HomeMy WebLinkAboutAgreement A-16-193 with Maternal, Child and Adolescent Health (MCAH).pdfAgency Name: County of Fresno, Department of Social Services Agreement No. 16 -193
Agreement#: 201510-2 Fiscal Year: 2015-16
AGREEMENT FUNDING APPLICATION
POLICY COMPLIANCE AND CERTIFICATION
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The undersigned hereby affirms that the statements contained in the Agreement Funding
Application (AFA) are true and complete to the best of the applicant's knowledge.
I certify that this Maternal, Child and Adolescent Health (MCAH) related program will comply
with all applicable provisions of Article 1, Chapter 1, Part 2, Division 106 of the Health and
Safety code (commencing with section 123225), Chapters 7 and 8 of the Welfare and
Institutions Code (commencing with Sections 14000 and 142), and any applicable rules or
regulations promulgated by CDPH pursuant to this article and these Chapters. I further certify
that this MCAH related program will comply with the MCAH Policies and Procedures Manual,
including but not limited to, Administration, Federal Financial Participation (FFP) Section. I
further certify that this MCAH related program will comply with all federal laws and regulations
governing and regulating recipients of funds granted to states for medical assistance pursuant
to Title XIX of the Social Security Act (42 U.S.C. section 1396 et seq.) and recipients offunds
allotted to states for the Maternal and Child Health Service Block Grant pursuant to Title V of
the Social Security Act (42 U.S.C. section 701 et seq.). I further agree that this MCAH related
program may be subject to all sanctions or other remedies applicable if this MCAH related
program violates any of the above laws, regulations and policies with which it has certified it
will comply.
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Original SignatUreOfffiCiaiaUthOJiZedt()
commit the Agency to an MCAH Agreement
Ernest Buddy Mendes
Name (Type or Print)
Laura Lopez
Name (Type or Print)
Page 7 of 7
Revised June 2014
Chairman. Board of Supervisors
Title
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Date 1
AFLP Director
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ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors
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Deputy