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Home My WebLink AboutAgreement A-16-533 with CDPH for TB Control.pdfAgreement No. 16-533 ACCEPTANCE OF AWARD County of Fresno, Department of Public Health Funding Period: July 1, 2016 through June 30, 2017 Base Award: $279,572 Food, Shelter, Incentives and Enablers Allotment; $16,413 I hereby accept this award. By accepting this award, I agree to the requirements as described in the Standards and Procedures Manual for FY 2016-2017 and any other conditfons stipulated by the California Department of Public Health, Tuberculosis Control Branch. £_ --£= ~ 12v<"' ~ Authorized Signature Ernest 8•1ddy Mendes Print Name ATTEST: BERNICE E. SEIDEL, Clerk Board of. Chairman, Board of Supervisors Title California Departmont of Public ~lealth Tuberculosis Control Branch Darfur Contracting Act Pursuant to Public Contract Code (PCC) sections 10475-10481, the Darfur Contracting Act's intent is to preclude State agencies from contracting with scrutinized companies that do business in the African nation of Sudan. A scrutinized company is a company doing specified types of business in Sudan as defined in PCC section 10476. Scrutinized companies are ineligible to, and cannot, contract with a State agency for goods or services (PCC section 10477{a)) unless obtaining permission from the Department of General Services according to the criteria set forth in PCC section 10477(b). Therefore, to be eligible to contract with the California Department of Public Health. please initial one of the following three paragraphs and complete the certification below: 1. 2. Initials 3. Initials CERTIFICATION We do not currently have, or we have not had within the previous three years, business activities or other operations outside of the United States. We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services (DGS) to submit a bid or proposal pursuant to Public Contract Code section 1 0477(b) or submit a contract/purchase order. A copy of the written permission from DGS is included with our bid, proposal or contract/purchase order. We currently have, or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a scrutinized company as defined in Public Contract Code section 10476. I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind this company to the clause listed above. This certification is made under the laws of the State of California. 'Company Name (Printed} County of Fresno By (Authorized Signature) Ernest Buddy Meodes .. Chairman, Board of .Supervisors Printed Name and Title of Person Signing 94-6000-512 ATIEST: BERNICE E. SEIDEL, Cieri< Board of Supervisors •• d. ,,rx.·,L~ ~-::t" ~~---···~~····· =~-.... e ty Dare Executed .. .. . . .... .. . . . . ... .. Exe'cf.lied In the co'unty aod State of . . -. ~} J-3 )~Oiy .fresno, CA Adapted from CDPH form 9067 (4109) Page i of 1 March 201.5 Qaljforaia Department qf Pubtic Heallh Tuberculosis ControL Branch STATE OF CALIFORNIA CALIFORNIA DEPARTMENT OF PUBLIC HEALTH CERTIFICATION REGARDING LOBBYING The undersigned certifies, to the best of his or her knowledge and belief, that: Attachment 1 (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member or Congress. an officer or employee of Congress, or an employee of a Member of Congress in connection with the making. awarding or entering Into of this Federal contract, Federal grant. or cooperative agreement and the extension. continuation, renewal, amendment, or modification of this Federal contract, grant, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for mfluencing or attempting to influence an officer or employee of any agency of the United States Government, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection witn this Federal contract, grant, cr cooperative agreement, the undersigned shall complete and submit Standard Form LLL. "Disclosure of Lobbying Activities'' in accordance with its fnstrtJctions. (3) The undersigned shall require that the language of this certificatlon be Included in the award documents for all subawards at an tiers (including subcontractors, subgrants, and contracts under grants and cooperative agreements) of $100,000 or more. and that all subreclpients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for makfng or entering into this transaction imposed by Section 1352, Title 31, U.S. C., any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100.000 for each such fellure. County of Fresno Ernest Buddy Mendes Nama or Contrnt;tor Print~d Nall'e or Person Sil,lning for Conlrll(:tor Chairman, Board of Supervisors Data\ After execution by or on behalf of Contractor, please return to: California Department of Public Health Tuberculosis Control Branch 850 Marina Bay Parkway, Building P, Second Floor Richmond. CA 94804-6403 ATIEST: BERNICE E. SEIDEL, Clerk Board of Supervisors .,(j\yN;, (' ~ CDPH reserves the right to notifiy the contractor in writing of an alternate submission address. Adap!ed from COPH Exhrbit O{F) {10J14) Page 24 of26 March 2016 Calrfornia Department of Publ·c Health Tubercu,osis Control Branch Contractor Certification Clauses CERTIFICATION I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that l am duly authorized to legally bind the prospective Contractor to the clause(s} listed below. This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federa/ID Number CountY.S!!Fres~o 94-6000-512 By (Authorized Signature) ~~~ Printed Name and Title oiPer!on Signing ATIEST: Ernest Buddy Mendes, Chairman, Board of Supervisors Date Executed Fresno CONTRACTOR CERTIFICATION CLAUSES 1. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 81 03) (Not applicable to pubHc entities.) 2. DRUG-FREE WORKPLACE REQUIREMENTS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation, possession or use of a control!ed substance is prohibited and specifying actions to be taken against employees for violations. b. Establish a Drug-Free Awareness Program to inform employees about: 1) the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3) any available counseling, rehabilitation and employee assistance programs; and, 4) penalties that may be imposed upon employees for drug abuse violations. c. Every employee who works on the proposed Agreement will: 1) receive a copy of the company's drug-free workplace policy statement; and, Adapted from OGS form CCC-307 {03.'28/2007) Page 1 of ..1 February 2014