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Home My WebLink AboutAgreement A-16-685-1 with First 5 for HMG.pdfAgreement No. 16-685-1 A-1 R0218 (1&2) Page 1 of 5 Agency Name: County of Fresno, Department of Public Health Project Name: Help Me Grow Fresno County Pass-through Contract Number: 201617-0989 Project ID Number: 0989-17 GL: HP3- 10-8503-00 100 % Agency Address: 1221 Fulton Mall Fresno, CA 93721 Start date/End date: 07/1/18-6/30/19 Total Contract amount: $1,852,885 FY1617: $702,277 FY 1718: $702,277 FY 18-19: $448,331 FY 1819 Other Project Funding: $ 241,409 35 % BOS District: 3 Agency phone #: 559-600-3330 Mailing address if different than above: n/a Website: www.fcdph.org Strategic Plan Tier: Tier 1: Children Families Project Description: Briefly address what F5FC is funding and why. If applicable, describe the goals/outcomes. This will be placed on the F5FC website. Fresno County Public Health Department (DPH) will pass-through funding under this contract to ensure Commission funds can be used as a local match to leverage state and federal funds further supporting implementation and sustainability of the Help Me Grow (HMG) system in Fresno County. Help Me Grow is a national model that promotes the development of a coordinated system to help families identify and treat developmental and behavioral issues of young children. The HMG model does not provide direct services, but rather is designed to leverage existing resources within communities to identify vulnerable children, link families to community based services and empower families to support their children's healthy development. The HMG model is built of four core components: Centralized Access Point, Family and Community Outreach, Child Health Provider Outreach, and Data Collection. This contract does not have any services attached as DPH will directly contract with EPU Children's Center to implement direct service components of HMG in Fresno County. DPH will work with Fresno County Help Me Grow Organizing Entity Fresno County Superintendent of Schools and Help Me Grow Fresno County Leadership Team members in the implementation and planning of HMG in Fresno County. F5FC Contract Manager: Kristina Hernandez Program Contact (Person who runs day to day program operations/supervisor/coordinator/manager) Prefix: Ms. Name: Rose Mary Rahn Title: Division Manager, MCAH Director, Director of Nurses E-mail: rrahn@co.fresno.ca.us Phone #: 559-600-3330 Finance Contact (Person responsible for submitting budgets, financial reports and/or invoices) Prefix: Mr. Name: Michael Chu Title: Accountant E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426 Notice Contact Direct Services Face Sheet & Scope of Work This document will be completed with First 5 Fresno County (F5FC) staff and Service Provider during a development meeting. A. Face Sheet R0218 (1&2) Page 2 of 5 (Person who has legal authority to sign contract) Prefix: Mr. Name: Dave Pomaville Title: Director E-mail: dpomaville@co.fresno.ca.us Phone #: 559-600-3200 Public Contact (Person responsible for general public calls requesting program information, how to access services, media, etc.) Prefix: Ms. Name: Rose Mary Rahn Title: Division Manager, MCAH Director, Director of Nurses E-mail: rrahn@co.fresno.ca.us Phone #: 559-600-3330 Persimmony Contact Financial Module – FINANCIAL DATA ENTRY (Person responsible for entering financial information) Prefix: Mr. Name: Michael Chu Title: Accountant E-mail: mchu@co.fresno.ca.us Phone #: 559-600-6426 Training: Access and No Training Required Persimmony Contact Financial Module – FINANCIAL APPROVAL (Person responsible for approving financial information) Prefix: Ms. Name: Rose Mary Rahn Title: Division Manager, MCAH Director, Director of Nurses E-mail: rrahn@co.fresno.ca.us Phone #: 559-600-3330 Training: Access and No Training Required Persimmony Monitoring Module – ANNUAL CONTRACT REVIEW (ACR) ACCESS (Person responsible for responding to administrative and programmatic components of the ACR) Prefix: Ms. Name: Rose Mary Rahn Title: Division Manager, MCAH Director, Director of Nurses E-mail: rrahn@co.fresno.ca.us Phone #: 559-600-3330 Persimmony Contact Financial Module – FINANCIAL APPROVAL (Person responsible for approving financial information) Name: Aphivanh (Appy) Xayavath Title: Staff Analyst E-mail: axayavath@co.fresno.ca.us Phone #: 559-600-6335 Direct Services Face Sheet & Scope of Work R0218 (1&2) Page 3 of 5 Agency Service Locations: List all physical addresses where F5FC services take place. If more than three sites, please include in this document by adding another row. Refer to the Fresno County website to find the correct County District for each service location. First 5 Fresno County Strategic Plan and First 5 CA Result and Service Area Alignment: Location(s) District(s) Location 1: 1221 Fulton Mall, Brix Building-4th Floor, Fresno, CA 93721 District 3 Goal per F5FC Strategic Plan: Percent of Funding Dollar Amount FY1819 FY1819 Goal 1: Health Promotion 100% $448,331 Primary Strategy per F5FC Strategic Plan: Percent of Funding Dollar Amount FY1819 FY1819 HP3 Development Screenings and Assessments 100% $448,331 State Result Area/Outcome Refer to the Annual Report & School Readiness Appendices Fiscal Year State Service Area Percent of Clients Percent of Funding FY1819 FY1819 3. Improved Child Health 3n) Quality Health Systems Improvement 0 % 100 % Direct Services Face Sheet & Scope of Work R0218 (1&2) Page 4 of 5 Service Provider Staff Confidentiality Agreement & Request for Persimmony User Logon All staff members of F5FC funded programs and projects (Service Providers) who are responsible for gathering or maintaining confidential information and records must adhere to this agreement. Responsibilities During the performance of Service Provider assigned duties related to the F5FC project, Service Provider might have access to confidential client information and records required f or effective coordination and delivery of services to children and their families. All confidential discussions, deliberations, records, and information generated or maintained in connection with these activities shall be disclosed only to persons who have the need to know and authority to access confidential consumer information or records. This includes information obtained and conveyed through all media including the Persimmony database. Service Provider must not disclose any confidential client information to any third party without the written autho rization from the client or legally authorized representative. Legal Liabilities Service Provider must adhere to the following: • Notice: All applicable employees, agents, and subcontractors shall be notified of state requirements for confidentiality and also notified that any person knowingly or intentionally violating the provisions of the state law is guilty of a misdemeanor. • Records pertaining to any individual recipient of F5FC will be confidential and will not be open to examination for any purpose not directly connected with the administration of local evaluation. • No person will publish, disclose, use, or permit the use of, or cause to be published, disclosed or used, any confidential information pertaining to any individual recipient of F5FC services. Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality Agreement This notice accompanies a disclosure of confidential information concerning a consumer of services fu nded by the F5FC. The above referenced agency is prohibited from making any further disclosure of this confidential information unless further disclosure is expressly permitted by the written authorization to release the information of the person to whom it pertains or as otherwise permitted by these regulations. A general authorization for the release of confidential information is NOT sufficient for this purpose. Acknowledgement of Confidentiality and Prohibition of Re-Disclosing Confidential Client Information Employment Confidentiality Agreement The Agency acknowledges responsibility not to divulge any confidential information or records concerning clients of F5FC funded services without proper written authorization. By signing the Direct Services Agreement, the Agency accepts confidentiality and prohibition of re-disclosing confidential funding requirements. Direct Services Face Sheet & Scope of Work R0218 (1&2) Page 5 of 5 Type of Agreement: Amendment-Direct Service Type of Procurement: Informal Formal Sole Source Annual Contract Review: Formal Informal BFF Policy Agreement Form Completed: Yes No (attach form to contract) N/A EFT Form Completed: Yes No (attach form to contract) W-9 Completed: Yes No Persimmony Set-Up: (check all that apply) No data - only basic info for state reporting Aggregate data Client level data reporting Narrative Performance module Financial module Financial module Monthly reporting Quarterly reporting One time payment State upload Type of Agency: (choose only one) City Government Private and/or for Profit Organization Community Benefit Organization (501(c)3 School District County Government State Government Faith Based Organization (attach policy) Other (please specify): Federal Government Agency Higher Education Commission Approved Date: 06/06/2018 First 5 Fresno County Staff Review and Approval FY1819 Contract Manager Approval 6/11/2018 Strategies Reviewed and Approved by Director 6/13/2018  See Description of Services (end notes)  F5FC Office Use Only Agency name: County of Fresno, Department of Public Health Contract number: 201617-0989 Program name: Help Me Grow Fresno County Pass- through Contract amount: $448,331 B-1 1 2 3 4 5 6 7 8 9 10 11 12 A B C 13 Year 1 Actuals Year 2 Budget Year 3 Budget 14 07/01/16-6/30/17 07/01/17-06/30/18 07/01/18-06/30/19 15 16 17 0 0 0 0 18 0 0 0 0 19 0 0 0 0 20 0 0 0 0 21 22 0 0 0 0 23 0 0 0 0 24 0 0 0 0 25 0 0 0 0 26 27 0 0 0 0 28 0 0 0 0 29 639,252 639,252 354,412 1,632,916 30 63,025 63,025 93,919 219,969 31 32 702,277 702,277 448,331 1,852,885 33 34 Year 1 Actuals Year 2 Budget Year 3 Budget Total Other Funding 35 A.Other Funding Source:350664 378149 241409 970222 36 B.Other Funding Source:0 0 0 0 37 C.Other Funding Source:0 0 0 0 38 350664 378149 241409 970222 County of Fresno Department of Public Health Help Me Grow Fresno County Pass-through FIRST 5 FRESNO COUNTY Category Agency Name: Project Name: Contract Term: Contract Number: Direct Service Budget Total Program Amount Title: Submission Date: Prepared by:Aphivanh Xayavath Staff Analyst Total Program Expenses C. Training/Travel Total Operating Expenses III. Program Expenses A. Materials and Supplies 07/01/2016-06/30/2019 201617-0989 6/8/2018 Total Other Funding IV. Professional Services VI. Indirect Costs VII. Other Funding Total Program I. Personnel A. Facilities Costs B. Operational/Supplies A. Salaries B. Benefits C. Taxes Total Personnel II. Operating Expenses Children Families Commission of Fresno County Service Provider Budget 1 Agency Name:Contract Term: 2 Project Name:Contract Number:3 4 5 6 7 Title FTE Amount Title FTE Amount Title FTE Amount Title FTE Amount 8 - - - 9 10 11 12 13 14 15 - - - - - - - - 16 B. Benefits 0% 17 C. Taxes 0% 18 19 20 21 22 23 24 25 26 27 28 29 33 34 35 36 37 38 39 40 41 43 44 50 51 52 53 A. Indirect Rate 26.50% 54 55 Total Proposed Budget Program Totals Subtotal Narrative/Justification for Materials and Supplies - Instructional Information - Narrative/Justification for Materials and Supplies - Narrative/Justification – - Narrative/Justification – Fresno County Department of Public Health’s indirect cost rate is 26.5%, prepared following OMB’s 2 CFR Part 200 guidelines and approved by County of Fresno’s Auditor-Controller/Treasure-Tax Collector Department. Any contracts with California Department of Public Health have a 25% ICR limit; Leveraged column calculated using 25%. Narrative/Justification – Pass-through funds to EPU for Help Me Grow Fresno County. Includes funds for personnel, operating expenses, and professional services costs. See Help Me Grow Fresno County - EPU budget for justification of costs. - Narrative/Justification for Materials and Supplies - Narrative/Justification – 354,412 Subtotal Narrative/Justification for Materials and Supplies D Select Other Funding Source: 07/01/18-6/30/19 - Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (FTE, Square Footage, etc) for these costs and provide the calculation - - Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (materials, services, leases) for these costs and provide the calculation - - - - YEAR 3 First 5 Amounts Leveraged Select Other Funding Source: - - - - Instructional Information 354,412 A. Facilities Costs II. Operating Expenses - - - Narrative/Justification – Explain these costs and how they apply to the program, then state methodology (name of local conferences & trainings) for these costs and provide the calculation Justification of Benefits and Taxes: B. Operational/Supplies - - - IV. Professional Services (Contracts, MOU's, Sub agreements, etc.) VI. Indirect (= Program Totals - Equipment x Percentage of Indirect) In the Narrative/Justification box explain these costs, how they will support/benefit the program, and how the percentage was determined. - - - - - - 193,127 - - - - Narrative/Justification – Provide the number of participants, cost per item, a description of the item, and justification for all expenses that support the clients of the program. In the Narrative/Justification box provide a detailed explanation of all professional services considered on this line item and how they are to support the program or staff (include calculations where applicable). Any services exceeding $5,000 must have attached a narrative delineating services. Narrative/Justification – 193,127 Instructional Information In the Narrative/Justification box provide a detailed explanation of all program expenses considered on this line item and how they are to support the program participants (include calculations where applicable). 448,331 241,409 - Narrative/Justification – 48,282 93,919 - County of Fresno Department of Public Health Help Me Grow Fresno County Pass-through 07/01/2016-06/30/2019 201617-0989 I. Personnel A B 07/01/18-6/30/19 07/01/18-6/30/19 The "Amount" should be: Annual Salary X the FTE whenever possible. 1 FTE = 40 hours / week C 07/01/18-6/30/19 C. Training/Travel - - A. Total Salaries & FTE Personnel Subtotal - A. Materials and Supplies - - Operating Expenses Subtotal - - III. Program Expenses 6/11/2018 1 of 1