materials $ 1,822.00 $4 79 380 1)Pentathlon Adventure&Iron Chef Challenge,380
$ 6,000.00 4 1500 2)Rainbow Days 1,500 students x$4=$6,000.00
$ 6,000.00 4 1500 3)SPITS 1500 students x$4=$6,000.00
Food Prep Materials $ 3,000.00 4 750 ELF Taste Testing Demos:1)Events-750 students x$4=
$ 1,750.00 2.5 700 2)Events-700 students x$2.50=$1,750
$ 6,000.00 4 1500 3)Trainings-1,500 students/staff x$4=$6,000
$ 6,000.00 4 1500 4)Lessons:1,500 students/staff/parents x$4=
$6,000
PSE Afterschool Pro'ects $ 8,000.00 $4 2,000 Nutrition education and Physical Activity materials to
Educ Curriculum Materials $ 6,000.00 $750 8 Gardening,Food Pantry,Nutrition,Physical Activity,&
Small Kitchen Appliances $ 7,500.00 $375 20 Small Kitchen Cooking Kits to include:mixer,food
TOTAL Materials Expenses $ 52,072.00
Amount #of Trips Justification
Travel Requested Miles FTE
3 CFHL Forum Expenses for 3 FTE:Lodging @$141
per night x 3 days/2 nights x 3 FTE_$846,Parking @
$57 per night x 2 nights x 2 vehicles=$228,and Per
diem @$46 x 3 days x 3 FTE_$414.Total$1,488
CFHL Forum in Garden Grove,($ 1,488.00
495 2 CFHL Forum Travel Expenses to Anaheim @.655 per
Milea a .655 Der mile $ 648.00 1 mile x 495 miles x 2 vehicles=$648.
Trainin s $
TOTAL Travel $ 2.136.00
Amount
cost
Maintenance
Requested Momn on M hs FTE Justification
IT Support-Computer/Phone
system/Internet Maintenance of
CFHL Staff $
TOTAL Maintenance $
TOTAL DIRECT EXPENSES $ 360,432 00
TOTAL INDIRECT EXPENSES $ 37,918.00
at 10.52
TOTAL EXPENSES $ 398,350.00
2
CalFresh Healthy Living EXHIBIT B
Fresno County Superintendent of Schools
YEAR 2 BUDGET
(October 1, 2024 - September 30, 2025)
PERSONNEL
Position Title and Name Annual Salary % FTE Benefit Rate Benefit Cost
Program Consultant, Cyndi Dean $ 107,767 70% 28.57% $ 21,552
Project Specialist, Charles Clancy $ 77,828 100% 20% $ 15,566
Project Specialist, Jason Wara $ 76,658 100% 20% $ 15,332
$ - $ -
Sub-Total $ 262,253 2.7 $ 52,450
Total Personnel $ 314,703
NON-CAPITAL SUPPLIES
Office Supplies $ 2,021 Notes: Total Budget is $398,350
Printing/Copying annually
Total Supplies $ 2,021
MATERIALS
Venue Event Materials $ 13,822
Food Prep Materials $ 15,000
PSE Afterschool Projects $ 6,000
Educ Curriculum & Materials $ 3,000
Small Kitchen Appliances $ 3,750
Total Materials $ 41,572
TRAVEL
CFHL Forum in Garden Grove, CA 1 $ 1,488 Notes: Travel out of town:
Mileage @ .655 per mile $ 648 Per diem - per staff$46.00
Trainings
Lodging per FTE - CFHL Forum=$141
Total Travel $ 2,136 per night; Trainings=$110 per night
MAINTENANCE
Computer/Phone system/Internet maintenance of
CFHL Staff
Total Maintenance $ -
Total Direct Costs $ 360,432
Administrative (Indirect) Costs @ 10.52% $ 37,918
TOTAL BUDGET $ 398,350
3
Budget Narrative Year 2 Exhibit B
Fresno County Superintendent of Schools
CalFresh Healthy Living
Contractor Name: Fresno County Superintendent of Schools
Contractor Address: 1111 Van Ness Ave.,Fresno,CA 93721
Contractor Phone Number: (559)265-3000
Contractor Contact Person Dr.Michele Cantwell-Copher,Superintendent of Schools
Budget Term: 10/1/2024-9/30/2025
EXPENDITURES JUSTIFICATIONS
Personnel Amount FTE Justification
Requested
Program Consultant,Cyndi Dea 107767.00 70% Manage staff,grant,and oversight of CFHL five communities.
Project Specialist,Charles Clarr 77828.00 100% Responsible for program activities for Kerman,Mendota,&Sancier.
Project Specialist,Jason Ware 76658.00 100% Responsible for ro ram activities in Parlier&Reedle .
0.00
0.00
Fringe benefits 52449.52
TOTAL Personnel Expenses 314702.52
bL-
Non-Capital Supplies Amount Unit Cost QTY FTE Justification
Requested
2021.00 $15.91 127 1 Misc-paper,pens,ink,envelopes,folders,etc.
Office Su lies
Printing/Copying
0.00
TOTAL Non-Capital Supplies 2021.00
Materials Amount Unit Cost CITY Justification
Requested
Venue Event Materials 1822.00 4.79 380 1 Pentathlon Adventure&Iron Chef Challenge,380
6000.00 4 1500 2)Rainbow Days 1,500 students x$4=$6,000.00
6000.00 4 1500 3)SRTS 1500 students x$4=$6,000.00
Food Prep Materials 3000.00 $4 750 ELP Taste Testing Demos:1 Events-750 students x$4=
6000.00 $4 1,500 2)Trainings-1,500 students/staff x$4=$6,000
6000.00 $4 1,500 3)Lessons:1,500 students/staff/parents x$4=
$6,000
PSE Afterschool Projects 6000.00 $4 1,500 Nutrition education and Physical Activity materials to
Educ Curriculum Materials 3000.00 $750 1 4 Gardening,Food Pantry,Nutrition,Physical Activity,&
Small Kitchen Appliances 3750.00 $375 10 Small Kitchen Cooking Kits to include:mixer,food
TOTAL Materials Expenses 41572.00
Amount #of Trips FTE Justification
Travel Requested Miles
3 CFHL Forum Expenses for 3 FTE:Lodging @$141
per night x 3 days/2 nights x 3 FTE=$846,Parking
@$57 per night x 2 nights x 2 vehicles=$228,and
Per diem @$46 x 3 days x 3 FTE=$414.Total
$1,488
CFHL Forum in Garden Grove, 1488.00
495 2 CFHL Forum Travel Expenses to Anaheim @.655
per mile x 495 miles x 2 vehicles=$648.
Mileage .655 per mile 648.00
Trainin s 0.00
TOTAL Travel 2136.00
or
Amount Cost per Month FTE Justification
Maintenance Requested Month
IT Support-Computer/Phone
system/Internet Maintenance of
CFHL Staff 0.00
TOTAL Maintenance 0.00
TOTAL DIRECT EXPENSES 360431.52
TOTAL INDIRECT EXPENSES 37918.40
at 10.52%
TOTAL EXPENSES $398,350
4
CalFresh Healthy Living EXHIBIT B
Fresno County Superintendent of Schools
YEAR 3 BUDGET
(October 1, 2025 - September 30, 2026)
PERSONNEL
Position Title and Name Annual Salary % FTE Benefit Rate Benefit Cost
Program Coordinator, Cyndi Dean $ 112,078 70% 28.59% $ 22,430
Project Specialist, Charles Clancy $ 80,941 100% 20% $ 16,188
Project Specialist, Jason Wara $ 79,725 100% 20% $ 15,945
$ - $ -
Sub-Total $ 272,744 2.7 $ 54,563
Total Personnel $ 327,307
NON-CAPITAL SUPPLIES Notes: Total Budget is $398,350
Office Supplies $ 1,193 annually
Printing/Copying
Total Non-Capital Supplies $ 1,193
MATERIALS
Venue Event Materials $ 12,996
Food Prep Materials $ 10,550
PSE Afterschool Projects $ 3,200
Educ Curriculum & Materials $ 400
Small Kitchen Appliances $ 2,665
Total Materials $ 29,811 Notes: Travel out of town:
Per diem - per staff
TRAVEL $46.00
CFHL Forum in Garden Grove, CA $ 1,488
Mileage @ .655 per mile $ 648 Lodging per FTE - CFHL
Forum=$141 per night;
Trainings Trainings=$110 per night
Total Travel $ 2,136
IT SUPPORT
Computer/Phone system/Internet
maintenance of CFHL Staff
Total IT Support $ -
Total Direct Costs $ 360,447
Administrative (Indirect) Costs at
10.52% $ 37,903
TOTAL BUDGET $ 398,350
5
Budget Narrative Year 3 Exhibit B
Fresno County Superintendent of Schools
CalFresh Healthy Living
Contractor Name: Fresno County Superintendent of Schools
Contractor Address: 1111 Van Ness Ave.,Fresno,CA 93721
Contractor Phone Number: (559 265-3000
Contractor Contact Person Dr.Michele Cantwell-Copher,Superintendent of Schools
Budget Term: 10/1/2025-9/30/2026
EXPENDITURES JUSTIFICATIONS
Personnel Amount
FTE Justification
Requested
Program Coordinator,Cyndi Dear $ 112,078.00 70% Manage staff,grant,and oversight of CFHL five com
Project Specialist,Charles Clanc) $ 80,941.00 100% Responsible for program activities for Kerman,Mend
Project Specialist,Jason Wara $ 79,725.00 100% Responsible for program activities in Parlier&Reedle
Fringe benefits $ 54,563.37
TOTAL Personnel Expenses $ 327,307.37
Non-Capital Supplies Amount Unit
CITY FTE Justification
Requested Cost
Office Supplies $ 1,193.00 $9.62 124 1 Misc-paper,pens,ink,envelopes,folde
Printing/Copying
AL Non-Capital Supplies Expenses $ 1,193.00
Materials Amount Unit
CITY Justification
Requested Cost
Venue Event Materials $ 4,332.00 $4 1,083 1)Pentathlon Adventure&Iron Chef
$ 4,332.00 $4 1,083 2)Rainbow Days @ 1,083 x$4=
$4,332
$ 4,332.00 $4 1,083 3)SRTS @ 1,083 students x$4=
$4,332
Food Prep Materials $ 5,275.00 $3.99 1,322 ELP Taste Testing Demos:Trainings @ 1,322
$ 5,275.00 $3.99 1,322 Lessons @ 1,322
students/staff/parents x$3.99=$5,275
PSE Afterschool Projects $ 3,200.00 $4.00 800 Nutrition education and Physical Activity
Educ Curriculum Materials $ 400.00 1 $4 1 Gardening,Food Pantry,Nutrition,Physical
Small Kitchen Appliances 1 $ 2,665.00 1$266.50 1 10 ISmall Kitchen Cooking Kits to include:mixer,
TOTAL Materials Expenses $ 29,811.00
Amount #of Miles Trips FTE Justification
Travel Requested
3 CFHL Forum Expenses for 3 FTE:
Lodging @$141 per night x 3 days/2
nights x 3 FTE_$846,Parking @$57
per night x 2 nights x 2 vehicles=
$228,and Per diem @$46 x 3 days x 3
CFHL Forum in Garden Grove,C $ 1,488.00 FTE_$414.Total$1,488
495 2 CFHL Forum Travel Expenses to
Anaheim @.655 per mile x 495 miles x
Mileage .655 per mile $ 648.00 2 vehicles=$648.
Trainin s $ -
TOTAL Travel $ 2,136.00
Amount Cost per #of
Month FTE Justification
Month
Maintenance Requested s
IT Support-Computer/Phone
system/Internet Maintenance of
CFHL Staff $
TOTAL Maintenance $
TOTAL DIRECT EXPENSIES1 $ 360,447.37
TOTAL INDIRECT EXPENSES $ 37,903.06
at 10.52%
TOTAL EXPENSES $ 398,350
Page 6 of 10
CalFresh Healthy Living EXHIBIT B
Fresno County Superintendent of Schools
EXTENSION I
(October 1, 2026 - September 30, 2027)
PERSONNEL
Position Title and Name Annual Salary % FTE Benefit Rate Benefit Cost
Program Coordinator, Cyndi Dean $ 116,561 70% 28.58% $ 23,319
Project Specialist, Charles Clancy $ 84,178 100% 20% $ 16,836
Project Specialist, Jason Wara $ 82,914 100% 20% $ 16,583
$ - $ -
Sub-Total $ 283,653 2.7 $ 56,738
Total Personnel $ 340,391
NON-CAPITAL SUPPLIES Notes: Total Budget is $398,350
Office Supplies $ 1,200 annually
Printing/Copying
Total Non-Capital $ 1,200
MATERIALS
Venue Event Materials $ 6,513
Food Prep Materials $ 10,200
PSE Afterschool Projects
Educ Curriculum & Materials
Small Kitchen Appliances
Total Materialsl $ 16,713
TRAVEL Notes: Travel out of town:
CFHL Forum in Garden Grove, CA $ 1,488 Per diem - per staff$46.00
Mileage @ .655 per mile $ 648 Lodging per FTE - CFHL Forum=$141
Trainings per night; Trainings=$110 per night
Total Travel $ 2,136
IT SUPPORT
Computer/Phone system/Internet maintenance of
CFHL Staff
Total IT Support $ -
Total Direct Costs $ 360,440
Administrative (Indirect) Costs @ 10.52% $ 37,910
TOTAL BUDGET $ 398,350
7
Budget Narrative Year 4 Exhibit B
Fresno County Superintendent of Schools
CalFresh Healthy Living
Contractor Name: Fresno County Superintendent of Schools
Contractor Address: 1111 Van Ness Ave.,Fresno,CA 93721
Contractor Phone Number: (559)265-3000
Contractor Contact Person Dr.Michile Cantwell-Copher,Superintendent of Schools
Budget Term: 10/1/2026-9/30/2027
EXPENDITURES JUSTIFICATIONS
Personnel Amount
FTE Justification
Requested
Program Coordinator,Cyndi Dean $ 116,561.00 70% Manage staff,grant,and oversight of CFHL five communities.
Project Specialist,Charles Clancy $ 84,178.00 100% Responsible for program activities for Kerman,Mendota,&Sanger.
Project Specialist,Jason Wara $ 82,914.00 100% Responsible for program activities in Parlier&Reedley.
$
Fringe benefits $ 56,737.59
TOTAL Personnel Expenses $ 340,390.59
Non-Capital Supplies Amount Unit
QTY FTE Justification
Requested Cost
Office Supplies $ 1,200.00 $9.60 125 1 Misc-paper,pens,ink,envelopes,folders,etc.
Printing/Copying
TOTAL Non-Capital Supplies Expenses $ 1,200.00
Materials Amount Unit
OTY Justification
Requested Cost
Venue Event Materials $ 3,257.00 $4 814 1)Pentathlon Adventure&Iron Chef Challenge @ 814
$ 3,256.00 $4 814 2)SRTS @ 814 students x$4=$3,256
Food Prep Materials $ 5,100.00 4 1,275 ELP Taste Testing Demos:Events @ 1,275
$ 5,100.00 4 1,275 Lessons @ 1,275 students/staff/parents x$4=
$5,100
PSE Afterschool Projects $
Educ Curriculum Materials $
Small Kitchen Appliances $
TOTAL Materials Expenses $ 16,713.00
Amount #of Trips FTE Justification
Travel Requested Miles
3 CFHL Forum Expenses for 3 FTE:Lodging @$141
per night x 3 days/2 nights x 3 FTE=$846,Parking
@$57 per night x 2 nights x 2 vehicles=$228,and
Per diem @$46 x 3 days x 3 FTE=$414.Total
CFHL Forum in Garden Grove,CA $ 1,488.00 1 1$1,488
495 2 CFHL Forum Travel Expenses to Anaheim @.655
Mileage @.655 per mile $ 648.00 per mile x 495 miles x 2 vehicles=$648.
Trainings $ -
TOTAL Travel $ 2,136.00
Amount Cost
Maintenance Requested per
Months FTE Justification
Month
IT Support-Computer/Phone
system/Internet Maintenance of CFHL
Staff $
TOTAL Maintenance $ -
TOTAL DIRECT EXPENSES $ 360,439.59
TOTAL INDIRECT EXPENSES at $ 37,910.25
10.52%
TOTAL EXPENSES $ 398,350
8
CalFresh Healthy Living EXHIBIT B
Fresno County Superintendent of Schools
EXTENSION II
(October 1, 2027 - September 30, 2028)
PERSONNEL
Position Title and Name Annual Salary % FTE Benefit Rate Benefit Cost
Program Coordinator, Cyndi Dean $ 121,223 70% 28.57% $ 24,243
Project Specialist, Charles Clancy $ 87,545 100% 20% $ 17,509
Project Specialist, Jason Wara $ 86,230 100% 20% $ 17,246
$ - $ -
Sub-Total $ 294,998 2.7 $ 58,998
Total Personnel $ 353,996
NON-CAPITAL SUPPLIES Notes: Total Budget is $398,350
Office Supplies annually
Printing/Copying
Total Non-Capital $ -
MATERIALS
Venue Event Materials $ 1,100
Food Prep Materials $ 3,199
PSE Afterschool Projects
Educ Curriculum & Materials
Small Kitchen Appliances
Total Materialsi $ 4,299
Notes: Travel out of town:
TRAVEL Per diem - per staff$46.00
CFHL Forum in Garden Grove, CA $ 1,488
Mileage @ .655 per mile $ 648 Lodging per FTE - CFHL Forum=$141
Trainings per night; Trainings=$110 per night
Total Travel $ 2,136
IT SUPPORT
Computer/Phone system/Internet maintenance of
CFHL Staff
Total IT Support $ -
Total Direct Costs $ 360,431
Administrative (Indirect) Costs @ 10.52% $ 37,918
TOTAL BUDGET $ 398,350
9
Budget Narrative Year 5 Exhibit B
Fresno County Superintendent of Schools
CalFresh Healthy Living
Contractor Name: Fresno County Superintendent of Schools
Contractor Address: 1111 Van Ness Ave.,Fresno,CA 93721
Contractor Phone Number: (559)265-3000
Contractor Contact Person Dr.Michele Cantwell-Copher,Superintendent of Schools
Budget Term: 10/1/2027-9/30/2028
EXPENDITURES JUSTIFICATIONS
Personnel Amount
FTE Justification
Requested
Program Coordinator,Cyndi Dean $ 121,223.00 70% Manage staff,grant,and oversight of CFHL five c
Project Specialist,Charles Clancy $ 87,545.00 100% Responsible for program activities for Kerman,Me
Project Specialist,Jason Wara $ 86,230.00 100% Responsible for program activities in Parlier&Ree
Fringe benefits $ 58,998.39
TOTAL Personnel Expenses $ 353,996.39
Non-Capital Supplies Amount Unit
CITY FTE Justification
Requested Cost
Office Supplies
Printing/Copying
TOTAL Non-Capital Supplies Expenses $
Materials Amount Unit
CITY Justification
Requested Cost
Venue Event Materials $ 1,100.00 $4 275 Pentathlon Adventure&Iron Chef
Food Prep Materials $ 3,199.00 $3.92 816 ELP Taste Testing Demos:Events @ 816
PSE Afterschool Projects $ -
Educ Curriculum Materials $
Small Kitchen Appliances $ -
TOTAL Materials Expenses $ 4,299.00
Amount #of Trips FTE Justification
Travel Requested Miles
3 CFHL Forum Expenses for 3 FTE:
Lodging @$141 per night x 3
days/2 nights x 3 FTE=$846,
Parking @$57 per night x 2 nights
x 2 vehicles=$228,and Per diem
@$46 x 3 days x 3 FTE=$414.
CFHL Forum in Garden Grove,CA $ 1,488.00 Total$1,488
495 2 CFHL Forum Travel Expenses to
Anaheim @.655 per mile x 495
Mileage @.655 per mile $ 648.00 miles x 2 vehicles=$648.
Trainings $ -
TOTAL Travel $ 2,136.00
Amount Cost per #of FTE Justification
Maintenance Requested Month Months
IT Support-Computer/Phone
system/Internet Maintenance of CFHL
Staff $ -
TOTAL Maintenance $ -
TOTAL DIRECT EXPENSES $ 360,431.39
TOTAL INDIRECT EXPENSES at $ 37,918.38
10.52%
TOTAL EXPENSES $ 398,350
10
Exhibit C
Insurance Requirements
1. Required Policies
Without limiting the County's right to obtain indemnification from the Contractor or any third
parties, Contractor, at its sole expense, shall maintain in full force and effect the following
insurance policies throughout the term of this Agreement or self-insurance equivalent thereof.
(A) Commercial General Liability. Commercial general liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence and an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
Coverage must include products, completed operations, property damage, bodily injury,
personal injury, and advertising injury. The Contractor shall obtain an endorsement to
this policy naming the County of Fresno, its officers, agents, employees, and volunteers,
individually and collectively, as additional insureds, but only insofar as the operations
under this Agreement are concerned. Such coverage for additional insureds will apply as
primary insurance and any other insurance, or self-insurance, maintained by the County
is excess only and not contributing with insurance provided under the Contractor's
policy.
(B) Automobile Liability. Automobile liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages.
Coverage must include any auto used in connection with this Agreement.
(C)Workers Compensation. Workers compensation insurance as required by the laws of
the State of California with statutory limits.
(D) Employer's Liability. Employer's liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence for bodily injury and for disease.
(E) Professional Liability. Professional liability insurance with limits of not less than One
Million Dollars ($1,000,000) per occurrence and an annual aggregate of Three Million
C-1
Exhibit C
Dollars ($3,000,000). If this is a claims-made policy, then (1) the retroactive date must
be prior to the date on which services began under this Agreement; (2) the Contractor
shall maintain the policy and provide to the County annual evidence of insurance for not
less than five years after completion of services under this Agreement; and (3) if the
policy is canceled or not renewed, and not replaced with another claims-made policy
with a retroactive date prior to the date on which services begin under this Agreement,
then the Contractor shall purchase extended reporting coverage on its claims-made
policy for a minimum of five years after completion of services under this Agreement.
(F) Molestation Liability. Sexual abuse / molestation liability insurance with limits of not
less than Two Million Dollars ($2,000,000) per occurrence, with an annual aggregate of
Four Million Dollars ($4,000,000). This policy must be issued on a per occurrence basis.
2. Additional Requirements
(A) Verification of Coverage. Within 30 days after the Contractor signs this Agreement,
and at any time during the term of this Agreement as requested by the County's Risk
Manager or the County Administrative Office, the Contractor shall deliver, or cause its
broker or producer to deliver, to the County of Fresno, Department of Public Health, P.O.
Box 11867, Fresno, CA 93775, Attention: Contracts Section —61" Floor, or email,
DPHContracts@fresnocountyca.gov, certificates of insurance and endorsements for all
of the coverages required under this Agreement.
(i) Each insurance certificate must state that: (1) the insurance coverage has been
obtained and is in full force; (2) the County, its officers, agents, employees, and
volunteers are not responsible for any premiums on the policy; and (3) the
Contractor has waived its right to recover from the County, its officers, agents,
employees, and volunteers any amounts paid under any insurance policy
C-2
Exhibit C
required by this Agreement and that waiver does not invalidate the insurance
policy.
(ii) The commercial general liability insurance certificate must also state, and include
an endorsement, that the County of Fresno, its officers, agents, employees, and
volunteers, individually and collectively, are additional insureds insofar as the
operations under this Agreement are concerned. The commercial general liability
insurance certificate must also state that the coverage shall apply as primary
insurance and any other insurance, or self-insurance, maintained by the County
shall be excess only and not contributing with insurance provided under the
Contractor's policy.
(iii) The automobile liability insurance certificate must state that the policy covers any
auto used in connection with this Agreement.
(B) Acceptability of Insurers. All insurance policies required under this Agreement must be
issued by admitted insurers licensed to do business in the State of California and
possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no
less than A: VII.
(C) Notice of Cancellation or Change. For each insurance policy required under this
Agreement, the Contractor shall provide to the County, or ensure that the policy requires
the insurer to provide to the County, written notice of any cancellation or change in the
policy as required in this paragraph. For cancellation of the policy for nonpayment of
premium, the Contractor shall, or shall cause the insurer to, provide written notice to the
County not less than 10 days in advance of cancellation. For cancellation of the policy
for any other reason, and for any other change to the policy, the Contractor shall, or shall
cause the insurer to, provide written notice to the County not less than 30 days in
advance of cancellation or change. The County in its sole discretion may determine that
C-3
Exhibit C
the failure of the Contractor or its insurer to timely provide a written notice required by
this paragraph is a breach of this Agreement.
(D) County's Entitlement to Greater Coverage. If the Contractor has or obtains insurance
with broader coverage, higher limits, or both, than what is required under this
Agreement, then the County requires and is entitled to the broader coverage, higher
limits, or both. To that end, the Contractor shall deliver, or cause its broker or producer
to deliver, to the County's Risk Manager certificates of insurance and endorsements for
all of the coverages that have such broader coverage, higher limits, or both, as required
under this Agreement.
(E) County's Remedy for Contractor's Failure to Maintain. If the Contractor fails to keep
in effect at all times any insurance coverage required under this Agreement, the County
may, in addition to any other remedies it may have, suspend or terminate this
Agreement upon the occurrence of that failure, or purchase such insurance coverage,
and charge the cost of that coverage to the Contractor. The County may offset such
charges against any amounts owed by the County to the Contractor under this
Agreement.
(F) Subcontractors. The Contractor shall require and verify that all subcontractors used by
the Contractor to provide services under this Agreement maintain insurance meeting all
insurance requirements provided in this Agreement. This paragraph does not authorize
the Contractor to provide services under this Agreement using subcontractors.
C-4
Exhibit D
Self-Dealing Transaction Disclosure Form
In order to conduct business with the County of Fresno ("County"), members of a
contractor's board of directors ("County Contractor"), must disclose any self-dealing transactions
that they are a party to while providing goods, performing services, or both for the County. A
self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in
which one or more of its directors has a material financial interest."
The definition above will be used for purposes of completing this disclosure form.
Instructions
(1) Enter board member's name, job title (if applicable), and date this disclosure is being
made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that
the board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
The form must be signed by the board member that is involved in the self-dealing
transaction described in Sections (3) and (4).
1
Exhibit D
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a
party to)
(4) Explain why this self-dealing transaction is consistent with the requirements of
Corporations Code § 5233 (a)
(5) Authorized Signature
Signature: Date:
2
Exhibit E
County of Fresno
23-10314
Page 1 of 4
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.
Exhibit E
County of Fresno
23-10314
Page 2 of 4
9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other
amounts (including any interest thereon) accruing to or received by the Grantee under this
Grant shall be paid by the Grantee to the Department, to the extent that they are properly
allocable to costs for which the Grantee has been reimbursed by the Department under this
Grant.
10. INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the
performance of the Project, shall act in an independent capacity and not as officers,
employees or agents of the Department.
11. MEDIA EVENTS: Grantee shall notify the Department's Grant Manager in writing at least
twenty (20)working days before any public or media event publicizing the accomplishments
and/or results of the Project and provide the opportunity for attendance and participation by
Department's representatives.
12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any
rights or remedies for any third- party as a beneficiary of this Grant or the project.
13. NOTICE: Grantee shall promptly notify the Department's Grant Manager in writing of any
events, developments or changes that could affect the completion of the project or the budget
approved for this Grant.
14. PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform
services under this Grant where such services are called for.
15. RECORDS: Grantee certifies that it will maintain Project accounts in accordance with
generally accepted accounting principles. Grantee further certifies that it will comply with the
following conditions for a grant award as set forth in the Request for Applications (Exhibit D)
and the Grant Application (Exhibit A).
A. Establish an official file for the Project which shall adequately document all
significant actions relative to the Project;
B. Establish separate accounts which will adequately and accurately depict all
amounts received and expended on this Project, including all grant funds received
under this Grant;
C. Establish separate accounts which will adequately depict all income received which
is attributable to the Project, especially including any income attributable to grant
funds disbursed under this Grant;
D. Establish an accounting system which will adequately depict final total costs of the
Project, including both direct and indirect costs; and,
E. Establish such accounts and maintain such records as may be necessary for the
state to fulfill federal reporting requirements, including any and all reporting
requirements under federal tax statutes or regulations.
16. RELATED LITIGATION: Under no circumstances may Grantee use funds from any
disbursement under this Grant to pay for costs associated with any litigation between the
Grantee and the Department.
Exhibit E
County of Fresno
23-10314
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: (This provision does not apply to Local Governmental Entities)
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.
Exhibit E
County of Fresno
23-10314
Page 4 of 4
4) For publications other than those described inparagraph B.3 above„ including
meeting abstracts, Grantee shall comply by providing the manuscript to the
Department not later than 12 months after the official date of publication.
5) Grantee is authorized to use grant money for publication costs, including fees charged
by a publisher for color and page charges, or fees for digital distribution.
Exhibit E
County of Fresno
Agreement#23-10314
Page 1 of 5
Additional Provisions
1. Additional Incorporated Documents
A. The following documents and any subsequent updates are not attached but are
incorporated herein and made a part hereof by this reference. CDPH will maintain on
file, all documents referenced herein and any subsequent updates, as required by
program directives. CDPH shall provide the Contractor with copies of said
documents and any periodic updates thereto, under separate cover.
1) Administrative Guidelines Manual
2) LHD Program Letters:
https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/NEOPB/Pages/LHDProgra
mLetters.aspx
3) SNAP-Ed Plan Guidance and Templates:
https:Hsnaped.fns.usda.gov/program-administration/quidance-and-templates
2. Cancellation /Termination
A. This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days
advance written notice to the Grantee.
B. CDPH reserves the right to cancel or terminate this Grant immediately for cause.
The Grantee may submit a written request to terminate this Grant only if CDPH
substantially fails to perform its responsibilities as provided herein.
C. The term "for cause" shall mean that the Grantee fails to meet the terms, conditions,
and/or responsibilities of this agreement. Causes for termination include, but are not
limited to the following occurrences:
1) If the Grantee knowingly furnishes any statement, representation, warranty, or
certification in connection with the agreement, which representation is materially
false, deceptive, incorrect, or incomplete.
2) If the Grantee fails to perform any material requirement of this Grant or defaults
in performance of this agreement.
3) Failure to adhere to the funding application parameters and or submitted plans to
address the application deliverables.
4) 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
Exhibit E
County of Fresno
Agreement#23-10314
Page 2 of 5
Additional Provisions
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.
3) Upon the effective date of termination of the Grant and the payment by CDPH of
all items properly changeable to CDPH hereunder, Grantee shall transfer, assign
and make available to CDPH all property and materials belonging to CDPH, all
rights and claims to any and all reservations, grants, and arrangements with
owners of media/PR materials, or others, and shall make available to CDPH all
written information regarding CDPH's media/PR materials, and no extra
compensation is to be paid to Grantee for its services.
4) Take such action as may be necessary, or as CDPH may specify, to protect and
preserve any property related to this agreement which is in the possession of the
Grantee and in which CDPH has or may acquire an interest.
I. CDPH may, at its discretion, require the Grantee to cease performance of certain
components of the Scope of Work as designated by CDPH and complete
performance of other components prior to the termination date of the Grant.
3. Avoidance of Conflicts of Interest by Grantee
A. CDPH intends to avoid any real or apparent conflict of interest on the part of the
Grantee, subgrants, or employees, officers and directors of the Grantee or
subgrants. Thus, CDPH reserves the right to determine, at its sole discretion,
whether any information, assertion or claim received from any source indicates the
existence of a real or apparent conflict of interest; and, if a conflict is found to exist,
to require the Grantee to submit additional information or a plan for resolving the
conflict, subject to CDPH review and prior approval.
B. Conflicts of interest include, but are not limited to:
Exhibit E
County of Fresno
Agreement#23-10314
Page 3 of 5
Additional Provisions
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.
4. Dispute Resolution Process
A. A Grantee grievance exists whenever there is a dispute arising from CDPH's action
in the administration of an agreement. If there is a dispute or grievance between the
Grantee and CDPH, the Grantee must seek resolution using the procedure outlined
below.
1) The Grantee should first informally discuss the problem with the CDPH Program
Grant Manager. If the problem cannot be resolved informally, the Grantee shall
direct its grievance together with any evidence, in writing, to the program Branch
Chief. The grievance shall state the issues in dispute, the legal authority or other
basis for the Grantee's position and the remedy sought. The Branch Chief shall
render a decision within ten (10) working days after receipt of the written
grievance from the Grantee. The Branch Chief shall respond in writing to the
Grantee indicating the decision and reasons therefore. If the Grantee disagrees
with the Branch Chief's decision, the Grantee may appeal to the second level.
2) When appealing to the second level, the Grantee must prepare an appeal
indicating the reasons for disagreement with Branch Chief's decision. The
Grantee shall include with the appeal a copy of the Grantee's original statement
of dispute along with any supporting evidence and a copy of the Branch Chief's
decision. The appeal shall be addressed to the Deputy Director of the division in
which the branch is organized within ten (10)working days from receipt of the
Branch Chief's decision. The Deputy Director of the division in which the branch
is organized or his/her designee shall meet with the Grantee to review the issues
raised. A written decision signed by the Deputy Director of the division in which
Exhibit E
County of Fresno
Agreement#23-10314
Page 4 of 5
Additional Provisions
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.
5. Executive Order N-6-22 -Economic Sanctions
On March 4, 2022, Governor Gavin Newsom issued Executive Order N-6-22 (the EO) regarding
Economic Sanctions against Russia and Russian entities and individuals. "Economic Sanctions"
refers to sanctions imposed by the U.S. government in response to Russia's actions in Ukraine, as
well as any sanctions imposed under state law. The EO directs state agencies to terminate
contracts with, and to refrain from entering any new contracts with, individuals or entities that are
determined to be a target of Economic Sanctions. Accordingly, should the State determine Grantee
is a target of Economic Sanctions or is conducting prohibited transactions with sanctioned
individuals or entities, that shall be grounds for termination of this Agreement. The State shall
provide Grantee advance written notice of such termination, allowing Grantee at least 30 calendar
days to provide a written response. Termination shall be at the sole discretion of the State.
Prior to awarding and executing grant, the State shall conduct its due diligence to determine if the
proposed awardee is a named individual or entity on federal and any state Economic Sanctions
lists. If the proposed awardee is listed, the State shall refrain from entering into the Grant.
Resources for locating names of sanctioned individuals and entities are available on the DGS Office
of Legal Services'webpage: Ukraine-Russia (ca.gov).
Exhibit E
County of Fresno
Agreement#23-10314
Page 5 of 5
Additional Provisions
If this Agreement is valued at$5 million or more, upon execution the State will send a separate
notification outlining additional requirements specified under the EO. Compliance with this
Economic Sanctions imposed in response to Russia's actions in Ukraine is required, including with
respect to, but not limited to, the federal executive orders identified in the EO and the sanctions
identified on the U.S. Department of the Treasury website (https://home.treasury.clov/policy-
issues/financial-sanctions/sanctionsprograms-and-country-information/ukraine-russia-
related-sanctions). Failure to comply may result in the termination of this Agreement.
California Department of Public Health
County of Fresno
23-103141
Exhibit F
Federal Terms and Conditions
(For Federally Funded Grant Agreements)
This exhibit contains provisions that require strict adherence to various contracting laws and
policies.
Index of Special Terms and Conditions
1. Federal Funds
2. Federal Equal Employment Opportunity Requirements
3. Debarment and Suspension Certification
4. Covenant Against Contingent Fees
5. Lobbying Restrictions and Disclosure Certification
6. Additional Restrictions
7. Human Subjects Use Requirments
8. Audit and Record Retention
9. Federal Requirements
CDPH (rev. 12-21) Page 1 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
1. Federal Funds
(Applicable only to that portion of an agreement funded in part or whole with federal funds.)
a. It is mutually understood between the parties that this Agreement may have been written
before ascertaining the availability of congressional appropriation of funds, for the mutual
benefit of both parties, in order to avoid program and fiscal delays which would occur if
the Agreement were executed after that determination was made.
b. This Agreement is valid and enforceable only if sufficient funds are made available to the
State by the United States Government for the fiscal years covered by the term of this
Agreement. In addition, this Agreement is subject to any additional restrictions,
limitations, or conditions enacted by the Congress or any statute enacted by the Congress
which may affect the provisions, terms or funding of this Agreement in any manner.
c. It is mutually agreed that if the Congress does not appropriate sufficient funds for the
program, this Agreement shall be amended to reflect any reduction in funds.
d. CDPH has the option to invalidate or cancel the Agreement with 30-days advance written
notice or to amend the Agreement to reflect any reduction in funds.
2. Federal Equal Opportunity Requirements
(Applicable to all federally funded grants entered into by the California Department of Public
Health (CDPH) formerly known as California Department of Health Services (CDHS).)
a. The Grantee will not discriminate against any employee or applicant for employment
because of race, color, religion, sex, national origin, physical or mental handicap,
disability, age or status as a disabled veteran or veteran of the Vietnam era. The Grantee
will take affirmative action to ensure that qualified applicants are employed, and that
employees are treated during employment, without regard to their race, color, religion,
sex, national origin, physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era. Such action shall include, but not be limited to the
following: employment, upgrading, demotion or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and career
development opportunities and selection for training, including apprenticeship. The
Grantee agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the Federal Government or CDPH, setting forth
the provisions of the Equal Opportunity clause, Section 503 of the Rehabilitation Act of
1973 and the affirmative action clause required by the Vietnam Era Veterans'
Readjustment Assistance Act of 1974 (38 U.S.C. 4212). Such notices shall state the
Grantee's obligation under the law to take affirmative action to employ and advance in
employment qualified applicants without discrimination based on their race, color, religion,
sex, national origin physical or mental handicap, disability, age or status as a disabled
veteran or veteran of the Vietnam era and the rights of applicants and employees.
b. The Grantee will, in all solicitations or advancements for employees placed by or on behalf
of the Grantee, state that all qualified applicants will receive consideration for employment
CDPH(rev. 12-21) Page 2 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
without regard to race, color, religion, sex, national origin physical or mental handicap,
disability, age or status as a disabled veteran or veteran of the Vietnam era.
c. The Grantee will send to each labor union or representative of workers with which it has
a collective bargaining agreement or other contract or understanding a notice, to be
provided by the Federal Government or the State, advising the labor union or workers'
representative of the Grantee's commitments under the provisions herein and shall post
copies of the notice in conspicuous places available to employees and applicants for
employment.
d. The Grantee will comply with all provisions of and furnish all information and reports
required by Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Era
Veterans' Readjustment Assistance Act of 1974 (38 U.S.C. 4212) and of the Federal
Executive Order No. 11246 as amended, including by Executive Order 11375, `Amending
Executive Order 11246 Relating to Equal Employment Opportunity,` and as
supplemented by regulation at 41 CFR part 60, "Office of the Federal Contract
Compliance Programs, Equal Employment Opportunity, Department of Labor," and of the
rules, regulations, and relevant orders of the Secretary of Labor.
e. The Grantee will furnish all information and reports required by Federal Executive Order
No. 11246 as amended, including by Executive Order 11375, 'Amending Executive Order
11246 Relating to Equal Employment Opportunity,' and as supplemented by regulation
at 41 CFR part 60, "Office of the Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor," and the Rehabilitation Act of 1973, and
by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and
will permit access to its books, records, and accounts by the State and its designated
representatives and the Secretary of Labor for purposes of investigation to ascertain
compliance with such rules, regulations, and orders.
f. In the event of the Grantee's noncompliance with the requirements of the provisions
herein or with any federal rules, regulations, or orders which are referenced herein, this
Agreement may be cancelled, terminated, or suspended in whole or in part and the
Grantee may be declared ineligible for further federal and state contracts in accordance
with procedures authorized in Federal Executive Order No. 11246 as amended and such
other sanctions may be imposed and remedies invoked as provided in Federal Executive
Order No. 11246 as amended, including by Executive Order 11375, `Amending Executive
Order 11246 Relating to Equal Employment Opportunity,' and as supplemented by
regulation at 41 CFR part 60, "Office of the Federal Contract Compliance Programs,
Equal Employment Opportunity, Department of Labor," or by rule, regulation, or order of
the Secretary of Labor, or as otherwise provided by law.
g. The Grantee will include the provisions of Paragraphs a through g in every subcontract
or purchase order unless exempted by rules, regulations, or orders of the Secretary of
Labor issued pursuant to Federal Executive Order No. 11246 as amended, including by
Executive Order 11375, 'Amending Executive Order 11246 Relating to Equal
Employment Opportunity,` and as supplemented by regulation at 41 CFR part 60, "Office
of the Federal Contract Compliance Programs, Equal Employment Opportunity,
Department of Labor," or Section 503 of the Rehabilitation Act of 1973 or(38 U.S.C. 4212)
of the Vietnam Era Veteran's Readjustment Assistance Act, so that such provisions will
be binding upon each subgrantee or vendor. The Grantee will take such action with
CDPH (rev. 12-21) Page 3 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
respect to any subcontract or purchase order as the Director of the Office of Federal
Contract Compliance Programs or CDPH may direct as a means of enforcing such
provisions including sanctions for noncompliance provided, however, that in the event the
Grantee becomes involved in, or is threatened with litigation by a subgrantee or vendor
as a result of such direction by CDPH, the Grantee may request in writing to CDPH, who,
in turn, may request the United States to enter into such litigation to protect the interests
of the State and of the United States.
3. Debarment and Suspension Certification
a. By signing this Grant, the Grantee agrees to comply with applicable federal suspension
and debarment regulations including, but not limited to 7 CFR Part 3017, 45 CFR 76, 40
CFR 32 or 34 CFR 85.
b. By signing this Grant, the Grantee certifies to the best of its knowledge and belief, that it
and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded by any federal department or agency;
(2) Have not within a three-year period preceding this application/proposal/agreement
been convicted of or had a civil judgment rendered against them for commission of
fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State or local) transaction or contract under a public
transaction; violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making
false statements, or receiving stolen property;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State or local) with commission of any of the offenses
enumerated in Paragraph b(2) herein; and
(4) Have not within a three-year period preceding this application/proposal/agreement
had one or more public transactions (Federal, State or local) terminated for cause or
default.
(5) Shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under federal regulations (i.e., 48 CFR part 9, subpart 9.4),
debarred, suspended, declared ineligible, or voluntarily excluded from participation in
such transaction, unless authorized by the State.
(6) Will include a clause entitled, "Debarment and Suspension Certification" that
essentially sets forth the provisions herein, in all lower tier covered transactions and
in all solicitations for lower tier covered transactions.
c. If the Grantee is unable to certify to any of the statements in this certification, the Grantee
shall submit an explanation to the CDPH Program Contract Manager.
d. The terms and definitions herein have the meanings set out in the Definitions and
Coverage sections of the rules implementing Federal Executive Order 12549.
CDPH(rev. 12-21) Page 4 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
e. If the Grantee knowingly violates this certification, in addition to other remedies available
to the Federal Government, the CDPH may terminate this Agreement for cause or default.
4. Covenant Against Contingent Fees
The Grantee warrants that no person or selling agency has been employed or retained to
solicit/secure this Grant upon an agreement of understanding for a commission, percentage,
brokerage, or contingent fee, except bona fide employees or bona fide established
commercial or selling agencies retained by the Grantee for the purpose of securing business.
For breach or violation of this warranty, CDPH shall have the right to annul this Grant without
liability or in its discretion to deduct from the Grant price or consideration, or otherwise
recover, the full amount of such commission, percentage, and brokerage or contingent fee.
5. Lobbying Restrictions and Disclosure Certification
(Applicable to federally funded grants in excess of $100,000 per Section 1352 of the 31,
U.S.C.)
a. Certification and Disclosure Requirements
(1) Each person (or recipient)who requests or receives a grant, subgrant, which is subject
to Section 1352 of the 31, U.S.C., and which exceeds $100,000 at any tier, shall file
a certification (in the form set forth in Attachment 1, consisting of one page, entitled
"Certification Regarding Lobbying")that the recipient has not made, and will not make,
any payment prohibited by Paragraph b of this provision.
(2) Each recipient shall file a disclosure (in the form set forth in Attachment 2, entitled
"Standard Form-LLL `disclosure of Lobbying Activities"') if such recipient has made or
has agreed to make any payment using nonappropriated funds (to include profits from
any covered federal action) in connection with a grant or any extension or amendment
of that grant, which would be prohibited under Paragraph b of this provision if paid for
with appropriated funds.
(3) Each recipient shall file a disclosure form at the end of each calendar quarter in which
there occurs any event that requires disclosure or that materially affect the accuracy
of the information contained in any disclosure form previously filed by such person
under Paragraph a(2) herein. An event that materially affects the accuracy of the
information reported includes:
(a) A cumulative increase of $25,000 or more in the amount paid or expected to be
paid for influencing or attempting to influence a covered federal action;
(b) A change in the person(s) or individuals(s) influencing or attempting to influence a
covered federal action; or
(c) A change in the officer(s), employee(s), or member(s) contacted for the purpose
of influencing or attempting to influence a covered federal action.
(4) Each person (or recipient) who requests or receives from a person referred to in
CDPH(rev. 12-21) Page 5 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
Paragraph a(1) of this provision a grant or subgrant exceeding $100,000 at any tier
under a grant shall file a certification, and a disclosure form, if required, to the next tier
above.
(5) All disclosure forms (but not certifications) shall be forwarded from tier to tier until
received by the person referred to in Paragraph a(1) of this provision. That person
shall forward all disclosure forms to CDPH Program Contract Manager.
b. Prohibition
Section 1352 of Title 31, U.S.C., provides in part that no appropriated funds may be
expended by the recipient of a federal contract or agreement, grant, loan, or cooperative
agreement to pay any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with any of the following covered
federal actions: the awarding of any federal contract or agreement, the making of any
federal grant, the making of any federal loan, entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification of any federal
contract or agreement, grant, loan, or cooperative agreement.
6. Additional Restrictions
Grantee shall comply with the restrictions under Division F, Title V, Section 503 of the
Consolidated Appropriations Act, 2012 (H.R. 2055), which provides that:
"SEC. 503.(a) No part of any appropriation contained in this Act or transferred pursuant
to section 4002 of Public Law 111-148 shall be used, other than for normal and
recognized executive-legislative relationships, for publicity or propaganda purposes, for
the preparation, distribution, or use of any kit, pamphlet, booklet, publication, electronic
communication, radio, television, or video presentation designed to support or defeat the
enactment of legislation before the Congress or any State or local legislature or legislative
body, except in presentation to the Congress or any State or local legislature itself, or
designed to support or defeat any proposed or pending regulation, administrative action,
or order issued by the executive branch of any State or local government, except in
presentation to the executive branch of any State or local government itself.
(b) No part of any appropriation contained in this Act or transferred pursuant to section
4002 of Public Law 111-148 shall be used to pay the salary or expenses of any grant or
contract recipient, or agent acting for such recipient, related to any activity designed to
influence the enactment of legislation, appropriations, regulation, administrative action, or
Executive order proposed or pending before the Congress or any State government,
State legislature or local legislature or legislative body, other than for normal and
recognized executive-legislative relationships or participation by an agency or officer of a
State, local or tribal government in policymaking and administrative processes within the
executive branch of that government.
(c) The prohibitions in subsections (a) and (b) shall include any activity to advocate or
promote any proposed, pending or future Federal, State or local tax increase, or any
proposed, pending, or future requirement or restriction on any legal consumer product,
including its sale or marketing, including but not limited to the advocacy or promotion of
gun control."
CDPH(rev. 12-21) Page 6 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
7. Human Subjects Use Requirements
(Applicable only to federally funded agreements in which performance, directly or through a
subgrantee/subaward, includes any tests or examination of materials derived from the human
body.)
By signing this Agreement, Grantee agrees that if any performance under this Agreement or
any subcontract or subagreement includes any tests or examination of materials derived from
the human body for the purpose of providing information, diagnosis, prevention, treatment or
assessment of disease, impairment, or health of a human being, all locations at which such
examinations are performed shall meet the requirements of 42 U.S.C. Section 263a (CLIA)
and the regulations thereunder.
8. Audit and Record Retention
(Applicable to agreements in excess of$10,000.)
a. The Grantee shall maintain books, records, documents, and other evidence, accounting
procedures and practices, sufficient to properly reflect all direct and indirect costs of
whatever nature claimed to have been incurred in the performance of this Agreement,
including any matching costs and expenses. The foregoing constitutes "records" for the
purpose of this provision.
b. The Grantee's facility or office or such part thereof as may be engaged in the performance
of this Agreement and his/her records shall be subject at all reasonable times to
inspection, audit, and reproduction.
c. Grantee agrees that CDPH, the Bureau of State Audits, or their designated
representatives including the Comptroller General of the United States shall have the right
to review and to copy any records and supporting documentation pertaining to the
performance of this Agreement. 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, the Grantee agrees
to include a similar right of the State to audit records and interview staff in any subgrantee
related to performance of this Agreement. (GC 8546.7, CCR Title 2, Section 1896).
d. The Grantee shall preserve and make available his/her records (1) for a period of three
years from the date of final payment under this Agreement, and (2)for such longer period,
if any, as is required by applicable statute, by any other provision of this Agreement, or
by subparagraphs (1) or (2) below.
(1) If this Agreement is completely or partially terminated, the records relating to the work
terminated shall be preserved and made available for a period of three years from the
date of any resulting final settlement.
(2) If any litigation, claim, negotiation, audit, or other action involving the records has been
started before the expiration of the three-year period, the records shall be retained
until completion of the action and resolution of all issues which arise from it, or until
the end of the regular three-year period, whichever is later.
CDPH (rev. 12-21) Page 7 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
f. The Grantee may, at its discretion, following receipt of final payment under this
Agreement, reduce its accounts, books and records related to this Agreement to
electoronic data storage device. Upon request by an authorized representative to inspect,
audit or obtain copies of said records, the Grantee and/or Subgrantee must supply or
make available applicable devices, hardware, and/or software necessary to view, copy
and/or print said records.
9. Federal Requirements
Grantee agrees to comply with and shall require all subgrantee's, if any, to comply with
all applicable Federal requirements including but not limited to the United States Code,
the Code of Federal Regulations, the Funding Opportunity Announcement, the Notice of
Award, the funding agreement, and any memoranda or letter regarding the applicable
Federal requirements.
CDPH(rev. 12-21) Page 8 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
Attachment 1
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CERTIFICATION REGARDING LOBBYING
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
an agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with the making, awarding or entering into of this Federal
contract, Federal grant, or cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of this Federal contract, grant, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency of the
United States Government, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal contract, grant, or
cooperative agreement, the undersigned shall complete and submit Standard Form LLL,
"Disclosure of Lobbying Activities" in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subGrantees, subgrants, and contracts
under grants and cooperative agreements) of$100,000 or more, and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by Section 1352, Title 31, U.S.C., any person who fails
to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
County of Fresno
Name of Grantee Printed Name of Person Signing for Grantee
23-10314�
Contract/ Grant Number Signature of Person Signing for Grantee
Date Title
After execution by or on behalf of Grantee, please return to:
CDPH (rev. 12-21) Page 9 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
California Department of Public Health
Nutrition Education and Obesity Prevention Branch
P.O. Box 997377, MS 7204
Sacramento, CA 95899-7377
Attn: Kimmy Casjens, Grant Manager
CDPH reserves the right to notifiy the Grantee in writing of an alternate submission address.
CDPH(rev. 12-21) Page 10 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
Attachment 2
CERTIFICATION REGARDING LOBBYING
Approved by OMB Complete this form to disclose lobbying
activities pursuant to 31 U.S.C. 13520348-0046
(See reverse for public burden disclosure)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
[ ] a. contract [ ] a. bid/offer/application [ ] a. initial filing
b. grant b. initial award b. material change
c. cooperative c. post-award For Material Change Only:
agreement
d. loan Year quarter
e. loan guarantee
f. loan insurance date of last report
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter
Name
and Address of Prime:
❑ Prime ❑ Subawardee
Tier , if known:
6. Federal Department/Agency 7. Federal Program Name/Description:
8. Federal Action Number, if known: 9. Award Amount, if known:
10.a. Name and Address of Lobbying b. Individuals Performing Services (including
Registrant address if different from 10a.
(If individual, last name, first name, Ml): (Last name, First name, MI):
11.Information requested through this form
is authorized by title 31 U.S.C. section Signature:
1352. This disclosure of lobbying
activities is a material representation of Print Name:
fact upon which reliance was placed by Title:
the tier above when this transaction was Telephone No.: Date:
made or entered into. This disclosure is
required pursuant to 31 U.S.C. 1352.
This information will be available for
public inspection. required disclosure
shall be subject to a not more than
$100,000 for each such failure.
Federal Use Only Authorized for Local Reproduction
Standard Form-LLL (Rev. 7-97)
CDPH (rev. 12-21) Page 11 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal
recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous
filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or
agreement to make payment to any lobbying entity for influencing or attempting to influence an officer
or employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with a covered Federal action. Complete all items
that apply for both the initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured
to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a
material change to the information previously reported, enter the year and quarter in which the
change occurred. Enter the date of the last previously submitted report by this reporting entity
for this covered Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include
Congressional District, if known. Check the appropriate classification of the reporting entity that
designates if it is, or expects to be a prime or subaward recipient. Identify the tier of the
subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are
not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name,
address, city, State and zip code of the prime Federal recipient. Include Congressional District,
if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least
one organizational level below agency name, if known. For example, Department of
Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known,
enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative
agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified
in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant
announcement number; the contract, grant, or loan award number; the application/proposal
control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal
agency, enter the Federal amount of the award/loan commitment for the prime entity identified
in item 4 or 5.
CDPH (rev. 12-21) Page 12 of 13
California Department of Public Health — Federal Terms and Conditions Exhibit F
10.(a) Enter the full name, address, city, State and zip code of the lobbying registrant under the
Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to
influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services and include full address if
different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11.The certifying official shall sign and date the form, print his/her name, title, and telephone
number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid
OMB Control Number.The valid OMB control number for this information collection is OMB No.0348-0046. Public reporting burden for this collection
of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork
Reduction Project(0348-0046),Washington,DC 20503.
CDPH (rev. 12-21) Page 13 of 13