HomeMy WebLinkAboutAgreement A-16-430 with California Health Collaborative.pdf
COUNTY OF FRESNO
Fresno, CA
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AGREEMENT
THIS AGREEMENT, is made and entered into this___ day of _______, 2016, by and between
COUNTY OF FRESNO, a Political Subdivision of the State of California, Fresno, California,
hereinafter referred to as “COUNTY”, and CALIFORNIA HEALTH COLLABORATIVE whose
remit to address is 1680 West Shaw Avenue, Fresno, CA 93711-3504, hereinafter referred to as
“CONTRACTOR” (collectively the “parties”).
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Behavioral Health, Substance Use Disorder
(DBH-SUD) Services has determined there is a need for Fresno County youth and young adults to
receive alcohol and drug abuse prevention services; and
WHEREAS, COUNTY is authorized to contract with privately operated agencies for the provision
of alcohol and drug abuse prevention services; and
WHEREAS, CONTRACTOR has the staff, and is willing and able to provide prevention services
required by COUNTY, pursuant to the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual promises, covenants and conditions,
hereinafter set forth, the sufficiency of which is acknowledged, the parties agree to as follows:
1. CONTRACTOR’s RESPONSIBILITIES
A. CONTRACTOR shall perform all services and fulfill all responsibilities for the
provision of Alcohol and Other Drug prevention services to reduce marijuana use and reduce illicit use of
prescription painkillers among targeted youth and young adults, ages 10-25, as identified in Exhibits A-1
and A-2, Scopes of Work, attached hereto and by this reference incorporated herein, COUNTY’s Request
for Proposal (RFP) # 952-5414 dated January 4, 2016, and Addendum I dated January 22, 2016,
hereinafter collectively referred to as COUNTY Revised RFP #952-5414, and CONTRACTOR’s
response to said RFP #952-5414, dated January 22, 2016, all incorporated herein by reference and made
part of this Agreement.
B. In the event of any inconsistency among these documents, the inconsistency shall be
resolved by giving precedence in the following order of priority: 1) to this Agreement, including all
Exhibits, 2) to the Revised RFP, and; 3) to the Response to the Revised RFP. A copy of COUNTY’s
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Revised RFP #952-5414, and CONTRACTOR’s response shall be retained and made available during
the term of this Agreement by COUNTY’s Purchasing Division.
C. CONTRACTOR agrees that the COUNTY’s DBH Director or her designee shall
have the right to discontinue or refuse the services of any of the CONTRACTOR’s individual staff
members or volunteers who have not or are not satisfactorily performing services under this Agreement,
without being obligated to terminate this Agreement. COUNTY’s DBH Director or her designee shall
determine whether a particular individual staff member or volunteer of CONTRACTOR is satisfactorily
performing services and such determination shall be binding upon the parties hereto.
D. CONTRACTOR shall perform services at a variety of locations, as specified in
Exhibit A.
E. CONTRACTOR shall maintain, at CONTRACTOR’s cost, a computer system
compatible with the California Outcomes Measurement System (CalOMS) for the provision of
submitting information required under the terms and conditions of this Agreement. CONTRACTOR
shall complete required CalOMS data entry for prevention service/activity by date of occurrence on a
weekly basis. No more than one week’s data shall be aggregated into one reported service.
F. CONTRACTOR’s administrative level agency representative, who is duly authorized
to act on behalf of the CONTRACTOR, must attend regularly scheduled monthly Behavioral Health
Board Substance Use Disorder Sub-Committee meetings and CONTRACTOR meetings and quarterly
Prevention Provider meetings, as deemed necessary by DBH Director or her designee.
G. CONTRACTOR’s staff may also be required to attend meetings and trainings on an
as-needed basis, which may include but are not limited to prevention and fiscal trainings provided by the
State of California.
2. TERM
The term of this Agreement shall be for a period of three (3) years, commencing on July 1,
2016 through and including June 30, 2019. This agreement may be extended for one (1) additional
consecutive twelve (12) month period upon written approval of both parties no later than thirty (30) days
prior to the first day of the next twelve (12) month extension period. The DBH Director or her designee
is authorized to execute such written approval on behalf of COUNTY based on CONTRACTOR’s
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satisfactory performance.
3. TERMINATION
A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
provided thereunder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving the CONTRACTOR thirty (30) days advance written notice.
B. Breach of Contract - COUNTY may immediately suspend or terminate this
Agreement in whole or in part, where in the determination of COUNTY there is:
1) An illegal or improper use of funds;
2) A failure to comply with any term of this Agreement;
3) A substantially incorrect or incomplete report submitted to COUNTY;
4) Improperly performed service.
In no event shall any payment by COUNTY constitute a waiver by COUNTY of
any breach of this Agreement or any default which may then exist on the part of CONTRACTOR.
Neither shall such payment impair or prejudice any remedy available to COUNTY with respect to the
breach or default. COUNTY shall have the right to demand of CONTRACTOR the repayment to
COUNTY of any funds disbursed to CONTRACTOR under this Agreement, which in the judgment of
COUNTY were not expended in accordance with the terms of this Agreement. CONTRACTOR shall
promptly refund any such funds upon demand or, at COUNTY’s option, such repayment shall be
deducted from future payments owing to CONTRACTOR under this Agreement.
C. Without Cause - Under circumstances other than those set forth above, this
Agreement may be terminated by CONTRACTOR or COUNTY or COUNTY’s DBH Director or
designee, upon the giving of thirty (30) days advance written notice of an intention to terminate.
CONTRACTOR may terminate with the appropriate thirty (30) days advance written
notice of intent to terminate transmitted by CONTRACTOR to COUNTY by Certified U.S. Mail Return
Receipt Requested addressed to the office of COUNTY as follows:
///
///
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Director (or her designee)
County of Fresno
Department of Behavioral Health
3133 N. Millbrook Ave
Fresno, CA 93703
4. COMPENSATION
A. For actual services provided as identified in the terms and conditions of this
Agreement and Exhibits A-1 and A-2, COUNTY agrees to pay CONTRACTOR and CONTRACTOR
agrees to receive compensation as identified in Exhibits B-1 and B-2, “Budget,” attached hereto and by
this reference incorporated herein, contingent upon confirmation of funding.
1. For the period July 1, 2016 through June 30, 2017, in no event shall actual
services performed be in excess of Six Hundred Sixty-Six Thousand Six Hundred Sixty-Six and No/100
Dollars ($666,666.00).
2. For the period July 1, 2017 through June 30, 2018, in no event shall actual
services performed be in excess of Six Hundred Sixty-Six Thousand Six Hundred Sixty-Six and No/100
Dollars ($666,666.00).
3. For the period July 1, 2018 through June 30, 2019, in no event shall actual
services performed be in excess of Six Hundred Sixty-Six Thousand Six Hundred Sixty-Six and No/100
Dollars ($666,666.00).
4. If this agreement is renewed for an additional one-year period pursuant to
Section 2, TERM, for the period July 1, 2019 through June 30, 2020, in no event shall actual services
performed be in excess of Six Hundred Sixty-Six Thousand Six Hundred Sixty-Six and No/100 Dollars
($666,666.00).
B. Except as described in this Agreement regarding State payment delays, payments by
COUNTY shall be in arrears after receipt, verification and approval of CONTRACTOR’s monthly
itemized invoices and required reports further described in Section Thirty-Two (32), REPORTS of this
Agreement, by COUNTY’s DBH-SUD Services. All final claims and/or any final budget modification
requests shall be submitted by CONTRACTOR within sixty (60) days following the final month of
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service for which payment is claimed. No action shall be taken by COUNTY’s DBH-SUD Services on
claims submitted beyond the sixty (60) day closeout period. Any compensation which is not expended
by CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
COUNTY’s DBH-SUD Services.
C. The contract maximum amount as identified in this Agreement and in Exhibits B-1
and B-2 may be reduced based upon State and Federal funding availability. In the event of such action,
the COUNTY’s DBH Director or her designee shall notify the CONTRACTOR in writing of the
reduction in the maximum amount within thirty (30) days of COUNTY’s notification.
In the event that the State of California is unable to meet its financial obligations and
payment to Counties for substance abuse services, DBH-SUD Services may delay or defer payment to
CONTRACTOR until such a time as the State budget issues are resolved. The amount of deferred
payment shall not exceed the amount of funding delayed by the State Controller to the COUNTY’s
DBH-SUD Services. The deferral by COUNTY shall not exceed the period of time the State Controller’s
delay of payment plus forty-five (45) days. In addition, if the State of California does not allocate
funding for services described in the terms and conditions of this Agreement, DBH-SUD Services shall
not be obligated to reimburse CONTRACTOR for services performed.
D. Except as described in this Agreement regarding State payment delays, payments by
COUNTY shall be in arrears after receipt, verification and approval of CONTRACTOR’s monthly
itemized invoices and required reports further described in Section Thirty-Two (32), REPORTS of this
Agreement, by COUNTY’s DBH-SUD Services. All final claims and/or any final budget modification
requests shall be submitted by CONTRACTOR within sixty (60) days following the final month of
service for which payment is claimed. No action shall be taken by COUNTY’s DBH-SUD Services on
claims submitted beyond the sixty (60) day closeout period. Any compensation which is not expended by
CONTRACTOR pursuant to the terms and conditions of this Agreement shall automatically revert to
COUNTY’s DBH-SUD Services.
E. If CONTRACTOR should fail to comply with any provision of this Agreement,
COUNTY shall be relieved of its obligation for further compensation. CONTRACTOR’s and
COUNTY’s obligations under this section shall survive the termination of this Agreement with respect to
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services provided during the term of this Agreement up until the termination date, regardless of the cause
of termination of this Agreement.
F. Public Information – CONTRACTOR shall disclose its funding source in all public
information, however, this requirement of disclosure of funding source shall not be required in spot radio
or television advertising.
G. Lobbying Activity – CONTRACTOR shall not directly or indirectly use any of the
funds provided under this Agreement for publicity, lobbying, or propaganda purposes designed to
support or defeat legislation pending before the Congress of the United States or the Legislature of the
State of California.
H. Political Activity – CONTRACTOR shall not directly or indirectly use any of the
funds under this Agreement for any political activity or to further the election or defeat of any candidate
for public office.
I. Cost of Living Adjustment – CONTRACTOR shall not utilize any funds provided
under this Agreement for cost of living adjustments to CONTRACTOR’s employee compensation in
excess of what is approved in the budget submitted with the RFP response.
J. COUNTY shall not be obligated to make payments under this Agreement for
employee morale or other staff expenses such as food, drink, picnics, and/or parties. The DBH Director
or her designee may provide an exception to the aforementioned requirement in part or in its entirety as
circumstances may warrant.
K. CONTRACTOR agrees to limit annual administrative costs paid through this
Agreement to a maximum of fifteen percent (15%) of the total annual program budget. Administrative
costs include all non-direct service personnel such as executive directors, clerical staff and fiscal staff and
identified corporate overhead. Employee benefits shall not exceed twenty percent (20%) of total salaries
for those employees working under this Agreement. Benefits shall include health insurance, retirement,
life insurance, and other optional benefits. Failure to conform to this provision will be grounds for
contract termination at the option of the County of Fresno, DBH Director or her designee. This Section
Four (4) COMPENSATION shall in no way be construed to classify CONTRACTOR or CONTRACTOR’s
officers, agents and employees as an officer, agent, servant, employee, joint venture, partner, or associate of
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COUNTY, pursuant to Section Six (6), INDEPENDENT CONTRACTOR.
5. INVOICING
CONTRACTOR shall invoice COUNTY by the twentieth (20th) of each month for actual
services rendered in the previous month in accordance with the budget projections in Exhibit B, attached
hereto and incorporated by this reference.
Invoices shall be submitted via e-mail to: sas@co.fresno.ca.us, Attn: Staff Analyst. As indicated
in Section Thirty-Three (33), herein below, invoices shall include all corresponding documentation
submitted and identified by line item, as identified in Exhibit B. Supporting documentation shall include
but is not limited to receipts; invoices received and documented administrative/overhead costs.
If an invoice is incorrect or is otherwise not in proper form or substance, COUNTY's DBH
Director or designee shall have the right to withhold payment as to only that portion of the invoice that is
incorrect or improper after five (5) days prior notice to CONTRACTOR. CONTRACTOR agrees to
continue to provide services for a period of ninety (90) days after notification of an incorrect or improper
invoice. If after said ninety (90) day period said invoice(s) is still not corrected to COUNTY's DBH,
Director's or designee's satisfaction, COUNTY's DBH, Director or designee may elect to terminate this
Agreement, pursuant to the termination provisions stated in Section Three (3), TERMINATION of this
Agreement. In addition, CONTRACTOR shall submit all invoices to COUNTY's DBH Director or
designee for services provided within ninety (90) days after each twelve (12) month period expires or this
Agreement is terminated. If invoices are not submitted within ninety (90) days after each twelve (12)
month period expires or this Agreement is terminated, COUNTY's DBH Director or designee shall have
the right to deny payment on such invoices.
6. INDEPENDENT CONTRACTOR
In performance of the work, duties, and obligations assumed by CONTRACTOR under this
Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all of
CONTRACTOR’s officers, agents and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venture, partner, or associate of the COUNTY. Furthermore, COUNTY shall have no
right to control or supervise or direct the manner or method by which CONTRACTOR shall perform its
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work and function. However, COUNTY shall retain the right to administer this Agreement so as to
verify that CONTRACTOR is performing its obligations in accordance with the terms and conditions
thereof. CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the rules
and regulations, if any, of governmental authorities having jurisdiction over matters which are directly or
indirectly the subject of this Agreement.
Because of its status as an independent contractor, CONTRACTOR shall have absolutely
no right to employment rights and benefits available to COUNTY employees. CONTRACTOR shall be
solely liable and responsible for providing to, or on behalf of, its employees all legally-required employee
benefits. In addition, CONTRACTOR shall be solely responsible and save COUNTY harmless from all
matters relating to payment of CONTRACTOR’s employees, including compliance with Social Security,
withholding, and all other regulations governing such matters. It is acknowledged that during the term of
this Agreement, CONTRACTOR may be providing services to others unrelated to the COUNTY or to
this Agreement.
7. SUBCONTRACTS
CONTRACTOR shall be required to assume full responsibility for all services and
activities covered by this Agreement, whether or not CONTRACTOR is providing services directly.
Further, CONTRACTOR shall be the sole point of contact with regard to contractual matters, including
payment of any and all charges resulting from this Agreement.
If CONTRACTOR should propose to subcontract with one or more third parties to carry
out a portion of services covered by this Agreement, any such subcontract shall be in writing and
approved as to form and content by COUNTY’s DBH Director or her designee prior to execution and
implementation. COUNTY’s DBH Director or her designee shall have the right to reject any such
proposed subcontract. Any such subcontract together with all activities by or caused by CONTRACTOR
shall not require compensation greater than the total budget contained herein. An executed copy of any
such subcontract shall be received by COUNTY before any implementation and shall be retained by
COUNTY. CONTRACTOR shall be responsible to COUNTY for the proper performance of any
subcontract. Any subcontractor shall be subject to the same terms and conditions that CONTRACTOR is
subject to under this Agreement.
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It is expressly recognized that CONTRACTOR cannot engage in the practice of medicine.
If any medical services are to be provided in connection with the services under this Agreement, such
medical services shall be performed by an independent contract physician. In this instance, the
requirements of the Confidential Medical Information Act (Civil Code 56 et seq.) shall be met.
8. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written consent
of all the parties without, in any way, affecting the remainder.
Notwithstanding the above, changes to line items in the budget, attached hereto as Exhibit
B, which do not exceed ten percent (10%) of the total maximum compensation payable to
CONTRACTOR, may be made with the written approval of COUNTY’s DBH Director or designee and
CONTRACTOR. Said budget line item changes shall not result in any change to the maximum
compensation amount payable to CONTRACTOR, as stated herein.
CONTRACTOR hereby agrees that changes to the compensation under this Agreement
may be necessitated by a reduction in funding from State and/or Federal sources. The COUNTY’s DBH
Director or her designee may modify the maximum compensation depending on State and Federal
funding availability, as stated in Section Four (4), COMPENSATION in this Agreement.
CONTRACTOR further understands that this Agreement is subject to any restrictions, limitations, or
enactments of all legislative bodies which affect the provisions, term or funding of this Agreement in any
manner.
9. NON-ASSIGNMENT
No party shall assign, transfer or subcontract this Agreement nor their rights or duties under
this Agreement without the prior written consent of COUNTY and CONTRACTOR.
10. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend COUNTY, its officers, agents, and employees from any and all costs and expenses, damages,
liabilities, claims, and losses occurring or resulting to COUNTY in connection with the performance, or
failure to perform, by CONTRACTOR, their officers, agents, or employees under this Agreement, and
from any and all costs and expenses, damages, liabilities, claims, and losses occurring or resulting to any
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person, firm, or corporation who may be injured or damaged by the performance, or failure to perform, of
each CONTRACTOR, their officers, agents or employees under this Agreement.
CONTRACTOR agrees to indemnify COUNTY for Federal, State of California audit
exceptions resulting from noncompliance herein on the part of the CONTRACTOR.
11. INSURANCE
Without limiting the COUNTY's right to obtain indemnification from 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:
A. Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occurrence and an annual aggregate of Two Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis. In
addition to the Commercial General Liability coverage, CONTRACTOR shall
provide an insurance policy for sexual abuse and molestation liability with these
same limits.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Five Hundred Thousand Dollars ($500,000.00) per person, One
Million Dollars ($1,000,000.00) per accident and for property damages of not less
than One Hundred Thousand Dollars ($100,000.00), or such coverage with a
combined single limit of One Million Dollars ($1,000,000.00). Coverage should
include owned and non-owned vehicles used in connection with this Agreement.
C. Professional Liability
If CONTRACTOR employs licensed professional staff, (e.g., Ph.D., R.N.,
L.C.S.W., M.F.C.C.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1,000,000.00) per occurrence, Three
Million Dollars ($3,000,000.00) annual aggregate.
D. Worker’s Compensation
A policy of Worker's Compensation insurance as may be required by the
California Labor Code.
CONTRACTOR shall obtain endorsements to the Commercial General Liability
insurance naming the County of Fresno, its officers, agents, and employees,
individually and collectively, as additional insured, but only insofar as the
operations under this Agreement are concerned. Such coverage for additional
insured shall apply as primary insurance and any other insurance, or self-
insurance, maintained by COUNTY, its officers, agents and employees shall be
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excess only and not contributing with insurance provided under
CONTRACTORS' policies herein. This insurance shall not be cancelled or
changed without a minimum of thirty (30) days advance written notice given to
COUNTY.
Within thirty (30) days from the date CONTRACTOR executes this Agreement,
CONTRACTOR shall provide certificates of insurance and endorsement as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Behavioral Health,
Substance Use Disorder Services, 3133 N. Millbrook Avenue, Fresno, CA 93703, Attention: DBH-
SUD Services Staff Analyst, stating that such insurance coverages have been obtained and are in full
force; that the County of Fresno, its officers, agents and employees will not be responsible for any
premiums on the policies; that such Commercial General Liability insurance names the County of
Fresno, its officers, agents and employees, individually and collectively, as additional insured, but only
insofar as the operations under this Agreement are concerned; that such coverage for additional insured
shall apply as primary insurance and any other insurance, or self-insurance, maintained by COUNTY,
its officers, agents and employees, shall be excess only and not contributing with insurance provided
under CONTRACTORS' policies herein; and that this insurance shall not be cancelled or changed
without a minimum of thirty (30) days advance, written notice given to COUNTY.
In the event CONTRACTOR fails to keep in effect at all times insurance coverage as
herein provided, the COUNTY may, in addition to other remedies it may have, suspend or terminate
this Agreement upon the occurrence of such event.
All policies shall be with admitted insurers licensed to do business in the State of
California. Insurance purchased shall be purchased from companies possessing a current A.M. Best, Inc.
rating of A FSC VII or better.
12. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
COUNTY and CONTRACTOR each consider and represent themselves as covered entities
as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191(HIPAA) and agree to use and disclose protected health information as required by law.
COUNTY and CONTRACTOR acknowledge that the exchange of protected health
information between them is only for treatment, payment, and health care operations.
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COUNTY and CONTRACTOR intend to protect the privacy and provide for the security
of Protected Health Information (PHI) pursuant to the Agreement in compliance with HIPAA, the Health
Information Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and
regulations promulgated thereunder by the U.S. Department of Health and Human Services (HIPAA
Regulations) and other applicable laws.
As part of the HIPAA Regulations, the Privacy Rule and the Security Rule require
CONTRACTOR to enter into a contract containing specific requirements prior to the disclosure of PHI,
as set forth in, but not limited to, Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the Code of
Federal Regulations (CFR).
13. DATA SECURITY
For the purpose of preventing the potential loss, misappropriation or inadvertent access,
viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse of
COUNTY resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter
into a contractual relationship with the COUNTY for the purpose of providing services under this
Agreement must employ adequate data security measures to protect the confidential information provided
to CONTRACTOR by the COUNTY, including but not limited to the following:
A. CONTRACTOR-Owned Mobile, Wireless, or Handheld Devices
CONTRACTOR may not connect to COUNTY networks via personally-owned
mobile, wireless or handheld devices, unless the following conditions are met:
1) CONTRACTOR has received authorization by COUNTY for
telecommuting purposes;
2) Current virus protection software is in place;
3) Mobile device has the remote wipe feature enabled; and
4) A secure connection is used.
B. CONTRACTOR-Owned Computers or Computer Peripherals
CONTRACTOR may not bring CONTRACTOR-owned computers or computer
peripherals into the COUNTY for use, including but not limited to mobile storage devices without prior
authorization from the COUNTY’s Chief Information Officer, or her designee. If data is approved to be
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transferred, data must be stored on a secure server approved by the COUNTY and transferred by means
of a Virtual Private Network (VPN) connection, or another type of secure connection. Said data must be
encrypted.
C. COUNTY-Owned Computer Equipment
CONTRACTOR may not use COUNTY computers or computer peripherals on
non-COUNTY premises without prior authorization from the COUNTY’s Chief Information Officer, or
her designee.
D. CONTRACTOR may not store COUNTY’s private, confidential or sensitive data
on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E. CONTRACTOR shall be responsible to employ strict controls to ensure the
integrity and security of COUNTY’s confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data processing
systems, data files and data processing equipment which stores or processes COUNTY data internally
and externally.
F. Confidential client information transmitted to one party by the other by means of
electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of 128
BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR is responsible to immediately notify COUNTY of any violations,
breaches or potential breaches of security related to COUNTY’s confidential information, data
maintained in computer files, program documentation, data processing systems, data files and data
processing equipment which stores or processes COUNTY data internally or externally.
H. COUNTY shall provide oversight to CONTRACTORS’ response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information provided
to CONTRACTOR. CONTRACTOR will be responsible to issue any notification to affected individuals
as required by law or as deemed necessary by COUNTY in its sole discretion. CONTRACTOR will be
responsible for all costs incurred as a result of providing the required notification.
14. NON-DISCRIMINATION
A. Eligibility for Services - CONTRACTOR shall prepare, prominently post in its
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facility, and make available to the DBH Director or her designee and to the public all eligibility
requirements to participate in the program funded under this Agreement. CONTRACTOR shall not
unlawfully discriminate in the provision of services because of race, religious creed, color, national
origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital
status, sex, gender, gender identity, gender expression, age, sexual orientation, or military or veteran
status as provided by State of California and Federal law in accordance with Title VI of the Civil Rights
Act of 1964 (42 USC Section 2000(d)); Age Discrimination Act of 1975 (42 USC Section 1681);
Rehabilitation Act of 1973 (29 USC Section 794); Education Amendments of 1972 (20 USC Section
1681); Americans with Disabilities Act of 1990 (42 USC Section 12132); Title 45, Code of Federal
Regulations, Part 84; provisions of the Fair Employment and Housing Act (California Government Code
Section 12900); and regulations promulgated thereunder (Title 2, CCR, Section 7285.0); Title 2, Division
3, Article 9.5 of the California Government Code commencing with Section 11135; and Title 9, Division
4, Chapter 6 of the California Code of Regulations commencing with Section 10800.
B. Equal Opportunity - CONTRACTOR shall comply with California Government
Code, Section 12990 and California Code of Regulations, Title II, Division 4, Chapter 5, in matters
related to the development, implementation, and maintenance of a nondiscrimination program.
CONTRACTOR shall not discriminate against any employee or applicant for employment because of
race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual
orientation, or military or veteran status. Such practices include retirement, recruitment, advertising,
hiring, layoff, termination, upgrading, demotion, transfer, rates of pay or other forms of compensation,
use of facilities, and other terms and conditions of employment. CONTRACTOR agrees to post in
conspicuous places, notices available to all employees and applicants for employment setting forth the
provisions of the Equal Opportunity Act (42 USC Section 2000(e)) in conformance with Federal
Executive Order No. 11246. CONTRACTOR agrees to comply with the provisions of the Rehabilitation
Act of 1973 (29 USC Section 794).
C. Suspension of Compensation - If an allegation of discrimination occurs, DBH-
SUD Services may withhold all further funds, until CONTRACTOR can show by clear and convincing
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evidence to the satisfaction of DBH-SUD Services that funds provided under this Agreement were not
used in connection with the alleged discrimination.
D. Nepotism - Except by consent of the DBH Director or her designee, no person
shall be employed by CONTRACTOR who is related by blood or marriage to or who is a member of the
Board of Directors or an officer of CONTRACTOR.
E. New Facilities and Disability Access - New facilities shall be wheelchair
accessible and provide access to the disabled, consistent with Title 9, California Code of Regulations,
Section 10820. If a new facility will be utilized, a plan ensuring accessibility to the disabled must be
developed. DBH-SUD Services shall assess, monitor, and document CONTRACTORS’ compliance
with the Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990 to ensure that
recipients/beneficiaries and intended recipients/beneficiaries of services are provided services without
regard to physical or mental disability and that CONTRACTOR has provided a facility accessible to the
physically disabled.
15. COMPLAINTS
CONTRACTOR shall log complaints and the disposition of all complaints from a client or
client’s family. CONTRACTOR shall provide a summary of the complaint log entries concerning
COUNTY-sponsored clients to COUNTY at monthly intervals by the fifteenth (15th) day of the
following month, in a format that is mutually agreed upon. CONTRACTOR shall post signs informing
consumer of their right to file a complaint or grievance. CONTRACTOR shall notify COUNTY of all
incidents reportable to state licensing bodies that affect COUNTY consumers within twenty-four (24)
hours of receipt of a complaint.
Within fifteen (15) days after each incident or complaint affecting COUNTY-sponsored
clients, CONTRACTOR shall provide COUNTY with information relevant to the complaint,
investigative details of the complaint, the complaint and CONTRACTOR' disposition of, or corrective
action taken to resolve the complaint.
16. NO THIRD PARTY BENEFICIARIES
It is understood and agreed by and between the parties that the services provided by
CONTRACTOR for COUNTY herein are solely for the benefit of the COUNTY, and that nothing in this
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Agreement is intended to confer on any person other than the parties hereto any right under or by reason
of this Agreement.
17. COMPLIANCE WITH LAWS AND POLICIES
CONTRACTOR shall comply with all applicable laws, ordinances and regulations in the
performance of its obligations under this Agreement and guidelines applicable to CONTRACTORS’
performance under this Agreement or any local ordinances, regulations, or policies applicable. Such
provisions include, but are not restricted to:
A. CONTRACTOR shall submit accurate, complete and timely claims and cost
reports, reporting only allowable costs.
B. CONTRACTOR shall comply with statistical reporting and program evaluation
systems as provided in State of California regulations and in this Agreement.
18. CONFLICT OF INTEREST
No officer, agent, or employee of COUNTY who exercises any function or responsibility
for planning and carrying out the services provided under this Agreement shall have any direct or indirect
personal financial interest in this Agreement. In addition, no employee of the COUNTY shall be
employed by CONTRACTOR to fulfill any contractual obligations with COUNTY. The
CONTRACTOR shall also comply with all Federal, State of California, and local conflict of interest
laws, statutes, and regulations, which shall be applicable to all parties and beneficiaries under this
Agreement and any officer, agent, or employee of COUNTY.
19. STATE ALCOHOL AND DRUG REQUIREMENTS
A. INDEMNIFICATION
CONTRACTOR 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, material men, laborers and any other person, firm or corporation furnishing
or supplying work, services, materials or supplies in connection with the performance of this Agreement
and from any and all claims and losses accruing or resulting to any person, firm or corporation who may
be injured or damaged by the CONTRACTOR in the performance of this Agreement.
///
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B. INDEPENDENT CONTRACTOR
CONTRACTOR and the agents and employees of CONTRACTOR, in the
performance of this Agreement, shall act in an independent capacity and not as officers or employees or
agents of State of California.
C. CONTROL REQUIREMENTS
This Agreement is subject to all applicable Federal and State laws, regulations and
standards. CONTRACTOR shall establish written procedures consistent with the State NNA
requirements. The provisions of this Agreement are not intended to abrogate any provisions of law or
regulation existing or enacted during the term of this Agreement.
D. NON - DISCRIMINATION PROVISION
1) Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and
to the public all eligibility requirements to participate in the program plan set forth in CONTRACTORS’
response to the RFP. No person shall, because of ethnic group identification, age, sex, color, disability,
medical condition, national origin, race, ancestry, marital status, religion, religious creed, political belief
or sexual preference be excluded from participation, be denied benefits of, or be subject to discrimination
under any program or activity receiving Federal or State of California assistance.
2) EMPLOYMENT OPPORTUNITY
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids discrimination against any person on
the grounds of race, color, national origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment advertising, hiring, layoff,
termination, upgrading, demotion, transfer, rates of pay or other forms of compensation, use of facilities,
and other terms and conditions of employment.
3) SUSPENSION OF COMPETITION
If an allegation of discrimination occurs, COUNTY may withhold all
further funds, until CONTRACTOR can show clear and convincing evidence to the satisfaction of
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COUNTY that funds provided under this Agreement were not used in connection with the alleged
discrimination.
4) NEPOTISM
Except by consent of COUNTY’s DBH Director or her designee, no
person shall be employed by CONTRACTOR who is related by blood or marriage to, or who is a
member of the Board of Directors or an officer of CONTRACTOR.
E. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality, including but not
limited to confidentiality of information requirements at Part 2, Title 42, Code of Federal Regulations;
California Welfare and Institutions Code, Sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6
of the California Health and Safety Code; Title 22, California Code of Regulations, Section 51009; and
Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
F. REVENUE COLLECTION POLICY
CONTRACTOR shall conform to all policies and procedures regarding revenue
collection issued by the State under the provisions of the Health and Safety Code, Division 10.5.
G. EXPENDITURE OF STATE GENERAL AND FEDERAL FUNDS
CONTRACTOR agrees that all funds paid out by the State shall be used exclusively
for providing alcohol and/or drug program services, administrative costs, and allowable overhead.
H. ACCESS TO SERVICES
CONTRACTOR shall provide accessible and appropriate services in accordance
with Federal and State statutes and regulations to all eligible persons.
I. REPORTS
CONTRACTOR agrees to participate in surveys related to the performance of this
Agreement and expenditure of funds and agrees to provide any such information in a mutually agreed
upon format.
///
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J. AUDITS
All State and Federal funds furnished the CONTRACTOR pursuant to this
Agreement along with required COUNTY match, related patient and participant fees, third-party
payments, or other related revenues and funds commingled with the foregoing funds are subject to audit
by the State. The State may audit all alcohol and drug program revenue and expenditures contained in
this Agreement for the purpose of establishing the basis for the subsequent year's negotiation.
K. RECORDS MAINTENANCE
1) CONTRACTOR shall maintain books, records, documents, and other
evidence necessary to monitor and audit this Agreement.
2) CONTRACTOR shall maintain adequate program and fiscal records relating
to individuals served under the terms of this Agreement, as required, to meet the needs of the State in
monitoring quality, quantity, fiscal accountability, and accessibility of services. Information on each
individual shall include, but not be limited to, admission records, patient and participant interviews and
progress notes, and records of service provided by various service locations, in sufficient detail to make
possible an evaluation of services provided and compliance with this Agreement.
20. FEDERAL CERTIFICATIONS
A. CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER COVERED TRANSACTIONS
1) DBH-SAS and CONTRACTOR recognize that Federal assistance funds will
be used under the terms of this Agreement. For purposes of this paragraph, CONTRACTOR will be
referred to as the "prospective recipient".
2) This certification is required by the regulations implementing Executive
Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities.
The regulations were published as Part VII of the May 26, 1988 Federal Register (pages19160-19211).
a. The prospective recipient of Federal assistance funds certifies by
entering this Agreement, that neither it nor its principals are presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
Federal department or agency.
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b. The prospective recipient of funds agrees by entering into this
Agreement, that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the Federal department or agency with which this transaction
originated.
c. Where the prospective recipient of Federal assistance funds is unable
to certify to any of the statements in this certification, such prospective participant shall attach an
explanation to this Agreement.
d. The prospective recipient shall provide immediate written notice to
DBH-SUDS if at any time prospective recipient learns that its certification in this clause of this
Agreement was erroneous when submitted or has become erroneous by reason of changed
circumstances.
e. The prospective recipient further agrees that by entering this
Agreement, it will include a clause identical to this clause of this Agreement, and titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered
Transactions", in all lower tier covered transactions and in all Solicitations for lower tier covered
transactions.
f. The certification in this clause of this Agreement is a material
representation of fact upon which reliance was placed by COUNTY when this transaction was entered
into.
B. AUDIT
CONTRACTOR shall grant DBH-SUD Services, State of California (if applicable),
the Federal grantor agency, the Comptroller General of the United States, or any of their duly authorized
representatives access to any books, documents, papers, and records of the CONTRACTOR which are
directly pertinent to this Agreement for the purpose of audits, examinations, excerpts and transactions.
The CONTRACTOR must retain all such required records for three (3) years after CONTRACTOR
makes final payment and all other pending matters are closed. C. CLEAN AIR AND WATER
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In the event funding under this Agreement exceeds one hundred thousand dollars
($100,000.00),the CONTRACTOR must comply with all applicable standards, orders, or requirements
issued under Section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), Section 506 of the Clean Water Act
(33 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR
part 32).
D. ENERGY EFFICIENCY
The CONTRACTOR must comply with the mandatory standards and policies
relating to energy efficiency which are contained in the state energy conservation plan issued in
compliance with Energy Policy and Conservation Act (Pub. L. 94-163).
21. DRUG-FREE WORKPLACE
CONTRACTOR shall comply with the requirements of the Drug-Free Work Place Act of
1990 (California Government Code Section 8350).
22. DISCLOSURE OF SELF-DEALING TRANSACTIONS
This provision is only applicable if the CONTRACTOR is operating as a corporation (a
for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR changes
its status to operate as a corporation.
Members of the CONTRACTORS’ Board of Directors shall disclose any self-dealing
transactions that they are a party to while CONTRACTOR is providing goods or performing services
under this Agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
is a party and in which one or more of its directors has a material financial interest. Members of the
Board of Directors shall disclose any self-dealing transactions that they are a party to by completing and
signing a Self-Dealing Transaction Disclosure Form (Exhibit C) and submitting it to the COUNTY prior
to commencing with the self-dealing transaction or immediately thereafter.
23. TAX EQUITY AND FISCAL RESPONSIBILITY ACT
To the extent necessary to prevent disallowance of reimbursement under Section 1861(v)
(1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(1)[I]), until the expiration of four (4)
years after the furnishing of services under this Agreement, CONTRACTOR shall make available, upon
written request of the Secretary of the United States Department of Health and Human Services, or upon
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request of the Comptroller General of the United States General Accounting Office, or any of their duly
authorized representatives, a copy of this Agreement and such books, documents, and records as are
necessary to certify the nature and extent of the costs of these services provided by CONTRACTOR
under this Agreement. CONTRACTOR further agrees that in the event CONTRACTOR carries out any
of its duties under this Agreement through a subcontract, with a value or cost of Ten Thousand and
No/100 Dollars ($10,000.00) or more over a twelve (12) month period, with a related organization, such
Agreement shall contain a clause to the effect that until the expiration of four (4) years after the
furnishing of such services pursuant to such subcontract, the related organizations shall make available,
upon written request of the Secretary of the United States Department of Health and Human Services, or
upon request of the Comptroller General of the United States General Accounting Office, or any of their
duly authorized representatives, a copy of such subcontract and such books, documents, and records of
such organization as are necessary to verify the nature and extent of such costs.
24. SINGLE AUDIT CLAUSE
A. If CONTRACTOR expends Seven Hundred Fifty Thousand Dollars
($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR agrees to conduct
an annual audit in accordance with the requirements of the Single Audit Standards as set forth in Office
of Management and Budget (OMB) Circular A-133. CONTRACTOR shall submit said audit and
management letter to COUNTY. The audit must include a statement of findings or a statement that there
were no findings. If there were negative findings, CONTRACTOR must include a corrective action plan
signed by an authorized individual. CONTRACTOR agrees to take action to correct any material non-
compliance or weakness found as a result of such audit. Such audit shall be delivered to COUNTY’s
Human Services Finance for review within nine (9) months of the end of any fiscal year in which funds
were expended and/or received for the program. Failure to perform the requisite audit functions as
required by this Agreement may result in COUNTY performing the necessary audit tasks, or at
COUNTY’s option, contracting with a public accountant to perform said audit, or, may result in the
inability of COUNTY to enter into future agreements with CONTRACTOR. All audit costs related to
this Agreement are the sole responsibility of CONTRACTOR.
B. A single audit report is not applicable if CONTRACTOR’s Federal contracts do not
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exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requirement or CONTRACTOR’s only
funding is through Drug related Medi-Cal. If a single audit is not applicable, a program audit must be
performed and a program audit report with management letter shall be submitted by CONTRACTOR to
COUNTY as a minimum requirement to attest to CONTRACTOR’s solvency. Said audit report shall be
delivered to COUNTY’s Human Services Finance for review, no later than nine (9) months after the
close of the fiscal year in which the funds supplied through this Agreement are expended. Failure to
comply with this Act may result in COUNTY performing the necessary audit tasks or contracting with a
qualified accountant to perform said audit. All audit costs related to this Agreement are the sole
responsibility of CONTRACTOR who agrees to take corrective action to eliminate any material
noncompliance or weakness found as a result of such audit. Audit work performed by COUNTY under
this section shall be billed to the CONTRACTOR at COUNTY’s cost, as determined by COUNTY’s
Auditor-Controller/Treasurer-Tax Collector.
C. CONTRACTOR shall make available all records and accounts for inspection by
COUNTY, the State of California, if applicable, the Comptroller General of the United States, the
Federal Grantor Agency, or any of their duly authorized representatives, at all reasonable times for a
period of at least three (3) years following final payment under this Agreement or the closure of all other
pending matters, whichever is later.
25. REFERENCES TO LAWS AND RULES
In the event any law, regulation, or policy referred to in this Agreement is amended during
the term thereof, the parties hereto agree to comply with the amended provision as of the effective date of
such amendment.
26. CHILD ABUSE REPORTING
CONTRACTOR shall utilize a procedure acceptable to COUNTY to ensure that all of
CONTRACTORS’ employees, volunteers, consultants, subcontractors or agents performing services
under this Agreement shall report all known or suspected child abuse or neglect to one or more of the
agencies set forth in Penal Code Section 11165.9. This procedure shall include having all of
CONTRACTORS’ employees, volunteers, consultants, subcontractors or agents performing services
under this Agreement sign a statement that he or she knows of and will comply with the reporting
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requirements set forth in Penal Code Section 11166. The statement to be utilized by CONTRACTOR is
set forth in Exhibit D, attached hereto and by this reference incorporated herein.
27. CHARITABLE CHOICE
CONTRACTOR may not discriminate in its program delivery against a participant or
potential participant on the basis of religion or religious belief, a refusal to hold a religious belief, or a
refusal to actively participate in a religious practice. Any specifically religious activity or service made
available to individuals by the CONTRACTOR must be voluntary as well as separate in time and
location from County-funded activities and services. CONTRACTOR shall inform COUNTY as to
whether it is faith-based. If CONTRACTOR identifies as faith-based it must submit to DBH-SUD
Services a copy of its policy on referring individuals to alternate services CONTRACTOR, and include a
copy of this policy for participants upon entry to services. The policy must inform individuals that they
may be referred to an alternative provider if they object to the religious nature of the program, and
include a notice to DBH-SUD Services. Adherence to this policy will be monitored during annual site
reviews. If CONTRACTOR identifies as faith-based, by July 1 of each year CONTRACTOR will be
required to report to DBH-SUD Services the number of individuals who requested referrals to alternate
providers based on religious objection.
28. EVALUATION AND MONITORING
COUNTY’s DBH Director or her designee shall monitor and evaluate the performance of
CONTRACTOR under this Agreement to determine to the best possible degree the success or failure of
the services provided under this Agreement. At the discretion of the COUNTY, a subcontractor may be
obtained by the COUNTY to independently evaluate and monitor the performance of the
CONTRACTOR. CONTRACTOR shall participate in the evaluation of the program for time periods as
determined by COUNTY’s DBH-SUD Services. CONTRACTOR shall participate in a program review
at least yearly, or as needed, at the discretion of COUNTY. The CONTRACTOR agrees to supply all
information requested by the COUNTY, County-subcontracted evaluator, State and/or Federal agency
during program evaluation, monitoring, and/or review.
COUNTY shall recapture from CONTRACTOR the value of any services or other
expenditures determined to be ineligible based on the COUNTY or State monitoring results. At the
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discretion of the COUNTY recoupment can be made through a future invoice reduction or
reimbursement by the CONTRACTOR.
29. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. section 2000d, and 45 C.F.R. Part
80) and Executive Order 12250 of 1979 which prohibits recipients of federal financial assistance from
discriminating against persons based on race, color, national origin, sex, disability or religion. This is
interpreted to mean that a Limited English Proficient (LEP) individual is entitled to equal access and
participation in federally funded programs through the provision of comprehensive and quality bilingual
services.
B. Policies and procedures for ensuring access and appropriate use of trained interpreters
and material translation services for all LEP consumers, including, but not limited to, assessing the cultural
and linguistic needs of its consumers, training of staff on the policies and procedures, and monitoring its
language assistance program. The CONTRACTOR’s procedures must include ensuring compliance of any
sub-contracted providers with these requirements.
C. CONTRACTOR shall not use minors as interpreters.
D. CONTRACTOR shall provide and pay for interpreting and translation services to
persons participating in CONTRACTOR’s services who have limited or no English language proficiency,
including services to persons who are deaf or blind. Interpreter and translation services shall be provided as
necessary to allow such participants meaningful access to the programs, services and benefits provided by
CONTRACTOR. Interpreter and translation services, including translation of CONTRACTOR’s “vital
documents” (those documents that contain information that is critical for accessing CONTRACTOR’s
services or are required by law) shall be provided to participants at no cost to the participant.
CONTRACTOR shall ensure that any employees, agents, subcontractors, or partners who interpret or
translate for a program participant, or who directly communicate with a program participant in a language
other than English, demonstrate proficiency in the participant's language and can effectively communicate
any specialized terms and concepts peculiar to CONTRACTOR’s services.
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E. In compliance with the State mandated Culturally and Linguistically Appropriate
Services standards as published by the Office of Minority Health, CONTRACTOR must submit to
COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR’s plan to address
all fifteen national cultural competency standards as set forth in the “National Standards on Culturally and
Linguistically Appropriate Services (CLAS)” attached hereto as Exhibit E and incorporated herein by
reference. COUNTY’s annual on-site review of CONTRACTOR shall include collection of documentation
to ensure all national standards are implemented. CONTRACTOR may solicit complementary assistance
from OnTrack Consulting (http://ontrackconsulting.org/news/culturally-linguistically-appropriate-services/)
for training in plan development. As the national competency standards are updated, CONTRACTOR’s
plan must be updated accordingly.
30. RECORDS
A. Record Establishment and Maintenance - CONTRACTOR shall establish and
maintain records in accordance with State and Federal rules and regulations in addition to those
requirements prescribed by COUNTY with respect to all matters covered by this Agreement. Except as
otherwise authorized by COUNTY, CONTRACTOR shall retain all other records for a period of five (5)
years after receiving the final payment under this Agreement or the earlier termination of this Agreement,
or until State and/or Federal audit findings applicable to such services are resolved, whichever is later.
B. Documentation - CONTRACTOR shall maintain adequate records in sufficient
detail to make possible an evaluation of services, and contain all the data necessary in reporting to the
State of California and/or Federal agency. All client records shall be maintained pursuant to applicable
State of California and Federal requirements concerning confidentiality.
C. Reports - CONTRACTOR shall submit to COUNTY monthly fiscal and all
program reports as further described in Section Thirty-Two (32), REPORTS and as indicated in Exhibit
A. Following the end of each fiscal year affected by this Agreement, CONTRACTOR shall submit a
complete and accurate year-end cost report. CONTRACTOR shall also furnish to COUNTY such
statements, records, reports, data, and information as COUNTY may request pertaining to matters
covered by this Agreement. All reports submitted by CONTRACTOR to COUNTY must be typewritten.
D. Suspension of Compensation - In the event that CONTRACTOR fails to provide
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reports specified in this Agreement, it shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance.
E. Disallowances – Payments by COUNTY shall be in arrears, for services provided
during the preceding month, within forty-five (45) days after receipt, verification and approval of
CONTRACTORS’ invoices by COUNTY’S DBH-SUD Services. If payment for services is denied or
disallowed by State; and subsequently resubmitted to COUNTY by CONTRACTOR, the disallowed
portion will be withheld from the next reimbursement to the CONTRACTOR until COUNTY has
received reimbursement from State for said services.
F. Client Confidentiality – CONTRACTOR shall conform to and COUNTY shall
monitor compliance with all State and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements of 42 Code of Federal
Regulations § 2.1 et seq., Welfare and Institutions Code §§ 5328, 10850 and 14100.2, Health and Safety
Code §§ 11977 and 11812, Civil Code, Division 1, Part 2.6, and 22 California Code of Regulations §
51009.
31. DISCLOSURE OF OWNDERSHIP AND CONTROL INTEREST INFORMATION
This provision is only applicable if CONTRACTOR is a disclosing entity, fiscal agent, or
managed care entity as defined in Code of Federal Regulations (C.F.R), Title 42 § 455.101 455.104, and
455.106(a)(1),(2).
In accordance with C.F.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(1),(2),
the following information must be disclosed by CONTRACTOR by completing Exhibit F, “Disclosure
of Ownership and Control Interest Statement”, attached hereto and by this reference incorporated herein.
CONTRACTOR shall submit this form to the Department of Behavioral Health within thirty (30) days
of the effective date of this Agreement. Submissions shall be scanned pdf copies and are to be sent via
email to DBHAdministration@co.fresno.ca.us attention: Contracts Administration:
1. Name and address of any person(s) whether it be an individual or corporation with an
ownership or controlling interest in the disclosing entity or managed care entity
a) Address must include the primary business address, every business location and
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P.O. Box address(es)
b) Date of birth and Social Security Number for individuals
c) Tax identification number for other corporations or entities with ownership or
controlling interest in the disclosing entity
2. Any subcontractor in which the disclosing entity has five (5) percent or more interest
3. Whether the person(s) with an ownership or controlling interest of the disclosing entity
is related to another person having ownership or controlling interest as a parent, spouse,
sibling or child. Including whether the person(s) with ownership or controlling interest
of the disclosing entity is related to a person (parent, spouse, sibling or child) with
ownership or has five (5) percent or more interest in any of its subcontractors
4. Name of any other disclosing entity in which an owner of the disclosing entity has an
ownership or control interest.
5. The ownership of any subcontractor with whom the provider has had business
transactions totaling more than $25,000 during the 12-month period ending on the date
of the request; and
6. Any significant business transactions between the provider and any wholly owned
supplier, or between the provider and any subcontractor, during the 5-year period
ending on the date of the request.
7. Any person(s) with an ownership or control interest in the provider, or agent or
managing employee of the provider; and
a) Has been convicted of a criminal offense related to that person's involvement in any
program under Medicare, Medicaid, or the title XX services program since the
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inception of those programs.
8. The ownership of any subcontractor with whom the provider has had business
transactions totaling more than $25,000 during the 12-month period ending on the
date of the request; and
a) Any significant business transactions between the provider and any wholly owned
supplier, or between the provider and any subcontractor, during the 5-year period
ending on the date of the request.
32. REPORTS
CONTRACTOR shall submit to COUNTY’s DBH-SUD Services such statements, records,
reports, data, and other information as the COUNTY may request pertaining to matters covered by this
Agreement.
1. CalOMS - Prevention service/activity data is to be reported via California’s
Outcomes Measurement System (CalOMS). Services are to be reported by the date of occurrence on a
weekly basis. No more than one week’s data shall be aggregated into one reported service. Program data
and any other information required to report progress on prevention goals and objectives to the State of
California for the CalOMS Annual Progress Report shall be provided to the County-contracted Program
Evaluator and/or County no later than September 1 of each fiscal year.
2. Measurement Tools - In addition to other program activities and outcomes reporting
as may be required by this Agreement, CONTRACTOR shall implement program measurement tools
and report program activities and outcomes as directed by the Program Evaluator and/or COUNTY staff.
3. Cost Reports – On an annual basis for each fiscal year ending June 30th
CONTRACTOR shall submit a complete and accurate detailed cost report(s). Cost reports must be
submitted to the COUNTY as a hard copy with a signed cover letter and an electronic copy by the due
date. Submittal must also include any requested support documents such as general ledgers. All reports
submitted by CONTRACTOR to COUNTY must be typewritten. COUNTY will issue instructions for
completion and submittal of the annual cost report, including the relevant cost report template(s) and due
dates within forty-five (45) days of each fiscal year end. All cost reports must be prepared in accordance
with Generally Accepted Accounting Principles. Unallowable costs such as lobbying or political
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donations must be deducted from the cost report and all invoices. If the CONTRACTOR does not submit
the cost report by the due date, including any extension period granted by the COUNTY, the COUNTY
may withhold payment of pending invoices until the cost report(s) has been submitted and clears
COUNTY desk audit for completeness and accuracy.
During the term of this Agreement and thereafter, COUNTY and CONTRACTOR agrees
to settle dollar amounts disallowed or settled in accordance with DHCS and COUNTY audit settlement
findings related to the DMC and realignment reimbursements. DHCS audit process is approximately
eighteen (18) to thirty-six (36) months following the close of the State fiscal year. COUNTY may choose
to appeal DHCS settlement results and therefore reserves the right to defer payback settlement with
CONTRACTOR until resolution of the appeal.
In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for the COUNTY to withhold monthly payments
until there is compliance. In addition, the CONTRACTOR shall provide written notification and
explanation to the COUNTY within fifteen (15) days of any funds received from another source to
conduct the same services covered by this Agreement.
33. PROPERTY OF COUNTY
A. All purchases over Five Thousand and No/100 Dollars ($5,000.00) shall be
identified as fixed assets and shall be maintained in COUNTY’s Asset Management System. Certain
purchases under Five Thousand and No/100 Dollars ($5,000.00) including but not limited to computers,
copiers, televisions, cameras and other sensitive items as determined by COUNTY’s DBH Director or
designee made during the life of this Agreement shall be identified as assets that can be inventoried and
maintained in COUNTY’s DBH Asset Inventory System. These assets shall be retained by COUNTY, as
COUNTY property, in the event this Agreement is terminated or upon expiration of this Agreement.
CONTRACTOR agrees to participate in an annual inventory of all COUNTY fixed and inventoried
assets and shall be physically present when fixed and inventoried assets are returned to COUNTY
possession at the termination or expiration of this Agreement. CONTRACTOR is responsible for
returning to COUNTY all COUNTY owned fixed and inventoried assets, or the monetary value of said
assets if unable to produce the assets at the expiration or termination of this Agreement.
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CONTRACTOR further agrees to the following:
1. To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2. To label all items of equipment, to perform periodic inventories as required
by COUNTY and to maintain an inventory list showing where and how the equipment is being used, in
accordance with procedures developed by COUNTY. All such lists shall be submitted to COUNTY
within ten (10) days of any request therefore; and
3. To report in writing to COUNTY immediately after discovery, the lost or
theft of any items of equipment. For stolen items, the local law enforcement agency must be contacted
and a copy of the police report submitted to COUNTY.
B. The purchase of any equipment by CONTRACTOR with funds provided hereunder
shall require the prior written approval of COUNTY’s DBH Director or designee, shall fulfill the
provisions of this Agreement as appropriate, and must be directly related to CONTRACTORS’ services
or activity under the terms of this Agreement. COUNTY’s DBH Director or designee may refuse
reimbursement for any costs resulting from equipment purchased, which are incurred by
CONTRACTOR, if prior written approval has not been obtained from COUNTY.
C. The terms and conditions described in this Section are not applicable to the leasing
of vehicles by CONTRACTOR with the funds provided under this Agreement.
34. PROHIBITION ON PUBLICITY
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTORS’ advertising, fundraising, or publicity (i.e.,
purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
Notwithstanding the above, publicity of the services described in Section One (1), CONTRACTOR’s
REPONSIBILITIES of this Agreement shall be allowed as necessary to raise public awareness about the
availability of such specific services when approved in advance by the DBH Director or her designee and
at a cost as provided in Exhibit B for such items as written/printed materials, the use of media (i.e., radio,
television, newspapers) and any other related expense(s).
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35. AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as COUNTY may
deem necessary, make available to COUNTY for examination all of its records and data with respect to
the matters covered by this Agreement. CONTRACTOR shall, upon request by COUNTY, permit
COUNTY to audit and inspect all such records and data necessary to ensure CONTRACTORS’
compliance with the terms of this Agreement.
If this Agreement exceeds Ten Thousand and No/100 Dollars ($10,000.00),
CONTRACTOR shall be subject to the examination and audit of the State of California Auditor General
for a period of three (3) years after final payment under Contract (California Government Code Section
8546.7).
Notwithstanding the provisions stated in Section Three (3), TERMINATION of this
Agreement, it is acknowledged by the parties hereto that this Agreement shall continue in full force and
effect until all audit procedures and requirements as stated in this Agreement have been completed to the
review and satisfaction of COUNTY. CONTRACTOR shall bear all costs in connection with or
resulting from any audit and/or inspections including, but not limited to, actual costs incurred and the
payment of any expenditures disallowed by either COUNTY, State, or Federal governmental entities,
including any assessed interest and penalties.
36. NOTICES
The persons and their addresses have authority to give and receive notices under this
Agreement include the following:
COUNTY CONTRACTOR
Director Chief Executive Officer
Fresno County DBH California Health Collaborative
3133 N. Millbrook Ave 1680 West Shaw Avenue
Fresno, CA 93703 Fresno, CA 93711-3504
37. CHANGE OF LEADERSHIP / MANAGEMENT
Any and all notices between COUNTY and CONTRACTOR provided for or permitted
under this Agreement or by law, shall be in writing and shall be deemed duly served when personally
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delivered to one of the parties, or in lieu of such personal service, when deposited in the United States
Mail, postage prepaid, addressed to such party.
In the event of any change in the status of CONTRACTORS’ leadership or management,
CONTRACTOR shall provide written notice to COUNTY within thirty (30) days from the date of
change. Such notification shall include any new leader or manager’s name, address and qualifications.
“Leadership or management” shall include any employee, member, or owner of CONTRACTOR who
either a) directs individuals providing services pursuant to this Agreement, b) exercises control over the
manner in which services are provided, or c) has authority over CONTRACTORS’ finances.
38. GOVERNING LAW
The parties agree that for the purpose of venue, performance under this Agreement is in
Fresno County, California.
The rights and obligations of the parties and all interpretation and performance of this
Agreement shall be governed in all respects by the laws of the State of California.
39. CONTRACTOR DOCUMENTATION
CONTRACTORS that are not licensed or certified by the State must submit organizational
documents to the State within thirty (30) days of Agreement execution date, within ninety (90) days of
the renewal or continuation of this Agreement or when there has been a change in name or ownership.
Organizational documents include Articles of Incorporation or Partnership Agreements (as applicable),
and business licenses, fictitious name permits, and such other information and documentation as may be
requested by the State. CONTRACTORS not meeting these requirements may have payments withheld
and/or contracts terminated.
40. NO UNLAWFUL USE OR UNLAWFUL USE MESSAGES REGARDING DRUGS
CONTRACTOR agrees that information produced through these funds, and which pertains
to drug- and alcohol-related programs, shall contain a clearly written statement that there shall be no
unlawful use of drugs or alcohol associated with the program. Additionally, no aspect of a drug- or
alcohol-related program shall include any message on the responsible use, if the use is unlawful, of drugs
or alcohol (HSC Section 11999).
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41. SMOKING PROHIBITION REQUIREMENTS
CONTRACTOR shall comply with Public Law 103-227, also known as the Pro-Children
Act of 1994 (20 USC Section 6081, et seq.), and with California Labor Code Section 6404.5, the
California Smoke-Free Workplace Law.
42. CLEAN AIR AND WATER
In the event funding under this Agreement exceeds One Hundred Thousand Dollars
($100,000.00), the CONTRACTOR must comply with all applicable standards, orders, or requirements
issued under section 306 of the Clean Air Act (42 U.S.C. 1857 (h)), section 506 of the Clean Water Act (33
U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR part 32).
43. TRAFFICKING IN PERSONS PROVISIONS – PRIVATE ENTITY
CONTRACTOR shall conform to all Federal statutes and regulations prohibiting
trafficking in persons, as well as trafficking-related activities, including, but not limited to the trafficking
of persons provisions in Section 106(g) of the Trafficking Victims Protection Act of 2000 (TVPA).
CONTRACTOR, CONTRACTOR’s employees, subrecipients, and subrecipients’
employees may not:
A. Engage in severe forms of trafficking in person during the period of time that the
award is in effect;
B. Procure a commercial sex act during the period of time that the award is in effect; or
C. Use forced labor in the performance of the award or subawards under the award.
This agreement may be unilaterally terminated, without penalty, if CONTRACTOR or a
subrecipient that is a private entity is determined to have violated a prohibition of the TVPA or has an
employee who is determined by the DBH Director or her designee to have violated a prohibition of the
TVPA through conduct that is either associated with performance under the award or imputed to the
CONTRACTOR or their subrecipient using the standards and due process for imputing the conduct of an
individual to an organization that are provided in 2 C.F.R. Part 180, “OMB Guidelines to Agencies on
Government-wide Debarment and Suspension (Nonprocurement).”
CONTRACTOR must inform the DBH Director or her designee immediately of any
information received from any source alleging a violation of a prohibition of the TVPA.
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44. ENERGY EFFICIENCY
The CONTRACTOR must comply with the mandatory standards and policies relating to
energy efficiency which are contained in the state energy conservation plan issued in compliance with
Energy Policy and Conservation Act (Pub. L. 94 163).
45. ENTIRE AGREEMENT
This Agreement, including RFP No. 952-5414, Addendum I, and all Exhibits attached
hereto, constitute the entire Agreement between the CONTRACTOR and COUNTY with respect to the
subject matter hereof and supersedes all previous negotiations, proposals, commitments, writings,
advertisements, publications, and understandings of any nature whatsoever unless expressly included in
this Agreement.
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Exhibit A-1
Page 1 of 9
1
SCOPE OF WORK
Section 2: Marijuana Prevention (PATH)
Implementation Plan
The Implementation Plan below outlines particulars for each campaign of the Performing Above
the High (PATH) Project including rationale for selection, detailed list of activities and
timelines, target population, and outcomes. The plan is broken down by campaign and/or CSAP
strategy area.
All educational and informational materials developed for program distribution will be
developed in Fresno County’s threshold languages (English, Hmong, and Spanish) and in
compliance with Culturally and Linguistically Appropriate Services (CLAS) standards.
Specific to evidence-based curriculum implementation, CHC’s AOD prevention programs will
implement the different levels of Too Good For Drugs. The implementation plan allows for
expanded reach throughout the county and is based on age of initiation. It also allows for easier
implementation of a standardized assessment tool, with wider student population reach, that
provides for easier comparison of AOD use rates over the years.
f PERFORMING v A rJABOVEfttiifiH
Exhibit A-1
Page 2 of 9
2
PATH Campaign 1: PATH Prevention Education
CSAP Strategy: Prevention Education
Background/Overview and rationale for selection:
The Performing Above the High (PATH) will implement the grade specific levels of the Too
Good for Drugs curriculum with a representative sample of school districts/communities of the three
regions of the county, including: Eastern – Parlier Unified School District (USD), Kings Canyon
USD, and Kingsburg USD; Central – Fresno USD, Central USD, and Washington USD; Western –
Mendota USD, Firebaugh USD, and Kerman USD.
Lastly, the Performing Above the High (PATH) Project will implement one-time
presentations using medically accurate and research proven information with youth and young adults
ages 10-25 in school districts throughout Fresno County. One-time presentations may also be
provided in other settings, including afterschool and with youth groups in community-based settings.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Out-Of-School Youth
Fiscal Year (FY) 2016-2017
° Implement TGFD with schools in the following school districts:
Parlier USD, Fresno USD, and Mendota USD
° Conduct 10-15 one-time presentations targeting middle, high
school, college age youth and in community settings. A minimum
of 5 presentations will target 18-25 year olds annually
Fiscal Year 2017-2018
° Implement TGFD with schools in the following school districts:
Kings Canyon USD, Central USD, Firebaugh USD
° Conduct 10-15 one-time presentations targeting middle, high
school, college age youth and in community settings. A minimum
of 5 presentations will target 18-25 year olds annually
Fiscal Year 2018-2019
° Implement TGFD with schools in the following school districts:
Kingsburg USD, Washington USD, Kerman USD
° Conduct 10-15 one-time presentations targeting middle, high
school, college age youth and in community settings. A minimum
of 5 presentations will target 18-25 year olds annually
Fiscal Year 2019-2020
° Implement TGFD at selected schools as dictated by community
needs
° Conduct 10-15 one-time presentations targeting middle, high
school, college age youth and in community settings. A minimum
of 5 presentations will target 18-25 year olds annually
Outcomes
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19, the
number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 3 of 9
3
PATH Campaign 2: PATH Advisory Committee
CSAP Strategy: Community Based Process
Background/Overview and rationale for selection:
CHC understands that engaging youth and adult professional in AOD prevention efforts increases the
level of possible reach with program campaigns and provides access to expertise or perspectives that can
support further development and improvement of the programs’ efforts and design.
By involving professionals from different community sectors as part of the countywide AOD
Prevention Advisory Board (AB), the program will engage professionals with expertise in areas that program
staff may lack. Also, in order to have youth voice and engagement in AOD prevention efforts, the program
will recruit / nominate youth to form part of a countywide Youth Advisory Board (YAB). Members of the AB
and YAB will be trained and engaged in AOD prevention efforts throughout the county and for the duration of
the contract term.
Target Population:
Scope of Work Activities and Timelines
Youth
Law Enforcement
Media
Treatment Professionals
School Administration
Parents
Prevention Professionals
Fiscal Year 2016-2017 through FY 2019-2020
• Recruit at least 15 adult professional representing varied disciplines
and community sectors to form part of the Advisory Board (AB)
• Recruit at least 6 youth and establish a countywide AOD
prevention Youth Advisory Board (YAB) representing the three
regions of Fresno County
• Establish a retention plan for maintaining AB and YAB members
involved
• Coordinate with AB and YAB members to develop a strategic plan
during FY 2017-2018 that evaluates program accomplishments and
provides direction for advancing future AOD prevention efforts for
Fresno County
• Train and engage AB and YAB members in AOD prevention
efforts throughout the contract period
• Coordinate with AB and YAB members to develop and implement
educational/advocacy/systems and environmental change activities
to deter drug and alcohol use in their communities. The activities
or projects may take place in their school, community or be
countywide
• Coordinate with the Lock It Up Project to plan and conduct an
annual AOD Prevention Youth Conference
• Annually evaluate AB and YAB members to assess their
satisfaction with the Boards and their involvement
Outcomes
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19,
the number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 4 of 9
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PATH Campaign 3: I Perform Above the High (iPATH)
CSAP Strategy: Environmental Approach, Alternative Activities,
Prevention Education, Information Dissemination
Background/Overview and rationale for selection:
The I Perform Above the High (iPATH) Campaign is designed to train Fresno County Youth to serve
as community youth advocates on local youth Advisory Boards (YAB), with the purpose of providing youth a
voice in marijuana prevention efforts and directly involving them in changing social norms in their
communities. YAB participants are trained in topics such as advocacy, policy change, public speaking,
community needs assessments, and marijuana prevention.
Annually, the iPATH campaign will also recruit youth and young adults countywide to join a
countywide iPATH YAB who will gather at an annual retreat known as the Youth Empowerment Summit
(YES). The YES will provide youth with an opportunity to create an annual countywide campaign which is
then implemented by local YABs in their own communities. Examples of campaigns include media
campaigns, policy/systems change efforts, and other sustainable forms of marijuana prevention activities.
Target Population:
Scope of Work Activities and Timelines
Middle School Students
High School Students
College Students
Out of School Youth
Fiscal Year 2016-2017
• Recruit 25 youth from a minimum of 3 schools, colleges, or
community based settings throughout Fresno County to be
involved in local YABs in their community. Recruit 30 youth to
participate in the annual Youth Empowerment Summit and
implement a minimum of one countywide prevention campaign.
A minimum of 30 youth will be recorded iPATH members.
Fiscal Year 2017-2018
• Recruit 25 youth from a minimum of 3 schools, colleges, or
community based settings throughout Fresno County to be
involved in local YABs in their community. Recruit 30 youth to
participate in the annual Youth Empowerment Summit and
implement a minimum of one countywide prevention campaign.
A minimum of 60 youth will be recorded iPATH Members.
Fiscal Year 2018-2019
• Recruit 25 youth from a minimum of 3 schools, colleges, or
community based settings throughout Fresno County to be
involved in local YABs in their community. Recruit 30 youth to
participate in the annual Youth Empowerment Summit and
implement a minimum of one countywide prevention campaign.
A minimum of 90 youth will be recorded iPATH Members.
Fiscal Year 2019-2020
• Recruit 25 youth from a minimum of 3 schools, colleges, or
community based settings throughout Fresno County to be
involved in local YABs in their community. Recruit 30 youth to
participate in the annual Youth Empowerment Summit and
implement a minimum of one countywide prevention campaign.
Outcomes
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19, the
number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 5 of 9
5
PATH Campaign 4: YouthPATH
CSAP Strategy: Information Dissemination
Background/Overview and rationale for selection:
The Youth Performing Above the High (YouthPATH) campaign enables PATH Project staff to reach
thousands of youth countywide with education and awareness information about the health,
developmental, and safety consequences of marijuana use. With the use of a customized mobile vehicle,
already owned and operated by the PATH Project, this campaign provides a moving billboard for marijuana
prevention messaging through an external wrap of the vehicle and internal display of public service
announcements which deglamorize substance use and abuse. Additionally, this campaign provides
interactive informational booths, in locations where the mobile unit cannot be utilized, all with the intent of
attracting youth and educating them on the consequences of marijuana use.
As an added component of this campaign, PATH will train and monitor youth to disseminate
marijuana prevention education through social media pages including Facebook, Instagram, Twitter, and
YouTube. These pages will be promoted at community events in order to build a captive audience for
marijuana prevention information dissemination.
Target Population:
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Out of School Youth
Fiscal Year 2016-2017
• Provide interactive informational booths at a minimum of 25
community and school-based settings targeting primarily youth
and young adults in Fresno County. Train a minimum of 5 youth
to assist in hosting the informational booths. Increase annual
membership in social networking sites by 5%.
Fiscal Year 2017-2018
• Provide interactive informational booths at 30 community and
school-based settings targeting primarily youth and young adults
in Fresno County. Train a minimum of 5 youth to assist in hosting
the informational booths. Ensure adequate reach in each region
of Fresno County (Eastern, Western, Central). Increase annual
membership in social networking sites by 5%.
Fiscal Year 2018-2019
• Provide interactive informational booths at 35 community and
school-based settings primarily targeting youth and young adults,
in Fresno County. Involve youth participation in hosting booths at
a minimum of 5 community events. Increase membership in
social networking sites by 5%.
Fiscal Year 2019-2020
• Provide interactive informational booths at 40 community and
school-based settings primarily targeting youth and young adults,
in Fresno County. Involve youth participation in hosting booths at
a minimum of 5 community events. Increase membership in
social networking sites by 5%.
Outcomes
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19, the
number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 6 of 9
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PATH Campaign 5: PATH-4-Life
CSAP Strategy: Information Dissemination
Background/Overview and rationale for selection:
Performing above the High for Life (PATH4Life) is a parent campaign which utilizes evidence-based and
research-based messages to educate Fresno County parents and legal guardians about marijuana use
among youth and young adults in an attempt to prevent, identify, and intervene in marijuana use.
Parent Marijuana Prevention Trainings: A 45-60 minute parent training on current marijuana trends, the
dangers and consequences of marijuana use among youth, signs and symptoms of marijuana use, and
information on available treatment resources in their local communities.
PATH Resource Manual: Create a marijuana prevention resource manual to be distributed to parents who
attend the PATH-4-Life Training.
PATH Media Campaign: Create an annual media campaign designed by parents for parents.
Target Population:
Scope of Work Activities and Timelines
Parents
Adults
Fiscal Year 2016-2017
• Provide a minimum of 5 parent trainings in each region of Fresno
County (Eastern, Western, and Central) for a total of 15 trainings.
Target a minimum of 150 parents countywide annually.
• Involve parents in a minimum of one (1) media campaign (print,
radio or TV) targeting parents with marijuana prevention
information.
• Create the PATH Parent Resource Manual and conduct one focus
group to identify parent satisfaction and additional information
to be included.
Fiscal Years 2017-2018, 2018-2019, 2019-2020
• Provide a minimum of 5 parent trainings in each region of Fresno
County (Eastern, Western, and Central) for a total of 15 trainings.
Target a minimum of 150 parents countywide annually.
• Involve parents in a minimum of one (1) media campaign (print,
radio or TV) targeting parents with marijuana prevention
information. Distribute the Parent Resource Manual at every
training
• Re-evaluate the PATH Parent Resource Manual on an annual basis
to ensure update-to-date resources are provided
Site of Service
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19,
the number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 7 of 9
7
PATH Campaign 6: Reality Tour
CSAP Strategy: Community Based Process, Information Dissemination
Background/Overview and rationale for selection:
Reality Tour is an evidence-based community-led drug prevention program designed to increase parent-
child communication between parent and child and increase negative attitudes surrounding substance use.
The Reality Tour Program is especially unique in that it involves the entire community in preventing
substance abuse through a series of presentations, dramatic representations, and community question and
answer session. This PATH Program implemented 7 Reality Tours during the last contract period and was
successful in targeting hundreds of parents and youth with the award-winning program.
Community Planning Committee - Recruit and organize a community-led Reality Tour Planning Committee
in each targeted community who will be responsible for leading main activities for the Reality Tour Planning,
recruiting volunteers, and recruiting participants. A community champion will be selected from each
community in order to develop sustainability for the program.
Each hosted tour will target a minimum of 100 participants.
Target Population:
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Parents
Law Enforcement
Community
Fiscal Year 2016-2017
• Implement 1-2 Reality Tours in the region of Eastern Fresno
County. Subcontract with Fresno Police Department and the
faith-based organization Bringing Broken Neighborhoods Back to
Life to implement a minimum of 2 additional tours in the city of
Fresno, specifically in high need neighborhoods.
Fiscal Year 2017-2018
• Implement 1-2 Reality Tours in the region of Western Fresno
County. Subcontract with Fresno Police Department and the
faith-based organization Bringing Broken Neighborhoods Back to
Life to implement a minimum of 2 additional tours in the city of
Fresno, specifically in high need neighborhoods.
Fiscal Year 2018-2019
• Implement 1-2 Reality Tours in the region of Eastern and/or
Western Fresno County. Subcontract with Fresno Police
Department and the faith-based organization Bringing Broken
Neighborhoods Back to Life to implement a minimum of 2
additional tours in the city of Fresno, specifically in high need
neighborhoods.
Fiscal Year 2019-2020
• Implement 1-2 Reality Tours a year in the region of Eastern
and/or Western Fresno County. Subcontract with Fresno PD and
the faith-based organization Bringing Broken Neighborhoods Back
to Life to implement a minimum of 2 additional tours in the city
of Fresno, specifically in high need neighborhoods
Site of Service
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19,
the number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 8 of 9
8
PATH Campaign 7: PATH&Law
CSAP Strategy: Community Based Process
Background/Overview and rationale for selection:
The Performing Above the High & Law Enforcement (PATH&LAW) Campaign is designed to establish and
foster relationships with local law enforcement agencies. By bridging the gap between enforcement of
marijuana possession/use agencies and marijuana prevention agencies. It is anticipated that solutions
will evolve that address the enforcement, or lack thereof, of marijuana use/possession laws in Fresno
County. Law Enforcement partners will be invited to participate in the Advisory Committee and will work
with project staff to provide technical assistance and training to Youth Advisory Board members in
support of their advocacy efforts.
Target Population:
Scope of Work Activities and Timelines
Law Enforcement
Fiscal Year 2016-2017
• PATH will participate in a minimum of 2 law enforcement
activities that increase collaboration between prevention and
enforcement efforts in Fresno County.
• PATH will assist law enforcement with the development of
one educational material that educates the community on
marijuana use/possession laws in Fresno County.
• PATH will involve law enforcement in a minimum of one
training for youth advocates.
Fiscal Year 2017-2018, 2018-2019, 2019-2020
• PATH will participate in a minimum of 3 law enforcement
activities annually that increase collaboration between
prevention and enforcement efforts in Fresno County.
• PATH will assist law enforcement with distributing the
educational material created in Year 1 – 2016-2017. A
minimum of 300 pieces of material will be distributed
countywide annually.
• PATH will involve law enforcement in a minimum of two
trainings for youth advocates annually.
Site of Service
Short-Term: By 6/30/17,
increase the number of youth
receiving educational services by
5% in Fresno County.
Intermediate: By 6/30/19, the
number of adults that have
received educational services in
Fresno County will increase by
10%.
Long-Term: By 6/30/20, the
average age of first time
marijuana use will increase by 2
years.
By 6/30/20, reduce youth
marijuana use by 5%.
Exhibit A-1
Page 9 of 9
9
Cultural Competency
Establishing cultural competence in community prevention services for substance abuse requires
the development of strategies, practices and infrastructure development among the lead agency
and in partnership with community based institutions and groups that will enable effective
design, implementation and evaluation of the program model. Therefore, CHC will address
cultural competency needs in program design and staffing determinations.
CHC’s plan allows the PATH Project to accomplish three goals:
1 The assessment and review of the target population, prevention program model, materials
and educational resources that demonstrates a project and its operations that is reflective
of the diversity of the community it serves.
2. Create opportunities for community leaders and stakeholders to partner and advance the
agenda for prevention services that meet the needs of a diverse target population in the
County
3. Increase the quality of services provided to youth and their families accessing a program
that has a culturally and linguistically competent model.
Furthermore, CHC will develop and complete a local needs assessments including surveys and
focus groups with members of the target population, community leaders and providers of health
and human services to design a prevention partnership model that will focus on the following
elements:
• Identify and establish opportunities for defined collaboration to assist targeted populations of
culturally diverse youth and families with multiple needs for resources and referral. This
strategy is designed to address and minimize environmental factors that may place youth and
families at risk for problems associated with marijuana use.
• Design strategies to improve the scope and quality of marketing and outreach to diverse
cultural groups as an integral part of the implementation of the prevention service model. The
marketing strategy will be reflective of the diversity of the cultures served by our program in
the targeted communities of Fresno County.
• Develop short and long term strategies for capacity building in the community that will
achieve sustainability of the prevention program at a level commensurate with existing and
future resources.
Exhibit A-2
Page 1 of 11
1
SCOPE OF WORK
Section 3: Rx Prevention (Lock It Up)
Implementation Plan
The following implementation plan outlines details for each campaign of the Lock It Up Project,
including rationale for selection, detailed list of activities and timelines, target population, and
outcomes.
All educational and informational materials developed for program distribution will be
developed in Fresno County’s threshold languages (English, Hmong, and Spanish) and in
compliance with Culturally and Linguistically Appropriate Services (CLAS) standards.
Specific to evidence-based curriculum implementation, CHC’s AOD prevention programs will
implement the different levels of Too Good For Drugs. The implementation plan allows for
expanded reach throughout the county and is based on age of initiation. It also allows for easier
implementation of a standardized assessment tool, with wider student population reach, that
provides for easier comparison of AOD use rates over the years.
nr *P R 0 J E
Exhibit A-2
Page 2 of 11
2
Prevention Education
CSAP Strategy: Prevention Education
Background/Overview and rationale for selection:
The Lock It Up Project will implement the grade specific levels of the Too Good for
Drugs curriculum with a representative sample of school districts/communities of the three
regions of the county, including: Eastern – Parlier Unified School District (USD), Kings
Canyon USD, and Kingsburg USD; Central – Fresno USD, Central USD, and Washington
USD; Western – Mendota USD, Firebaugh USD, and Kerman USD.
In order to fill the need for prevention messaging countywide, Lock It Up Project will
implement one-time presentations, with youth and young adults not participating in curriculum
implementation throughout Fresno County and offer Educate Fresno County training and “Rx for
Understanding: Be Smart About Rx Drugs” as indicated by community needs and interest.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Out of School Youth
Fiscal Year (FY) 2016-2017
° Implement TGFD with schools in the following school
districts: Parlier USD, Fresno USD, and Mendota USD
° Conduct 10-15 one-time presentations targeting middle,
high school, college age youth and in community settings
Fiscal Year 2017-2018
° Implement TGFD with schools in the following school
districts: Kings Canyon USD, Central USD, Firebaugh USD
° Conduct 10-15 one-time presentations targeting middle,
high school, college age youth and in community settings
Fiscal Year 2018-2019
° Implement TGFD with schools in the following school
districts: Kingsburg USD, Washington USD, Kerman USD
° Conduct 10-15 one-time presentations targeting middle,
high school, college age youth and in community settings
Fiscal Year 2019-2020
° Implement TGFD at selected schools as dictated by
community needs
° Conduct 10-15 one-time presentations targeting middle,
high school, college age youth and in community settings
Outcomes
Short-term goal-By 6/30/17,
increase the participation in
the campaigns to reduce youth
access to Rx and over the
counter drugs by 5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will have
reported a life-time reduction in
prescription and over the
counter drug use by 5%
Exhibit A-2
Page 3 of 11
3
Youth Coalition
CSAP Strategy: Prevention Education/Information
Dissemination
Background/Overview and rationale for selection:
In collaboration with partner schools/school districts, Lock It Up Project will convene Youth
Coalitions in the communities of Reedley, Sanger and Firebaugh. Each coalition will consist of
the following: a) leadership skills training, b) media projects c) raising awareness on school
campus and the community regarding prescription and over the counter drug abuse among youth
through educational activities. The Youth Coalition promotes a drug free lifestyle through active
participation in Lock It Up Project’s campaigns.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
FY 2016-2017 through FY 2019-2020
• Recruit a minimum of 10-15 youth from each site to
participate in youth coalition
• Develop and/or update training materials
• Conduct regular meetings with the youth coalitions
• Coordinate with existing members to create a recruitment
and retainment plan
• Develop and regularly update a calendar of activities for
coalition members
• Establish a tracking system to monitor participation of
youth in coalition activities
• Youth will create a minimum of 1 media/educational
project and participate in a total of 3 activities on school
campus or in their community and complete Educate
Fresno County training
• Coordinate with evaluation team to develop assessment
tools that help measure participant satisfaction
.
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5%
By 6/30/20, youth will
have reported a life-time
reduction in prescription and
over the counter drug by 5%
Exhibit A-2
Page 4 of 11
4
Peer Education Program
CSAP Strategy: Prevention Education/Information
Dissemination
Background/Overview and rationale for selection:
Peer Education Program is a semester long program aimed at engaging college-age young adults
in the prevention of prescription and over-the-counter drugs on their college campus and
throughout Fresno County. Students receive monthly trainings and are tasked with completing
different projects each month such as media projects, educational presentations for
peers/professors, tabling events on their college/university campus, in-service trainings, town
hall meetings, etc. Returning students will be able to assist in the training of peer educators in the
role of peer mentors. The Peer Education Program promotes a drug free lifestyle through active
participation in Lock It Up Project’s campaigns.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
FY 2016-2017 through FY 2019-2020
• Sub-contract with California Health Sciences
University for the expansion of Peer Education
Program targeting future pharmacy students in Fresno
County. The goal is to promote use of prescription
drug monitoring program, partner with medical
providers, and raise awareness throughout Fresno
County on youth prescription drug abuse prevention.
• Recruit 8-10 college students from CSU-Fresno and
8-10 students from Fresno City College to participate
in Peer Education Program. Peers will:
o Receive 1-2 development trainings per month
o Conduct one individual project such as tabling
event, media project, and educational
presentations
o Participate in planning and organizing one end
of year project
Outcomes
Short-term goal-By 6/30/17,
increase the participation in the
campaigns to reduce youth
access to Rx and over the
counter drugs by 5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and over
the counter drugs by high
school age youth
Long-term goal-By 6/30/20,
youth will have decreased
lifetime use of Rx drugs by 5%
in Fresno County
By 6/30/20, youth will have
reported a life-time reduction in
prescription and over the
counter drug use by 5%
Exhibit A-2
Page 5 of 11
5
Parent/Adult Education
CSAP Strategy: Prevention Education
Background/Overview and rationale for selection:
Parent/Adult Education targets parents, adults and youth serving professionals with educational
presentations on the dangers of prescription and over-the-counter drug abuse/misuse, importance
of safe guarding prescription medication and proper disposal of expired/unused medication.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students: teen
parents
College Students
Other: Senior Citizens
FY 2016-2017 through FY 2019-2020
• Provide 15 trainings to parents/adults reaching a total of
80 participants
• Regularly review and update educational materials for
content as needed
• Coordinate with evaluation team to develop assessment
instruments that measure the effectiveness of the
materials
• Create and regularly maintain a calendar of parent/adult
education activities
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will
have reported a life-time
reduction in prescription and
over the counter drug use by
5%
Exhibit A-2
Page 6 of 11
6
Town Hall Meetings
CSAP Strategy: Information Dissemination
Background/Overview and rationale for selection:
Town Hall meetings are an effective method to raise awareness about prescription and over the
counter drugs through presentations from a panel of experts that includes representatives from
law enforcement, mental health services, education, medical, and individuals directly impacted
by the abuse of prescription drugs.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Parents
Fiscal Year 2016-2017
Conduct 2 community town hall meetings in the
communities of Parlier and Fresno
Fiscal Year 2017-2018
Conduct 2 community town hall meetings in the
communities of Reedley and Firebaugh
Fiscal Year 2018-2019
Conduct 2 community town hall meetings in the
communities of Kingsburg, and West Fresno
Fiscal Year 2019-2020
Conduct 2 community town hall meetings in accordance to
community interest and needs
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will have
reported a life-time reduction
in prescription and over the
counter drug use by 5%
Exhibit A-2
Page 7 of 11
7
Lock It Up, Clean It Out, Drop It Off Initiative
CSAP Strategy: Environmental Process/Information
Dissemination
Background/Overview and rationale for selection:
A network of community stakeholders coming together to support safe disposal sites for the
collection of unused/expired medication throughout Fresno County. Currently 9 law enforcement
agencies host a safe disposal collection site in the communities of Fresno, Clovis, Reedley,
Orange Cove, Parlier, Mendota, Coalinga, and Sanger. The Lock It Up Project and community
stakeholders will continue to convene bi-monthly meetings to discuss progress in the collection
and disposal of prescription medications.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Law Enforcement, pharmacist,
treatment, clinics, medical
providers, community
stakeholders
Fiscal Year 2016-2017 – FY 2019-20
• Continue to convene the workgroup of community
stakeholders
• Continue to collect and report the amount of
prescription drugs collected at participating sites
• Facilitate strategy development sessions, as needed,
to address challenges associated with the drop-off
boxes (e.g. misuse, graffiti, etc.)
• Expand collection sites to 1-2 Fresno County
communities.
• Expand community outreach in each of the
participating sites to inform residents of the drop-off
sites and educate about proper disposal
• Coordinate with evaluation team to develop
assessment tools to evaluate the campaign’s
effectiveness
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will have
reported a life-time reduction
in prescription and over the
counter drug use by 5%
Exhibit A-2
Page 8 of 11
8
Pharmacy Initiative/Medical Provider Education
CSAP Strategy: Environmental Process/ Information
Dissemination
Background/Overview and rationale for selection:
Partnership with pharmacy professionals to educate their clients on safe guarding of prescription
medication, promoting the use of lock boxes, and promoting safe disposal sites throughout
Fresno County.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
Pharmacist
Fiscal Year 2016-2017
° Recruit one chain pharmacy to participate in “Pharmacy
Initiative”. Provide quarterly visits to 28 participating
pharmacies to distribute safe disposal flyers and educational
materials. Provide 1-2 educational presentations for future
medical providers
Fiscal Year 2017-2018
° Provide quarterly visits to 28 participating pharmacies to
distribute safe disposal flyers and educational materials.
Provide 1-2 educational presentations for future medical
providers
Fiscal Year 2018-2019
° Provide quarterly visits to 28 participating pharmacies to
distribute safe disposal flyers and educational materials.
Provide 1-2 educational presentations for future medical
providers
Fiscal Year 2019-2020
° Provide quarterly visits to 28 participating pharmacies to
distribute safe disposal flyers and educational materials.
Provide 1-2 educational presentations for future medical
providers
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will have
reported a life-time reduction
in prescription and over the
counter drug use by 5%
Exhibit A-2
Page 9 of 11
9
Community Outreach
CSAP Strategy: Information Dissemination
Background/Overview and rationale for selection:
Increase public awareness of prescription and over-the-counter drug abuse and generate
community support for prevention efforts.
Target Population
Scope of Work Activities and Timelines
Elementary School Students
Middle School Students
High School Students
College Students
General community
Parents/Adults
Fiscal Year 2016-2017 through FY 2019-2020
• Provide outreach activities throughout Fresno
County, promoting Lock It Up Projects activities,
goals and objectives such as: Red Ribbon week
activities, Month to Prevent Prescription Drug Abuse
in March, Prescription Drug Abuse Awareness event,
youth focused activities, etc.
• Increase community outreach efforts with hard to
reach populations or at non-traditional venues such as
school sporting events and locations frequently
visited by youth such as malls
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will have
reported a life-time reduction
in prescription and over the
counter drug use by 5%
Exhibit A-2
Page 10 of 11
10
Advisory Board and Youth Advisory Board
CSAP Strategy: Community Based Process
Background/Overview and rationale for selection:
CHC understands that engaging youth and adult professional in AOD prevention efforts increases
the level of possible reach with program campaigns and provides access to expertise or perspectives that
can support further development and improvement of the programs’ efforts and design.
By involving professionals from different community sectors as part of the countywide AOD
Prevention Advisory Board (AB), the program will engage professionals with expertise in areas that
program staff may lack. Also, in order to have youth voice and engagement in AOD prevention efforts,
the program will recruit / nominate youth to form part of a countywide Youth Advisory Board (YAB).
Members of the AB and YAB will be trained and engaged in AOD prevention efforts throughout the
county and for the duration of the contract term.
Target Population
Scope of Work Activities and Timelines
Youth
Adults
Other Professionals
Fiscal Year 2016-2017 through FY 2019-2020
• Recruit at least 15 adult professional representing varied
disciplines and community sectors to form part of the
Advisory Board (AB)
• Recruit at least 6 youth and establish a countywide AOD
prevention Youth Advisory Board (YAB) representing the
three regions of Fresno County
• Establish a retention plan for maintaining AB and YAB
members involved
• Coordinate with AB and YAB members to develop a strategic
plan during FY 2017-2018 that evaluates program
accomplishments and provides direction for advancing future
AOD prevention efforts for Fresno County
• Train and engage AB and YAB members in AOD prevention
efforts throughout the contract period
• Coordinate with AB and YAB members to develop and
implement educational/advocacy/systems and environmental
change activities to deter drug and alcohol use in their
communities. The activities or projects may take place in their
school, community or be countywide
• Coordinate with the PATH Project to plan and conduct an
annual AOD Prevention Youth Conference
• Annually evaluate AB and YAB members to assess their
satisfaction with the Boards and their involvement
Outcomes
Short-term goal-By
6/30/17, increase the
participation in the campaigns
to reduce youth access to Rx
and over the counter drugs by
5%.
Intermediate Goal- By
2018, 5% reduction in
frequency of use of Rx and
over the counter drugs by high
school age youth
Long-term goal-By
6/30/20, youth will have
decreased lifetime use of Rx
drugs by 5% in Fresno County
By 6/30/20, youth will have
reported a life-time reduction
in prescription and over the
counter drug use by 5%
Exhibit A-2
Page 11 of 11
11
Cultural Competency
Establishing cultural competence in community prevention services for substance abuse requires
the development of strategies, practices and infrastructure development among the lead agency
and in partnership with community based institutions and groups that will enable effective
design, implementation and evaluation of the program model. Therefore, CHC will address
cultural competency needs in program design and staffing determinations.
CHC’s plan allows Lock It Up to accomplish three goals:
1 The assessment and review of the target population, prevention program model, materials and
educational resources that demonstrates a project and its operations that is reflective of the
diversity of the community it serves.
2. Create opportunities for community leaders and stakeholders to partner and advance the agenda
for prevention services that meet the needs of a diverse target population in the County
3. Increase the quality of services provided to youth and their families accessing a program that has
a culturally and linguistically competent model.
Furthermore, CHC will develop and complete a local needs assessments including surveys and
focus groups with members of the target population, community leaders and providers of health
and human services to design a prevention partnership model that will focus on the following
elements:
• Identify and establish opportunities for defined collaboration to assist targeted populations of
culturally diverse youth and families with multiple needs for resources and referral. This
strategy is designed to address and minimize environmental factors that may place youth and
families at risk for problems associated with marijuana use.
• Design strategies to improve the scope and quality of marketing and outreach to diverse
cultural groups as an integral part of the implementation of the prevention service model. The
marketing strategy will be reflective of the diversity of the cultures served by our program in
the targeted communities of Fresno County.
• Develop short and long term strategies for capacity building in the community that will
achieve sustainability of the prevention program at a level commensurate with existing and
future resources.
Budget Categories-Line Item Description
Director of Program Services $77,134 10%
Program Manager $64,890 25%
Program Coordinator $42,179 100%
Outreach Specialist $36,421 100%
Outreach Specialist $34,278 100%
Outreach Specialist $34,278 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
EQUIPMENT List the following equipment categories and provide a brief description for each
0401 - Purchase of Equipment -One time expense for the purchase of one
0402 - Equipment Rent/Lease
0403-Equipment Maintenance: minor equipment repair for copier and
FACILITIES List the following facilities categories and provide a brief description for each
0451 - Rent/Lease Building - Staff Office/Cubicle Space/Common Areas
0452 - Facilities Maintenance
0453 - Utilities
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone,
0302 - Answering Service
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-Workbooks for Too Good for Drugs
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications - Relevant educational materials and other publications
0355 - Legal Notices/Advertising
Calculated based on personnel salaries.
Includes medical benefits, dental benefits, vision benefits, and retirement
benefits.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance
0253 - Insurance Other
FRESNO COUNTY
FY 2016-2017 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - Mileage for in-county staff travel to countywide to
0502 - Staff Travel (Out of County) - Per diem and travel costs associated
0503 - Staff Training/Registration - Training Registration expenses to attend
0504 - Transportation -Transportation of program participants (i.e. Youth
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives- Incentives for participants of
0552 - Program Supplies - Curriculum- PATH already owns the Too Good
0553 - Program Supplies - Food-Refreshments, snacks, and meals provided
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services - Subcontract with Fresno Police Department
0602 - Contracted Services
Exhibit B-1
Page 1 of 16
FRESNO COUNTY
FY 2016-2017 BUDGET
BUDGET JUSTIFICATION NARRATIVE
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
3150 - Client Fees -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping -Fiscal Management
0652 - External Audit - Audit Fees
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Indirect Costs
0702 - Licenses/Taxes
0703 - County Administration Fee
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed justification.
The amount cannot exceed 1/12th of the total cost proposal for this section.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal -
Mental Health Medi-Cal -
3130 - State Grant -
3140 - Private Donations -
Exhibit B-1
Page 2 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director of Program Evi Hernandez $77,134 10%$7,713.00 -$ 7,713$
0102 Program Manager Daisy Lopez $64,890 25%$16,223.00 -$ 16,223$
0103 Program Coordinato Haide Medina $42,179 100%$42,179.00 -$ 42,179$
0104 Outreach Specialist James White $36,421 100%$36,421.00 -$ 36,421$
0105 Outreach Specialist Dulce Velazquez $34,278 100%$34,278.00 -$ 34,278$
0106 Outreach Specialist Yolanda Padilla $34,278 100%$34,278.00 -$ 34,278$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $171,092 -$ 171,092$
0151 $1,985 -$ 1,985$
0152 $13,089 -$ 13,089$
0153 -$ -$
0154 $1,916 -$ 1,916$
PAYROLL TAXES TOTAL $16,990 -$ 16,990$
EMPLOYEE BENEFITS
0201 Health Insurance $5,458 -$ 5,458$
0202 Life Insurance $200 -$ 200$
0203 Retirement $13,687 -$ 13,687$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $19,345 -$ 19,345$
TAXES & BENEFITS TOTAL -$ 36,335$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
% Time dedicated
559-221-6315 Date:
Proposed Program Budget
Total Proposed BudgetLine Item Description to services SAPT Funding Other Funding Other Funding
Budget Categories-
dlopez@healthcollaborative.org
(Must be Itemized)
PERSONNEL/SALARIES
Date:
Performing Above the High (PATH)Approved by:
559-221-6219Fax Number:
1680 West Shaw Avenue Fresno, CA 93711
1680 West Shaw Avenue Fresno, CA 93711 Signature:
April 21, 2016
2016-2017 Submitted by:
FRESNO COUNTY
PERSONNEL BUDGET
California Health Collaborative
California Health Collaborative
State Disability Insurance
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
Exhibit B-1
Page 3 of 16
California Health Collaborative
Performing Above the High (PATH)Approved by:
February 3, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $207,427 $0 $0 $207,427
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,960 $9,960
0302 $0
$9,960 $0 $0 $9,960
0351 $1,300 $1,300
0352 $800 $800
0353 $9,000 $9,000
0354 $1,500 $1,500
0355 $0
$12,600 $0 $0 $12,600
0401 $1,800 $1,800
0402 $0
0403 $0
$1,800 $0 $0 $1,800
FACILITIES
0451 $11,705 $11,705
0452 $0
0453 $0
$11,705 $0 $0 $11,705
0501 $9,000 $9,000
0502 $2,000 $2,000
0503 $2,500 $2,500
0504 $2,000 $2,000
$15,500 $0 $0 $15,500
0551 $4,500 $4,500
0552 $0
0553 $2,800 $2,800
$7,300 $0 $0 $7,300
0601 $4,000 $4,000
0602 $0
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $19,562 $19,562
$34,055 $0 $0 $34,055
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
ONE TIME ADVANCE
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
TRAVEL COSTS TOTAL
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
PROGRAM SUPPLIES
Budget Categories-Line Item Description
INSURANCE
Provider Name:
Program:
TRAVEL COSTS
Staff Travel (Out of County)
Staff Training/Registration
Transportation
FACILITIES TOTAL
Staff Mileage
Equipment Rent/Lease
Equipment Maintenance
Facilities Maintenance
Utilities
EQUIPMENT TOTAL
Rent/Lease Building
Printing/Reproduction
Publications
Legal Notices/Advertising
EQUIPMENT
OFFICE EXPENSE TOTAL
Purchase of Equipment
Answering Service
OFFICE EXPENSE
Soc Rec., Workbooks
Telecommunications/data lines
COMMUNICATIONS TOTAL
Office Supplies
FRESNO COUNTY
FY 2016-2017 BUDGET
Liability Insurance
Insurance Other-Specify
COMMUNICATIONS
INSURANCE TOTAL
Date:
(Must Be Itemized)
Exhibit B-1
Page 4 of 16
Budget Categories-Line Item Description
Director of Program Services $79,448 10%
Program Manager $66,837 25%
Program Coordinator $43,444 100%
Outreach Specialist $37,513 100%
Outreach Specialist $35,307 100%
Outreach Specialist $35,307 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives - Incentives for participants of
0552 - Program Supplies - Curriculum - PATH already owns the Too Good
0553 - Program Supplies - Food - Refreshments, snacks, and meals
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - Mileage for in-county staff travel to countywide to
0502 - Staff Travel (Out of County) - Per diem and travel costs associated
0503 - Staff Training/Registration - Training Registration expenses to attend
0504 - Transportation - Transportation of program participants (i.e. Youth
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 - Purchase of Equipment
0402 - Equipment Rent/Lease
0403-Equipment Maintenance: minor equipment repair for copier and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 - Rent/Lease Building - Staff Office/Cubicle Space/Common Areas
0452 - Facilities Maintenance
0453 - Utilities
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone,
0302 - Answering Service
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks - Workbooks for Too Good for Drugs
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications - Relevant educational materials and other publications
Calculated based on personnel salaries.
Includes medical benefits, dental benefits, vision benefits, and retirement
benefits.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance
0253 - Insurance Other
FRESNO COUNTY
FY 2017-2018 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-1
Page 5 of 16
FRESNO COUNTY
FY 2017-2018 BUDGET
BUDGET JUSTIFICATION NARRATIVE
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal
Mental Health Medi-Cal
3130 - State Grant
3140 - Private Donations
3150 - Client Fees
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Fiscal Management
0652 - External Audit - Audit Fees
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Indirect Costs
0702 - Licenses/Taxes
0703 - County Administration Fee
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services - Subcontract with Fresno Police Department
0602 - Contracted Services
Exhibit B-1
Page 6 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director of Program Evi Hernandez $79,448 10%$7,945 -$ 7,945$
0102 Program Manager Daisy Lopez $66,837 25%$16,709 -$ 16,709$
0103 Program Coordinato Haide Medina $43,444 100%$43,444 -$ 43,444$
0104 Outreach Specialist James White $37,513 100%$37,513 -$ 37,513$
0105 Outreach Specialist Dulce Velazquez $35,307 100%$35,307 -$ 35,307$
0106 Outreach Specialist Yolanda Padilla $35,307 100%$35,307 -$ 35,307$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $0 $176,225 $0 $0 $0 $0 -$ 176,225$
0151 $2,044 -$ 2,044$
0152 $13,481 -$ 13,481$
0153 -$ -$
0154 $1,974 -$ 1,974$
PAYROLL TAXES TOTAL $0 $17,499 $0 $0 $0 $0 -$ 17,499$
EMPLOYEE BENEFITS
0201 Health Insurance $5,622 -$ 5,622$
0202 Life Insurance $200 -$ 200$
0203 Retirement $14,098 -$ 14,098$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $0 $19,920 $0 $0 $0 $0 -$ 19,920$
TAXES & BENEFITS TOTAL -$ 37,419$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
State Disability Insurance
(Must be Itemized)
PERSONNEL/SALARIES
Line Item Description to services SAPT Funding Other Funding Other Funding Total Proposed Budget
Fax Number:559-221-6219
dlopez@healthcollaborative.org
Budget Categories-% Time dedicated Proposed Program Budget
1680 West Shaw Avenue Fresno, CA 93711
1680 West Shaw Avenue Fresno, CA 93711 Signature:
559-221-6315 Date:
California Health Collaborative Date:April 21, 2016
Performing Above the High (PATH)Approved by:
FRESNO COUNTY
PERSONNEL BUDGET
2017-2018 Submitted by:California Health Collaborative
Exhibit B-1
Page 7 of 16
California Health Collaborative
Performing Above the High (PATH)Approved by:
April 21, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $213,644 $0 $0 $213,644
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,960 $9,960
0302 $0
$9,960 $0 $0 $9,960
0351 $1,200 $1,200
0352 $800 $800
0353 $8,000 $8,000
0354 $1,500 $1,500
0355 $0
$11,500 $0 $0 $11,500
0401 $0
0402 $0
0403 $0
$0 $0 $0 $0
FACILITIES
0451 $11,705 $11,705
0452 $0
0453 $0
$11,705 $0 $0 $11,705
0501 $8,500 $8,500
0502 $2,000 $2,000
0503 $2,000 $2,000
0504 $2,000 $2,000
$14,500 $0 $0 $14,500
0551 $4,400 $4,400
0552 $0
0553 $2,800 $2,800
$7,200 $0 $0 $7,200
0601 $4,000 $4,000
0602 $0
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $17,345 $17,345
$31,838 $0 $0 $31,838
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment
Equipment Rent/Lease
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Date:
INSURANCE
Budget Categories-Line Item Description
(Must Be Itemized)
FRESNO COUNTY
FY 2017-2018 BUDGET
Provider Name:
Program:
Exhibit B-1
Page 8 of 16
Budget Categories-Line Item Description
Director of Program Services $81,831 10%
Program Manager $68,842 25%
Program Coordinator $44,747 100%
Outreach Specialist $38,639 100%
Outreach Specialist $36,366 100%
Outreach Specialist $36,366 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives - Incentives for participants of
0552 - Program Supplies - Curriculum - Too Good for Drugs- 8th Grade
0553 - Program Supplies - Food - Refreshments, snacks, and meals
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - Mileage for in-county staff travel to countywide to
0502 - Staff Travel (Out of County) - Per diem and travel costs associated
0503 - Staff Training/Registration - Training Registration expenses to attend
0504 - Transportation - Transportation of program participants (i.e. Youth
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 - Purchase of Equipment
0402 - Equipment Rent/Lease
0403-Equipment Maintenance: minor equipment repair for copier and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 - Rent/Lease Building - Staff Office/Cubicle Space/Common Areas
0452 - Facilities Maintenance
0453 - Utilities
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone,
0302 - Answering Service -
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-Workbooks for Too Good for Drugs
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications - Relevant educational materials and other publications
0355 - Legal Notices/Advertising
Calculated based on personnel salaries.
Includes medical benefits, dental benefits, vision benefits, and retirement
benefits.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance
0253 - Insurance Other
FRESNO COUNTY
FY 2018-2019 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-1
Page 9 of 16
FRESNO COUNTY
FY 2018-2019 BUDGET
BUDGET JUSTIFICATION NARRATIVE
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal
Mental Health Medi-Cal
3130 - State Grant
3140 - Private Donations
3150 - Client Fees
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Fiscal Management.
0652 - External Audit - Audit Services
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Indirect Costs
0702 - Licenses/Taxes -
0703 - County Administration Fee
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services - Subcontract with Fresno Police Department
0602 - Contracted Services
Exhibit B-1
Page 10 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director of Program Evi Hernandez $81,831 10%$8,183 -$ 8,183$
0102 Program Manager Daisy Lopez $68,842 25%$17,210 -$ 17,210$
0103 Outreach Specialist Haide Medina $44,747 100%$44,747 -$ 44,747$
0104 Outreach Specialist James White $38,639 100%$38,639 -$ 38,639$
0105 Outreach Specialist Dulce Velazquez $36,366 100%$36,366 -$ 36,366$
0106 Outreach Specialist Yolanda Padilla $36,366 100%$36,366 -$ 36,366$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $0 $181,511 $0 $0 $0 $0 -$ 181,511$
0151 $2,106 -$ 2,106$
0152 $13,886 -$ 13,886$
0153 -$ -$
0154 $2,033 -$ 2,033$
PAYROLL TAXES TOTAL $0 $18,025 $0 $0 $0 $0 -$ 18,025$
EMPLOYEE BENEFITS
0201 Health Insurance $5,790 -$ 5,790$
0202 Life Insurance $200 -$ 200$
0203 Retirement $14,521 -$ 14,521$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $0 $20,511 $0 $0 $0 $0 -$ 20,511$
TAXES & BENEFITS TOTAL -$ 38,536$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
State Disability Insurance
(Must be Itemized)
PERSONNEL/SALARIES
Line Item Description to services SAPT Funding Other Funding Other Funding Total Proposed Budget
Fax Number:559-221-6219
dlopez@healthcollaborative.org
Budget Categories-% Time dedicated Proposed Program Budget
1680 West Shaw Avenue Fresno, CA 93711
1680 West Shaw Avenue Fresno, CA 93711 Signature:
559-221-6315 Date:
California Health Collaborative Date:April 21, 2016
Performing Above the High (PATH)Approved by:
FRESNO COUNTY
PERSONNEL BUDGET
2018-2019 Submitted by:California Health Collaborative
Exhibit B-1
Page 11 of 16
California Health Collaborative
Performing Above the High Project Approved by:
April 21, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $220,047 $0 $0 $220,047
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,960 $9,960
0302 $0
$9,960 $0 $0 $9,960
0351 $1,000 $1,000
0352 $800 $800
0353 $7,500 $7,500
0354 $1,000 $1,000
0355 $0
$10,300 $0 $0 $10,300
0401 $0
0402 $0
0403 $0
$0 $0 $0 $0
FACILITIES
0451 $11,705 $11,705
0452 $0
0453 $0
$11,705 $0 $0 $11,705
0501 $8,500 $8,500
0502 $1,500 $1,500
0503 $1,500 $1,500
0504 $2,000 $2,000
$13,500 $0 $0 $13,500
0551 $3,200 $3,200
0552 $0 $0
0553 $2,000 $2,000
$5,200 $0 $0 $5,200
0601 $4,000 $4,000
0602 $0
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $15,142 $15,142
$29,635 $0 $0 $29,635
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment
Equipment Rent/Lease
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Date:
INSURANCE
Budget Categories-Line Item Description
(Must Be Itemized)
FRESNO COUNTY
FY 2018-2019 BUDGET
Provider Name:
Program:
Exhibit B-1
Page 12 of 16
Budget Categories-Line Item Description
Director of Program Services $84,286 10%
Program Manager $70,907 25%
Program Coordinator $46,090 100%
Outreach Specialist $39,798 100%
Outreach Specialist $37,457 100%
Outreach Specialist $37,457 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description for
0551 - Program Supplies - Client Incentives - Incentives for participants of
0552 - Program Supplies - Curriculum - Too Good for Drugs- 8th Grade
0553 - Program Supplies - Food - Refreshments, snacks, and meals
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - Mileage for in-county staff travel to countywide to
0502 - Staff Travel (Out of County) - Per diem and travel costs associated
0503 - Staff Training/Registration - Training Registration expenses to attend
0504 - Transportation - Transportation of program participants (i.e. Youth
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 - Purchase of Equipment
0402 - Equipment Rent/Lease
0403-Equipment Maintenance: minor equipment repair for copier and
vehicle maintenance.
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 - Rent/Lease Building - Staff Office/Cubicle Space/Common Areas
0452 - Facilities Maintenance
0453 - Utilities
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone,
0302 - Answering Service -
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-Workbooks for Too Good for Drugs
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications - Relevant educational materials and other publications
0355 - Legal Notices/Advertising
Calculated based on personnel salaries.
Includes medical benefits, dental benefits, vision benefits, and retirement
benefits.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance
0253 - Insurance Other
FRESNO COUNTY
FY 2019-2020 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-1
Page 13 of 16
FRESNO COUNTY
FY 2019-2020 BUDGET
BUDGET JUSTIFICATION NARRATIVE
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal
Mental Health Medi-Cal
3130 - State Grant
3140 - Private Donations
3150 - Client Fees
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Fiscal Management.
0652 - External Audit - Audit Services
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Indirect Costs
0702 - Licenses/Taxes -
0703 - County Administration Fee
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services - Subcontract with Fresno Police Department
0602 - Contracted Services
Exhibit B-1
Page 14 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director of Program Evi Hernandez $84,286 10%$8,429 -$ 8,429$
0102 Program Manager Daisy Lopez $70,907 25%$17,727 -$ 17,727$
0103 Program Coordinator Haide Medina $46,090 100%$46,090 -$ 46,090$
0104 Outreach Specialist James White $39,798 100%$39,798 -$ 39,798$
0105 Outreach Specialist Dulce Velazquez $37,457 100%$37,457 -$ 37,457$
0106 Outreach Specialist Yolanda Padilla $37,457 100%$37,457 -$ 37,457$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 1170500%-$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $0 $186,958 $0 $0 $0 $0 -$ 186,958$
0151 14493 $2,169 -$ 2,169$
0152 $14,302 -$ 14,302$
0153 -$ -$
0154 $2,094 -$ 2,094$
PAYROLL TAXES TOTAL $0 $18,565 $0 $0 $0 $0 -$ 18,565$
EMPLOYEE BENEFITS
0201 Health Insurance $5,964 -$ 5,964$
0202 Life Insurance $200 -$ 200$
0203 Retirement $14,957 -$ 14,957$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $0 $21,121 $0 $0 $0 $0 -$ 21,121$
TAXES & BENEFITS TOTAL -$ 39,686$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
State Disability Insurance
(Must be Itemized)
PERSONNEL/SALARIES
Line Item Description to services SAPT Funding Other Funding Other Funding Total Proposed Budget
Fax Number:559-221-6219
dlopez@healthcollaborative.org
Budget Categories-% Time dedicated Proposed Program Budget
1680 West Shaw Avenue Fresno, CA 93711
1680 West Shaw Avenue Fresno, CA 93711 Signature:
559-221-6315 Date:
California Health Collaborative Date:April 21, 2016
Performing Above the High (PATH)Approved by:
FRESNO COUNTY
PERSONNEL BUDGET
2019-2020 Submitted by:California Health Collaborative
Exhibit B-1
Page 15 of 16
California Health Collaborative
Performing Above the High Project Approved by:
April 21 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $226,644 $0 $0 $226,644
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,960 $9,960
0302 $0
$9,960 $0 $0 $9,960
0351 $800 $800
0352 $500 $500
0353 $7,500 $7,500
0354 $800 $800
0355 $0
$9,600 $0 $0 $9,600
0401 $0
0402 $0
0403 $0
$0 $0 $0 $0
FACILITIES
0451 $11,705 $11,705
0452 $0
0453 $0
$11,705 $0 $0 $11,705
0501 $7,500 $7,500
0502 $1,000 $1,000
0503 $1,000 $1,000
0504 $1,500 $1,500
$11,000 $0 $0 $11,000
0551 $3,000 $3,000
0552 $0 $0
0553 $2,300 $2,300
$5,300 $0 $0 $5,300
0601 $4,000 $4,000
0602 $0
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $11,645 $11,645
$26,138 $0 $0 $26,138
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment
Equipment Rent/Lease
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Date:
INSURANCE
Budget Categories-Line Item Description
(Must Be Itemized)
FRESNO COUNTY
FY 2019-2020 BUDGET
Provider Name:
Program:
Exhibit B-1
Page 16 of 16
Budget Categories-Line Item Description
Director of Program Services $77,134 5%
Program Manager $60,329 100%
Program Coordinator $41,205 100%
Outreach Specialist $33,306 100%
Outreach Specialist $33,306 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
EQUIPMENT List the following equipment categories and provide a brief description for each
0401 - Purchase of Equipment -
0402 - Equipment Rent/Lease-
0403-Equipment Maintenance: minor equipment repair for copier and
FACILITIES List the following facilities categories and provide a brief description for each
0451 - Rent/Lease Building - Cost of rent for assigned program space
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone, fax, etc.
0302 - Answering Service -
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications -
0355 - Legal Notices/Advertising -
Calculated based on personnel salaries
Includes medical benefits, dental benefits, vision benefits, and retirement
benefits.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance
0252 - Liability Insurance-
0253 - Insurance Other -
FRESNO COUNTY
FY 2016-2017 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-2
Page 1 of 16
FRESNO COUNTY
FY 2016-2017 BUDGET
BUDGET JUSTIFICATION NARRATIVE
0452 - Facilities Maintenance -
0453 - Utilities -
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - In-county travel for program activities such as:
0502 - Staff Travel (Out of County) - Travel to conferences/trainings
0503 - Staff Training/Registration - Professional and staff development
0504 - Transportation -Cost associated with the transportation of youth to
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 - Program Supplies - Client Incentives
0552 - Program Supplies - Curriculum and accompanying workbooks
0553 - Program Supplies - Food for program sponsored activities
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services -
0602 - Contracted Services - California Health Sciences University for
3150 - Client Fees -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Accounting services for the program
0652 - External Audit - Share of cost for independent audit
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Administrative costs
0702 - Licenses/Taxes -
0703 - County Administration Fee -
ONE TIME ADVANCE Used for startup costs and is available upon request with a detailed
The amount cannot exceed 1/12th of the total cost proposal for this section.
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal -
Mental Health Medi-Cal -
3130 - State Grant -
3140 - Private Donations -
Exhibit B-2
Page 2 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director Evi Hernandez $77,134 5%5%$3,857 -$ 3,857$
0102 Program Manager Marisol Zamora $60,329 100%100%$60,329 -$ 60,329$
0103 Program Coordinato Tou Moua $41,205 100%100%$41,205 -$ 41,205$
0104 Outreach Specialist Daniel Gonzalez $33,306 100%100%$33,306 -$ 33,306$
0105 Outreach Specialist Stephanie Gonzalez $33,306 100%100%$33,306 -$ 33,306$
0106 -$ -$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $172,003 -$ 172,003$
0151 $1,737 -$ 1,737$
0152 $13,158 -$ 13,158$
0153 -$ -$
0154 $1,892 -$ 1,892$
PAYROLL TAXES TOTAL $16,787 -$ 16,787$
EMPLOYEE BENEFITS
0201 Health Insurance $11,043 -$ 11,043$
0202 Life Insurance $172 -$ 172$
0203 Retirement $8,291 -$ 8,291$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $19,506 -$ 19,506$
TAXES & BENEFITS TOTAL -$ 36,293$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
% Time dedicated
(559) 221-6315 Date:
Proposed Program Budget
Total Proposed BudgetLine Item Description to services SAPT Funding Other Funding Other Funding
Budget Categories-
mzamora@healthcollaborative.org
(Must be Itemized)
PERSONNEL/SALARIES
Date:
Lock It Up Project Approved by:
(559) 221-6219Fax Number:
1680 West Shaw Avenue
Fresno, CA 93711 Signature:
April 22, 2016
2016-2017 Submitted by:
FRESNO COUNTY
PERSONNEL BUDGET
California Health Collaborative
California Health Collaborative
State Disability Insurance
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
Exhibit B-2
Page 3 of 16
California Health Collaborative
Lock It Up Project Approved by:
April 22, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $208,296 $0 $0 $208,296
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,600 $9,600
0302 $0
$9,600 $0 $0 $9,600
0351 $2,915 $2,915
0352 $0
0353 $12,000 $12,000
0354 $0
0355 $0
$14,915 $0 $0 $14,915
0401 $0
0402 $0
0403 $2,000 $2,000
$2,000 $0 $0 $2,000
FACILITIES
0451 $10,451 $10,451
0452 $0
0453 $0
$10,451 $0 $0 $10,451
0501 $13,892 $13,892
0502 $2,000 $2,000
0503 $3,000 $3,000
0504 $2,500 $2,500
$21,392 $0 $0 $21,392
0551 $7,500 $7,500
0552 $2,500 $2,500
0553 $2,500 $2,500
$12,500 $0 $0 $12,500
0601 $0
0602 $4,000 $4,000
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $6,700 $6,700
$21,193 $0 $0 $21,193
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
ONE TIME ADVANCE
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
TRAVEL COSTS TOTAL
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
PROGRAM SUPPLIES
Budget Categories-Line Item Description
INSURANCE
Provider Name:
Program:
TRAVEL COSTS
Staff Travel (Out of County)
Staff Training/Registration
Transportation
FACILITIES TOTAL
Staff Mileage
Equipment Rent/Lease
Equipment Maintenance
Facilities Maintenance
Utilities
EQUIPMENT TOTAL
Rent/Lease Building
Printing/Reproduction
Publications
Legal Notices/Advertising
EQUIPMENT
OFFICE EXPENSE TOTAL
Purchase of Equipment
Answering Service
OFFICE EXPENSE
Soc Rec., Workbooks
Telecommunications/data lines
COMMUNICATIONS TOTAL
Office Supplies
FRESNO COUNTY
FY 2016-2017 BUDGET
Liability Insurance
Insurance Other-Specify
COMMUNICATIONS
INSURANCE TOTAL
Date:
(Must Be Itemized)
Exhibit B-2
Page 4 of 16
Budget Categories-Line Item Description
Director of Program Services $79,448 5%
Program Manager $62,139 100%
Program Coordinator $42,441 100%
Outreach Specialist $34,305 100%
Outreach Specialist $34,305 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 - Purchase of Equipment -
0402 - Equipment Rent/Lease-
0403-Equipment Maintenance: minor equipment repair for copier and
vehicle maintenance.
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone, fax, etc.
0302 - Answering Service -
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications -
0355 - Legal Notices/Advertising -
Calculated based on personnel salaries
Includes medical, dental, vision and retirement benefits.
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance - WC insurance coverage
0252 - Liability Insurance- Total cost of liability insurance
0253 - Insurance Other -
FRESNO COUNTY
FY 2017-2018 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-2
Page 5 of 16
FRESNO COUNTY
FY 2017-2018 BUDGET
BUDGET JUSTIFICATION NARRATIVE
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal -
Mental Health Medi-Cal -
3130 - State Grant -
3140 - Private Donations -
3150 - Client Fees -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Accounting services for the program
0652 - External Audit - Share of cost for annual independent audit
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs -
0702 - Licenses/Taxes -
0703 - County Administration Fee -
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 - Program Supplies - Client Incentives
0552 - Program Supplies - Curriculum and accompanying workgroups
0553 - Program Supplies - Food for program sponsored activities
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services -
0602 - Contracted Services - California Health Sciences University for
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - In-county travel to conduct program activities such
0502 - Staff Travel (Out of County) - Travel to conferences/trainings
0503 - Staff Training/Registration - Professional/staff development training
0504 - Transportation -Cost associated participant transportation
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 - Rent/Lease Building - cost of program rent space
0452 - Facilities Maintenance -
0453 - Utilities -
Exhibit B-2
Page 6 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director Evi Hernandez $79,448 5%$3,972 -$ 3,972$
0102 Program Manager Marisol Zamora $62,139 100%$62,139 -$ 62,139$
0103 Program Coordinato Tou Moua $42,441 100%$42,441 -$ 42,441$
0104 Outreach Specialist Daniel Gonzalez $34,305 100%$34,305 -$ 34,305$
0105 Outreach Specialist Stephanie Gonzalez $34,305 100%$34,305 -$ 34,305$
0106 -$ -$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $0 $177,162 $0 $0 $0 $0 -$ 177,162$
0151 $1,789 -$ 1,789$
0152 $13,553 -$ 13,553$
0153 -$ -$
0154 $1,949 -$ 1,949$
PAYROLL TAXES TOTAL $0 $17,291 $0 $0 $0 $0 -$ 17,291$
EMPLOYEE BENEFITS
0201 Health Insurance $11,374 -$ 11,374$
0202 Life Insurance $177 -$ 177$
0203 Retirement $8,539 -$ 8,539$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $0 $20,090 $0 $0 $0 $0 -$ 20,090$
TAXES & BENEFITS TOTAL -$ 37,381$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
State Disability Insurance
(Must be Itemized)
PERSONNEL/SALARIES
Line Item Description to services SAPT Funding Other Funding Other Funding Total Proposed Budget
Fax Number:(559) 221-6219
mzamora@healthcollaborative.org
Budget Categories-% Time dedicated Proposed Program Budget
1680 West Shaw Avenue
Fresno, California Signature:
(559) 221-6315 Date:
California Health Collaborative Date:April 22, 2016
Lock It Up Project Approved by:
FRESNO COUNTY
PERSONNEL BUDGET
2017-2018 Submitted by:California Health Collaborative
Exhibit B-2
Page 7 of 16
California Health Collaborative
Lock It Up Project Approved by:
April 22, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $214,543 $0 $0 $214,543
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,600 $9,600
0302 $0
$9,600 $0 $0 $9,600
0351 $1,666 $1,666
0352 $0
0353 $10,000 $10,000
0354 $0
0355 $0
$11,666 $0 $0 $11,666
0401 $0
0402 $0
0403 $2,000 $2,000
$2,000 $0 $0 $2,000
FACILITIES
0451 $10,453 $10,453
0452 $0
0453 $0
$10,453 $0 $0 $10,453
0501 $12,000 $12,000
0502 $2,000 $2,000
0503 $1,500 $1,500
0504 $1,500 $1,500
$17,000 $0 $0 $17,000
0551 $7,500 $7,500
0552 $3,892 $3,892
0553 $2,500 $2,500
$13,892 $0 $0 $13,892
0601 $0
0602 $4,000 $4,000
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $6,700 $6,700
$21,193 $0 $0 $21,193
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment
Equipment Rent/Lease
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Date:
INSURANCE
Budget Categories-Line Item Description
(Must Be Itemized)
FRESNO COUNTY
FY 2017-2018 BUDGET
Provider Name:
Program:
Exhibit B-2
Page 8 of 16
Budget Categories-Line Item Description
Director of Program Services $81,831 5%
Program Manager $64,003 100%
Program Coordinator $43,715 100%
Outreach Specialist $35,334 100%
Outreach Specialist $35,334 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 - Purchase of Equipment -
0402 - Equipment Rent/Lease-
0403-Equipment Maintenance: minor equipment repair for copier and
vehicle maintenance.
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone, fax, etc.
0302 - Answering Service -
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications -
0355 - Legal Notices/Advertising -
Calculated based on personnel salaries
Includes medical, dental, vision, and retirement benefits
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance - WC insurance coverage
0252 - Liability Insurance - Total cost of liability insurance
0253 - Insurance Other -
FRESNO COUNTY
FY 2018-2019 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-2
Page 9 of 16
FRESNO COUNTY
FY 2018-2019 BUDGET
BUDGET JUSTIFICATION NARRATIVE
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal -
Mental Health Medi-Cal -
3130 - State Grant -
3140 - Private Donations -
3150 - Client Fees -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Accounting services for the program
0652 - External Audit - Share of cost for annual independent audit
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Administrative costs
0702 - Licenses/Taxes -
0703 - County Administration Fee -
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 - Program Supplies - Client Incentives
0552 - Program Supplies - Curriculum and accompanying workbooks
0553 - Program Supplies - Food for program activities
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services -
0602 - Contracted Services - California Health Sciences University for
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - In-county travel to conduct program activities
0502 - Staff Travel (Out of County) - Travel to conferences/trainings
0503 - Staff Training/Registration - Professional staff development training
0504 - Transportation - Youth participant transportation
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 - Rent/Lease Building - Cost of rent for assigned program space
0452 - Facilities Maintenance -
0453 - Utilities -
Exhibit B-2
Page 10 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director Evi Hernandez $81,831 5%$4,092 -$ 4,092$
0102 Program Manager Marisol Zamora $64,003 100%$64,003 -$ 64,003$
0103 Program Coordinator Tou Moua $43,715 100%$43,715 -$ 43,715$
0104 Outreach Specialist Daniel Gonzalez $35,334 100%$35,334 -$ 35,334$
0105 Outreach Specialist Stephanie Gonzalez $35,334 100%$35,334 -$ 35,334$
0106 -$ -$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $0 $182,478 $0 $0 $0 $0 -$ 182,478$
0151 $1,843 -$ 1,843$
0152 $13,960 -$ 13,960$
0153 -$ -$
0154 $2,007 -$ 2,007$
PAYROLL TAXES TOTAL $0 $17,810 $0 $0 $0 $0 -$ 17,810$
EMPLOYEE BENEFITS
0201 Health Insurance $11,715 -$ 11,715$
0202 Life Insurance $182 -$ 182$
0203 Retirement $8,795 -$ 8,795$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $0 $20,692 $0 $0 $0 $0 -$ 20,692$
TAXES & BENEFITS TOTAL -$ 38,502$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
State Disability Insurance
(Must be Itemized)
PERSONNEL/SALARIES
Line Item Description to services SAPT Funding Other Funding Other Funding Total Proposed Budget
Fax Number:(559) 221-6219
mzamora@healthcollaborative.org
Budget Categories-% Time dedicated Proposed Program Budget
1680 West Shaw Avenue
Fresno, California 93711 Signature:
(559) 221-6315 Date:
California Health Collaborative Date:April 22, 2016
Lock It Up Project Approved by:
FRESNO COUNTY
PERSONNEL BUDGET
2018-2019 Submitted by:California Health Collaborative
Exhibit B-2
Page 11 of 16
California Health Collaborative
Lock It Up Project Approved by:
April 22, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $220,980 $0 $0 $220,980
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,600 $9,600
0302 $0
$9,600 $0 $0 $9,600
0351 $666 $666
0352 $0
0353 $9,949 $9,949
0354 $0
0355 $0
$10,615 $0 $0 $10,615
0401 $0
0402 $0
0403 $1,000 $1,000
$1,000 $0 $0 $1,000
FACILITIES
0451 $10,452 $10,452
0452 $0
0453 $0
$10,452 $0 $0 $10,452
0501 $11,507 $11,507
0502 $2,000 $2,000
0503 $1,000 $1,000
0504 $1,500 $1,500
$16,007 $0 $0 $16,007
0551 $7,500 $7,500
0552 $1,500 $1,500
0553 $1,500 $1,500
$10,500 $0 $0 $10,500
0601 $0
0602 $4,000 $4,000
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $6,700 $6,700
$21,193 $0 $0 $21,193
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment
Equipment Rent/Lease
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Date:
INSURANCE
Budget Categories-Line Item Description
(Must Be Itemized)
FRESNO COUNTY
FY 2018-2019 BUDGET
Provider Name:
Program:
Exhibit B-2
Page 12 of 16
Budget Categories-Line Item Description
Director of Program Services $84,286 5%
Program Manager $65,923 100%
Program Coordinator $45,026 100%
Outreach Specialist $36,394 100%
Outreach Specialist $36,394 100%
PAYROLL TAXES TOTAL
EMPLOYEE BENEFITS
TOTAL
EQUIPMENT List the following equipment categories and provide a brief description for each
category:
0401 - Purchase of Equipment -
0402 - Equipment Rent/Lease-
0403-Equipment Maintenance: minor equipment repair for copier and
vehicle maintenance.
COMMUNICATIONS 0301 - Telecommunications/data lines - Telephone, cell phone, fax, etc.
0302 - Answering Service -
OFFICE EXPENSE 0351-Office Supplies: Includes Items necessary to carry out the daily
activities to accomplish the program goals and objectives including paper, filing
supplies, pens, pencils, scissors, and other supplies.
0352 - Social/Rec, Workbooks.-
0353-Printing/Reproduction includes items such as the printing of business
cards, program pamphlets, position vacancy advertising and other materials
related to the program.
0354 - Publications -
0355 - Legal Notices/Advertising -
Calculated based on personnel salaries
Includes medical, dental, vision, and retirement benefits
INSURANCE List the following insurance categories:
0251 - Workers Compensation Insurance - WC insurance coverage
0252 - Liability Insurance - Total cost of liability insurance
0253 - Insurance Other -
FRESNO COUNTY
FY 2019-2020 BUDGET
BUDGET JUSTIFICATION NARRATIVE
PERSONNEL/ SALARIES Annual Salary and FTE equivalence as in budget.
Annual (12 Month)
Salary for this
% of FTE dedicated
to this program
Position descriptions submitted with proposal.
Exhibit B-2
Page 13 of 16
FRESNO COUNTY
FY 2019-2020 BUDGET
BUDGET JUSTIFICATION NARRATIVE
REVENUE/MATCH Please identify all anticipated funding sources and distinguish whether the
3120 - Drug Medi-Cal -
Mental Health Medi-Cal -
3130 - State Grant -
3140 - Private Donations -
3150 - Client Fees -
FISCAL AND AUDITS List the following fiscal and audits categories and provide a brief description for
0651 - Accounting/Bookkeeping - Accounting services for the program
0652 - External Audit - Share of cost for annual independent audit
OTHER COSTS List the following categories and provide a brief description for each category:
0701 - Indirect Costs - Administrative costs
0702 - Licenses/Taxes -
0703 - County Administration Fee -
0749-Other Costs - Other business services such as applicant TB tests,
drug screens, and other program-related items that don't necessarily fit into
another line item.
PROGRAM SUPPLIES List the following program supplies categories and provide a brief description
0551 - Program Supplies - Client Incentives
0552 - Program Supplies - Curriculum and accompanying workbooks
0553 - Program Supplies - Food for program activities
CONSULTANCY List the following consulting categories and provide a brief description for each
0601 - Consultant Services -
0602 - Contracted Services - California Health Sciences University for
TRAVEL List the following travel categories and provide a brief description for each
0501 - Staff Mileage - In-county travel to conduct program activities
0502 - Staff Travel (Out of County) - Travel to conferences/trainings
0503 - Staff Training/Registration - Professional staff development training
0504 - Transportation - Youth participant transportation
FACILITIES List the following facilities categories and provide a brief description for each
category:
0451 - Rent/Lease Building - Cost of rent for assigned program space
0452 - Facilities Maintenance -
0453 - Utilities -
Exhibit B-2
Page 14 of 16
Fiscal Year:
Provider Name:
Program:
Mailing Address:
Street Address:
Phone Number:
No. of Budgeted FTE Administration:Direct Service:E-Mail Address:
Annual % of FTE
(12-Month)dedicated to
Salary this program Admin.Direct Admin.Direct Admin.Direct Admin.Direct Admin.Direct
0101 Director Evi Hernandez $84,286 5%$4,214 -$ 4,214$
0102 Program Manager Marisol Zamora $65,923 100%$65,923 -$ 65,923$
0103 Program Coordinator Program Coordinator $45,026 100%$45,026 -$ 45,026$
0104 Outreach Specialist Daniel Gonzalez $36,394 100%$36,394 -$ 36,394$
0105 Outreach Specialist Stephanie Gonzalez $36,394 100%$36,394 -$ 36,394$
0106 -$ -$
0107 -$ -$
0108 -$ -$
0109 -$ -$
0110 -$ -$
0111 -$ -$
0112 -$ -$
0113 -$ -$
0114 -$ -$
0115 -$ -$
0116 -$ -$
0117 -$ -$
0118 -$ -$
0119 -$ -$
0120 -$ -$
0121 -$ -$
0122 -$ -$
0123 -$ -$
0124 -$ -$
0125 -$ -$
0126 -$ -$
0127 -$ -$
0128 -$ -$
0129 -$ -$
0130 -$ -$
SALARIES TOTAL $0 $187,951 $0 $0 $0 $0 -$ 187,951$
0151 $1,898 -$ 1,898$
0152 $14,378 -$ 14,378$
0153 -$ -$
0154 $2,067 -$ 2,067$
PAYROLL TAXES TOTAL $0 $18,343 $0 $0 $0 $0 -$ 18,343$
EMPLOYEE BENEFITS
0201 Health Insurance $12,066 -$ 12,066$
0202 Life Insurance $188 -$ 188$
0203 Retirement $9,059 -$ 9,059$
0204 Benefits Other - Specify -$ -$
EMPLOYEE BENEFITS TOTAL $0 $21,313 $0 $0 $0 $0 -$ 21,313$
TAXES & BENEFITS TOTAL -$ 39,656$
TOTAL PERCENT OF BENEFITS TO SALARIES #DIV/0!11%
Workers' Compensation Insurance
PAYROLL TAXES
State Unemployment Insurance
F.I.C.A./O.A.S.D.I.
State Disability Insurance
(Must be Itemized)
PERSONNEL/SALARIES
Line Item Description to services SAPT Funding Other Funding Other Funding Total Proposed Budget
Fax Number:(559) 221-6219
mzamora@healthcollborative.org
Budget Categories-% Time dedicated Proposed Program Budget
1680 West Shaw Avenue
Fresno, California Signature:
(559) 221-6319 Date:
California Health Collaborative Date:April 22, 2016
Lock It Up Project Approved by:
FRESNO COUNTY
PERSONNEL BUDGET
2019-2020 Submitted by:California Health Collaborative
Exhibit B-2
Page 15 of 16
California Health Collaborative
Lock It Up Project Approved by:
April 22, 2016 Date:
SAPT Funding Other Funding Other Funding Proposed Program
Budget Budget Budget Budget
SALARY, PAYROLL TAX, AND EMPLOYEE BENEFITS TOTAL $227,607 $0 $0 $227,607
0252 $435 $435
0253 $0
$435 $0 $0 $435
0301 $9,600 $9,600
0302 $0
$9,600 $0 $0 $9,600
0351 $1,666 $1,666
0352 $0
0353 $8,059 $8,059
0354 $0
0355 $0
$9,725 $0 $0 $9,725
0401 $0
0402 $0
0403 $1,000 $1,000
$1,000 $0 $0 $1,000
FACILITIES
0451 $10,453 $10,453
0452 $0
0453 $0
$10,453 $0 $0 $10,453
0501 $12,500 $12,500
0502 $0
0503 $0
0504 $1,000 $1,000
$13,500 $0 $0 $13,500
0551 $7,200 $7,200
0552 $0
0553 $1,069 $1,069
$8,269 $0 $0 $8,269
0601 $0
0602 $4,000 $4,000
$4,000 $0 $0 $4,000
0651 $27,826 $27,826
0652 $725 $725
$28,551 $0 $0 $28,551
0701 $14,493 $14,493
0702 Licenses/Taxes $0
0703 $0
0749 $5,700 $5,700
$20,193 $0 $0 $20,193
$333,333 $0 $0 $333,333
3120 $0
3130 $0
3140 $0
3150 $0
$0 $0 $0 $0
$333,333 $0 $0 $333,333
REVENUE/MATCH TOTAL
NET PROGRAM BUDGET
TOTAL PROGRAM EXPENDITURES
REVENUE/MATCH
Medi-Cal
State Grant
Private Donations
Client Fees
FISCAL AND AUDITS TOTAL
OTHER COSTS
Indirect Costs
County Administration Fee
Other Business Services
OTHER COSTS TOTAL
Consultant Services
Contracted Services
CONSULTANCY TOTAL
FISCAL AND AUDITS
Accounting/Bookkeeping
External Audit
PROGRAM SUPPLIES
Program Supplies-Client Incentives
Program Supplies-Curriculum
Program Supplies-Food
PROGRAM SUPPLIES TOTAL
CONSULTANCY
TRAVEL COSTS
Staff Mileage
Staff Travel (Out of County)
Staff Training/Registration
Transportation
TRAVEL COSTS TOTAL
Equipment Maintenance
EQUIPMENT TOTAL
Rent/Lease Building
Facilities Maintenance
Utilities
FACILITIES TOTAL
Publications
Legal Notices/Advertising
OFFICE EXPENSE TOTAL
EQUIPMENT
Purchase of Equipment
Equipment Rent/Lease
Answering Service
COMMUNICATIONS TOTAL
OFFICE EXPENSE
Office Supplies
Soc Rec., Workbooks
Printing/Reproduction
Liability Insurance
Insurance Other-Specify
INSURANCE TOTAL
COMMUNICATIONS
Telecommunications/data lines
Date:
INSURANCE
Budget Categories-Line Item Description
(Must Be Itemized)
FRESNO COUNTY
FY 2019-2020 BUDGET
Provider Name:
Program:
Exhibit B-2
Page 16 of 16
Exhibit C
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members
of a contractor’s board of directors (hereinafter referred to as “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 utilized 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.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
ExhibitCPage2of2(1)CompanyBoardMemberInformation:Name:N/ADate:JobTitle:(2)Company/AgencyNameandAddress:NotApplicable(3)Disclosure(Pleasedescribethenatureoftheself-dealingtransactionyouareapartyto):NotApplicable(4)Explainwhythisself-dealingtransactionisconsistentwiththerequirementsofCorporationsCode5233(a):NotApplicable(5)AuthorizedSignatureSignature:Date:cJihk
ExhibitDPage1of1NOTICEOFCHILDABUSEREPORTINGLAWTheundersignedherebyacknowledgesthatPenalCodeSection11166andthecontractualobligationsbetweenCountyofFresno(COUNTY)andCONTRACTOR,relatedtoprovisionofservicesforvisitationcenters,requirethattheundersignedreportallknownorsuspectedchildabuseorneglecttooneormoreoftheagenciessetforthinPenalCode(P.C.)Section(§)11165.9.Forpurposesoftheundersigned’schildabusereportingrequirements,“childabuseorneglect”includesphysicalinjuryinflictedbyotherthanaccidentalmeansuponachildbyanotherperson,sexualabuseasdefinedinP.C.§11165.1,neglectasdefinedinP.C.§11165.2,willfulcrueltyorunjustifiablepunishmentasdefinedinP.C.§11165.3,andunlawfulcorporalpunishmentorinjuryasdefinedinP.C.§11165.4.Achildabusereportshallbemadewhenevertheundersigned,inhisorherprofessionalcapacityorwithinthescopeofhisorheremployment,hasknowledgeoforobservesachildwhomtheundersignedknowsorreasonablysuspectshasbeenthevictimofchildabuseorneglect.(P.C§11166.)Thechildabusereportshallbemadetoanypolicedepartmentorsheriffsdepartment(notincludingaschooldistrictpoliceorsecuritydepartment),ortoanycountywelfaredepartment,includingFresnoCountyDepartmentofSocialServices24HourCAREFINE.(SeePC§11165.9.).Forpurposesofchildabusereporting,a“reasonablesuspicion”meansthatitisobjectivelyreasonableforapersontoentertainasuspicion,baseduponfactsthatcouldcauseareasonablepersoninalikeposition,drawing,whenappropriate,onhisorhertrainingandexperience,tosuspectchildabuseorneglect.Thepregnancyofachilddoesnot,inandofitself,constituteabasisforreasonablesuspicionofsexualabuse.(P.C.§11166(a)(1).)Substantialpenaltiesmaybeimposedforfailuretocomplywiththesechildabusereportingrequirements.Furtherinformationandacopyofthelawmaybeobtainedfromthedepartmentheadordesignee.Ihavereadandunderstandtheabovestatementandagreetocomplywiththechildabusereportingrequirements.DATE
Exhibit E
Page 1 of 2
CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES
CONTRACTOR shall adhere to and develop written procedures in accordance with the below standards
adapted from the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in
Health Care:
Culturally Competent Care:
1. Organizations must ensure that consumers receive from all staff members effective,
understandable, and respectful care that is provided in a manner compatible with
their cultural health beliefs and practices and preferred language.
2. Organizations must implement strategies to recruit, retain, and promote at all levels
of the organization a diverse staff and leadership that are representative of the
demographic characteristics of the service area.
3. Organizations must ensure that staff at all levels and across all disciplines receive
ongoing education and training in culturally and linguistically appropriate service
delivery.
Language Access Services:
4. Organizations must offer and provide language assistance services, including bilingual
staff and interpreter services, at no cost to consumers with limited English proficiency
at all points of contact, in a timely manner during all hours of operation.
5. Organizations must provide to consumers in their preferred language both verbal
offers and written notices informing them of their right to receive language assistance
services.
6. Organizations must assure the competence of language assistance provided to limited
English proficient consumers by interpreters and bilingual staff. Family and friends
should not be used to provide interpretation services (except on the request of the
consumer).
7. Organizations must make available easily understood patient-related materials and
post signage in the languages of the commonly encountered groups and/or groups
represented in the service area.
Organizational Supports:
8. Organizations must develop, implement, and promote a written strategic plan that
outlines clear goals, policies, operational plans, and management
accountability/oversight mechanisms to provide culturally and linguistically
appropriate services.
Exhibit E
Page 2 of 2
9. Organizations must conduct initial and ongoing organizational self-assessments of
CLAS related activities and are encouraged to integrate cultural and linguistic
competence-related measures into their internal audits, performance improvement
programs, consumer satisfaction Assessments, and Outcomes-Based Evaluations.
10. Organizations must ensure that data on the individual consumer’s race, ethnicity, and
spoken and written language are collected in program records, integrated into the
organizations management information systems, and periodically updated.
11. Organizations must maintain a current demographic, cultural, and epidemiological
profile of the community as well as a needs assessment to accurately plan for and
implement services that respond to the cultural and linguistic characteristics of the
service area.
12. Organizations must develop participatory, collaborative partnerships with
communities and utilize a variety of formal and informal mechanisms to facilitate
community and consumer involvement in designing and implementing CLAS-related
activities.
13. Organizations must ensure that conflict and grievance resolution processes are
culturally and linguistically sensitive and capable of identifying, preventing, and
resolving cross-cultural conflicts or complaints by consumers.
14. Organizations must regularly make available to the public information about their
progress and successful innovations in implementing these standards and to provide
public notice in their communities about the availability of this information.
15. Organizations must ensure communication regarding the organization’s progress in
implementing and sustaining CLAS to all stakeholders, constituents, and general
public.
CONTRACTOR shall develop written procedures in accordance with the above standards. The
provisions of this Agreement are not intended to abrogate any provisions of law or regulation existing
or enacted during the term of this Agreement.
Exhibit F
Page 1 of 2
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. Identifying Information
Name of entity D/B/A
Address (number, street) City State ZIP code
CLIA number Taxpayer ID number (EIN) Telephone number
( )
II. Answer the following questions by checking “Yes” or “No.” If any of the questions are answered “Yes,” list names and
addresses of individuals or corporations under “Remarks” on page 2. Identify each item number to be continued.
A. Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution, organizations, or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
YES NO
by Titles XVIII, XIX, or XX? ......................................................................................................................... ❒ ❒
B. Are there any directors, officers, agents, or managing employees of the institution, agency, or
organization who have ever been convicted of a criminal offense related to their involvement in such
programs established by Titles XVIII, XIX, or XX? ...................................................................................... ❒ ❒
C. Are there any individuals currently employed by the institution, agency, or organization in a managerial,
accounting, auditing, or similar capacity who were employed by the institution’s, organization’s, or
agency’s fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only) ........... ❒ ❒
III. A. List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under “Remarks” on page 2. If more than one individual is reported and any of these persons are
related to each other, this must be reported under “Remarks.”
NAME ADDRESS EIN
B. Type of entity: ❒ Sole proprietorship ❒ Partnership ❒ Corporation
❒ Unincorporated Associations ❒ Other (specify)
C. If the disclosing entity is a corporation, list names, addresses of the directors, and EINs for corporations
under “Remarks.”
D. Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities?
(Example: sole proprietor, partnership, or members of Board of Directors) If yes, list names, addresses
of individuals, and provider numbers. ..........................................................................................................
❒ ❒
NAME ADDRESS PROVIDER NUMBER
ExhibitFPage2of2IV.A.Hastherebeenachangeinownershiporcontrolwithinthelastyear?Ifyes,givedate.B.Doyouanticipateanychangeofownershiporcontrolwithintheyear?Ifyes,when?C.Doyouanticipatefilingforbankruptcywithintheyear?Ifyes,when?V.Isthefacilityoperatedbyamanagementcompanyorleasedinwholeorpartbyanotherorganization?..Ifyes,givedateofchangeinoperations.VI.HastherebeenachangeinAdministrator,DirectorofNursing,orMedicalDirectorwithinthelastyear?.VII.A.Isthisfacilitychainaffiliated?(Ifyes,listname,addressofcorporation,andEIN.)NameEINN/AAddress(number,name)CityStateZIPcodeB.IftheanswertoquestionVILA,isNO,wasthefacilityeveraffiliatedwithachain?(Ifyes,listname,addressofcorporation,andEIN.)NameEINN/AAddress(number,name)CityStateZIPcodeWhoeverknowinglyandwillfullymakesorcausestobemadeafalsestatementorrepresentationofthisstatement,maybeprosecutedunderapplicablefederalorstatelaws.Inaddition,knowinglyandwillfullyfailingtofullyandaccuratelydisclosetheinformationrequestedmayresultindenialofarequesttoparticipateorwheretheentityalreadyparticipates,aterminationofitsagreementorcontractwiththeagency,asappropriate.Nameofauthorizedrepresentative(typed)StephenRamirezTitleChiefExecutiveOfficerSignature7jDate/JUl/UA/C6RemarksN/AYESNO0ElElElElEl