HomeMy WebLinkAboutAgreement A-17-053 with Samuels Center.pdf
COUNTY OF FRESNO
Fresno, CA
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AGREEMENT
THIS AGREEMENT is made and entered into this _______ day of ________________, 2017,
by and between the COUNTY OF FRESNO, a Political Subdivision of the State of California,
hereinafter referred to as "COUNTY", and SARAH SAMUELS CENTER FOR PUBLIC HEALTH
RESEARCH AND EVALUATION, a Corporation, whose address is 1222 Preservation Park Way,
Oakland, California, 94612, hereinafter referred to as "CONTRACTOR".
W I T N E S S E T H:
WHEREAS, COUNTY, through its Department of Public Health, is in need of a qualified
agency to provide evaluation of activities completed under the Department’s Nutrition Education and
Obesity Prevention (NEOP) program; and
WHEREAS, CONTRACTOR, has the facilities, equipment and personnel skilled in the
provision of such evaluation services; and
WHEREAS, CONTRACTOR, is qualified and is willing to provide such services, pursuant to
the terms and conditions of this Agreement.
NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
hereto agree as follows:
1. RESPONSIBILITIES
A. CONTRACTOR shall perform all services and fulfill all responsibilities as identified in
COUNTY’s Request for Proposal (RFP) No. 17-031 dated November 9, 2016, Addendum No. One (1)
to RFP No. 17-031 dated November 29, 2016 (collectively referred to herein as COUNTY’s Revised
RFP), and CONTRACTOR’s Response to said Revised RFP dated December 12, 2016, both
incorporated herein by reference and made part of this Agreement. 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; (2) to the Revised RFP; (3) to the Response to RFP. A copy of
COUNTY’s RFP No. 17-031 and CONTRACTOR’s Response shall be retained and made available
during the term of this Agreement by COUNTY’s General Services Department, Purchasing Division.
B. CONTRACTOR shall perform all services and fulfill all responsibilities
identified in Exhibit A, attached hereto and by this reference incorporated herein.
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2. TERM
This Agreement shall become effective on March 1, 2017 and shall terminate on the 30th
day of September, 2019. This Agreement may be extended for two (2) additional consecutive twelve
(12) month periods upon the same terms and conditions herein set forth 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 Department of Public Health Director or designee is authorized to execute such written
approval on behalf of COUNTY based on CONTRACTOR’s satisfactory performance and available
funding.
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 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
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Agreement may be terminated by COUNTY upon the giving of thirty (30) days advance written notice
of an intention to terminate to CONTRACTOR.
4. COMPENSATION
A. COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive
compensation at the rates as identified in Exhibit B, attached hereto and incorporated herein by this
reference. For the period of March 1, 2017 through and including September 30, 2017, in no event
shall actual services performed under this Agreement be in excess of One Hundred Twenty Thousand
Dollars and No/100 ($120,000.00). For the period of October 1, 2017 through and including
September 30, 2018, in no event shall actual services performed under this Agreement be in excess of
One Hundred Thousand Dollars and No/100 ($100,000.00). For the period of October 1, 2018 through
and including September 30, 2019, in no event shall actual services performed under this Agreement
be in excess of One Hundred Twenty Thousand Dollars and No/100 ($120,000.00). It is understood
that all expenses incidental to CONTRACTOR's performance of actual services under this Agreement
shall be borne by CONTRACTOR.
B. Payments by COUNTY shall be in arrears, for services provided during the
preceding month, within forty-five (45) days after receipt and verification of CONTRACTOR's
invoices by COUNTY's Department of Public Health. If CONTRACTOR should fail to comply with
any provision of this Agreement, COUNTY shall be relieved of its obligation for further
compensation.
C. COUNTY shall not be obligated to make any payments under this Agreement if
the request for payment is received by the COUNTY more than forty-five (45) days after the end of
the Federal Fiscal Year.
D. CONTRACTOR shall be held financially liable for any and all future
disallowances/audit exceptions due to CONTRACTOR’s deficiency discovered through the State
audit process. At COUNTY’S election, the disallowed amount will be remitted within forty-five (45)
days to County upon notification or shall be withheld from subsequent payments to CONTRACTOR.
5. INVOICING
CONTRACTOR shall invoice COUNTY monthly, by the thirtieth (30th) day of each
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month for the prior month’s expenditures, addressed to the County of Fresno, Department of Public
Health, OPPC-NEOP, P.O. Box. 11867, Fresno, CA 93775, Attention: OPPC-NEOP Staff Analyst.
Invoices shall detail line items as specified in Exhibit B, including original budget amount(s), current
month’s expenses, year-to-date expenses, and budget balances. In addition, invoices shall also include
all relevant supporting documentation including but not limited to copies of original statements,
program expense receipts, payroll records and mileage claims.
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 venturer, 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 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. MODIFICATION
Any matters of this Agreement may be modified from time to time by the written
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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, that do not exceed ten percent (10%)
of the maximum compensation payable to the CONTRACTOR may be made with written approval of
COUNTY’s Department of Public Health Director or designee and the designee of the California
Department of Public Health.
8. NON-ASSIGNMENT
Neither party shall assign, transfer or subcontract this Agreement nor their rights or
duties under this Agreement without the prior written consent of the other party.
9. HOLD-HARMLESS
CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's request,
defend the COUNTY, its officers, agents and employees from any and all costs and expenses,
including attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to
COUNTY in connection with the performance, or failure to perform, by CONTRACTOR, its officers,
agents or employees under this Agreement, and from any and all costs and expenses, including
attorney fees and court costs, damages, liabilities, claims and losses occurring or resulting to any
person, firm or corporation who may be injured or damaged by the performance, or failure to perform,
of CONTRACTOR, its officers, agents or employees under this Agreement.
10. 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.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
B. Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
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not less than Two Hundred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) per accident and for property damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit of Five Hundred Thousand Dollars ($500,000). 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) per occurrence, Three
Million Dollars ($3,000,000) 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 the COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under the CONTRACTOR's 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 endorsements as stated above for all of the
foregoing policies, as required herein, to the County of Fresno, Department of Public Health, P.O. Box
11867, Fresno, California, 93775, Attention: Contracts Section – 6th Floor, stating that such insurance
coverage 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
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insurance, or self-insurance, maintained by the COUNTY, its officers, agents and employees, shall be
excess only and not contributing with insurance provided under the CONTRACTOR’s 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 from companies possessing a current A.M. Best, Inc. rating
of A FSC VII or better.
11. CONFIDENTIALITY
All services performed by CONTRACTOR under this Agreement shall be in strict
conformance with all applicable Federal, State of California and/or local laws and regulations relating
to confidentiality.
12. 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
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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 without prior authorization from the COUNTY’s Chief
Information Officer, and/or designee(s), including but not limited to mobile storage devices. If data is
approved to be 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 or anyone having an employment relationship with the
COUNTY, may not use COUNTY computers or computer peripherals on non-COUNTY premises
without prior authorization from the COUNTY’s Chief Information Officer, and/or designee(s).
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 CONTRACTOR’s response to all incidents
arising from a possible breach of security related to COUNTY’s confidential client information
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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.
13. NON-DISCRIMINATION
During the performance of this Agreement, CONTRACTOR shall not unlawfully
discriminate against any employee or applicant for employment, or recipient 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 pursuant to all applicable State of California and
Federal statutes and regulations.
14. LICENSES/CERTIFICATION
CONTRACTOR shall throughout the term of this Agreement maintain all necessary
licenses, permits, approvals, certificates, waivers and exemptions necessary for the provision of the
services hereunder and required by the laws and regulations of the United States of America, State of
California, Fresno County and any other applicable government agencies. CONTRACTOR shall
notify COUNTY immediately in writing of its inability to obtain or maintain such licenses, permits,
approvals, certificates, waivers and exemptions, irrespective of the pendency of any appeal related
thereto. In addition, CONTRACTOR shall comply with all other applicable laws, rules, or regulations,
as any may now exist or be hereafter changed.
15. COMPLIANCE WITH STATE REQUIREMENTS
CONTRACTOR recognizes that COUNTY operates is NEOP program under an
agreement with the State of California Department of Public Health, and that under said agreement the
State imposes certain requirements on the COUNTY and its subcontractors. CONTRACTOR shall
adhere to all State requirements, including those identified in Exhibit C, attached hereto and by this
reference incorporated herein. It is understood that Exhibit C also grants the COUNTY certain rights
which are reserved to the State; such rights are fully described therein.
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16. PROPERTY OF COUNTY
All purchases over Five Thousand and No/100 Dollars ($5,000.00) and certain
purchases under Five Thousand and No/100 Dollars ($5,000.00) such as computers, printers, cameras
and other sensitive items made during the life of this Agreement shall be identified as fixed assets with
an assigned County of Fresno Accounting Inventory Number. These fixed assets shall be retained by
the 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
assets and shall be physically present when fixed assets are returned to COUNTY possession at the
termination or expiration of this Agreement.
17. RECORDS
Financial and statistical data shall be kept and reports made as required by the
COUNTY’s Department of Public Health Director and the State. All such records shall be available
for inspection by the designated Auditors of COUNTY or State at reasonable times during normal
business hours. All such records shall be maintained through the end of this Agreement. All records
shall be considered property of COUNTY and shall be retained by COUNTY at the termination or
expiration of this Agreement.
18. REPORTS
CONTRACTOR shall submit to COUNTY within ten (10) calendar days all program
reports for the preceding month. CONTRACTOR shall also furnish to COUNTY such statements,
records, reports, data, and other information as COUNTY may request pertaining to matters covered
by this Agreement. In the event that CONTRACTOR fails to provide such reports or other information
required hereunder, it shall be deemed sufficient cause for COUNTY to withhold monthly payments
until there is compliance. In addition, CONTRACTOR shall provide written notification and
explanation to the COUNTY within five (5) days of any fund received from another source to conduct
the same services covered by this Agreement.
19. PROHIBITION OF PUBLICITY
None of the funds, materials, property or services provided directly or indirectly under
this Agreement shall be used for CONTRACTOR’s advertising, fundraising or publicity (e.g.,
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purchasing of tickets/tables, silent auction donations, media promotions) for the purpose of self-
promotion. Notwithstanding the above, publicity of the services described in Section One (1) of this
Agreement shall be allowed as necessary to raise public awareness about the availability of such
specific services when approved in advance in writing by COUNTY’s NEOP Project Coordinator and
the California Department of Public Health. Such items include but are not limited to written/printed
materials, materials posted on the Internet, or the use of media (e.g., radio, television, billboards,
newspapers), and any related expense. Documents prepared by CONTRACTOR using funding under
this Agreement for external release shall undergo appropriate review and approval prior to release.
Review may take up to thirty (30) business days. Materials, whether newly developed or reprinted,
shall include an appropriate acknowledgement/funding statement.
20. 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 CONTRACTOR’s 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, attached hereto as Exhibit D
and incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the
self-dealing transaction or immediately thereafter.
15. AUDITS AND INSPECTIONS
CONTRACTOR shall at any time during business hours, and as often as the COUNTY
may deem necessary, make available to the COUNTY for examination all of its records and data with
respect to the matters covered by this Agreement. CONTRACTOR shall, upon request by the
COUNTY, permit the COUNTY to audit and inspect all such records and data necessary to ensure
CONTRACTOR's compliance with the terms of this Agreement.
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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 Auditor for a period of
three (3) years after final payment under contract (Government Code Section 8546.7).
16. NOTICES
The persons and their addresses having authority to give and receive notices under this
Agreement include the following:
COUNTY CONTRACTOR
Director, County of Fresno Executive Director
Department of Public Health Sarah Samuels Center
P.O. Box 11867 1221 Preservation Park Way
Fresno, CA 93775 Oakland, CA 94612
Any and all notices between the COUNTY and the CONTRACTOR provided for or
permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
personally 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.
17. GOVERNING LAW
The parties agree, that for the purposes of venue, performance under this Agreement is
to be 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.
18. SEVERABILITY
The provisions of this Agreement are severable. The invalidity or unenforceability of
any one provision in the Agreement shall not affect the other provisions.
19. ENTIRE AGREEMENT
This Agreement, including all Exhibits, constitutes the entire agreement between the
CONTRACTOR and COUNTY with respect to the subject matter hereof and supersedes all previous
Agreement negotiations, proposals, commitments, writings, advertisements, publications, and
understanding of any nature whatsoever unless expressly included in this Agreement.
///
l IN WITNESS WHERJ.:OF. the parties hereto have executed this Agreement as of the day and
:j
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;.ear lirst hereinabove written.
CONTRACTOR:
SARAH SAMUELS CENTER FOR PUBLIC
HEALTH RESEARCH AND EVALUATION
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Date:
Chairman of the Board. or
President. or any Vice President
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By--------------
Print Name: -----------
fitle: -----------------Secretary (of Corporation). or
any Assistant Secretary. or
Chief Financial Onicer. or
any Assistant Treasurer
Date: --------
Mailing i\ddress:
1222 Preservation Park Way
Oakland. CA 94612
Phone#: (51 0) 271·6 799
Contact: Sallie Yoshida. Executive Director
E-mail: sallic(i/Jsamuelscenter.com
:'
COUNTY OF FRESNO:
Chairman. Board of Supervisors
Date:
BERNICE E. SEIDEL. Clerk
Board of Supervisors
I'LEASE SEE ADDITIONAL
SIGNATlJRE PAGE ATTACHED
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Exhibit A
Page 1 of 7
Activity
No.
Evaluation Activity Description Formative Process Outcome
or Impact
Time Frame**
Tool/Documentation
E.1.1 On an on-going basis, record SNAP-Ed activities, sites,
participants reached, and other required elements for
USDA’s SNAP-Ed Education and Administration
Reporting System.
X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
X EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other:
E.1.2 Continue to develop & implement Champion
Engagement System for SNAP-Ed agencies to track
community and agency champions who are leading and
assisting with Champions for Change work in their
communities and the work that they do. Department
will be the hub agency for the system.
X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Champion Engagement
System
E.1.3 Monitor reach, effectiveness, adoption,
implementation, and maintenance of champion-led
and community-driven PSE changes through policy
review, surveys, key informant interviews, and/or
observational assessments.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
X PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Champion Engagement
System, evaluation tools, exposure
surveys and related reports,
evaluation summaries/ reports
E.1.4 Monitor reach, effectiveness, adoption,
implementation, and maintenance of champion-led
organizational changes at faith-based organizations
through activity and communications tracking
(Champion Engagement System), policy review,
surveys, key informant interviews, and/or
observational assessments.
X X
Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
x PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Champion Engagement
System, evaluation tools, evaluation
summaries/reports
E.1.5 Monitor reach, effectiveness, adoption,
implementation, and maintenance of champion-led PSE
changes at schools through activity and
X X Year 1
Q1 Q2 Q3 Q4
x x
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Exhibit A
Page 2 of 7
communications tracking (Champion Engagement
System), policy review, surveys, key informant
interviews, and/or observational assessments.
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
Food Behavior Checklist
UC Intent to Change
List other: Champion Engagement
System, evaluation tools, evaluation
summaries/reports
E.1.6 Monitor reach, effectiveness, adoption,
implementation, and maintenance of champion-led
built environment (land use and planning) PSE changes
through activity and communications tracking
(Champion Engagement System), policy review,
surveys, key informant interviews, and/or
observational assessments.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Champion Engagement
System, evaluation tools, evaluation
summaries/reports
E.1.7 Monitor and evaluate outcomes of direct education
activities with CDPH approved evaluation curriculum
evaluation tools. Department and contractor will lead.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
x PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Evaluation
summaries/reports
E.1.8 Success Stories: Give to adults who complete a class
series to capture qualitative feedback.
X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Success Story forms
E.1.9 Pre/Post Assessments: Adult Evaluation of knowledge
gain and behavior change in adult series-based classes
X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
x Food Behavior Checklist
UC Intent to Change
List other: Plan, Shop, Save & Cook
Evaluation
E.1.10 Policy System and Environment (PSE) Change – Annual
reporting on measures of reach, effectiveness,
X X Year 1
Q1 Q2 Q3 Q4 EARS/ATF
Exhibit A
Page 3 of 7
adoption, implementation and maintenance. x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
X PSE RE-AIM Report
x UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Smarter Lunchrooms
Champion training sign-in sheets,
feedback forms, MEET training sign-
in sheets, feedback forms,
Facebook Analytics, Constant
Contact data tables
E.1.12 CX3 is a protocol for evaluating neighborhood
environments. As such, all methods and deliverables
are listed in the above table as opposed to in a
separate evaluation table.
Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: CX3 Tools, completed
forms, maps, data base
E.1.13 UCCE, Department and contractor will explore, identify,
and plan a joint outcome evaluation, related to
nutrition education and/or school wellness efforts.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
Year 3
Q1 Q2 Q3 Q4
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: UCCE and Department
joint evaluation plan
E.1.14 UCCE, Department and contractor will pilot a joint
outcome evaluation.
X X Year 1
Q1 Q2 Q3 Q4
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: UCCE and Department
joint evaluation tools
E.1.15 UCCE, Department and contractor will implement a
joint outcome evaluation.
X X Year 1
Q1 Q2 Q3 Q4
Year 2
Q1 Q2 Q3 Q4
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
Exhibit A
Page 4 of 7
Year 3
Q1 Q2 Q3 Q4
x x x x
UC Intent to Change
List other: UCCE and Department
joint evaluation summaries/reports
E.1.16 Department and contractor will explore and identify a
C4C staff training to build capacity of staff and
champions to identify, lead and support community-
driven PSE work.
X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
Year 3
Q1 Q2 Q3 Q4
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Selected training
curriculum
E.1.17 Department will provide staff training on selected
curriculum(a) in year 1 and conduct 3 trainings with
champions in year 2 and 3 trainings with champions in
year 3. Contractor will take lead on evaluating
trainings.
X X Year 1
Q1 Q2 Q3 Q4
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
X X X X
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Training evaluation tools
and evaluation results
E.2.1 On an on-going basis, record SNAP-Ed activities, sites,
participants reached, and other required elements for
USDA’s SNAP-Ed Education and Administration
Reporting System.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
x EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other:
E.2.2 Use the RE-AIM evaluation framework to report on an
annual basis progress for Healthy Retail, Food Access,
and Marketing Objective activity and communications
tracking, on-site nutrition assessments, surveys and/or
key informant interviews of champions, funded staff,
customers, managers, and/or other stakeholders.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
x PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Evaluation tools,
evaluation summaries/reports
E.2.3 Develop evaluation plan and provide technical
assistance for evaluation piloting and implementation
of Mobile Demonstration Kitchen Sustainability Model.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Exhibit A
Page 5 of 7
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
Food Behavior Checklist
UC Intent to Change
List other:
E.2.4 Use the RE-AIM evaluation framework to report on an
annual basis progress for the FCHIP Farm to Table
Workgroup’s local best practice to expand access to
fruits and vegetables through activity and
communications tracking, on-site nutrition
assessments, surveys and/or key informant interviews
of champions, funded staff, customers, and/or other
stakeholders.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
x PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Evaluation tools,
evaluation
E.3.1 On an on-going basis, record SNAP-Ed activities, sites,
participants reached, and other required elements for
USDA’s SNAP-Ed Education and Administration
Reporting System
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
x EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other:
E.3.2 Use the RE-AIM evaluation framework to report on an
annual basis progress for Worksite Wellness Objective,
for worksites and school districts, with specific
indicators of reach, effectiveness, adoption,
implementation and maintenance through pre- and
post-assessments (Check for Health survey in the Get
Fit Business Kit), activity and communications tracking,
interviews with staff, worksite policy review, and
environmental observations where appropriate.
X X Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
EARS/ATF
X PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Evaluation tools,
evaluation summaries/reports
E.4.1 On an on-going basis, record SNAP-Ed activities, sites,
participants reached, and other required elements for
USDA’s SNAP-Ed Education and Administration
Reporting System.
x Year 1
Q1 Q2 Q3 Q4
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
x EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other:
E.4.2 Use the RE-AIM evaluation framework to report on an
annual basis progress for School Wellness Objective
x x Year 1
Q1 Q2 Q3 Q4 EARS/ATF
Exhibit A
Page 6 of 7
with specific indicators of reach, effectiveness,
adoption, implementation and maintenance through
activity and communication tracking, surveys,
interviews, policy review and/or school environmental
observations.
x x
Year 2
Q1 Q2 Q3 Q4
x x x x
Year 3
Q1 Q2 Q3 Q4
x x x x
x PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Evaluation tools,
evaluation reports/summaries
E.4.4 Teacher Observation Tool: Assess teachers perceived
behavior change of students
x
Year 1
Q1 Q2 Q3 Q4
X X
Year 2
Q1 Q2 Q3 Q4
X X X X
Year 3
Q1 Q2 Q3 Q4
X X X X
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Teacher Observation
Tool, Online Data Entry Portal
E.4.5 Teacher Tasting Tool: assesses the teacher’s perception
of student’s baseline exposure to various foods and
willingness to either try again or ask for these foods in
the future
x Year 1
Q1 Q2 Q3 Q4
X X
Year 2
Q1 Q2 Q3 Q4
X X X X
Year 3
Q1 Q2 Q3 Q4
X X X X
EARS/ATF
PSE RE-AIM Report
UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Teacher Tasting Tool,
Online Data Entry Portal
E.4.7 Policy System and Environment (PSE) Change – Annual
reporting on measures of reach, effectiveness,
adoption, implementation and maintenance
x x Year 1
Q1 Q2 Q3 Q4
X X
Year 2
Q1 Q2 Q3 Q4
X X X X
Year 3
Q1 Q2 Q3 Q4
X X X X
EARS/ATF
X PSE RE-AIM Report
X UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other:
E.4.8 Community Assessment: Smarter Lunchrooms Self-
Assessment Scorecard
x Year 1
Q1 Q2 Q3 Q4
X X
Year 2
Q1 Q2 Q3 Q4
X X X X
Year 3
Q1 Q2 Q3 Q4
X X X X
x EARS/ATF
x PSE RE-AIM Report
X UC CalFresh Workbook
Food Behavior Checklist
UC Intent to Change
List other: Smarter Lunchrooms
Scorecards, Smarter Lunchrooms
Site Plans, Photos, Success Stories
**Time Frame: Year & Quarter: Year 1 (FFY 2017); Year 2 (FFY 2018); Year 3 (FFY 2019); Qtr. 1 (Oct. 1-Dec. 31); Qtr. 2 (Jan. 1-March 31); Qtr. 3 (Apr. 1-Jun. 30); Qtr. 4 (Jul. 1-Sept.30)
Exhibit A
Page 7 of 7
Standard Activities
Activity Description Timeframe Documentation
5.1 Utilize media, social media, blogs, and agency websites to
promote and cross-promote SNAP-Ed activities, success stories,
events, community forums, and/or approved messaging.
Ongoing On file: Facebook analytics, blog analytics
*Contributes to all objectives as appropriate
5.2 Monthly invoices Due 30 days after the end of
each month
Monthly invoices with backup documentation
including but not limited to: Checklist, Personnel
Salaries and Benefits, Summary Spreadsheets, Bi-
weekly Time Logs or timesheets, detail for travel,
receipts, invoices, recipes
5.3 Enter program activity data entry into Activity Tracking Forum
(ATF) state data base.
Due Jan. 15, Apr. 15, Jul. 15,
Oct. 15. Year 1 reporting will
only include April 15, Jul. 15
and Oct. 15.
Program activity, demographic and participation
data entry single sessions provided into ATF.
5.3 Work with Department to complete the Semi-Annual Progress
Report
Due Apr. 15 and Oct. 15 May include but is not limited to: backup
documentation, pictures, evaluation reports,
policies, success stories, press releases, challenges
and strategies to address them, fiscal reports.
5.4 Submit Quarterly Champions for Change Narrative Reports on
progress towards meeting subcontractors’ respective activities.
Due Jan. 31, Apr. 30, Jul. 31,
Oct. 31. Year 1 reporting will
only include April 30, Jul. 31
and Oct. 31.
Back up documentation includes Champions for
Change Narrative Report. Back up documentation
for activity reporting must be kept on file by
activity number and quarter and readily accessible
if needed. This includes but not limited to:
• Evaluation activities
• Trainings/Meetings (agenda, notes)
• PSE (meeting agendas, e-mails, pictures)
• Success Stories
• Evaluation Reports
5.5 Work with Department subcontractors to plan, monitor, analyze,
report, evaluate and comply with required and PSE change
evaluation activities.
Ongoing Evaluation Reports, RE-AIM framework (PSE year-
end reporting form) and Success Stories
5.6 Participate in Department and State periodic in-person trainings
and webinars as appropriate.
Ongoing ATF, Department Quarterly Champions for Change
Narrative Reports
5.7 Participate in Champions for Change Program Lead meetings and
All-Team meetings as appropriate.
Ongoing Agenda, meeting notes
YEAR ONE: March 1, 2017 - Sept. 30, 2017
1. Staffing: Salary/Benefits:
% of SNAP-
Ed Time
spent on
Mgmt/Admi
n Duties
% of SNAP-
Ed Time
spent on
Direct
SNAP-Ed
Delivery
1 Sallie Yoshida 0.10 25.00%75.00%136,270.00$ $13,627.00 38.30%$5,219.14 $4,711.54 $18,846
2 Heidi Skolnik 0.15 100.00%75,000.00$ $11,250.00 38.30%$4,308.75 $0.00 $15,559
3 Christine Mineart 0.20 100.00%65,000.00$ $13,000.00 38.30%$4,979.00 $0.00 $17,979
4 Bryden Johnston 0.23 100.00%64,095.65$ $14,742.00 38.30%$5,646.19 $0.00 $20,388
5 Diego Gamboa 0.15 100.00%41,093.35$ $6,164.00 38.30%$2,360.81 $0.00 $8,525
6 Yoko Shimizu 0.08 100.00%54,150.00$ $4,332.00 38.30%$1,659.16 $5,991.16 $5,991
7 Keiko Kanayama 0.07 100.00%45,051.45$ $3,153.60 38.30%$1,207.83 $4,361.43 $4,361
0.98 Staffing: Salary/Benefits:$66,269 $25,381 $15,064 $91,649
2. Non-Capital Equipment/Supplies:
Budget Item Description/Justification FTE Cost per
Item
# of
Items Total
1 1 $0.50 100 $50
2 1 $49.00 3 $147
3 1 $26.00 2 $52
4 1 $1.85 720 $1,332
Total Supplies:$1,581
3. Materials:
Budget Item Cost per
Item
# of
Items Total
1 $1 600 $600
Total Materials:$600
4. Travel:
Position Title/Name Location Trips No. People Days Nights Per Diem Lodging Miles @
$.54
Reg.
Fee Other Total
1
Oakland-Fresno. Other:
rental car/parking 2 1 2 1 $51.00 $111.00 $155.00 $736
2
Oakland-Fresno. Other:
rental car/parking 1 1 2 1 $51.00 $111.00 $155.00 $368
3
Oakland-Fresno. Other:
rental car/parking 2 1 2 1 $51.00 $111.00 $155.00 $736
4
Oakland-Fresno. Other:
rental car/parking 1 1 2 1 $51.00 $111.00 $155.00 $368
5
Oakland-Fresno. Other:
rental car/parking 2 1 2 1 $51.00 $111.00 $155.00 $736
For completed surveys and other evaluation tools
Survey and evaluation software. 3 months ($49/month).
Postage
Survey software. 2 months ($26/month).
12 Key informational interviews (60 minutes each; $1.85 per minute)
Description/Justification
Training and evaluation materials
SNAP-Ed
Admin
Costs
Total SNAP-
Ed Funded
Salary and
Benefits
FTE Total SNAP-
Ed Salary
SNAP-Ed Time Spent
Annual
Salary
Statutory benefits include SSI, Medicar, CA UI, ETT/FUTA and Worker's Compensation. Discretionary
benefits include 401k, Health Insurance, Commuter benefits, Paid time off, and all federal and state holidays.
Definition and basis for calculations of benefit rate(s):
Describe what is covered in the benefit rate for your agency.
Transciption
Quicktap
Survey Monkey
Name Benefit
Rate
Total
SNAP-Ed
Benefits
Director of Programs
Research Specialist
Research Specialist
Contract Manager
Office ManagerPosition #Research Specialist
Research Specialist
Position Title
Research Specialist/Bryden
Johnston
Description/
Justification
1 day program mtgs
Data collection
Research Specialist/Bryden
Johnston
In-State
Staff trainings
Data collection
Staff trainings
Research Specialist/Christine
Mineart
Research Specialist/Bryden
Johnston
Research Specialist/Christine
Mineart
Printing
Total Travel:$2,944
5. Building/Space:
Calculation Description Cost per
month FTE # of Mo(s).Total
1 $0
Total Building/Space:$0
6. Maintenance:
Location Name/Address Cost per
month FTE # of Mo(s).Total
1 $0
Total Maintenance:$0
7. Equipment and Other Capital Expenditures:
Budget Item Description/Justification # items Cost per
Item FTE Misc.Total
1 $0
$0
8. Indirect Costs:
Indirect
Cost Rate Total
1 24.00%$23,226
Total Indirect Costs:$23,226
Total Year 1 Budget:
YEAR TWO: Oct. 1, 2017 - Sept. 30, 2018
1. Staffing: Salary/Benefits:
% of SNAP-
Ed Time
spent on
Mgmt/Admi
n Duties
% of SNAP-
Ed Time
spent on
Direct
SNAP-Ed
Delivery
1 Sallie Yoshida 0.07 25.00%75.00%136,270.00$ $9,538.90 38.30%$3,653.40 $3,298.07 $13,192
2 Heidi Skolnik 0.14 100.00%75,000.00$ $10,425.00 38.30%$3,992.78 $0.00 $14,418
3 Christine Mineart 0.17 100.00%65,000.00$ $10,920.00 38.30%$4,182.36 $0.00 $15,102
4 Bryden Johnston 0.18 100.00%64,116.00$ $11,220.30 38.30%$4,297.37 $0.00 $15,518
5 Diego Gamboa 0.10 100.00%40,000.00$ $4,000.00 38.30%$1,532.00 $0.00 $5,532
6 Yoko Shimizu 0.06 100.00%54,150.00$ $3,021.00 38.30%$1,157.04 $4,178.04 $4,178
7 Keiko Kanayama 0.05 100.00%45,051.45$ $2,377.37 38.30%$910.53 $3,287.90 $3,288
0.76 Staffing: Salary/Benefits:$51,503 $19,725 $10,764 $71,228
2. Non-Capital Equipment/Supplies:
Total SNAP-
Ed Funded
Salary and
Benefits
Contract Manager
Office Manager
Director of Programs
Research Specialist
Research Specialist
Research Specialist
Research Specialist
Location Name/Address
Position #Position Title Name Annual
Salary
Total SNAP-
Ed Salary
Benefit
Rate
Total
SNAP-Ed
Benefits
SNAP-Ed
Admin
Costs
FTE
SNAP-Ed Time Spent
Total
Admin/Program
Dollars
$96,774.00
$120,000
Definition and basis for calculations of benefit rate(s):
Describe what is covered in the benefit rate for your agency.
Statutory benefits include SSI, Medicar, CA UI, ETT/FUTA and Worker's Compensation. Discretionary
benefits include 401k, Health Insurance, Commuter benefits, Paid time off, and all federal and state holidays.
Percent of total direct costs. Includes rent, communications, insurance, equipment, general office support, IT support, general office supplies, accountant and
payroll services, business licenses, dues and subscriptions.
Calculation Method
Calculation Description
I I I
I I I
Budget Item Description/Justification FTE Cost per
Item
# of
Items Total
1 1 $0.50 100 $50
2 1 $49.00 3 $147
3 1 $26.00 2 $52
4 1 $1.85 1560 $2,886
Total Supplies:$3,135
3. Materials:
Budget Item Cost per
Item
# of
Items Total
1 $1 600 $600
Total Materials:$600
4. Travel:
Position Title/Name Location Trips No. People Days Nights Per Diem Lodging Miles @
$.54
Reg.
Fee Other Total
1
Oakland-Sacramento.
Other: rental
car/parking 1 1 3 2 $51.00 $111.00 $155.00 $530
2
Oakland-Fresno. Other:
rental car/parking 4 1 2 1 $51.00 $111.00 $155.00 $1,472
3
Oakland-Fresno. Other:
rental car/parking 1 1 2 1 $51.00 $111.00 $155.00 $368
4
Oakland-Fresno. Other:
rental car/parking 4 1 2 1 $51.00 $111.00 $155.00 $1,472
5
Oakland-Fresno. Other:
rental car/parking 1 1 2 1 $51.00 $111.00 $155.00 $368
6
Oakland-Fresno. Other:
rental car/parking 4 1 2 1 $51.00 $111.00 $155.00 $1,472
Total Travel:$5,682
5. Building/Space:
Calculation Description Cost per
month FTE # of Mo(s).Total
1 $0
Total Building/Space:$0
6. Maintenance:
Location Name/Address Cost per
month FTE # of Mo(s).Total
1 $0
Total Maintenance:$0
7. Equipment and Other Capital Expenditures:
Budget Item Description/Justification # items Cost per
Item FTE Misc.Total
1 $0
$0
8. Indirect Costs:
Research Specialist/Bryden
Johnston Staff trainings
Printing
Postage For completed surveys and other evaluation tools
Quicktap Survey and evaluation software. 3 months ($49/month).
Survey Monkey Survey software. 2 months ($26/month).
Transciption Key informational interviews (15 60-minute and 22 30-minute; $1.85 per minute)
Location Name/Address
Description/Justification
Training and evaluation materials
Description/
Justification
In-State
Research Specialist/Bryden
Johnston 1 day conference
Data collection
Research Specialist/Bryden
Johnston
Calculation Description
Research Specialist/Christine
Mineart
Research Specialist/Bryden
Johnston Staff trainings
Staff trainings
Research Specialist/Christine
Mineart Data collection
[
Indirect
Cost Rate Total
1 24.00%$19,355
Total Indirect Costs:$19,355
Total Year 2 Budget:
YEAR THREE: Oct. 1, 2018 - Sept. 30, 2019
1. Staffing: Salary/Benefits:
% of SNAP-
Ed Time
spent on
Mgmt/Admi
n Duties
% of SNAP-
Ed Time
spent on
Direct
SNAP-Ed
Delivery
1 Sallie Yoshida 0.09 25.00%75.00%136,270.00$ $12,264.30 38.30%$4,697.23 $4,240.38 $16,962
2 Heidi Skolnik 0.15 100.00%75,000.00$ $11,175.00 38.30%$4,280.03 $0.00 $15,455
3 Christine Mineart 0.18 100.00%65,000.00$ $11,635.00 38.30%$4,456.21 $0.00 $16,091
4 Bryden Johnston 0.23 100.00%62,452.17$ $14,364.00 38.30%$5,501.41 $0.00 $19,865
5 Diego Gamboa 0.15 100.00%40,277.33$ $6,041.60 38.30%$2,313.93 $0.00 $8,356
6 Yoko Shimizu 0.08 100.00%57,720.00$ $4,617.00 38.30%$1,768.31 $6,385.31 $6,385
7 Keiko Kanayama 0.08 100.00%45,056.00$ $3,600.00 38.30%$1,378.80 $4,978.81 $4,979
0.96 Staffing: Salary/Benefits:$63,697 $24,396 $15,604 $88,093
2. Non-Capital Equipment/Supplies:
Budget Item Description/Justification FTE Cost per
Item
# of
Items Total
1 1 $0.50 100 $50
2 1 $49.00 3 $147
3 1 $26.00 2 $52
4 1 $1.85 1560 $2,886
Total Supplies:$3,135
3. Materials:
Budget Item Cost per
Item
# of
Items Total
1 $1 600 $600
Total Materials:$600
4. Travel:
Position Title/Name Location Trips No. People Days Nights Per Diem Lodging Miles @
$.54
Reg.
Fee Other Total
1
Oakland-Sacramento.
Other: rental
car/parking 1 1 3 2 $51.00 $111.00 $155.00 $530
2
Oakland-Fresno. Other:
rental car/parking 4 1 2 1 $51.00 $111.00 $155.00 $1,472
1 day conference
Data collection
Description/
Justification
Postage
Transciption
Survey and evaluation software. 3 months ($49/month).
Survey software. 2 months ($26/month).
Key informational interviews (15 60-minute and 22 30-minute; $1.85 per minute)
Description/Justification
Training and evaluation materials
Office Manager
Definition and basis for calculations of benefit rate(s):
Describe what is covered in the benefit rate for your agency.
Statutory benefits include SSI, Medicar, CA UI, ETT/FUTA and Worker's Compensation. Discretionary
benefits include 401k, Health Insurance, Commuter benefits, Paid time off, and all federal and state holidays.
For completed surveys and other evaluation tools
Quicktap
Survey Monkey
Printing
In-State
Research Specialist/Bryden
Johnston
Research Specialist/Bryden
Johnston
SNAP-Ed
Admin
Costs
Total SNAP-
Ed Funded
Salary and
Benefits
Director of Programs
Research Specialist
Research Specialist
Research Specialist
Research Specialist
Contract Manager
Calculation Method
Percent of total direct costs. Includes rent, communications, insurance, equipment, general office support, IT support, general office supplies, accountant and
payroll services, business licenses, dues and subscriptions.
$100,000
Total
Admin/Program
$80,645.00
Position #Position Title Name FTE
SNAP-Ed Time Spent
Annual
Salary
Total SNAP-
Ed Salary
Benefit
Rate
Total
SNAP-Ed
Benefits
3
Oakland-Fresno. Other:
rental car/parking 1 1 2 1 $51.00 $111.00 $155.00 $368
4
Oakland-Fresno. Other:
rental car/parking 3 1 2 1 $51.00 $111.00 $155.00 $1,104
5
Oakland-Fresno. Other:
rental car/parking 1 1 2 1 $51.00 $111.00 $155.00 $368
6
Oakland-Fresno. Other:
rental car/parking 3 1 2 1 $51.00 $111.00 $155.00 $1,104
Total Travel:$4,946
5. Building/Space:
Calculation Description Cost per
month FTE # of Mo(s).Total
1 $0
Total Building/Space:$0
6. Maintenance:
Location Name/Address Cost per
month FTE # of Mo(s).Total
1 $0
Total Maintenance:$0
7. Equipment and Other Capital Expenditures:
Budget Item Description/Justification # items Cost per
Item FTE Misc.Total
1 $0
$0
8. Indirect Costs:
Indirect
Cost Rate Total
1 24.00%$23,226
Total Indirect Costs:$23,226
Total Year 3 Budget:
Staff trainings
Staff trainings
Data collection
Staff trainings
$120,000
Total
Admin/Program
$96,774.00
Calculation Method
Percent of total direct costs. Includes rent, communications, insurance, equipment, general office support, IT support, general office supplies, accountant and
Research Specialist/Bryden
Johnston
Research Specialist/Bryden
Johnston
Research Specialist/Christine
Mineart
Research Specialist/Christine
Mineart
Location Name/Address
Calculation Description
I I I
County of Fresno
16‐10139
Page 1 of 3
EXHIBIT C
STANDARD GRANT CONDITIONS
1. APPROVAL: This Grant is of no force or effect until signed by both parties and
approved by the Department of General Services, if required. The Grantee may not
commence performance until such approval has been obtained
2. AMENDMENT: No amendment or variation of the terms of this Grant shall be
valid unless made in writing, signed by the parties, and approved as required. No oral
understanding or Agreement not incorporated in the Grant is binding on any of the
parties. In no case shall the Department materially alter the scope of the Project set
forth in Exhibit A.
3. ASSIGNMENT: This Grant is not assignable by the Grantee, either in
whole or in part, without the written consent of the Grant Manager in the form
of a written amendment to the Grant.
4. AUDIT: Grantee agrees that the Department, the Bureau of State Audits,
or their designated representative shall have the right to review and to copy any
records and supporting documentation pertaining to this Grant. Grantee agrees
to maintain such records for a possible audit for a minimum of three (3) years
after final payment or completion of the project funded with this Grant, unless a
longer period of records retention is stipulated. Grantee agrees to allow the
auditor(s) access to such records during normal business hours and to allow
interviews of any employees who might reasonably have information related to
such records. Further, Grantee agrees to include a similar right of the State to
audit records and interview staff in any subcontract related to the project.
5. CONFLICT OF INTEREST: Grantee certifies that it is in compliance
with all applicable state and/or federal conflict of interest laws.
6. INDEMNIFICATION: Grantee agrees to indemnify, defend and save
harmless the State, its officers, agents and employees from any and all claims
and losses accruing or resulting to any and all contractors, subcontractors,
suppliers, laborers, and any other person, firm or corporation furnishing or
supplying work services, materials, or supplies in connection with the project,
and from any and all claims and losses accruing or resulting to any person, firm
or corporation who may be injured or damaged by Grantee in the performance
of any activities related to the Project.
County of Fresno
16‐10139
Page 2 of 3
7. FISCAL MANAGEMENT SYSTEMS AND ACCOUNTING STANDARDS:
Grantee agrees that, at a minimum, its fiscal control and accounting procedures will
be sufficient to permit tracing of all grant funds to a level of expenditure adequate to
establish that such funds have not been used in violation of any applicable state or
federal law, or the provisions of this Grant. Grantee further agrees that it will
maintain separate Project accounts in accordance with generally accepted
accounting principles.
8. GOVERNING LAW: This Grant is governed by and shall be interpreted in
accordance with the laws of the State of California.
9. INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates,
credits, or other amounts (including any interest thereon) accruing to or
received by the Grantee under this Grant shall be paid by the Grantee to the
Department, to the extent that they are properly allocable to costs for which the
Grantee has been reimbursed by the Department under this Grant.
10. INDEPENDENT GRANTEE: Grantee, and its agents and employees of
Grantee, in the performance of the Project, shall act in an independent capacity
and not as officers, employees or agents of the Department.
11. MEDIA EVENTS: Grantee shall notify the Department’s Grant Manager
in writing at least twenty (20) working days before any public or media event
publicizing the accomplishments and/or results of the Project and provide the
opportunity for attendance and participation by Department’s representatives.
12. NO THIRD-PARTY RIGHTS: The Department and Grantee do not
intend to create any rights or remedies for any third- party as a beneficiary of
this Grant or the project.
13. NOTICE: Grantee shall promptly notify the Department’s Grant
Manager in writing of any events, developments or changes that could affect
the completion of the project or the budget approved for this Grant.
14. PROFESSIONALS: Grantee agrees that only licensed professionals
will be used to perform services under this Grant where such services are
called for.
County of Fresno
16‐10139
Page 3 of 3
15. RECORDS: Grantee certifies that it will maintain Project accounts in
accordance with generally accepted accounting principles. Grantee further
certifies that it will comply with the following conditions for a grant award as set
forth in the Request for Applications (Exhibit D) and the Grant Application
(Exhibit A).
Establish an official file for the Project which shall adequately document all
significant actions relative to the Project;
Establish separate accounts which will adequately and accurately depict all
amounts received and expended on this Project, including all grant funds
received under this Grant;
Establish separate accounts which will adequately depict all income
received which is attributable to the Project, especially including any income
attributable to grant funds disbursed under this Grant;
Establish an accounting system which will adequately depict final total
costs of the Project, including both direct and indirect costs; and,
Establish such accounts and maintain such records as may be necessary
for the state to fulfill federal reporting requirements, including any and all
reporting requirements under federal tax statutes or regulations.
16. RELATED LITIGATION: Under no circumstances may Grantee use funds from
any disbursement under this Grant to pay for costs associated with any litigation between
the Grantee and the Department.
17. RIGHTS IN DATA: Grantee and the Department agree that all data, plans,
drawings, specifications, reports, computer programs, operating manuals, notes,
and other written or graphic work submitted under Exhibit A in the performance of
the Project funded by this Grant shall be in the public domain. Grantee may
disclose, disseminate and use in whole or in part, any final form data and
information received, collected, and developed under this Project, subject to
appropriate acknowledgment of credit to the Department for financial support.
Grantee shall not utilize the materials submitted to the Department (except data) for
any profit making venture or sell or grant rights to a third-party who intends to do
so. The Department has the right to use submitted data for all governmental
purposes.
18. VENUE: The Department and Grantee agree that any action arising
out of this Grant shall be filed and maintained in the Superior Court, County of
Sacramento, California. Grantee waives any existing sovereign immunity for
the purposes of this Grant, if applicable.
Exhibit D
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 corpora tion 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 dat e 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).
Exhibit D
Page 2 of 2
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: