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HomeMy WebLinkAboutAgreement A-17-413 with CA Dept. of Public Health.pdfState of California – Health and Human Services Agency – California Department of Public Health CDPH 1229 (10/2016) Page 1 of 3 SAFE AND ACTIVE COMMUNTIES BRANCH NALOXONE DISTRIBUTION GRANT PROGRAM Awarded By THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter “Department” TO County of Fresno, hereinafter “Grantee” Implementing the project, “NALOXONE DISTRIBUTION,” hereinafter “Project” GRANT AGREEMENT NUMBER 16-11030 The Department awards this Grant and the Grantee accepts and agrees to use the Grant funds as follows: AUTHORITY: The Department has authority to grant funds for the Project under Health and Safety Code, Section 1179.80. PURPOSE: The Department shall provide a grant to and for the benefit of the Grantee; the purpose of the Grant is to reduce the rate of fatal overdose from opioid drugs including heroin and prescription opioids as specified in Exhibit A, Grant Application, which is hereby incorporated to serve as the Project. GRANT AMOUNT: The maximum amount payable under this Grant shall not exceed $65,730 dollars ($65,730). TERM OF GRANT: The term of the Grant shall begin on June 1, 2017, or upon approval of this grant, and terminates on June 30, 2019. No funds may be requested or invoiced for work performed or costs incurred after June 30, 2019. PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will be: California Department of Public Health County of Fresno Stacy Alamo Mixson, MPH Dr. Ken Bird PO Box 997377, MS 7214 Sacramento, CA 95899-7377 Phone: 916.552.9852 Phone: 5596003200 Fax: 916.552.9810 Fax: E-mail: Stacy.Alamo@cdph.ca.gov E-mail: kbird@co.fresno.ca.us Fresno 93775 1221 Fulton Mall State of California – Health and Human Services Agency – California Department of Public Health CDPH 1229 (10/2016) Page 2 of 3 Direct all inquiries to: California Department of Public Health, Safe and Active Communities Branch County of Fresno Attention: Nancy Bagnato, MPH Attention: Brandon Hill PO Box 997377, MS 7214 1221 Fulton Mall Sacramento, CA 95899-7377 Phone: 916.552.9846 Phone : 5596006468 Fax: 916.552.9810 FAX : E-mail: Nancy.Bagnato@cdph.ca.gov E-mail : bhill@co.fresno.ca.us Either party may change its Project Representative upon written notice to the other party. STANDARD PROVISIONS. The following exhibits are attached and made a part of this Grant by this reference: Exhibit A GRANT APPLICATION (The Grant Application provides the description of the project and associated cost) Exhibit B BUDGET DETAIL AND PAYMENT PROVISIONS Exhibit C STANDARD GRANT CONDITIONS Exhibit D REQUEST FOR APPLICATIONS Including all the requirements and attachments contained therein Exhibit E ADDITIONAL PROVISIONS GRANTEE REPRESENTATIONS: The Grantee(s) accept all terms, provisions, and conditions of this grant, including those stated in the Exhibits incorporated by reference above. The Grantee(s) shall fulfill all assurances and commitments made in the application, declarations, other accompanying documents, and written communications (e.g., e-mail, correspondence) filed in support of the request for grant funding. The Grantee(s) shall comply with and require its contractors and subcontractors to comply with all applicable laws, policies, and regulations. IN WITNESS THEREOF, the parties have executed this Grant on the dates set forth below. Fresno 93775 CCC 04/2017 CERTIFICATION ATTEST: BERNICE E. SEIDEL, Clerk · Board of Supervisors · · By~~uty I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that I 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) Federal ID Number ~"'-..D~ t-c-L~t'\0 q q \0 000~\ l.. By (Art1!~ Signilrifre) Printed Name and Title of Person Signing Q.,.:\G-A ~a.~o \ ~'1'"~ ~J.. t ~~:,~ Date Executed I Executed in the County of . ""'-~L ~ \ "U:> \\ ~l('~'brc . '-" CONTRACTOR CERTIFICATION CLAUSES I. STATEMENT OF COMPLIANCE: Contractor has, unless exempted, complied with the nondiscrimination program requirements. (Gov. Code §12990 (a-f) and CCR, Title 2, Section 11102) (Not applicable to public 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 controlled 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, 2) agree to abide by the terms of the company's statement as a condition of employment on the Agreement. Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements ifthe department determines that any ofthe following has occurred: the Contractor has made false certification, or violated the I certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REQUIREMENT: Contractor hereby certifies that Contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003. Contractor agrees to make a good faith effort to provide a minimum number of hours of pro bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm’s offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a. All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www.dir.ca.gov, and Public Contract Code Section 6108. b. The contractor agrees to cooperate fully in providing reasonable access to the contractor’s records, documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor’s compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.3. 8. GENDER IDENTITY: For contracts of $100,000 or more, Contractor certifies that Contractor is in compliance with Public Contract Code section 10295.35. DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California. 1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code §10410): 1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code §10411): 1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service. If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub. Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission, payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e)) 2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. c. Both domestic and foreign corporations (those incorporated outside of California) must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION: A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement. 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district; (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions; or (3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. CDPH Naloxone Grant Program Application Response ID:66 Data 1. Naloxone Distribution Projects California Department of Public Health Safe and Active Communities Branch Naloxone Grant Program REQUEST FOR APPLICATIONS (RFA #16-10967): Naloxone Distribution Projects Application Please complete and submit this application for the Naloxone Grant Program as soon as possible, but no later than May 1, 2017 in order to initiate the development of a grant agreement with CDPH. Please send questions by April 17, 2017 to ngp@cdph.ca.gov . Please provide the following information: 1. Local Health Department County of Fresno Department of Public Health 2. Health Officer Information Name : Ken Bird Phone Number : 5596003200 E-mail Address : kbird@co.fresno.ca.us 3. Name of Grantee (Legal Business Name) County of Fresno 4. Principal Investigator (PI) Information Name : Dr. Ken Bird Address 1 : 1221 Fulton Mall City, Zip : Fresno 93775 Phone : 5596003200 E-mail : kbird@co.fresno.ca.us New Analysis Question 5. Person to Direct Inquiries to: Name : Brandon Hill Address 1 : 1221 Fulton Mall City, Zip : Fresno, 93775 Phone : 5596006468 E-mail : bhill@co.fresno.ca.us 6. Person Authorized to Sign the Final Grant Agreement on Behalf of Your Agency Name : David Pomaville Title : Director 7. Your Organization's DEA Number AB1296931 8. Address associated with your DEA Number (This address will be used for shipment of naloxone Exhibit A product.) Address 1 : PO Box 11867 City, Zip : Fresno 93775 2. Naloxone Distribution Projects Please refer to the Naloxone Grant Program Local Health Department Allocation Chart included as Attachment A in the Naloxone Grant Program Request for Applications (RFA) to determine the amount of grant product and funding being offered to your organization. The allocation available for administrative costs, if accepted, may be used to cover costs of conducting outreach and assessment of local entities, receipt and distribution of naloxone products, reporting, or other activities related to the grant implementation. However, LHDs may elect to opt out of receiving the administrative allocation and instead apply that dollar amount to the purchase of additional naloxone product. 9. Funding amount you are requesting for the purchase of naloxone product (Narcan nasal spray) 62600 10. Funding amount you are requesting for administrative costs 3130 11. How would you like to have your allocation of naloxone product delivered to you (at no cost)? In two shipments; receiving half in a second shipment in June, 2018 12. Understanding that you may need to conduct further outreach to identify those local entities that are ready and qualified to distribute/administer naloxone, who do you see as potential recipients at this time? Harm Reduction Centers/Syringe Exchange Programs Substance use Disorder Treatment Services Homeless Shelter Programs *In your distribution plan, due to CDPH/SACB 60 days after the grant agreement is executed, you will list the names and types of local entities you select to receive the naloxone product. 3. Naloxone Distribution Projects Syringe exchange/harm reduction programs that have established naloxone distribution systems in place (as defined in the RFA) are a priority for the distribution of naloxone due to the high risk population that accesses these services. 13. Do you have a syringe exchange/harm reduction program in your jurisdiction? YES 14. If YES, do you anticipate any challenges in working with the syringe exchange/harm reduction program in the distribution of naloxone? NO If YES, please describe: 15. At this time, do you anticipate any challenges to implementing any of the activities required by the grant? No If YES, please describe: 4. Naloxone Distribution Projects By submitting this application, your organization is agreeing to: 1. Conduct outreach to identify local entities within their health jurisdiction that already have a naloxone distribution system in place and have the capacity to efficiently and effectively provide naloxone and Exhibit A training to first responders (as described in section C, number 2 in this RFA).* Local entities may include harm reduction/syringe exchange programs, substance use disorder treatment providers, homeless programs, jails, emergency services providers, law enforcement, and others. *If a LHD identifies the need to establish a new naloxone distribution system(s) in their jurisdiction, the LHD must ensure that any new naloxone distribution system meets the definition provided in section C, number 3 in this RFA prior to distributing naloxone. 2. Select local entities to receive naloxone based on the level of risk of overdose among the population(s) they serve and need for naloxone (Narcan) product. Priority consideration is to be given to harm reduction/syringe exchange programs, if present within the health jurisdiction. (A list of California harm reduction/syringe exchange programs that currently have a naloxone distribution system in place is included as Attachment B). 3. Submit a naloxone distribution plan to CDPH/SACB for approval by June 16, 2017, or within 60 days of receiving CDPH final approval of the grant agreement. The plan will be submitted on-line and must include the names of selected local entities, the type(s) of services they provide, a description of the target population(s) they serve, and the number of naloxone product they will receive. CDPH will provide a standardized distribution plan template. 4. Begin distributing naloxone product to selected local entities by July 16, 2017, or within 90 days of receiving CDPH final approval of the grant agreement. All naloxone must be distributed to selected local entities by September 30, 2018. 5. Document and submit a final report to CDPH/SACB by April 1, 2019, on the distribution of naloxone for accountability and evaluation purposes. 6. Enter into a Standard Grant Agreement with CDPH. Attachment C includes a grant agreement template, Budget Detail and Payment Provisions, Standard Grant Conditions, and Additional Provisions. Thank you! Please hit the SUBMIT button. 5. Thank You! Please submit any questions to ngp@cdph.ca.gov . Confirmation Email Apr 28, 2017 12:08:08 Success: Email Sent to: NGP@cdph.ca.gov Confirmation Email Apr 28, 2017 12:08:08 Success: Email Sent to: bhill@co.fresno.ca.us Exhibit A County of Fresno 16-11030 Exhibit B Budget Detail and Payment Provisions Page 1 of 2 1. Invoicing and Payment A. Upon final approval of the Grant Agreement, and upon receipt and approval of an invoice, the State agrees to reimburse the Grantee for the specified Administrative Allocation amount in accordance with the costs specified herein. B. The invoice shall include the Grant Number and shall be submitted in triplicate upon final approval of the Grant Agreement: Nancy Bagnato, MPH California Department of Public Health Safe and Active Communities Branch PO Box 997377, MS 7214 Sacramento, CA 95899-7377 C. Invoices shall: 1) Be prepared on Grantee letterhead. If the invoice is not on produced letterhead, the invoice must be signed by an authorized official, employee or agent certifying that the expenditures claimed represent activities performed and are in accordance with Exhibit A Grant Application under this Grant. 2) Bear the Grantee’s name as shown on the Grant. 3) Identify the billing and/or performance period covered by the invoice. 4) Itemize costs for the billing period in the same or greater level of detail as indicated in this Grant. Subject to the terms of this Grant, reimbursement may only be sought for those costs and/or cost categories expressly identified as allowable and approved by CDPH. 2. Budget Contingency Clause A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Grantee or to furnish any other considerations under this Agreement and Grantee shall not be obligated to fulfill any provisions of this Agreement. B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to Grantee to reflect the reduced amount. 3. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in, Government Code Chapter 4.5, commencing with Section 927. 4. Amounts Payable A. The amounts payable shall not exceed: 1) $62,600 for Narcan Products for the budget period of 06/01/17 through 06/30/19. 2) $3,130 for Administrative Costs for the budget period of 06/01/17 through 06/30/19. County of Fresno 16-11030 Exhibit B Budget Detail and Payment Provisions Page 2 of 2 B. Payment allocations shall be made in accordance with the amounts listed in Paragraph 4.A., above. Pursuant to the Budget Act of 2016, this is one-time funding available for expenditure through June 30, 2019. The Grantee will only receive reimbursement for Administrative Costs, if requested. The Grantee will receive direct distribution of Narcan Products in the amount stated and no invoicing will be required. 5. Timely Submission of Final Invoice A. A final undisputed invoice shall be submitted for payment no more than thirty (30) calendar days following the expiration or termination date of this Grant, unless a later or alternate deadline is agreed to in writing by the program grant manager. Said invoice should be clearly marked “Final Invoice”, indicating that all payment obligations of the State under this Grant have ceased and that no further payments are due or outstanding. B. The State may, at its discretion, choose not to honor any delinquent final invoice if the Grantee fails to obtain prior written State approval of an alternate final invoice submission deadline. County of Fresno 16-11030 Page 1 of 4 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. 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. County of Fresno 16-11030 Page 2 of 4 9.INCOME RESTRICTIONS: Grantee agrees that any refunds, rebates, credits, or other amounts (including any interest thereon) accruing to or received by the Grantee under this Grant shall be paid by the Grantee to the Department, to the extent that they are properly allocable to costs for which the Grantee has been reimbursed by the Department under this Grant. 10.INDEPENDENT CONTRACTOR: Grantee, and its agents and employees of Grantee, in the performance of the Project, shall act in an independent capacity and not as officers, employees or agents of the Department. 11.MEDIA EVENTS: Grantee shall notify the Department’s Grant Manager in writing at least twenty (20) working days before any public or media event publicizing the accomplishments and/or results of the Project and provide the opportunity for attendance and participation by Department’s representatives. 12.NO THIRD-PARTY RIGHTS: The Department and Grantee do not intend to create any rights or remedies for any third- party as a beneficiary of this Grant or the project. 13.NOTICE: Grantee shall promptly notify the Department’s Grant Manager in writing of any events, developments or changes that could affect the completion of the project or the budget approved for this Grant. 14.PROFESSIONALS: Grantee agrees that only licensed professionals will be used to perform services under this Grant where such services are called for. 15.RECORDS: Grantee certifies that it will maintain Project accounts in accordance with generally accepted accounting principles. Grantee further certifies that it will comply with the following conditions for a grant award as set forth in the Request for Applications (Exhibit D) and the Grant Application (Exhibit A). A.Establish an official file for the Project which shall adequately document all significant actions relative to the Project; B.Establish separate accounts which will adequately and accurately depict all amounts received and expended on this Project, including all grant funds received under this Grant; C.Establish separate accounts which will adequately depict all income received which is attributable to the Project, especially including any income attributable to grant funds disbursed under this Grant; D.Establish an accounting system which will adequately depict final total costs of the Project, including both direct and indirect costs; and, E.Establish such accounts and maintain such records as may be necessary for the state to fulfill federal reporting requirements, including any and all reporting requirements under federal tax statutes or regulations. 16.RELATED LITIGATION: Under no circumstances may Grantee use funds from any disbursement under this Grant to pay for costs associated with any litigation between the Grantee and the Department. County of Fresno 16-11030 Page 3 of 4 17.RIGHTS IN DATA: Grantee and the Department agree that all data, plans, drawings, specifications, reports, computer programs, operating manuals, notes, and other written or graphic work submitted under Exhibit A in the performance of the Project funded by this Grant shall be in the public domain. Grantee may disclose, disseminate and use in whole or in part, any final form data and information received, collected, and developed under this Project, subject to appropriate acknowledgment of credit to the Department for financial support. Grantee shall not utilize the materials submitted to the Department (except data) for any profit making venture or sell or grant rights to a third-party who intends to do so. The Department has the right to use submitted data for all governmental purposes. 18.VENUE: The Department and Grantee agree that any action arising out of this Grant shall be filed and maintained in the Superior Court, California. Grantee waives any existing sovereign immunity for the purposes of this Grant, if applicable. 19.STATE-FUNDED RESEARCH GRANTS: A.Grantee shall provide for free public access to any publication of a department-funded invention or department-funded technology. Grantee further agrees to all terms and conditions required by the California Taxpayer Access to Publicly Funded Research Act (Chapter 2.5 (commencing with Section 13989) of Part 4.5 of Division 3 of Title 2 of the Government Code). B.As a condition of receiving the research grant, Grantee agrees to the following terms and conditions which are set forth in Government Code section 13989.6 (“Section 13989.6”): 1)Grantee is responsible for ensuring that any publishing or copyright agreements concerning submitted manuscripts fully comply with Section 13989.6. 2)Grantees shall report to the Department the final disposition of the research grant, including, but not limited to, if it was published, when it was published, where it was published, when the 12-month time period expires, and where the manuscript will be available for open access. 3)For a manuscript that is accepted for publication in a peer-reviewed journal, the Grantee shall ensure that an electronic version of the peer-reviewed manuscript is available to the department and on an appropriate publicly accessible database approved by the Department, including, but not limited to, the University of California’s eScholarship Repository at the California Digital Library, PubMed Central, or the California Digital Open Source Library, to be made publicly available not later than 12 months after the official date of publication. Manuscripts submitted to the California Digital Open Source Library shall be exempt from the requirements in subdivision (b) of Section 66408 of the Education Code. Grantee shall make reasonable efforts to comply with this requirement by ensuring that their manuscript is accessible on an approved publicly accessible database, and notifying the Department that the manuscript is available on a department-approved database. If Grantee is unable to ensure that their manuscript is accessible on an approved publicly accessible database, Grantee may comply by providing the manuscript to the Department not later than 12 months after the official date of publication. County of Fresno 16-11030 Page 4 of 4 4)For publications other than those described inparagraph B.3 above,, including meeting abstracts, Grantee shall comply by providing the manuscript to the Department not later than 12 months after the official date of publication. 5)Grantee is authorized to use grant money for publication costs, including fees charged by a publisher for color and page charges, or fees for digital distribution. State of California—Health and Human Services Agency California Department of Public Health KAREN L. SMITH, MD, MPH EDMUND G. BROWN JR. Director and State Public Health Officer Governor CDPH Safe and Active Communities Branch, MS 7214  P.O. Box 997377 Sacramento, CA 95899 (916)552-9800 ● (916) 552-9821 FAX Internet Address: www.cdph.ca.gov March 27, 2017 TO: POTENTIAL LOCAL HEALTH DEPARTMENT APPLICANTS SUBJECT: RELEASE OF REQUEST FOR APPLICATIONS NALOXONE DISTRIBUTION PROJECTS The California Department of Public Health (CDPH), Safe and Active Communities Branch (SACB) is pleased to announce the release of a Request for Applications (RFA) for Naloxone Distribution Projects. Through this non-competitive RFA process, CDPH/SACB is offering grants of naloxone product (Narcan nasal spray) and funding for project administration to local health departments (LHDs) in all 61 California health jurisdictions to conduct Naloxone Distribution Projects. LHDs will provide Narcan to local entities within their jurisdictions that have naloxone distribution systems. The term of the grant award is June 1, 2017 to June 30, 2019. Two (repeating) informational webinars will be held for eligible applicants. Participation in one of these webinars is mandatory. The webinars are scheduled for: Monday, April 3, 2017: 1:00 pm – 2:00 pm To register for this session go to https://cdph.webex.com/cdph- en/k2/j.php?MTID=t33dfebb403abd78bd2e954c947af5015 Tuesday, April 4, 2017: 10:00 am – 11:00 am To register for this session go to https://cdph.webex.com/cdph- en/k2/j.php?MTID=tc801f8d752d4385ed72b3f38a3b52e85 Submit any questions you would like addressed during the webinar(s) to ngp@cdph.ca.gov by March 31, 2017. Please see the RFA for additional requirements, timelines, and instructions. Sincerely, Stacy Alamo Mixson, MPH Chief, Safe and Active Communities Branch California Department of Public Health Exhibit D Exhibit D RFA: Naloxone Grant Program 2017 1 California Department of Public Health Safe and Active Communities Branch Naloxone Grant Program REQUEST FOR APPLICATIONS (RFA #16-10967): Naloxone Distribution Projects A.Introduction Senate Bill (SB) 833 (Chapter 30, Statutes of 2016) established a new Naloxone Grant Program within the California Department of Public Health (CDPH) with the goal of reducing the number of fatal overdoses in California from opioid drugs, including prescription opioids and heroin, by increasing access to the life-saving drug naloxone. A total of $3 million was allocated on a one-time basis to support this program. B.Purpose of RFA Through this non-competitive Request for Application (RFA) process, the CDPH Safe and Active Communities Branch (SACB) is offering grants of naloxone product (Narcan nasal spray) and funding to all 61 local health departments (LHDs) to conduct Naloxone Distribution Projects. LHDs will provide naloxone product to local programs, agencies and community-based organizations (local entities) within their jurisdictions that have naloxone distribution systems and are in the best position to save lives from opioid overdose. C.Background In 2015, with funding from the Centers for Disease Control and Prevention (CDC), SACB initiated the California Prescription Drug Overdose Prevention Initiative to promote a multi-faceted statewide response involving many partners and a variety of strategies (www.cdph.ca.gov/programs/SACB/Pages/PrescriptionDrugOverdoseProgram.aspx). Initiative staff also provide support to the CDPH Director’s Prescription Opioid Misuse and Overdose Prevention Workgroup and partners with the California Healthcare Foundation to fund local opioid safety coalitions that promote safe prescribing, use of naloxone, and expansion of medically assisted treatment options. The California Opioid Overdose Surveillance Dashboard (https://pdop.shinyapps.io/ODdash_v1/), developed by SACB research scientists, displays data demonstrating the severity of the problem. The Naloxone Grant Program will further strengthen California’s public health response to opiate overdose. 1.Drug overdose (poisoning) is the leading cause of unintentional injury death in the United States, causing more deaths than motor vehicle crashes. Opioids – both prescription painkillers and heroin – are responsible for most of those deaths. The number of Californians affected by prescription and non-prescription opioid misuse and overdose is substantial, with rates varying significantly across counties, and even within counties. Exhibit D RFA: Naloxone Grant Program 2017 2 2. Naloxone is a medication that works almost immediately to reverse opiate overdose. Naloxone is currently a prescription drug, but is not a controlled substance. It has few known adverse effects, no potential for abuse, and can be rapidly administered through intramuscular injection or nasal spray. While most professional first responders and emergency departments are equipped with naloxone, emergency service providers may not arrive in time to revive overdose victims. Trained and equipped bystanders such as friends, family, and other non-health care providers and drug users themselves can effectively respond and reverse an opioid overdose. Given the success of bystander naloxone programs, the CDC and the World Health Organization have recommended expanding the availability of naloxone to lay people. 3. Naloxone Distribution Systems: 1) work under a standing order from a licensed clinician/medical director; 2) have staff that are trained (or are trained to provide education to others) on naloxone storage and administration, overdose prevention techniques, how to recognize an opioid overdose (signs and symptoms), how to respond by calling 911 and provide rescue breathing, and post-overdose care; 3) dispense naloxone products; and 4) document distribution efforts. 4. Laws are currently in place that support making naloxone more readily available. For example, California Civil Code Section 1714.22 (Statutes of 2013, Chapter 707, Section 1) eliminates civil and criminal liability for: 1) licensed health care providers that prescribe naloxone and issue standing orders for the distribution of naloxone, and 2) individuals, who have received supply of naloxone and had the required training, who administer naloxone to someone suspected of experiencing an overdose. This law took effect on January 1, 2014. D. Term of Grant Award The term of the grant award is June 1, 2017, (or upon final Grant Agreement approval by CDPH) to June 30, 2019. E. Applicant Eligibility Governmental health departments in all 61 California local health jurisdictions are eligible and encouraged to apply to the Naloxone Grant Program. F. Product and Funding Allocation The Naloxone Grant Program is offering funding amounts allocated for naloxone product and project administrative costs to every health jurisdiction in California based on a formula developed to maximize the potential for saving lives. The formula addresses the need for naloxone using data from each county to calculate an average number of opioid-involved (including heroin) overdose deaths and emergency department visits for each of the last three years. The formula utilizes information on effective naloxone distribution and overdose reversals from a CDC report (www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm) to determine a kit-to-save ratio, which translates to approximately four kits distributed for each life saved. The Exhibit D RFA: Naloxone Grant Program 2017 3 three-year average of deaths and emergency department visits for each county is then multiplied by four to determine the estimated number of kits to be distributed for each county. The cost of the naloxone product and a base minimum number of kits for each county are factored into the calculation. A Naloxone Grant Program Local Health Department Allocations Chart, which lists the amounts available to each LHD for the purchase of naloxone (Narcan nasal spray) and for project administration, is provided as Attachment A. LHDs that receive a grant from the Naloxone Grant Program will not purchase the naloxone product. In order to obtain the best purchase price, expedite the delivery of naloxone product, and avoid additional administrative burden on LHDs, CDPH/SACB will procure a bulk purchase of Narcan nasal spray from the manufacturer ADAPT Pharma (at a price of $75 per carton of two doses), and the manufacturer will ship the product (at no additional cost) directly to each grantee. Grantees can choose to have the naloxone product delivered all in one shipment or split their allocation in half and receive a second shipment in June, 2018. The funding offered to each LHD for project administration, if accepted, may be used to cover costs of: conducting outreach and assessment of local entities; receipt, storage, and distribution of naloxone product; reporting; and other activities related to project implementation. If accepting the allocation for administrative costs, LHDs will submit a single invoice for reimbursement of the amount to CDPH/SACB upon final CDPH approval of the Grant Agreement in accordance with Exhibit B, Budget Detail and Payment Provisions (included in Attachment B). LHDs may elect to opt out of receiving the project administration allocation and instead apply that dollar amount to the purchase of additional naloxone product. G.Grant Requirements Naloxone Grant Program grantees are required to: 1.Conduct outreach to identify local entities within their health jurisdiction that already have a naloxone distribution system in place and have the capacity to efficiently and effectively provide naloxone and training to first responders (as described in section C, number 3 in this RFA).* Local entities may include harm reduction/syringe exchange programs, substance use disorder treatment providers, homeless programs, jails, emergency services providers, law enforcement, and others. * If a LHD identifies the need to establish a new naloxone distribution system(s) in their jurisdiction, the LHD must ensure that any new naloxone distribution system meets the definition provided in section C, number 3 in this RFA prior to distributing naloxone. 2.Select local entities to receive naloxone based on the level of risk of overdose among the population(s) they serve and need for naloxone (Narcan) product. Exhibit D RFA: Naloxone Grant Program 2017 4 Priority consideration is to be given to harm reduction/syringe exchange programs, if present within the health jurisdiction. (A list of California harm reduction/syringe exchange programs that currently have a naloxone distribution system in place is included as Attachment C.) 3.Submit a naloxone distribution plan to CDPH/SACB for approval by June 16, 2017, or within 60 days of receiving CDPH final approval of the Grant Agreement. The plan will be submitted on-line and must include the names of selected local entities, the type(s) of services they provide, a description of the target population(s) they serve, and the number of naloxone product they will receive. CDPH will provide a standardized distribution plan template. 4.Begin distributing naloxone product to selected local entities by July 16, 2017, or within 90 days of receiving CDPH final approval of the Grant Agreement. All naloxone must be distributed to selected local entities by September 30, 2018. 5.Document and submit a final report to CDPH/SACB by April 1, 2019, on the distribution of naloxone for accountability and evaluation purposes. 6.Enter into a Standard Grant Agreement with CDPH. Attachment C includes a Grant Agreement template, Budget Detail and Payment Provisions, Standard Grant Conditions, and Additional Provisions. H.Reporting Requirements In order to demonstrate that the naloxone product provided through the Naloxone Grant Program were effectively distributed and utilized, CDPH/SACB will require LHDs to document and report information in a final report, due April 1, 2019, on the local entities that received naloxone product from the grantee (e.g., organization name, type and location, date of distribution, and number of doses distributed), the individuals that received naloxone from the local entities, and if possible, the number of overdose reversals that can be attributed to the Naloxone Grant Program. On-line data collection forms and instructions, developed with input from grantees and other stakeholders, will be provided. I.Funding Restriction Grantees may not seek reimbursement/gain for, or sell the naloxone product received through, this grant award. J.Mandatory Letter of Interest A Letter of Interest is required and must be received by April 7, 2017. The letter is non-binding. Please complete the on-line Letter of Interest at www.surveygizmo.com/s3/3436352/d311e1c1f806 which requires the following information: 1.LHD County/Jurisdiction. 2.Health Officer Name and contact information. 3.Contact information for individual responsible for the application. Exhibit D RFA: Naloxone Grant Program 2017 5 4.An indication of the intent to apply (or not apply). 5.An indication of the intent to receive the funding allocation dedicated for administrative needs, or a redirection of this funding toward the purchase of additional naloxone product. K.Informational Webinars (Mandatory) Two (repeating) informational webinars will be held for eligible applicants to provide additional information and to address questions. Participation in one of these webinars is mandatory for all potential applicants and registration is required. Monday, April 3, 2017; 1:00 pm – 2:00 pm To register for this session go to https://cdph.webex.com/cdph- en/k2/j.php?MTID=t33dfebb403abd78bd2e954c947af5015 Tuesday, April 4, 2017; 10:00 am – 11:00 am To register for this session go to https://cdph.webex.com/cdph- en/k2/j.php?MTID=tc801f8d752d4385ed72b3f38a3b52e85 Please submit any questions you would like addressed during the webinar(s) to ngp@cdph.ca.gov by March 31, 2017. L.Other Available Resources Because this is a one-time allocation of funding, CDPH/SACB is not able to offer start-up or ongoing technical assistance or training support. However, a website has been established for grantees (and others who may be interested) that will include helpful materials and resources. Please visit www.cdph.ca.gov/programs/SACB/Pages/NaloxoneGrantProgram.aspx M.Application Submission Instructions In order to initiate the development of a Grant Agreement with CDPH, applications are to be submitted on-line as soon as possible, but no later than May 1, 2017. To complete an application, go to www.surveygizmo.com/s3/3436263/f7385e3c96d5. For reference, a copy of the application has been provided as Attachment D. Please submit any questions regarding the RFA or application to ngp@cdph.ca.gov by April 17, 2017. All questions and responses will be posted by April 21, 2017 to: www.cdph.ca.gov/programs/SACB/Pages/NaloxoneGrantProgram.aspx N.Grant Award Process On-line applications will be reviewed for completeness and the information provided will be used to develop a CDPH Grant Agreement. The resulting Grant Agreement will be sent to the applicant agency for signature. Once signed and returned to CDPH, and then signed by CDPH’s Contract Management Unit, the Grant Agreement is considered fully executed. Exhibit D RFA: Naloxone Grant Program 2017 6 O.RFA Time Schedule Event Date RFA Release March 27, 2017 Questions to be Addressed During Webinars Due March 31, 2017 Mandatory Informational Webinars (Repeating) April 3, 2017 1:00 p.m. to 2:00 p.m. April 4, 2017 10:00 a.m. to 11:00 a.m. On-Line Mandatory Letter of Interest Due April 7, 2017 On-Line Applications Due to CDPH/SACB May 1, 2017 Grant Start Date June 1, 2017 (or upon CDPH final approval of Grant Agreement) Exhibit D Counties Funding Available for Narcan Product Number of Doses Funds Available for Admin Costs or Additional Narcan Product Alameda $76,600 2,042 $3,830.00 Alpine $10,125 270 $506.25 Amador $10,125 270 $506.25 Butte $20,200 538 $1,010.00 Calaveras $10,125 270 $506.25 City of Berkeley $10,125 270 $506.25 City of Long Beach $10,125 270 $506.25 City of Pasadena $10,125 270 $506.25 Colusa $10,125 270 $506.25 Contra Costa $61,600 1,642 $3,080.00 Del Norte $10,125 270 $506.25 El Dorado $10,125 270 $506.25 Fresno $62,600 1,670 $3,130.00 Glenn $10,125 270 $506.25 Humboldt $25,600 682 $1,280.00 Imperial $17,000 454 $850.00 Inyo $10,125 270 $506.25 Kern $74,600 1,990 $3,730.00 Kings $11,000 294 $550.00 Lake $11,600 310 $580.00 Lassen $10,125 270 $506.25 Los Angeles $387,700 10,338 $19,385.00 Madera $12,400 330 $620.00 Marin $15,000 400 $750.00 Mariposa $10,125 270 $506.25 Mendocino $11,400 304 $570.00 Merced $16,600 442 $830.00 Modoc $10,125 270 $506.25 Mono $10,125 270 $506.25 Monterey $29,600 790 $1,480.00 Napa $10,125 270 $506.25 Nevada $10,125 270 $506.25 Orange $233,200 6,218 $11,660.00 Placer $23,000 614 $1,150.00 Plumas $10,125 270 $506.25 Riverside $148,300 3,954 $7,415.00 Sacramento $103,600 2,762 $5,180.00 Naloxone Grant Program – Local Health Department Allocations California Department of Public Health Attachment A Page 1 of 2 3/22/2017 Attachment A - LHD Allocations Exhibit D Counties Funding Available for Narcan Product Number of Doses Funds Available for Admin Costs or Additional Narcan Product Naloxone Grant Program – Local Health Department Allocations California Department of Public Health Attachment A San Benito $10,125 270 $506.25 San Bernardino $108,300 2,888 $5,415.00 San Diego $248,300 6,622 $12,415.00 San Francisco $97,600 2,602 $4,880.00 San Joaquin $68,200 1,818 $3,410.00 San Luis Obispo $25,700 686 $1,285.00 San Mateo $24,800 662 $1,240.00 Santa Barbara $33,100 882 $1,655.00 Santa Clara $47,900 1,278 $2,395.00 Santa Cruz $36,000 960 $1,800.00 Shasta $31,600 842 $1,580.00 Sierra $10,125 270 $506.25 Siskiyou $10,125 270 $506.25 Solano $27,900 744 $1,395.00 Sonoma $40,400 1,078 $2,020.00 Stanislaus $42,100 1,122 $2,105.00 Sutter $10,125 270 $506.25 Tehama $10,125 270 $506.25 Trinity $10,125 270 $506.25 Tulare $32,400 864 $1,620.00 Tuolumne $10,125 270 $506.25 Ventura $85,800 2,288 $4,290.00 Yolo $10,500 280 $525.00 Yuba $10,125 270 $506.25 Page 2 of 2 3/22/2017 Attachment A - LHD Allocations Exhibit D State of California -Health and Human Services Agency-California Department of Public Health CDPH 1229 (10/2016) SAFE AND ACTIVE COMMUNTIES BRANCH NALOXONE DISTRIBUTION GRANT PROGRAM Awarded By ATIACHMENT B THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH, hereinafter "Department" TO {Name of Grantee}, hereinafter "Grantee" Implementing the project, "NALOXONE DISTRIBU TION," hereinafter "Project" GRANT AGREEMENT NUMBER XX-XXXXX The Department awards this Grant and the Grantee accepts and agrees to use the Grant funds as follows: AUTHORITY: The Department has authority to grant funds for the Project under Health and Safety Code, Section 1179.80. PURPOSE: The Department shall provide a grant to and for the benefit of the Grantee; the purpose of the Grant is to reduce the rate of fatal overdose from opioid drugs including heroin and prescription opioids as specified in Exhibit A, Grant Application, which is hereby incorporated to serve as the Project. GRANT AMOUNT: The maximum amount payable under this Grant shall not exceed $xx,xxx dollars ($xx,xxx). TERM OF GRANT: The term of the Grant shall begin on June 1, 2017, or upon approval of this grant, and terminates on June 30, 2019. No funds may be requested or invoiced for work performed or costs incurred after June 30, 2019. PROJECT REPRESENTATIVES. The Project Representatives during the term of this Grant will be: California Department of Public Health Grantee: [Legal Business Name] Stacy Alamo Mixson, MPH �ame} ame: Principal Investigator (PI) IPU tlox 997377, MS 7214 !Address: Sacramento, CA 95899-7377 City, ZIP: Phone: 916.552.9852 Phone: Fax: Fax: 916.552.9810 E-mail: Stacy.Alamo@cdph.ca.gov E-mail: Page 1 of 3 Exhibit D Exhibit D Exhibit D Exhibit D Grantee's Name XX-XXXXX Exhibit B Budget Detail and Payment Provisions Page 1 of 2 1. Invoicing and Payment A. Upon final approval of the Grant Agreement, and upon receipt and approval of an invoice, the State agrees to reimburse the Grantee for the specified Administrative Allocation amount in accordance with the costs specified herein. B. The invoice shall include the Grant Number and shall be submitted in triplicate upon final approval of the Grant Agreement: Nancy Bagnato, MPH California Department of Public Health Safe and Active Communities Branch PO Box 997377, MS 7214 Sacramento, CA 95899-7377 C. Invoices shall: 1) Be prepared on Grantee letterhead. If the invoice is not on produced letterhead, the invoice must be signed by an authorized official, employee or agent certifying that the expenditures claimed represent activities performed and are in accordance with Exhibit A Grant Application under this Grant. 2) Bear the Grantee’s name as shown on the Grant. 3) Identify the billing and/or performance period covered by the invoice. 4) Itemize costs for the billing period in the same or greater level of detail as indicated in this Grant. Subject to the terms of this Grant, reimbursement may only be sought for those costs and/or cost categories expressly identified as allowable and approved by CDPH. 2. Budget Contingency Clause A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Grantee or to furnish any other considerations under this Agreement and Grantee shall not be obligated to fulfill any provisions of this Agreement. B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to Grantee to reflect the reduced amount. 3. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in, Government Code Chapter 4.5, commencing with Section 927. 4. Amounts Payable A. The amounts payable shall not exceed: 1) $XXX,XXX for Narcan Products for the budget period of 06/01/16 through 06/30/19. 2) $XXX,XXX for Administrative Costs for the budget period of 06/01/16 through 06/30/19. Exhibit D Grantee's Name XX-XXXXX Exhibit B Budget Detail and Payment Provisions Page 2 of 2 B. Payment allocations shall be made in accordance with the amounts listed in Paragraph 4.A., above. Pursuant to the Budget Act of 2016, this is one-time funding available for expenditure through June 30, 2019. The Grantee will only receive reimbursement for Administrative Costs, if requested. The Grantee will receive direct distribution of Narcan Products in the amount stated and no invoicing will be required. 5. Timely Submission of Final Invoice A. A final undisputed invoice shall be submitted for payment no more than thirty (30) calendar days following the expiration or termination date of this Grant, unless a later or alternate deadline is agreed to in writing by the program grant manager. Said invoice should be clearly marked “Final Invoice”, indicating that all payment obligations of the State under this Grant have ceased and that no further payments are due or outstanding. B. The State may, at its discretion, choose not to honor any delinquent final invoice if the Grantee fails to obtain prior written State approval of an alternate final invoice submission deadline. Exhibit D Exhibit D Exhibit D Exhibit D Exhibit D Exhibit D Exhibit D Exhibit D Exhibit D Attachment C California Harm Reduction/Syringe Exchange Programs with Existing Naloxone Distribution Systems County Organization Program Name (if different) Alameda Needle Exchange Emergency Distribution (NEED) Alameda Casa Segura HIV Education & Prevention Project of Alameda County (HEPPAC) Contra Costa A New Leaf Treatment Center Casa Segura HEPPAC Fresno Fresno Needle Exchange Humboldt Humboldt Area Center for Harm Reduction (HACHR) Peer Outreach Program Humboldt Humboldt County Department of Health and Human Services North Coast AIDS Project (NorCAP) Lake Any Positive Change Los Angeles Venice Family Clinic Common Ground Los Angeles LA Community Health Project Los Angeles Homeless Health Care Los Angeles (HHCLA) Needle Exchange at the Center for Harm Reduction Los Angeles Tarzana Treatment Centers Marin Marin Treatment Center Mendocino Mendocino County AIDS/Viral Hepatitis Network (McAVHN) Orange Solace Foundation Sacramento/Yolo Harm Reduction Services Safe Points Syringe Exchange Sacramento/Yolo Safer Alternatives thru Networking and Education (SANE) San Francisco Homeless Youth Alliance San Francisco Needle Exchange (SFNE) San Francisco San Francisco AIDS Foundation SAS Needle Exchange San Francisco St. James Infirmary San Francisco Asian and Pacific Islander Wellness Program Trans: Thrive San Francisco San Francisco Drug User’s Union San Francisco Glide Memorial Church Glide Harm Reduction Services San Diego A New Path (Parents for Addition and Healing) San Luis Obispo County of San Luis Obispo Behavioral Health Dept. San Luis Obispo SLOSEP San Mateo AIDS Community Research Consortium (ACRC) ACRC Syringe Access Program (ASAP) Santa Cruz Janus of Santa Cruz Shasta Shasta Community Health Center Health Outreach for People Everywhere (HOPE) Ventura Ventura County Health Care Agency Syringe Replacement Program Exhibit D Attachment D 1 California Department of Public Health (CDPH) Safe and Active Communities Branch Naloxone Grant Program REQUEST FOR APPLICATIONS (RFA #16-10967): Naloxone Distribution Projects APPLICATION (WORD Version) Please complete and submit this application for the Naloxone Grant Program on-line at www.surveygizmo.com/s3/3436263/f7385e3c96d5 as soon as possible, but no later than May 1, 2017, in order to initiate the development of a grant agreement with CDPH. Send questions by April 17, 2017 to ngp@cdph.ca.gov. Please provide the following information: 1. Local Health Department: 2. Name of Health Officer: Phone Number: E-mail Address: 3. Name of Grantee (Legal Business Name): 4. Name of Principal Investigator (PI): Address: City, Zip: Phone: FAX: E-Mail: 5. Name of Person to Direct Inquiries to: Address: City, Zip: Phone: Fax: E-Mail: 6. Name and Title of Person Authorized to Sign the Final Grant Agreement on Behalf of Your Agency: 7. Your organization’s DEA Number: 8. Address associated with your DEA Number (this address will be used for shipment of naloxone product): Exhibit D Attachment D 2 Please refer to the Naloxone Grant Program Local Health Department Allocation Chart included as Attachment A in the Naloxone Grant Program Request for Applications (RFA) to determine the amount of grant product and funding being offered to your organization. The allocation available for administrative costs, if accepted, may be used to cover costs of conducting outreach and assessment of local entities, receipt and distribution of naloxone product, reporting, or other activities related to the grant implementation. However, LHDs may elect to opt out of receiving the administrative allocation and instead apply that dollar amount to the purchase of additional naloxone product. 9. Funding amount you are requesting for the purchase of naloxone product (Narcan nasal spray): 10. Funding amount you are requesting for administrative costs: 11. How would you like to have your allocation of the naloxone product delivered to you (at no cost)? __ All in one shipment __ In two shipments; receiving half in a second shipment in June, 2018. 12. Understanding that you may need to conduct further outreach to identify those local entities that are ready and qualified to distribute/administer naloxone, who do you see as potential recipients at this time? __ Harm Reduction Centers/Syringe Exchange Programs __ Substance Use Disorder Treatment Services __ Homeless Shelter Programs __ Law Enforcement __ Emergency Medical Services __ Fire Services __ Other: ____________ (In your distribution plan, due to CDPH/SACB 60 days after the grant agreement is executed, you will list the names and types of local entities you select to receive the naloxone product). Syringe exchange/harm reduction programs that have established naloxone distribution systems in place (as defined in the RFA) are a priority for the distribution of naloxone due to the high risk population that accesses these services. 13. Do you have a syringe exchange/harm reduction program in your jurisdiction? __ YES ___ NO If YES, do you anticipate any challenges in working with the syringe exchange/harm reduction program in the distribution of naloxone? ___ YES ___ NO Exhibit D Attachment D 3 If YES, please describe: 14. At this time, do you anticipate any challenges to implementing any of the activities required by the grant? ___ YES ___ NO If YES, please describe: By submitting this application, your organization is agreeing to: 1.Conduct outreach to identify local entities within their health jurisdiction that already have a naloxone distribution system in place and have the capacity to efficiently and effectively provide naloxone and training to first responders (as described in section C, number 2 in this RFA).* Local entities may include harm reduction/syringe exchange programs, substance use disorder treatment providers, homeless programs, jails, emergency services providers, law enforcement, and others. *If a LHD identifies the need to establish a new naloxone distribution system(s) in their jurisdiction, the LHD must ensure that any new naloxone distribution system meets the definition provided in section C, number 3 in this RFA prior to distributing naloxone. 2.Select local entities to receive naloxone based on the level of risk of overdose among the population(s) they serve and need for naloxone (Narcan) product. Priority consideration is to be given to harm reduction/syringe exchange programs, if present within the health jurisdiction. (A list of California harm reduction/syringe exchange programs that currently have a naloxone distribution system in place is included as Attachment B). 3.Submit a naloxone distribution plan to CDPH/SACB for approval by June 16, 2017, or within 60 days of receiving CDPH final approval of the grant agreement. The plan will be submitted on-line and must include the names of selected local entities, the type(s) of services they provide, a description of the target population(s) they serve, and the number of naloxone product they will receive. CDPH will provide a standardized distribution plan template. 4.Begin distributing naloxone product to selected local entities by July 16, 2017, or within 90 days of receiving CDPH final approval of the grant agreement. All naloxone must be distributed to selected local entities by September 30, 2018. 5.Document and submit a final report to CDPH/SACB by April 1, 2019, on the distribution of naloxone for accountability and evaluation purposes. Exhibit D Attachment D 4 6.Enter into a Standard Grant Agreement with CDPH. Attachment C includes a grant agreement template, Budget Detail and Payment Provisions, Standard Grant Conditions, and Additional Provisions. Thank you! SUBMIT Exhibit D County of Fresno 16-11030 Page 1 of 3 Exhibit E Additional Provisions Page 1 of 3 1. Cancellation / Termination A.This Grant may be cancelled by CDPH without cause upon thirty (30) calendar days advance written notice to the Grantee. B.CDPH reserves the right to cancel or terminate this Grant immediately for cause. The Grantee may submit a written request to terminate this Grant only if CDPH substantially fails to perform its responsibilities as provided herein. C.The term “for cause” shall mean that the Grantee fails to meet the terms, conditions, and/or responsibilities of this agreement. Causes for termination include, but are not limited to the following occurrences: 1)If the Grantee knowingly furnishes any statement, representation, warranty, or certification in connection with the agreement, which representation is materially false, deceptive, incorrect, or incomplete. 2)If the Grantee fails to perform any material requirement of this Grant or defaults in performance of this agreement. 3)If the Grantee files for bankruptcy, or if CDPH determines that the Grantee becomes financially incapable of completing this agreement. D.Grant termination or cancellation shall be effective as of the date indicated in CDPH’s notification to the Grantee. The notice shall stipulate any final performance, invoicing or payment requirements. E.In the event of early termination or cancellation, the Grantee shall be entitled to compensation for services performed satisfactorily under this agreement and expenses incurred up to the date of cancellation and any non-cancelable obligations incurred in support of this Grant. F.In the event of termination, and at the request of CDPH, the Grantee shall furnish copies of all proposals, specifications, designs, procedures, layouts, copy, and other materials related to the services or deliverables provided under this Grant, whether finished or in progress on the termination date. G.The Grantee will not be entitled to reimbursement for any expenses incurred for services and deliverables pursuant to this agreement after the effective date of termination. H.Upon receipt of notification of termination of this Grant, and except as otherwise specified by CDPH, the Grantee shall: 1)Place no further order or subgrants for materials, services, or facilities. 2)Settle all outstanding liabilities and all claims arising out of such termination of orders and subgrants. County of Fresno 16-11030 Page 2 of 3 Exhibit E Additional Provisions Page 2 of 3 3) Upon the effective date of termination of the Grant and the payment by CDPH of all items properly changeable to CDPH hereunder, Grantee shall transfer, assign and make available to CDPH all property and materials belonging to CDPH, all rights and claims to any and all reservations, grants, and arrangements with owners of media/PR materials, or others, and shall make available to CDPH all written information regarding CDPH’s media/PR materials, and no extra compensation is to be paid to Grantee for its services. 4) Take such action as may be necessary, or as CDPH may specify, to protect and preserve any property related to this agreement which is in the possession of the Grantee and in which CDPH has or may acquire an interest. I. CDPH may, at its discretion, require the Grantee to cease performance of certain components of the Scope of Work as designated by CDPH and complete performance of other components prior to the termination date of the Grant. 2. Avoidance of Conflicts of Interest by Grantee A. CDPH intends to avoid any real or apparent conflict of interest on the part of the Grantee, subgrants, or employees, officers and directors of the Grantee or subgrants. Thus, CDPH reserves the right to determine, at its sole discretion, whether any information, assertion or claim received from any source indicates the existence of a real or apparent conflict of interest; and, if a conflict is found to exist, to require the Grantee to submit additional information or a plan for resolving the conflict, subject to CDPH review and prior approval. B. Conflicts of interest include, but are not limited to: 1) An instance where the Grantee or any of its subgrants, or any employee, officer, or director of the Grantee or any subgrant or has an interest, financial or otherwise, whereby the use or disclosure of information obtained while performing services under the grant would allow for private or personal benefit or for any purpose that is contrary to the goals and objectives of the grant. 2) An instance where the Grantee’s or any subgrant’s employees, officers, or directors use their positions for purposes that are, or give the appearance of being, motivated by a desire for private gain for themselves or others, such as those with whom they have family, business or other ties. C. If CDPH is or becomes aware of a known or suspected conflict of interest, the Grantee will be given an opportunity to submit additional information or to resolve the conflict. A Grantee with a suspected conflict of interest will have five (5) working days from the date of notification of the conflict by CDPH to provide complete information regarding the suspected conflict. If a conflict of interest is determined to exist by CDPH and cannot be resolved to the satisfaction of CDPH, the conflict will be grounds for terminating the grant. CDPH may, at its discretion upon receipt of a written request from the Grantee, authorize an extension of the timeline indicated herein. County of Fresno 16-11030 Page 3 of 3 Exhibit E Additional Provisions Page 3 of 3 3. Dispute Resolution Process A. A Grantee grievance exists whenever there is a dispute arising from CDPH’s action in the administration of an agreement. If there is a dispute or grievance between the Grantee and CDPH, the Grantee must seek resolution using the procedure outlined below. 1) The Grantee should first informally discuss the problem with the CDPH Program Grant Manager. If the problem cannot be resolved informally, the Grantee shall direct its grievance together with any evidence, in writing, to the program Branch Chief. The grievance shall state the issues in dispute, the legal authority or other basis for the Grantee's position and the remedy sought. The Branch Chief shall render a decision within ten (10) working days after receipt of the written grievance from the Grantee. The Branch Chief shall respond in writing to the Grantee indicating the decision and reasons therefore. If the Grantee disagrees with the Branch Chief’s decision, the Grantee may appeal to the second level. 2) When appealing to the second level, the Grantee must prepare an appeal indicating the reasons for disagreement with Branch Chief’s decision. The Grantee shall include with the appeal a copy of the Grantee's original statement of dispute along with any supporting evidence and a copy of the Branch Chief’s decision. The appeal shall be addressed to the Deputy Director of the division in which the branch is organized within ten (10) working days from receipt of the Branch Chief’s decision. The Deputy Director of the division in which the branch is organized or his/her designee shall meet with the Grantee to review the issues raised. A written decision signed by the Deputy Director of the division in which the branch is organized or his/her designee shall be directed to the Grantee within twenty (20) working days of receipt of the Grantee's second level appeal. B. If the Grantee wishes to appeal the decision of the Deputy Director of the division in which the branch is organized or his/her designee, the Grantee shall follow the procedures set forth in Division 25.1 (commencing with Section 38050) of the Health and Safety Code and the regulations adopted thereunder. (Title 1, Division 2, Chapter 2, Article 3 (commencing with Section 1140) of the California Code of Regulations). C. Disputes arising out of an audit, examination of an agreement or other action not covered by subdivision (a) of Section 20204, of Chapter 2.1, Title 22, of the California Code of Regulations, and for which no procedures for appeal are provided in statute, regulation or the Agreement, shall be handled in accordance with the procedures identified in Sections 51016 through 51047, Title 22, California Code of Regulations. D. Unless otherwise stipulated in writing by CDPH, all dispute, grievance and/or appeal correspondence shall be directed to the CDPH Grant Manager. E. There are organizational differences within CDPH’s funding programs and the management levels identified in this dispute resolution provision may not apply in every contractual situation. When a grievance is received and organizational differences exist, the Grantee shall be notified in writing by the CDPH Grant Manager of the level, name, and/or title of the appropriate management official that is responsible for issuing a decision at a given level.