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HomeMy WebLinkAboutAgreement A-18-162 with CDPH.pdfCALIFORNIA DEPARTMENT OF PUBLIC HEAL TH MATERNAL, CHILD AND ADOLESCENT HEAL TH (MCAH) DIVISION FUNDING AGREEMENT PERIOD FY 2017-2018 AGENCY INFORMATION FORM Agencies are required to submit an electronic and signed copy (original singatures only) of this form along with their Annual AFA Package . Agencies are required to submit updated information when updates occur during the fiscal year. Updated submissions do not require certification signatures . AGENCY IDENTIFICATION INFORMATION Any program related information being sent from the CDPH MCAH Division will be directed to all Program Directors. 201710 MCAH 201710 BIH # 15-10157 CHVP Update Effective Date : _______ (only required when submitting updates) Federal Employer ID#: Complete Official Agency Name : Business Office Address : Agency Phone : Agency Fax: Agency Website : 94-6000512 County of Fresno 1221 Fulton Mall , Fresno , CA 93721 (559) 600-3330 (559) 455-4 705 www.fcdph.org Page 1of2 Agreement No. 18-162 (?Jaase enter tMe agre~Jnent,or.eontra~t l'.'IUmber for each 0fthe applicat>I~ progr~ms 201710 MCAH '40171:O BlH . 15-10157 CHVP ·, ·-- The unaersignee hereby affirms" tnaHhe statements. contained ih the,Agre.ementFundJntl Application (AFA) are tru~ and complete to~the best of the appli~nt',s knowledg~. · I certify th.at these,MatemaJ, · Child and "Adoles,cernt Health (MCAH) programs will comply with all. appli~able ,previsions af Article t, Chapter 1, J!>ar:t 2, ... Division ·106 efthe Health and Sa'fety .code fcommencihg with ,seqtibn t23225)~ :Chapters 7 and $ oHhe. Welfare and ln$fitutions Cocte (commenciri;g:with Section$ 14000 ariq ,1:42), ariq any appltc~ble A,Jla.s or: n~gulations promulgated by CDPl7t pursuant to this ar:tide am:tthese: Chapters~ I further certify Jhatall .MC~H·related programs will comply witb the most current MQAH.Rolicies and' Ptoiedures Maril:lal, incf udihg buf net lirnit~d.to, Admihistratien,.Feeeral Finandal Parti~ipation (FFP}",Section. Jfurther certifythc!ttheMCA!r!trelated, programs will .. comply with all federal laws and Tegulations gpyemilitJi~nd regutati~9 recipients of funds grantee to states for medical assistance pursuant to Title XIX of th~ Social "SecLrr'ify Ad (i42 U.$,C. section 1396 et seq,) and recipient~ of fµnds an~ttee tQ states Joef :the f'!llatemar.~n<:I 'Child f{ealth · Servi~ Block Grant pursuantto Title v Qf'the Socfal security Act (42 l:J.S.¢.:·.section 7O1.etseq.). I further • . agr~e.fnat:the MCAl-i relate~ programs. may\be sllbje~t to,allsanctiorts, o~ olher 1ret'fled1es appli®ble, if ~e MCAH related programs violate ar:iy of the a.b'9Vff l:aw~. re,gulatlons apd p0Jic1es with Whicn if haij ~itifted,it wilf,comply: · · · · Sal Quintero Name '(Print) ~ ame (Print)' ATTEST: i.,....-----------BERNICE E. SEIDEL Clerk of the Board of Supervisors County of Fresno, State of California By c::R~ ~ Deputy Chairperson of the Board of Supervisors of the County of Fresno Title Date · • pate . ' :.-,,_. . ' . . I l STATE OF CALIFORNIA CALIFORNIA CIVIL RIGHTS LAWS ATTACHMENT DGS OLS 04 (Rev. 01/17) DEPARTMENT OF GENERAL SERVICES OFFICE OF LEGAL SERVICES Pursuant to Public Contract Code section 2010, a person that submits· a bid or proposal to, or otherwise proposes to enter into or renew a contract with, a state agency with respect to any contract in the amount of $100,,000 or above shall certify, under penalty of perjury, at the time the bid or proposal is submitted or the contract is renewed, all of the following: 1. CALIFORNIA CIVIL RIGHTS LAWS: For contracts executed or renewed after January 1, 2017, the contractor certifies compliance with the Unruh Civil Rights Act (Section 51 of the Civil Code) and the Fair Employment and Housing Act (Section 12960 of the Government Code); and 2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after January 1, 2017, if a Contractor has an internal policy against a sovereign nation or peoples recognized by the United States government, the Contractor certifies that such policies are not used in violation of the Unruh Civil Rights Act (Section 51 of the Civil Code) or the Fair Employment and Housing Act (Section 12960 of the Government Code). CERTIF(CATION I, the official named below, certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Proposer/Bidder Firm Name (Printed) County of Fresno By (Authorized Signature) etc±: Printed Name and Title of Person Signing Federal ID Number 946000512 Sal Quintero, Chairperson of the Board of Supervisors of the County of Fresno Executed in the County of Executed in the State of Fresno CA Date Executed ATTEST: BERNICE E. SEIDEL 1 I Clerk of the Board of Supervisors '"t \ ~ l ID(i County of Fresno, State of California _______ ..,,,__,___._ ________ By~\I ~ Deputy CCC 04/2017 CERTIFICATION 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) County of Fresno Federal ID Number 946000512 Sal Quintero, Chairperson of the Board of Supervisors of the County of Fresno ll================'F"========= ATTEST: Date Executed Executed in the County of BERNICE E. SEIDEL Fresno Clerk of the Board of Supervisors County of Fresno, State of California ~=~C~O~N'-"T=RA~C~T=O=R=C=E=R=T=I=F=IC=A=T=I=!O=N=C=L=A=U=S=E=S==== By ~• -, c~ 1. 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 if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the Deputy 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.